Neonatology

On May 7, 2024, Russian President has signed a decree No. 309 “On the national development goals of the Russian Federation for the period up to 2030 and for the future up to 2036”. The document defines the following national development goals of the Russian Federation: preservation of the population, health promotion and improvement of human well-being, family support.

According to experts from the Russian Society of Neonatologists, modernization of neonatal intensive care units is one of the key factors in reducing infant mortality in the Russian Federation. The article lists the key factors for improving inpatient medical care for newborns to achieve target goals, including: strengthening the material and technical base of perinatal centers and children’s hospitals, modernization of intensive care units for newborns, purchase of high-tech medical equipment, overcoming the shortage of qualified medical personnel.

The implementation of new national projects in our country allows us to hope for their solution in the near future.

Identification of risk factors for the development of intraventricular hemorrhages (IVH) is an urgent direction and is important in the development of prevention strategies.

The aim: to identify ante-, intra- and postnatal risk factors for the development of IVH of varying severity in premature infants in the early neonatal period based on the analysis of anamnesis data, the results of clinical, laboratory and instrumental tests.

Material and methods. The retrospective case-control study was conducted from 2017 to 2020 in National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of the Russian Federation. The infants included in the study (100 premature infants with various degrees of IVH) were divided into three groups depending on the severity of IVH: group 1 – premature newborns with IVH grade 1 (n=66); group 2 – premature newborns with IVH grade 2 (n=26); group 3 – premature newborns with IVH grade 3 (n=8).

Results. It was found that the smaller gestational age (GA) and anthropometric data at birth (weight and length) the heavier the degree of IVH (p<0.001) were. The gender of infants, as well as Apgar scores at 1^st and 5^th minutes did not differ significantly between the groups. All infants of group 3 required invasive respiratory therapy, cardiotonic and vasopressor therapy. In group 2 invasive respiratory therapy was noted in 80.8%, in cardiotonic and vasopressor therapy – in 69.2%. Fluctuations in diastolic blood pressure during 24 hours before IVH had a significant effect on the severity of IVH. According to ROC analysis the threshold value of minimum diastolic pressure (23.5 mm Hg or less, sensitivity 80% and specificity 79%) and heart rate fluctuations during 24 hours before IVH (40 beats per minute or more, sensitivity 80% and specificity 78%) associate with the IVH grade 3 were found.

Conclusion. Low GA, low birth weight and length, the need for invasive respiratory therapy, cardiotonic and vasopressor therapy, low diastolic blood pressure and heart rate fluctuations in the previous 24 hours before IVH are risk factors for the development of IVH in premature infants.

Objective: to determine the relationship between the growth dynamics of the corpus callosum and the cerebellar vermis with characteristics of early psychomotor development in premature newborns with a gestational age of 32 weeks or less.

Material and methods. Assessment of psychomotor development and ultrasound of the brain with measurements of the size of the cerebellar vermis and corpus callosum were carried out in premature newborns (n=51) born between 23 and 32 weeks of gestation. Depending on the neurological outcome, the children were divided into 2 groups with a favorable clinical outcome and without significant structural changes in the brain according to ultrasound data and with an unfavorable neurological outcome and/or with ultrasound signs of grade 2, 3 intraventricular hemorrhage, periventricular leukomalacia, periventricular venous infarction, posthemorrhagic normotensive ventriculodilation.

Results. It was found that in both groups, the length of the corpus callosum, height, and thickness of the cerebellar vermis correlated with postconceptual age and body weight at the time of the study. Significant differences in the growth rate of the length of the corpus callosum between the groups were obtained, while the absolute indicators differed significantly not only in the length but in the thickness of the corpus callosum, upon reaching an age equivalent to full term.

Conclusion. Perinatal hypoxic damage of the central nervous system, a slowdown in the growth rate of the corpus callosum in premature infants observed. The growth rate of the corpus callosum can be used as an objective indicator in assessing the early development of the central nervous system in premature infants.

High rates of perinatal morbidity and mortality in complicated multiple pregnancies make it important for medical conditions to further research for markers of adverse outcomes.

