ADAPTATION OF EARLY NEONATAL CHILDREN BORN FROM MOTHERS WHO REHIVED COVID-19 DURING PREGNANCY (DESCRIPTION OF TWO CASES)

The frequency of detection of infected children with SARS-CoV-2, which is 10% of the total number of infected, including newborns, suggests the need for careful diagnosis of pathological conditions that may occur in children, particularly in the neonatal period. If at the beginning of the detection of COVID-19 it was claimed that the coronavirus SARS-CoV-2 does not affect children, then analyzing the new data we see that 2% of patients with diagnosed clinical cases of COVID-19 are children, including newborns. The article describes observations of several clinical cases of early neonatal adaptation of children born to women who had mild to severe COVID-19 during the first and third trimesters of pregnancy, respectively, because these children at birth had vesicular rash, symptom, which is considered rare for this category of newborns. In 2020, 2,300 newborns were born in the neonatal department of the 3rd City Clinical Hospital of Lviv, with every 5th woman in labor (20%) relapsed to COVID-19 during pregnancy.Analyzing the course of early neonatal adaptation, we found that the adaptation period of such children may not differ from the adaptation of newborns in the number and manifestations of transient conditions characteristic of the first days of life, whose mothers did not suffer from COVID-19 during pregnancy. However, coronavirus infection in women in both the first and third trimesters of pregnancy may be associated with signs of congenital vesiculosis in children, accompanied by inflammatory changes in the blood and blood clotting in the period of early neonatal adaptation in the newborn. Children had no other signs of pathological symptoms (fever, lethargy, drowsiness, hypotension, rhinorrhea, pharyngitis, cough, respiratory disorders (tachypnea, wheezing), vomiting, diarrhea and feeding disorders)), characteristic of infectious diseases specific to newborns, which can be masked by transient states. Manifestations of transient conditions in the observed children were: milia, simple erythema, desquamative peeling of the epidermis, toxic erythema, physiological jaundice.Treatment of the affected areas of the skin with rash elements with 0.05% aqueous solution of chlorhexidine, a three-day course of ampicillin, administered to the child from the first hours of life at a dose of 100 mg / kg / day intravenously contributed to the disappearance of vesiculosis. The maintenance therapy was a multiprobiotic in the form of drops. In the presented cases, no obstacles to breastfeeding and cohabitation of mother and child were observed. In the departments of newborn maternity hospitals, it is necessary to find opportunities, for diagnostic purposes, to conduct microbiological studies of pustules and biomaterial from the mucous membranes of the genital tract to further compare the results and establish etiological factors of vesiculosis, determine biochemical blood tests - CRP, ALT, AST, LD serum, coagulation parameters.

Caesarean section in severe preeclampsia: features of early neonatal adaptation

Objective. To study the course of early neonatal adaptation depending on the anesthetic aid in abdominaldelivery of pregnant women with severe preeclampsia. Characteristic o fchildren and research methods. Thea uthorscarried outaprospective cohort study o f342 childrenborn from mothers with severepreeclampsia. The children were grouped according to their gestationalage. The author sanalyzed perinatallosse sand assessed general condition according to the Apgarscaleat the 1st and 5th minutes of life, aswell as the neurological status of newborns according to the NACS scale at the 15thminute of life and in 2 hours depending on the anesthesia method used during the caesareansection.Results. The authors found that the newborns from mothers with severe preeclampsia, starting from the 34th week of gestation, demonstrated a significantly more pronounced negative effect of total intravenous anesthesia on their somatic (birth in a state of hypoxia) and neurological status as compared with spinalanesthesia (р<0,05). ><0,05).Conclusion. The results are of practical value to neonatologists, as total intravenous anesthesia is expectedto causethe revealed violations of the adaptive ability of newborns and the doctor is able to provide adequate timely assistance to children.

About evaluation of nutritive state in premature infants

Insulin-like growth factor 1 (IGF-1) plays an important role in the energy balance of the newborn baby's body, is associated with protein stores, which allows us to consider its level as an indicator of nutritional status.Objective: to study the value of insulin-like growth factor 1 and basic nutrients in the blood in premature infants in the process of neonatal adaptation.Materials and methods. Dynamics blood levels of insulin-like growth factor 1 in premature newborns included two trends: decrease (1 group) and increase (2 group). During a pregnancy most mothers of newborns from 1 group had been nonspecific respiratory and urinary-sexual organs’sinfectious diseases, in mothers of newborns from 2 group prevailed disorders which carried high risk of fetal hypoxia. During a neonatal period blood levels of albumen of newborns from 1 group decreased and blood levels of glucose increased; blood levels of nutrients in newborns from 2 group did not change.Conclusions. Dynamics blood levels of insulin-like growth factor 1 in premature newborns are markers of metabolism’s processes which were originated in fetal stage and continue in the neonatal period.

