Neonatology

The problem of choosing the mode and parameters of mechanical ventilation of newborns with respiratory failure remains very relevant. According to modern concepts, the criteria for effective respiratory support are a stable level of saturation and normative indicators of the acid-base, and gas composition of the blood, maintaining a balance between the proposed respiratory support and the child’s basic needs.

Purpose of the study. To determine the role of monitoring the electrical activity of the diaphragm in improving the effectiveness of respiratory support in premature newborns with severe respiratory failure.

Material and methods. 46 premature newborns weighing less than 650 g required mechanical ventilation from birth were included in the study. 2 study groups were formed based on ventilation modes. The 1^st group was on respiratory support PC SIMV+PSV mode. The 2^nd group is newborns with NAVA. The study continuously monitored the electrical diaphragm activity, assessing the actual peak pressure and respiratory volume. Parameters are determined by using a flow sensor. The values of the partial pressure of carbon dioxide in capillary blood and the duration of treatment in the intensive care unit were additionally analyzed.

Results. Comparison of actual indicators of peak pressure and respiratory volume in patients of both groups revealed that children from the 1^st group (PC SIMV+PSV mode) required higher peak pressure and respiratory volume. Hypocapnia was observed in more cases in the 1^st group compared with the 2^nd group of patients. The patients from the 2^nd group were weaned from the ventilation more quickly than the patients from the 1^st group. Therefore, the duration of the treatment for newborns at the NICU was 4–6 days, supplemental oxygen was not provided.

Conclusion. Continuous monitoring of the electrical activity of the diaphragm gives an idea of the severity of the patient’s condition but also describes in detail his respiratory status. It allows for the selection of ventilation parameters in proportion to the child’s needs while maintaining a normal blood gas composition.

The sufficient number of studies on the dynamics of TREC (T-cell receptor excision circle) and KREC (kappa-deleting recombination excision circle) levels in both preterm infants and older children. The data are limited and contradictory for preterm babies. Therefore, is required further research to better understand the dynamics of markers in the research group.

Objective. Assessment of the dynamics of TREC and KREC levels in newborns with different gestational ages. Study significant maternal risk factors affecting the interested criteria.

Material and methods. The cross-sectional (simultaneous) study included 203 newborns with a gestation period of 22–41 weeks, born in 2023–2024. The dynamics of TREC and KREC were evaluated. The influence of maternal factors on TREC and KREC indicators was considered. The material for the study – dried blood stains drawn on Guthrie cards and taken as part of neonatal screening.

Results. A gradual increase in the levels of KREC and TREC due to gestational age was evaluated. Mostly intensive, the process takes part in a 28–30 week group of patients. Afterward, the interesting for us values reach a plateau. It was found that there was a statistically significant decrease in TREC levels in newborns from women with a history of spontaneous miscarriages (p=0.002); medical abortions (p=0.021) and congenital kidney malformations (p=0.01). The level of CREC was statistically significantly decreased in the group of newborns with a mother’s history of chronic salpingitis and oophoritis (p=0.03), chronic pyelonephritis (p=0.031)

Conclusion. The strong correlation between KREC/TREC levels and gestational age was noted. Statistically significant maternal factors influencing the assessed parameters have been identified. The question remains open as to the degree of their influence on TREC and KREC values.

The close relationship between the degree of deficit in motor and mental functions and the structural pathology of the brain is demonstrated by numerous works by national and foreign specialists. Studies devoted to the structural features of the brain and its reactions to the effects of damaging factors in newborns born weighing less than 1500 g at less than 28 weeks of gestation are of great interest.

The aim of the study was to clarify the frequency of structural CNS lesions (IVH, PVL) detected in the newborn period of predominately premature infants born with VLBW and ELBW.

Material and methods. The study was conducted based on the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of the Russian Federation. The study included 366 very premature infants in the period from 2019 to 2022. Birth weight was the main grouping feature: The ELBW group consisted of 143 (39.1%) newborns, and the VLBW group 223 (60.9%). Gestational age used as an additional indicator: group 1 – GW 24–26/6 weeks – 30 (8.2%) newborns; group 2 – GW 27–29/6 weeks – 110 (30.1%) newborns; group 3 – GW 30–34 weeks – 226 (61.7%) newborns.