Objective. To study the content of TREC and KREC molecules in premature newborns due to the gestational age, chorionicity, specific complications of the antenatal period (twin-twin transfusion syndrome, selective fetal growth restriction), and the presence of infections and inflammatory diseases in pregnant women and newborns. General blood test indicators and other biomarkers of infection and inflammatory diseases on the 7^th day of life were researched.

Material and methods. A single-center cross-sectional study of premature infants 7 days old (144–168 h of life) was conducted based on the Ural Research Institute of Maternity and Child Care, Ministry of Health of the Russian Federation, Yekaterinburg, during the period from 01.01.2023 till 20.12.2023.

The study involved 435 premature newborns of gestational age (25/0–36/6 weeks). The main group consists of 120 monochorionic twins (n=120). Patients of the main group were divided depending on complications of the antenatal period: newborns with twin-twin transfusion syndrome (n=30; 15 pairs), selective fetal growth restriction syndrome (n=40; 20 pairs), and without complications of intrauterine development (n=50; 25 pairs). The comparison group (n=315) was represented by newborns from singleton pregnancies (n=247) and chorionic twins (n=68).

All children underwent immunological screening with quantitative determination of TRECs and KRECs DNA using real-time polymerase chain reaction. The set of reagents “Immuno-BiT” (ABV-test, Russian Federation) was used.

Statistical processing of the material was performed in SPSS 27.0 using nonparametric criteria. Differences were considered statistically significant at p<0.05.

Results. In premature newborns of gestational age 25/0–31/6 weeks, significantly low levels of TREC were detected, indicating suppression of T-cell immunity (p<0.0001). In dichorionic premature twins 25/0–36/6 weeks of gestational age, a statistically significant increase in the number of KRECs was observed, which characterizes the activation of B-cell immunity (p<0.05). In the complicated course of monochorionic multiple pregnancies, immune features were diagnosed: after undergoing feto-fetal transfusion syndrome – a decrease of TRECs DNA (p=0.039), and against the background of selective fetal growth restriction – an increase in the level of KREC (p=0.032). An inverse correlation was determined between the pregnancy disease “Urinary tract infection with bacteriuria” and the KREC content in MH twins (r= -0.267; p=0.003). A negative correlation was revealed between the number of TREC and KREC molecules in MH twins on the 7^th day of life, the presence of various infections and inflammatory diseases in the early neonatal period, and the content of segmented neutrophils (%, abs.), as well as a positive correlation between TREC levels and the number lymphocytes (%, abs.).

Conclusion. The level of TREC in monochorionic twins depends on gestational age and the presence of specific complications of the antenatal period (twin-twin transfusion syndrome and selective fetal growth restriction) must be taken into account when interpreting the results of expanded neonatal screening.

Objective.To present the results of hypotensive glaucoma surgery in children with retinopathy of prematurity (ROP).

Material and methods. An analysis of surgical hypotensive treatment of glaucoma in 6 (9 eyes) children with ROP aged from 1 month to 1 year was carried out in the eye department of the clinic of the Tashkent Pediatric Medical Institute. According to the stages and phases of ROP, patients were divided into 2 groups, the first included 3 (5 eyes) children with stages I–III of the active phase of the disease, the second – 3 children (4 eyes) with stages IV–V regressive (scar) phase. One patient had a bilateral process with stage V regressive phase with postoperative aniridia. The gestational age at birth of the examined children was 21–36 weeks. The duration of observation is 18 months. Taking into account echobiometric and gonioscopic characteristics, the type and volume of hypotensive surgical treatment were determined. In the first group, ab externa sinusotrabeculotomy was performed, in the second group, ab externa sinusotrabeculotomy, cyclodialysis, cycloretraction with autoscleral drainage.

Results. Surgical antihypertensive treatment in stages I–III of the active phase of ROP led to stabilization of the glaucomatous process in 77% of cases; in stages IV–V of the scar phase, satisfactory results were noted in 50%. Moreover, hemorrhagic complications after 18 months led to subatrophy of the eyeball in 2 (50%) cases in patients in the second group of patients.