ВНУТРІШНЬОПЕЧІНКОВИЙ ХОЛЕСТАЗ ВАГІТНИХ ПІСЛЯ ЗАСТОСУВАННЯ ДОПОМІЖНИХ РЕПРОДУКТИВНИХ ТЕХНОЛОГІЙ: КЛІНІЧНІ ОСОБЛИВОСТІ

80 pregnant women were examined after assisted reproductive technology (ART) programs: 40 women with manifestations of intrahepatic cholestasis of pregnant women (IHP) - the main group and 40 women without manifestations of IHP (comparison group).In the majority (62.5%) of patients after ART, the diagnosis of IHP established after 30 weeks of pregnancy. Some patients (27.5%) reported short-term episodes of IHP up to 24 weeks of gestation. In 17.5% of women, IHP had a severe course. Almost a third (27.5%) of women are over 35 years old. Women with IHP have a significantly higher frequency of allergies in the anamnesis (35.0%), liver pathology (20.0%) and diseases of the gastrointestinal tract (25.0%). In one third of women, IHP developed repeatedly, 42.5% of the main patients indicated a family history burdened with IHP. Almost a third of women (27.5% vs. 12.5%, p<0.05) had a history of polycystic ovary syndrome.The current pregnancy characterized by a high frequency of complications. A quarter of patients (25.0%) had early preeclampsia. In the second half of pregnancy, the threat of preterm birth noted in most women during the manifestation of IHP (60.0%). The incidence of fetal distress in women with IHP was almost 2 times higher than in patients without this complication (47.5% vs. 25.0%, respectively, p <0.05). The frequency of preeclampsia is also higher (40.0%).The vast majority of women in the main group were born by cesarean section (70.0%). Almost half of patients with IHP were premature (45.0%). A third of women (35.0%) had fetal distress in childbirth. In 27.5%, childbirth complicated by bleeding of more than 5% of body weight. The postpartum period was characterized by a 4-fold increase in the frequency of late bleeding (20.0% vs. 5.0%, p <0.05).One case of antenatal mortality noted in pregnant women after ART with IHP. Almost half of the children were born with asphyxia of varying severity (48.7%), with 10.3% diagnosed with severe asphyxia. One third of children were born with a body weight below 2500 g (30.8%). In 74.4% of newborns from mothers of the main group, various disorders of the period of early neonatal adaptation were noted, among which the most prominent were: RDS (35.9%), jaundice (43.6%) and gastrointestinal syndrome (30.8%). The 2-fold increased incidence of hemorrhagic syndrome (17.9%) is noteworthy.

Transient Pulmonary Artery Hypertension in Holstein Neonate Calves

The neonatal period is a challenging phase for calves, and during this phase constant adaptations are required. The aim of the present study was to evaluate the invasive hemodynamics with the Swan-Ganz catheter in neonate calves to understand adaptive changes during the first 30 days of life. A prospective and observational study was conducted with 10 Holstein calves. Assessments of the right atrial pressure (RAP), right ventricular pressure (RVP), pulmonary artery pressure (PAP), pulmonary capillary pressure (PW), cardiac output (CO), heart rate (HR), pulmonary vascular resistance (PVR), and blood gas levels were performed. The analyses of PAP, PVR, PW, HR, sO2, and arterial blood gases differed (p < 0.05) between the evaluated periods. Our results indicated transient pulmonary artery hypertension during the process of extrauterine adaptation during the first 30 days of life. This hypertension must be considered as physiological and consequent to the neonatal adaptation process.

