Neonatal hypoglycemia in children with risk factors

Objective: The analysis of clinical-laboratory peculiarities and the dynamics of glycemia clarifying the terms of blood glucose stabilization during the early neonatal period in children having risk factors of the development of such state.Methods: Open, retrospective , continuous, single-center study was conducted. It was aimed at getting preliminary data that is important for planning further tactics of examining newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation).The target group of the survey included 522 newborns of both genders in the early neonatal period (from 0 to 7 days of life).Results: There is data on the frequency of first indicated hypoglycemia in newborns having risk factors of the development of such state, clinicallaboratory peculiarities, the dynamics of glycemia during early neonatal period, and also the period of blood glucose stabilization (the age of reaching normoglycemia). Neonatal hypoglycemia was detected in 40.2% of examined children. Laboratory manifestation during the first day of life was noticed 62.9% of cases with the further normalization of glucose level in blood in 24 hours in 73.3% of newborns. Significant reduction of blood glucose was observed in 54.8% of cases requiring hypoglycemia therapy with parenteral prescription of 10% glucose solution. Hypoglycemia jugulated against oral correction of 5% glucoses solution in 40.5 % of cases. 4.8% of children got the level of glucose stabilized after introduction of supplementary feeding.Conclusion: The results of the newborns having risk factors on hypoglycemia development (kids having large body weight at birth, children whose mothers have diabetes, newborns having intrauterine growth retardation) examinations are presented. The peculiarities of neonatal hypoglycemia are: the absence of a typical clinical symptoms among 89% of children. Asymptomatic course of hypoglycemia confirms the importance and necessity of glycemia monitoring in the early neonatal period in order to conduct timely and adequate therapy.

Some opportunistic infections in the structure of premature birth causes

Aim. To determine the structure and detection rate of some opportunistic infections in premature birth.Materials and methods. The study was carried out at the premises of the Research Institute of Maternity and Childhood Protection and the Pathology Department of the Khabarovsk Perinatal Center. We studied 62 placentas from women whose pregnancy ended prematurely and placentas and organ samples (heart, lungs, liver, and kidneys) from 14 premature infants who died in the early neonatal period. Thirty placentas of women who delivered full-term live babies were classified as a control group. Genomes of Chlamydia trachomatis, Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma species (Ureaplasma urealyticum + Ureaplasma parvum), Cytomegalovirus, Herpes simplex virus, Human herpesvirus 4 type, Human herpesvirus 6 type, Parvovirus B19, Listeria monocytogenes, Streptococcus agalactiae, Streptococcus species, Streptococcus pyogenes, Haemophilus influenza, Klebsiella pneumoniae, Candida albicans were detected by polymerase chain reaction (PCR) in samples of placental tissue and samples of internal organs of deceased newborns. Results. The rate of opportunistic agent detection in the placentas from women with preterm birth made 59.6% and in the sectional material from premature newborns who died in the early neonatal period (78.6%), which figures exceeded the same indicator in the control group (30.0%) respectively, by 2.0 (p=0.007) and 2.6 (p=0.002), respectively. In 47.9±7.2% of cases of all positive results, the material from women with preterm birth presented with various combinations of two, three, and four infectious agents, having common pathogenic links, which contributes to the aggravation of pathogenic processes, comorbidity or multimorbidity. According to the detection rates, in terms of total monoinfections and mixed infection components, pathogens detected during preterm birth were distributed as follows: U. urealyticum ‒ 34,2±5,4%; S. agalactiae ‒ 17,1±4,3%; M. hominis ‒ 15,8±4,1%; S. species (S. sanguis, S. salivarius, S. mitis, S. mutans) ‒ 13,1±3,8%; Cytomegalovirus ‒ 11,8±3,7%; Human herpesvirus 4 type – 9,2±3,3%; M. genitalium ‒ 2,6±1,8%. Conclusion. PCR testing showed that placentas from women whose pregnancy ended prematurely and samples of placenta and organs of premature infants who died in the early neonatal period presented with opportunistic agents colonizing female genital tract (streptococci, mycoplasmas) or ubiquitous herpesviruses persistent and reproduced in human lymphocytes (Cytomegalovirus, Human herpesvirus 4 type). Associations of microorganisms that cause comorbidity or multimorbidity account for a significant portion of the infectious agents detected. The context for a microbiota-integrated opportunistic agent to transform into a pathogenic strain, identification of transformation predictors, and possible tools to correct the disorders – all these require further research.

