Circulatory insufficiency and hypotension related to the ductus arteriosus in neonates
Abstract
The biological role of the ductus arteriosus (DA) in neonates varies from an innocent bystander role during normal postnatal transition, to a supportive role when there is compromise to either systemic or pulmonary blood flow, to a pathological state in the presence of hemodynamically significant systemic to pulmonary shunts, as occurs in low birth weight infants. Among a wide array of clinical manifestations arising due to the ductal entity, systemic circulatory insufficiency and hypotension are of significant concern as they are particularly challenging to manage. An understanding of the physiologic interplay between the DA and the circulatory system is the key to developing appropriate targeted therapeutic strategies. In this review, we discuss the relationship of systemic hypotension to the DA, emphasizing the importance of critical thinking and a precise individual approach to intensive care support. We particularly focus on the variable states of hypotension arising directly due to a hemodynamically significant DA or seen in the period following successful surgical ligation. In addition, we explore the mechanistic contributions of the ductus to circulatory insufficiency that may manifest during the transitional period, states of maladapted transition (such as acute pulmonary hypertension of the newborn), and congenital heart disease (both ductal dependent and non-ductal dependent lesions). Understanding the dynamic modulator role of the ductus according to the ambient physiology enables a more precise approach to management. We review the pathophysiology, clinical manifestations, diagnosis, monitoring, and therapeutic intervention for the spectrum of DA-related circulatory compromise.
Amplitude-integrated electroencephalography in term infants with hypoxic-ischemic encephalopathy
Abstract
Hypoxic-ischemic encephalopathy remains an urgent medical and social problem. Amplitude-integrated electroencephalography (aEEG) is a technique for assessing the functional state of the brain of newborns with asphyxia. This review describes the operation principle, advantages and disadvantages, diagnostic and prognostic significance of this technique, as well as examples of aEEG trends. The introduction of neuromonitoring into broad clinical practice will improve the quality of medical care in neonatal practice.
Tissues of perinatal origin is a unique source of cells for regenerative medicine. Part I. Cord blood
Abstract
In the Last two decades, tissues of perinataL origin attract an increasing attention of researchers and medicaL practitioners in connection to perspectives of their use in ceLL therapy of a wide range of acquired or inherited diseases. Hundreds of clinical trials are designed for studying the safety and efficacy of cells isolated from umbilical cord blood, placenta, umbilical cord stroma, amniotic membranes and amniotic fluid in a wide range of pathological conditions in cardiology, neurology, angiology, traumatology and orthopedics, liver, kidney and reproductive system disorders, etc. In this review, authors have made an attempt to summarize some data concerning the properties and prospects of the use in regenerative medicine of cells and cell-free products obtained from only two of these sources: umbilical cord blood and umbilical cord stroma.
Congenital anomalies of the kidney and urinary tract: an analysis of modern diagnostic principles and prognostically significant markers of renal tissue damage
Abstract
The review presents an analysis of data on the principles of diagnosis of congenital anomalies of the kidneys and urinary tract in the pre- and postnatal period. Critical analysis of the most common methods for assessing the degree of kidney damage, considered risk factors for the development of abnormalities of the kidneys and urinary tract. Critically assessed endogenous markers of impaired renal function in children with anomalies of kidney and urinary tract development.
Certain aspects of the pathophysiology of the immune response of a preterm infant
Abstract
Certain aspects of the functioning of an immune function of a preterm infant are being discussed in the article - in particular, immune functions of skin, respiratory system and gastrointestinal tract. Separate part of the article dedicated to the relationships between nutrition and immune function development in preterm infants, the role of breast milk has been emphasized.
The nosological structure and features of interstitial
lung diseases in children during the first 2 years of life:
results of a multicenter study
Abstract
The article presents data about study included 76 children of the first two years of life with interstitial lung diseases (ILD). According to symptoms of chILD-syndrome, all patients had respiratory signs and interstitial changes on X-ray. 93.4% of patients had respiratory symptoms, hypoxemia was revealed in 68.4% of patients by pulsoximetry. The presence of those symptoms allowed to establish chILD-syndrome in all patients, and, on the basis of clinical and laboratory-instrumental studies, nosological form was refined. Children of our study have forms of ILD such as congenital alveolar-capillary dysplasia (1.3%), pulmonary hypoplasia (17%), Wilson-Mikity syndrome (21.1%), subpleural cysts in patients with Down syndrome (6.6%), neuroendocrine cell hyperplasia of infancy (23.7%), congenital deficiency of surfactant protein B (1.3%), brain-lung-thyroid syndrome (2.6%), bronchiolitis obliterans with organizing pneumonia (10.5%), disorders related to systemic disease processes (Langerhans cell histiocytosis - 14.6%, Niemann-Pick disease - 1.3%). The features of clinical picture, data of laboratory-instrumental methods of investigation, severity of the disease's course, prognosis, predictors of the death outcome in patients with these rare diseases, have been analyzed in all patients including preterm infants.
Risk factors and short-term outcomes of life-threatening conditions in newborns: analysis of data from the Arkhangelsk County Birth Registry (Russia)
Abstract
The aim of this study was to investigate prevaLence and short-term outcomes of Life-threatening conditions in newborns. We have used data from The ArkhangeLsk County Birth Registry. TotaLLy, 43 327 births were recorded from January 1, 2012 to December 31, 2014; 41 932 singLe aLive newborns matched the incLusion criteria. We used defined criteria, such as birth weight <1500 g, gestationaL age <32 weeks, and 5 minute Apgar score <5 of neonataL near faiLure (in this study, Life-threatening conditions). In our study, 595 (1.4%) newborns had at Least one of the defined Life-threatening conditions. Compared to newborns without Life-threatening conditions, the proportion of aLL studied short-term outcomes in newborns (earLy neonataL death, need to mechanicaL ventiLation, bLood transfusion, and system antibiotic treatment) was higher in babies who had any Life-threatening conditions. SingLe mothers, women with aLcohoL abuse, Late antenataL visit, as weLL as women with prior stiLLbirth, preterm deLivery were at higher risk to give birth to babies with Life-threatening conditions. Diabetes meLLitus, gestationaL diabetes, cesarean section, preterm rupture of membranes, non-cephaLic presentation, and birth defects aLso increased the risk of Life-threatening conditions in newborns.
Wiskott-Aldrich syndrome, Neonatologists vision
Abstract
Wiskott-Aldrich syndrome and X-linked thrombocytopenia have a common etiology. The degree of severity depends on the type of mutation in the WASP gene. The manifestation of petechiae, ecchymosis, bloody stool, thrombocytopenia since birth allows to suspect this pathology. Combined antibacterial, antifungal therapy, IVIG, substitution therapy, specific therapy for viral infections are required for the treatment in the neonatal period. The genetic verification of the diagnosis is very important to conduct of early specific treatment.