Effective ventilation: the most critical intervention for successful delivery room resuscitation
Abstract
Lung aeration is the critical first step that triggers the transition from fetal to postnatal cardiopulmonary physiology after birth. When an infant is apneic or does not breathe sufficiently, intervention is needed to support this transition. Effective ventilation is therefore the cornerstone of neonatal resuscitation. In this article, we review the physiology of cardiopulmonary transition at birth, with particular attention to factors the caregiver should consider when providing ventilation. We then summarize the available clinical evidence for strategies to monitor and perform positive pressure ventilation in the delivery room setting.
Surfactants in acute respiratory distress syndrome in infants and children: past, present and future
Abstract
There is a lack of definitive data on the effective management of acute respiratory distress syndrome (ARDS) in infants and children. The development and validation of the Berlin definition (BD) for ARDS and the Pediatric Acute Lung Injury Consensus Conference (PALICC) recommendations in children represented a major advance in optimizing research and treatment, mainly due to the introduction of a severe ARDS category. Proposed reasons for the lack of consistent results with surfactants in children and infants compared with neonates include different causes, type of lung damage (direct or indirect), timing and mode of administration as well as the type of surfactant used. Secretory phospholipase A2 plays an important role in inflammation and possible dysfunction of surfactants in ARDS. BronchoaLveoLar Lavage (BAL) with normal saline and surfactant allows the removal of inhaled material, the recruitment of non-ventilating areas and the maintenance of the surfactant pool size. BAL with diluted surfactant allows rapid absorption of the surfactant at the air/liquid interface, which blocks the progression of pathological lung disease and in turn disrupts the inflammatory cycle. Importantly, it is now recognized that the type of surfactant, the time of administration and the method of administration could all play an important role in the management of ARDS, and there is evidence that surfactant is effective and well tolerated in children and infants with ARDS.
Efficiency of recombinant human erythropoietin in extremely and very low birth weight infants
Abstract
The review is based on Literature data and the results of our own research, is about history of study and science use of recombinant human erythropoietin (rh-EPO), its biological effect and effectiveness for the prevention and treatment of anemia of prematurity, and its neuroprotective properties in extremely and very low birth weight infants. In the long term, rh-EPO could improve cognitive function in preterm infants, accelerate recovery of neurological functions, improve motor and Language abilities in children with very Low birth weight. The data indicate that further researches of the biological effect of rh-EPO could significantly expand the range of its application.
Tissues of perinatal origin: a unique source of cells for regenerative medicine. Part II. Umbilical cord
Abstract
For many years, tissues of perinatal origin attract an increased attention due to the prospects of using the so-called mesenchymal stem cells (MSC) in the treatment of a wide range of acquired or hereditary diseases. Hundreds of researches, experimental and clinical studies are directed to examine the biological properties of MSC from placenta, umbilical cord stroma and amniotic fluid, safety and efficacy of their application in various fields of regenerative medicine: cardiology, neurology, angiology, traumatology and orthopedics, in diseases of the Liver, kidneys, reproductive system, etc. In this part of the review authors summarize the data concerning the properties and use in regenerative medicine of MSC obtained from umbilical cord tissue and cell-free MSC-derived products.
Clinical pathophysiology of the respiratory system in preterm infants
Abstract
In the review on the basis of modern literature and our own data from the clinical positions pathophysiological principles of the most common respiratory disorders in preterm infants in neonatal period and infancy are elucidated (neonatal respiratory distress syndrome, bronchopulmonary dysplasia (BPD), BPD-associated pulmonary hypertension, apnea of prematurity, transient tachypnea of the newborn, and in older age: acute respiratory syncytial virus bronchiolitis, bronchial asthma). A consistent vision for structural, biochemical and functional features of the respiratory system in preterm infants, which are prerequisites for the development of the diseases, are described. An inverse dependence of epidemiology of number of lung diseases of prematurity on gestational age has been established. Modern diagnostic, therapeutic and preventive strategies in preterm infants with respiratory disorders are pathogenetically substantiated.
Comparison of the efficiency of solution octenidine dihydrochloride and phenoxyethanol and ethyl alcohol as skin antiseptics before venous catheterization in newborns
Abstract
The aim of this study was to evaluate the effectiveness of ethyl alcohol and solution octenidine dihydrochloride and phenoxyethanol as skin antiseptics before central and peripheral venous catheterization in newborns undergoing treatment in the intensive care unit (NICU).