Evaluation of the effectiveness of early intervention methods in newborns who have suffered hypoxic-ischemic CNS damage

Timely diagnosis of cerebral disorders both in the prenatal period and in the early neonatal period, as well as early rehabilitation treatment is the basis for the prevention of childhood disability. To this end, the so-called Early Intervention System is being introduced in Ukraine. The effectiveness of early intervention techniques directly depends on timely diagnosis and correctly chosen intervention tactics. Given the high neuroplasticity of the developing brain, it is advisable to start the elements of neurodevelopmental therapy from infancy. The aim of the work is to evaluate the effectiveness of methods of early intervention in children of the first 3 months of life who have suffered hypoxic-ischemic CNS damage in the neonatal period, by assessing the main indicators of psycho-motor development. 101 children who were treated in the neonatal pathology department due to hypoxic-ischemic CNS damage and did not have concomitant somatic pathology were examined. The children were in the ward for rehabilitation. To assess the effectiveness of comprehensive rehabilitation in young children, it is advisable to use adapted for Ukraine scale of Munich functional developmental diagnostics, which allows to assess the child's development in all major areas, its harmony and effectiveness of rehabilitation measures during the first 3 years of life. Statistical processing of the obtained results should be performed in the license package "Statistica 6.1 for Windows". Timely diagnosis of cerebral disorders both in the prenatal period and in the early neonatal period, as well as early rehabilitation treatment is the basis for the prevention of childhood disability. Given the high neuroplasticity of the developing brain, it is advisable to start the elements of neurodevelopmental therapy from infancy. The effectiveness of the methods recommended for use depends on timely diagnosis and correctly chosen intervention tactics. Assessment of the effectiveness of care for children at risk of deviant psychomotor development should be based on the application of the criteria and scales recommended by international expert groups, which are adapted in our country. Signs of full-fledged early intervention in the region are: perinatal diagnosis of congenital pathology, timely provision of medical and rehabilitation, social and special pedagogical services to children aged 0 to 3 years and their families. In order to achieve the set goals, in our opinion, the priority measures should be steps to implement the national protocol for care for children with perinatal CNS injuries, approval and implementation in Ukraine of the modern International Classification of Functioning, Life and Health Restrictions, providing medical care, rehabilitation and social services for young children.

FEATURES OF PREGNANCY AND DELIVERY IN ADOLESCENT WOMEN

Aim: to assess the risk of adverse consequences of adolescent pregnancy for mother and foetus in women from Lviv region. Material and methods. Complications of pregnancy and childbirth in adolescent women were studied retrospectively at the Lviv Regional Clinical Hospital. Results and discussion. 134 cases of adolescent childbirths for 2013 to 2017 were analyzed. The analysis of data on the course of pregnancy in adolescent women showed that the vast majority of them had complicated pregnancy and were at risk of preterm childbirth. A significant proportion of young women, 78 (58.2%), significantly more often required the therapy during pregnancy. Assessment of the health status of newborns showed that ¼ (24.6%) of young women gave birth to premature babies, and almost 1/3 of children, 51 (38.0%), from young mothers had a complicated early neonatal period. Within the spectrum of complications, the commonest diagnosis was "prematurity" in 33 (24.6%) children from young mothers. The pathological course of the early neonatal period in 51 (38.0%) children of the main group required transfer to other departments for further treatment. 82 (61.2%) children from this group were discharged home, while in the control group all 100 (100.0%) children were discharged from maternity home. Conclusions. The study has demonstrated that the risk factors for perinatal pathology in newborns from adolescent women included probably complicated pregnancy, risk of spontaneous abortion (17.9%), preterm birth (24.6%), and the childbirth of premature infants with impaired condition at birth, who needed treatment in other medical institutions (38.0%). Adolescent pregnant women are at risk for obstetric and perinatal complications.