To assess the structural features of the brain of premature infants, neurosonography (NSG) was performed at the age of 1–2, 3–4 and 7 days of life, and further assessment was indicated by a neurologist. The severity of IVH was based on the localization of hemorrhage and the presence of dilation of the ventricular system, according to NSG data. Statistical analysis and data processing were performed using: the d’Agostino–Pearson test, Mann–Whitney, and Dunn’s test. Fisher’s exact test was used for analyzing quantitative data. The language of statistical programming is R in the shell RStudio 2021.09.0+351 (USA).

Results. In the course of the study for infants with a GА of 28 weeks or less, changes in brain structures detected in the first days of life were considered in the absolute majority of cases to be severe (PVL; 3rd-degree IVH and PVL) or moderate (2–3 degree IVH). Thus, in preterm infants with GА 24–26/6 weeks, the incidence of 2–3 degree IVH and isolated PVL was 16.7%, 3rd degree IVH and PVL – 13.3%; in infants with GА 27–29/6 weeks. The incidence of 2–3 degree IVH was found in 4.5%, isolated PVL in 13.6% of infants, and 3rd degree IVH and PVL– 0%; in preterm infants with GА 30–34 weeks, the incidence of 2–3 degree IVH was 2.2%, isolated PVL – 8.0%, and 3rd degree IVH and PVL – 0%.

Conclusion. Structural brain lesions such as IVH and PVL were more frequently diagnosed in the group of children with gestational age <26 weeks and extremely low birth weight.

The hemostatic system is strikingly different in premature infants and has several features associated with a tendency to hypocoagulation. This fact is a reason for the high risk of bleeding, in particular, cerebral hemorrhage – intraventricular hemorrhages (IVH).

The aim of the study was to compare changes in the coagulation tests in premature newborns with IVH and evaluate the effectiveness of transfusion of fresh frozen plasma (FFP) in preventing the progression of IVH in the early neonatal period.

Material and methods. The retrospective cohort study was conducted from 2017 to 2020 at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of 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); 3 group – premature newborns with IVH grade 3 (n=8). The frequency of hemorrhagic syndrome was carried out, and the сoagulation tests in each group were evaluated. Hemorrhagic syndrome, in addition to IVH, manifested itself in the form of Pulmonary hemorrhage and Gastrointestinal Hemorrhage.

Results. It was found that the risk of developing IVH increased in the presence of hemorrhagic syndrome. Thus, in group 3, hemorrhagic syndrome was registered in 100% of cases. Statistically significant differences in the сoagulation tests such as fibrinogen (≤1.19 g/l), Quick Prothrombin Time Test (≤68.4%), the international normalized ratio (INR) (≥1.23) (p=0.005, p=0.001, p<0.001, respectively) were established. When comparing other parameters, statistically significant differences were not established. It was not found a statistically significant relationship between the transfusion of FFP and the progression of IVH in newborns.

Conclusion. Risk factors for the development and progression of IVH in premature infants in the early neonatal period were the presence of hemorrhagic syndrome, changes in the сoagulation tests – low levels of fibrinogen, Quick Prothrombin Time Test, and high INR. Correction of coagulation factors by transfusion of FFP does not prevent the progression of IVH.

The decision on the possibility of breastfeeding children born from mothers with oncology diseases and chemotherapy during pregnancy must be based on the results comparing the benefits and risks ratio of breastfeeding for each specific mother and her newborn.

The purpose of this study is to evaluate the possibility of supporting breastfeeding in children born from mothers with oncology diseases during pregnancy.

Material and methods. The cohort single-center study included 159 children (data collected retrospectively and prospectively) born from mothers with an established diagnosis of cancer during pregnancy. They were observed at the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Ministry of Health of the Russian Federation. The criteria evaluated in the study were the method of feeding a newborn, the possibility of maintaining or suppressing lactation, and the causes of it.