Material and methods. During a prospective comparative study examined 221 pairs of samples of scrapings from the skin taken at the central and peripheral vein catheterization from 138 newborns were treated in NICU since October 2016 to September 2017 and required in the treatment venous catheterization. During the manipulation, the material was collected twice: the first scraping from the skin was taken after using skin antiseptics before venous catheterization, the second before catheter was attached. In 114 cases (51.6%) when baby's birth weight was >1500 g, skin treatment before venous catheterization was performed with 70% ethyl alcohol, and in 107 cases (48.4%) in newborns with very low and extremely low birth weight, skin treatment was carried out with solution octenidine dihydrochloride and phenoxyethanol.
Results. In 21 (18.4%) cases treatment of the skin was carried out with solution octenidine dihydrochloride and phenoxyethanol, in 12 (11.2%) treatment of the skin was carried out with solution of 70% ethyl alcohol. There were no statistically significant differences between the efficacy of these antiseptics (p=0.1891).
Conclusions. It was found that the solution octenidine dihydrochloride and phenoxyethanol solution has a similar efficiency with a solution of 70% ethyl alcohol as skin antiseptic and can be used for central and peripheral venous catheterization in premature newborns with very low and extremely low birth weight.
The effect of cord milking on the rate of blood transfusions in premature newborns with very low and extremely low body weight
Abstract
The article is devoted of assessment of cord milking on the blood transfusion rate in premature newborns with very low (LBW) and extremely low birth weight (ELBW).
Material and methods. 565 the newborn with birth weight <1500 g who were treated in NICU of Perinatal Center of Voronezh Regional Teaching Hospital #1 were included in the study during two time periods: before cord milking was introduced in the practice (period 1, 2012-2013) and after that (period 2, 2014-2016).
Results. It has been established that the use of cord milking procedure contributes to the prevention of anemia in the early neonatal period and leads to a decrease in the blood transfusions rate. Before milking was introduced 44 (54.3%) ELBW needed transfusion and after - 45 (33.1%) patients (p<0.005). In LWB group 14 (9.4%) patients needed transfusion during the period 1. During period 2 red blood cells were transfused to 7 (3.5%) newborns (p<0.05). Using milking procedure led to a significant decrease in the number of newborns with LBW and ELBW who needed blood transfusion in the first week of their life, which was statistically significant. The introduction of the milking procedure did not affect the incidence of severe intraventricular hemorrhage in preterm infants with extremely low and very low birth weight.
Conclusion. Cord milking procedure helps to reduce the cases of severe anemia and the number of blood transfusions in the early neonatal period.
Neonatal thyrotoxicosis in premature twins from mother with a history of diffuse toxic goiter
Abstract
Neonatal thyrotoxicosis is a rare and dangerous condition that occurs in the early neonatal world, and is associated with transplacental transfer of antibodies to the receptor of the TSH antibodies of the mother. The disease can develop several years after the radical treatment of Graves' disease.
Material and methods. The described clinical case of the development of neonatal thyrotoxicosis in premature twin from a mother with thyroidectomy in anamnesis.
Results. Against the background of thyrostatic therapy in children, symptoms and laboratory signs of thyrotoxicosis were noted, however, in one the child developed, secondary hypothyroidism. This required of a course of therapy with levothyroxine
Clinical case: extreme-preterm baby with the Cornelia de Lange syndrome
Abstract
Cornelia de Lange syndrome (Brahmana de Lange syndrome, Amsterdam dwarfism, OMIM code 122470, 300590, 300882, 610759, 614701, International Statistical Classification of Diseases and Related Health Problems: Q87.1) is a rare genetically heterogeneous disease with autosomal dominant (NIPBL, SMC3 or RAD21) or X-linked (SMC1A and HDAC8) types of inheritance, characterized by specific facial dysmorphism, limb development abnormalities, development delay, gastrointestinal pathology, and heart and kidney inborn anomalies. Sometimes this syndrome associated with malformations of palate, loss of hearing, congenital diaphragmatic hernia. The prevalence ranges from 1:45 000 to 1:62 500 newborns. Most common cases (50-80% according to different authors) associated with mutation in NIPBL gene, located in the locus of chromosome 5p13.2. About 5% of Cornelia de Lange cases are associated with missense mutations in the SMC1A, SMC3, RAD21 and HDAC8 genes. All these genes play a key role in the functioning of a complex of proteins that regulate the processes of separation of chromatids in the course of cell division. The article presents a clinical case of extreme preterm baby with Cornelia de Lange syndrome (diagnosis was confirmed after whole-exome sequencing NGS). Also, we present review of literature data on genetics, pathogenesis, clinical manifestations, methods of diagnostic (including molecular genetic methods) and opportunities of symptomatic treatment.