Conclusion. In the active phase of stages I–III of ROP, hypotensive surgery in the trabecular zone was used; in the cicatricial phase of stages IV–V of ROP, combined hypotensive surgery was used both in the trabecular zone and in the ciliary body area using autoscleral drainage.

Objective of the study. To evaluate the cost-effectiveness of caffeine citrate for the prevention and treatment of apnea in extremely low birth weight (ELBW) and very low birth weight (VLBW) infants.

Material and methods. The study has been performed using a mathematical model. The decision tree model was applied for alternative medical care scenarios. The study considered direct medical costs.

Results. According to the estimated data, the number of premature infants with ELBV and VLBV was 7700 patients and including 1900 infants with cerebral palsy (CP) in 2023. It is anticipated that the utilisation of caffeine citrate for the treatment of apnea of prematurity will result in a reduction of CP by 42% (1100 cases). The incremental cost-effectiveness ratio (ICER) per case of CP prevented was 230 145.17 rubles. When the cost of a routine rehabilitation program for premature infants with CP was 250 377.78 rubles (RUR) per year. By reducing the number of CP cases, we will save on the rehabilitation program in the amount of 0.278 billion RUR in one year. The utilisation of caffeine citrate has no influence on the alteration of the healthcare system budget in terms of the costs of providing medical care for premature infants with ELBW and VLBW. In regard to the target population, the discrepancy in costs between the current and anticipated practice was RUR 0.255 billion (+4.90%), which represents of 8.08% reduction in the costs of the rehabilitation program. The increase in drug costs in the tariff structure is compensated not only by a reduction in direct medical costs for rehabilitation activities, but also by a reduction in the costs of performing ventilation, including amortisation and maintenance of equipment.

The review presents various opinions on the effect of a short frenulum of the tongue on breastfeeding, speech problems, frequency of occurrence, classification, and the time of trimming the frenulum of the tongue (frenotomy). Modern methods of treatment, indications for surgical or conservative intervention, and complications were described. The authors pay attention that the decision on an intervention will be made by the team: a neonatologist, a breastfeeding specialist, a dental surgeon, or a maxillofacial surgeon. The choice of treatment method should be reflected in medical documentation, and the informed consent of parents is obtained.

The article presents modern approaches to providing care to a full-term newborn in the maternity ward and the bulk of activities necessary for the child after the maternity ward.

Citrullinemia type I belongs to the group of hereditary diseases with a violation of the urea formation cycle. It leads to the development of hyperammonemia. Ammonium accumulates in the cerebrospinal fluid and damages glial cells, increasing osmolarity with the development of cerebral edema that subsequent disability of the child.

The main diagnostic criterion for type I citrullinemia is hyperammonemia combined with high citrulline levels. The diagnosis confirms molecular genetic testing for the presence of pathogenic variants of the ASS 1 gene. The survival rate and prognosis of the disease depend on the severity of the brain lesion and correlate with the level of ammonia in the blood, and the duration of exposure. Early diagnosis of type I citrullinemia in newborns avoids brain damage.

The child described in the article was born before the introduction of the expanded neonatal screening program. Clinical symptoms occurred at the age of 1 day 16 hours and were non-specific. Irreversible brain damage in the neonatal period was avoided, as an inherited metabolic disease was suspected. We suspected hyperammonemia that was detected. The observation is performed with the full development of the child with the observance of the diet, the medical correction of hyperammonemia, and regular medical examination by specialists.

The introduction of an extended neonatal screening program will help with the diagnostics of type I citrullinemia and initiate pathogenetic therapy in the preclinical stages.

The article is devoted to the legal aspects of the organization of internal quality and safety control, in particular, the work of the medical commission and the internal control service in medical organizations as protection tools when considering patient complaints.

The article describes common psychological and emotional complications faced by parents (mothers) whose infants are in the neonatal intensive care unit, and also suggestions ways to prevent them.