Prevalence of Allergic Diseases in Children Vaccinated Against Tuberculosis and Hepatitis B in the Early Neonatal Period: Literature Review

Background. T-cell response is shifted towards Th2-type predominance in newborns. This makes them particularly vulnerable to exposure of various external pathogens, development of severe infections, moreover, it is also a risk factor for allergic diseases development. Various methods of switching the immune response to Th1-type are currently under research, and one of them is vaccination.Objective. The aim of the study is to provide data on the prevalence of allergic pathology among children vaccinated against tuberculosis and hepatitis B, as well as the effect of vaccines on immune response type.Results. Data on both increase and decrease in the prevalence of atopic conditions in children vaccinated with BCG and against hepatitis B were analyzed, thus, most of them cannot be considered reliable. The results of several large studies do not reveal any correlation between vaccination and the presence of allergic disease in children. There is data that BCG and hepatitis B vaccines shift the immune response towards Th1-type activation.Conclusion. Vaccination in the early neonatal period may affect switching of the immune response towards Th1-type. That, in turn, can affect the prevalence of allergic pathology in vaccinated children. However, the data available for now is not sufficient to reliably estimate the possible effect of vaccination on atopic conditions manifestation in the future.

Maternal and neonatal outcomes in pregnancies complicated by eclampsia – analysis of cases from 2008–2018

Objective: Evaluation of perinatal results in a set of pregnancies complicated by eclampsia. Methods: Analysis of 67,304 births performed at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital, Brno from 2008–2018. During the given period, eclampsia was dia gnosed in 16 mothers (0.2‰). The during the time of eclampsia (week of gestation, prepartum, intrapartum, postpartum) fetal and neonatal status (signs of intrauterine distress, pH of the umbilical artery, Apgar score, intrauterine fetal death, death in the early neonatal period) were evaluated. Symptoms and course of the eclamptic attack, maternal comorbidities, associated obstetric complications (placental abruption, surgical complications, blood loss, hysterectomy) and non-obstetric complications (coagulopathy, renal and hepatic impairment, neurological complications) were monitored. Results: Out of a total of 16 cases of eclampsia, 13 cases (81.3%) were confi rmed during pregnancy, one case (6.2%) during childbirth, and two cases (12.5%) within 24 hours after childbirth. The mean gestational week of eclampsia was 33 weeks and 3 days. The typical course of an eclamptic attack characterized by headache and visual disturbances followed by a rapid onset of convulsions was noted in fi ve cases (31%). Fetal hypoxia with a pH of the umbilical artery less than 7.10 occurred in four cases (25%). The dependence of the decrease in pH value on the time interval from the dia gnosis of eclampsia to the termination of pregnancy was demonstrated. The pH of the umbilical artery decreased on average by 0.054 every 30 minutes from the onset of the eclamptic attack until the end of pregnancy. There were 3 perinatal deaths in the group (19%). Intrauterine fetal death occurred in one case due to partial abruption of the placenta during an eclamptic attack; two newborns died in the early neonatal period. The cause of death was sepsis in one case and perforation of the intestine in necrotizing enterocolitis in the other. The death of the mother was not recorded in the fi le. The incidence of preeclampsia in subsequent pregnancies reached 18.8%. Non-obstetric and neurological complications (amaurosis, subarachnoid hemorrhage, amnesia) occurred in the group in three cases (18.8%), and renal failure occurred in two cases (12.5%). Conclusion: The incidence of eclampsia at the Department of Gynecology and Obstetrics, Masaryk University, Faculty of Medicine and University Hospital, Brno reached 0.2‰ and was stable for a long time. Associated serious maternal complications occurred in 37.5% of cases and neonatal complications in 31.3% of cases. Early dia gnosis of eclampsia and minimization of the time delay until the end of pregnancy is a prerequisite for reducing the risk of associated complications. An interdisciplinary approach is needed. Key words: eclampsia – convulsions – urgent conditions in obstetrics – perinatal outcomes – hypoxia