Results. After the comparison of two studied groups (retrospective and prospective), it was found that the number of children (8 out of 89 children) receiving breast milk in the prospectively (2021–2023) did not differ from the number of children (8 out of 70 children) receiving mother’s milk retrospectively (before 2020) (Pearson’s criterion χ² with Yates correction, p=0.809). It is not possible to increase the percentage of breastfeeding in women with breast cancer and hematological diseases at this stage due to objective reasons: the incompatibility of antitumor treatment with breastfeeding, the severity of the condition of mothers after childbirth, hypogalactia, the anxiety of women, and the unwillingness to maintain lactation.

Conclusion. Based on international studies, it should be recommended to preserve the lactation and breastfeeding of newborns with mother’s milk for women who do not plan to undergo chemotherapy treatment after delivery. Moreover, women with persistent remission must prolong lactation and breastfeeding. It is also important to pay attention to the emotional status of mothers who are ill, which is associated with the inability to breastfeed newborns for objective reasons. Moreover, we must focus on her psychological support and counseling on the question of formula feeding. It is necessary to increase the informational support of oncologists, obstetricians-gynecologists, and neonatologists on the criteria of lactation in mothers with oncological diseases and make recommendations for feeding newborns in the studied groups.

The article provides a review of national and international literature devoted to the study of the microbiota of breast milk. The results of recent studies’ ecosystem of the mammary gland are presented. Current scientific theories of the origin of the microbiota of breast milk were analyzed. Modern data on the microbial composition of breast milk is presented.

Laboratory diagnostics of hemostatic disorders and targeted therapy of thrombohemorrhagic conditions in newborns are relevant areas of scientific and clinical research. The hemostasis of a newborn differs from that of an adult due to the peculiarities of the qualitative and quantitative composition of the elements of the coagulation system. Classical methods for assessing hemostasis in vitro have several disadvantages. Modern integral methods are thromboelastography, thromboelastometry (ROTEM) and thrombodynamics allow for assessing hemostasis in vivo conditions. Thromboelastometry helps identify predictors of thrombohemorrhagic complications. Therefore, this method is particularly promising for choosing appropriate therapy in the early stages of clinical manifestations of hemorrhagic syndrome or thrombotic complications.

Necrotizing enterocolitis (NEC) is a severe disease of the newborn’s gastrointestinal tract that results in severe inflammation and necrosis of the intestinal wall.

This case report describes an extremely premature infant with a severe recurrent course of NEC, resulting in two episodes of intestinal perforation. The disease was characterized by early onset (day of life 10) with a history of congenital pneumonia (caused by Escherichia coli) and patent ductus arteriosus. We describe the clinical course, diagnostic search, surgical treatment results, and follow-up data. The report highlights an unfavorable combination of risk factors for NEC development and deterioration. Additional laboratory and instrumental diagnostic tools (fecal calprotectin, plasma cytokines, extensive ultrasound investigation) were used to optimize treatment tactics at different stages of the pathological process.

The article is devoted to the organizational and legal aspects of the introduction of family-oriented methods of nursing newborns in hospitals, the possibilities of expanding the participation of legal representatives in the care of their children, taking into account the sanitary and epidemiological requirements of legislation and the consolidation of the rules of such participation in local regulations of a medical organization.

The article discusses some difficulties in establishing breastfeeding in neonatal intensive care units and special care units. Some practical recommendations are offered to support and maintain breastfeeding in premature infants.

Maternal involvement in neonatal care has been shown to significantly improve clinical outcomes for high-risk neonates and promote parental well-being. However, implementing these practices in neonatal intensive care units (NICUs) in low and middle-income countries (LMICs) presents unique challenges due to resource constraints, cultural differences, infrastructural and workforce limitations. This discussion paper describes the strategies and considerations for effectively involving mothers in the care of high-risk neonates in NICUs in LMICs. Through a review of existing literature, case studies, and practical recommendations, this paper aims to provide a comprehensive framework for the successful implementation of parental involvement in neonatal care.