КОМПЛЕКС ПРОФІЛАКТИЧНИХ ЗАХОДІВ ДЛЯ ВАГІТНИХ ПІСЛЯ ДРТ З ВИСОКИМ РИЗИКОМ ПРЕЕКЛАМПСІЇ

The purpose of the study: to evaluate the effectiveness of the proposed set of preventive measures for pregnant women after ART with a high risk of preeclampsia. Material and methods. To test the effectiveness of the proposed set of prophylactic measures, 60 pregnant women after ART were selected, which were randomly divided into 2 groups: 30 women who received the recommended complex (main group) and 30 women (comparison group), whose preeclampsia was prevented by order of the Ministry of Health. № 417 "Guidelines for the provision of outpatient obstetric and gynecological care." Results. The use of the recommended measures improves lipid metabolism (significant reduction of triglycerides and low density cholesterol), eliminates vitamin D deficiency, balances the cytokine profile (reduction of proinflammatory focus), reduces the prothrombotic potential of the hemostasis system (reduction of D-dimer and background marker damage). Improving the general condition and the use of psychotherapy can reduce the manifestations of vegetative-vascular dystonia, anxiety and improve quality of life. Such changes provide a more favorable background for the development of gestation. The incidence of preeclampsia decreased by 43.8% (from 26.7 to 15.0%), and mainly due to early preeclampsia, the incidence of which decreased by 78%, no cases of severe preeclampsia were reported. The frequency of placental insufficiency, fetal distress and growth retardation is reduced. The frequency of birth of children in a state of asphyxia is reduced by 2 times (up to 20.0 vs. 46.7%), severe asphyxia is not observed. Significantly lower and the frequency of violations of the period of neonatal adaptation (30.0 vs. 53.3%). Conclusions. The use of treatment and prophylactic complex to prevent preeclampsia in pregnant women after ART can improve a woman's homeostasis, balance vegetative-vascular regulation, reduce the incidence of preeclampsia by 43.8% (from 26.7 to 15.0%) and other complications of pregnancy and childbirth, improve perinatal outcomes. Proven medical, social and economic efficiency of the developed complex allows to recommend it for implementation in medical practice.

EVALUATION OF FETAL REACTIVITY IN A TEST WITH ACOUSTIC STIMULATION IN WOMEN WITH A HISTORY OF CESAREAN SECTION

Object of study: pregnancy in women with a history of cesarean section, perinatal period. The problem to be solved: clarification of the perinatal significance of the factor “scarred uterus”, substantiation of the clinical significance of the test with acoustic stimulation of the fetus as a method for predicting early neonatal adaptation. Main scientific results: it was found that pregnancy in women with a history of cesarean section is characterized by an increased perinatal risk and is associated with psychoemotional stress of the mother, which affects the reactivity of fetal cerebral hemodynamics. It has been shown that the test with acoustic stimulation of fetus allows one to gain an idea of the fetus's perception of stressful influences, which should be taken into account when drawing up a delivery plan. The area of practical use of research results: obstetric departments of maternity hospitals and multidisciplinary hospitals. An innovative technological product: technology for assessing the state of the fetus in full-term pregnancy, which allows predicting complications of early neonatal adaptation based on the susceptibility of the fetus in the test with acoustic stimulation. Scope of application of an innovative technological product: obstetric clinical practice, perinatal medicine.

SSRIs and SNRIs (SRI) in Pregnancy: Effects on the Course of Pregnancy and the Offspring: How Far Are We from Having All the Answers?

Serotonin has important roles in the development of the brain and other organs. Manipulations of synaptic serotonin by drugs such as serotonin reuptake inhibitors (SRI) or serotonin norepinephrine reuptake inhibitors (SNRI) might alter their development and function. Of interest, most studies on the outcome of prenatal exposure to SRI in human have not found significant embryonic or fetal damage, except for a possible, slight increase in cardiac malformations. In up to a third of newborns exposed to SRI, exposure may induce transient neonatal behavioral changes (poor neonatal adaptation) and increased rate of persistent pulmonary hypertension. Prenatal SRI may also cause slight motor delay and language impairment but these are transient. The data on the possible association of prenatal SRIs with autism spectrum disorder (ASD) are inconsistent, and seem to be related to pre-pregnancy treatment or to maternal depression. Prenatal SRIs also appear to affect the hypothalamic hypophyseal adrenal (HPA) axis inducing epigenetic changes, but the long-term consequences of these effects on humans are as yet unknown. SRIs are metabolized in the liver by several cytochrome P450 (CYP) enzymes. Faster metabolism of most SRIs in late pregnancy leads to lower maternal concentrations, and thus potentially to decreased efficacy which is more prominent in women that are rapid metabolizers. Studies suggest that the serotonin transporter SLC6A4 promoter is associated with adverse neonatal outcomes after SRI exposure. Since maternal depression may adversely affect the child’s development, one has to consider the risk of SRI discontinuation on the fetus and the child. As with any drug treatment in pregnancy, the benefits to the mother should be considered versus the possible hazards to the developing embryo/fetus.

Neonatal meconium aspiration: risk factors and adaptation by the newborns

Aim: to identify the risk factors of meconium aspiration and study its impact on neonatal adaptation.Materials and methods. Medical records of 44 women and their infants were studied.Results. In 85 % of cases, the diagnosis of complicated pregnancy was made, in 100 % cases – there was a complicated delivery; 100 % of newborns were put on mechanical ventilation, 95 % of them were diagnosed with cerebral depression syndrome, and 72.5 % – with aspiration pneumonia. Conclusion. A differentiated approach to the management of pregnancy and labor will reduce perinatal morbidity.