Clinical and Prognostic Value of Calcium and Phosphorus Levels as Possible Markers of Endothelial Dysfunction in Preterm Infants

The system maintaining a sufficient level of calcium and phosphorus is formed only by the end of the first month of life, and in pretermure infants even later. These elements play a crucial role in many physiological processes. They also affect vascular function, endothelium, and endothelial nitric oxide (NO) synthase. Therefore, the aim of our study was to analyze the relationship of serum phosphorus and calcium levels with markers of endothelial dysfunction and features of the early neonatal period. The study included 37 preterm infants that received standard clinical, laboratory, and instrumental examination. As markers of endothelial dysfunction, the 4a/4b polymorphism of the eNOS gene was investigated and quantitative measurement of NO metabolites in urine was performed. Phosphorus and calcium levels in 37 preterm infants on the first day were 4.06 ± 1.88 mg/dL and 1.89 ± 2.08 mg/dL, and on the six day 4.89 ± 2.02 mg/dL and 1.86 ± 1.80 mg/dL, respectively. Combined hypocalcemia and hypophosphatemia were found in 27 (73.0%) of 37 examined infants. The presence of severe condition in early neonatal period was positively correlated with calcium levels on the first and sixth days after birth. There were determined positive correlation between calcium and phosphorus levels on the first day after birth and severity of clinical symptoms in neonatal period and birth gestational age. Serum calcium level in preterm birth infants was positively correlated with respiratory failure on the sixth day. Correlation between calcium and phosphorus serum levels was observed for severe and stable infants on the first day, but on the six day only in preterm birth infants with stable condition. We have not found an association between phosphorus and calcium levels and markers of endothelial dysfunction in preterm birth infants. Serum phosphorus and calcium levels and studied markers of endothelial dysfunction have been found to be independent markers of the risk of developing a complicated early neonatal period in preterm infants.

Perinatal outcomes of newborns born from young mothers with epidural analgesia

Objective. To evaluate the features of the course of the early neonatal period of newborns born from young women under conditions of epidural analgesia.Material and methods. The authors conducted a prospective, comparative, randomized, longitudinal, monocenter study. Patients of Group 1 (n=25) were anesthetized with a narcotic analgesic (2% Тrimeperedine 1,0 ml intramuscularly). Patients of Group 2 (n=30) received long-term epidural analgesia (EA) with 0,2% Ropivacaine (10,0 ml/hour). All patients delivered full-term infants. The course of labor, clinical and laboratory characteristics of newborns in the early neonatal period were evaluated.Results. There were no significant differences in the duration of labor, volume of blood loss, and other characteristics between the groups. There were no clinical differences between the groups of newborns. We did not find a negative effect of epidural analgesia on the Apgar score at the 1st (p=0,166) and 5th (p=0,217) minutes of life and the neuropsychiatric status of the newborn (p=0,322). At the same time, in the group of long-term epidural analgesia, there was a tendency to a higher incidence of moderate and mild asphyxia (19,2% versus 9,5%; p=0,436). When comparing the acid-base state of umbilical cord arterial blood, significant differences were found in the following indicators: lower pH (p=0,042) and pO2 level (p=0,007) and higher pCO2 level (p=0,031) in arterial cord blood.Conclusion. Epidural analgesia during labor in young women is accompanied by a lower level of pH and pO2 and a higher level of pCO2 in the arterial cord blood as compared to a Group of Тrimeperedine, which indicates a more pronounced shift in the acid-base state of the fetal blood. When analyzing neurological outcomes in newborns, there were no statistically significant differences. However, further follow-up is required for children born from young mothers who have received long-term epidural analgesia in labor.