SAFETY AND QUALITY OF INTRAVENOUS LIPIDS FOR NEWBORNS: EFFECTS ON CRITICAL DISEASES AND METABOLIC DISORDERS (PART II)

Premature birth and its complications cause stress in newborns, which restrains their physical growth for several weeks after birth and is associated with chronic morbidity and neurological disability in the future. Preterm infants face such difficulties as respiratory distress, cardiovascular disease, gastrointestinal dysfunction and very low birth weight. Most complications in newborns are associated with oxidative stress that develops during the early period of growth. The formation of free radicals entails oxidative damage to many organs and systems of the body and is the main factor responsible for the development of typical diseases of preterm infants, such as bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, and respiratory distress syndrome. Premature infants depend on adequate early parenteral nutrition, which not only guarantees they will survive but also ensures positive health outcomes later in life. Early use of intravenous lipids helps to prevent essential fatty acid deficiencies, provides energy and substrates for cell membrane synthesis, which are important for the growth and development of infants with very low and extremely low birth weight. This publication represents data on the effect of intravenous lipids on critical conditions and metabolic disorders in newborns. Literature sources are analyzed and the existing evidence of the possible influence of lipid emulsions on critical diseases in newborns is presented: intraventricular hemorrhage; necrotizing enterocolitis, patent ductus arteriosus and thrombocytopenia; glucose metabolism (hypo- and hyperglycemia); hyperbilirubinemia and chronic liver damage. The literature review is aimed at finding optimal strategies for the use of lipid emulsions in intensive care of newborns to improve the quality of care for premature infants. The purpose of this work is to analyze the results of published studies and systematize data on the feasibility and safety of lipid emulsions used in newborns with critical diseases of the perinatal period.

CHARACTERISTICS OF METABOLIC PROCESSES IN THE FORMATION OF MENSTRUAL FUNCTION DISORDERS IN ADOLESCENT GIRLS WITH OBESITY

Іntroduction. Today, a quarter of the population of economically developed countries has a body weight that is 15% larger than the norm. According to various authors, the timely onset of menarche in women with various forms of obesity and reproductive dysfunction is observed in 31% of cases only. Obesity results in insulin resistance, which in its turn results in hyperinsulinemia. The main reason of the connection of insulin resistance with reproductive function disorders consists in the specific influence of insulin on ovaries. Insulin suppresses apoptosis, binding to receptors of various growth factors that promotes long existence of atresizing follicles. In the pathogenesis of the metabolic syndrome, along with the development of hyperinsulinemia and insulin resistance, a significant role belongs to the imbalance of adipocytokines, one of which is adiponectin. The aim is to analyze metabolic processes in the formation of menstrual dysfunction in adolescent girls with obesity to improve diagnostic methods of menstrual disorders. Material and methods. Clinical and laboratory examination of adolescent girls aged 12-18 years was held, among which 79 had obesity and complaints about menstrual dysfunction (the main group); 31 with normal body weight and regular menstrual cycle (the control group). Research methods: general clinical, biochemical (indicators of lipid and carbohydrate metabolism were determined), instrumental (ultrasound), statistical. Results. It was found that 53.3% of the girls from the main group had the beginning of the first menstruation after 14 years, delayed menstruation from 42 days to 6 days, duration 2.1 ± 0.05 days, which was significantly shorter, the volume of 10.2 ± 0.05; 0.4 points (average 1-2 pads per day) was significantly lower (p <0.05). Ultrasound showed uterine hypoplasia in almost every second girl in the main group - 36 (45.46%). Hyperleptinemia and leptin resistance was found in obesity of the first degree 34.8 ± 1.75, in obesity of the second degree 37.15 ± 2.12, in obesity of the third degree 40.64 ± 2.0. It was 14.35 ng / ml in the control group, p<0,01. Hyperleptinemia in the main group was accompanied by hyperinsulinemia in 26% of cases and insulin resistance. The relationship between low values of adiponectin and elevated body mass index in patients of the main group was established, which was confirmed by the results of correlation analysis (adiponectin & body mass index: ρ = -0.74). Analysis of the results revealed a decrease of A/L level in the main group by 4.3 times. Based on our own results, the A/L and HOMA-AD models can be considered more accurate for determining insulin resistance. Conclusions. 1. Changes of the menstrual cycle in overweight girls were found. The association of adipokines secretion disorders is characterized by hyperleptinemia, leptin resistance, decreased Adiponectin / Leptin index and hypoadiponectinemia, which, in combination with insulin resistance, indicates the participation of adipokines in the genesis of oligomenorrhea. The algorithm of adolescents’ treatment with menstrual dysfunction on the background of obesity must include the calculation of Adiponectin/Leptin and HOMA-AD, which will make it possible to avoid overdiagnosis of insulin resistance.

MODERN APPROACH AND CLINICAL EXPERIENCE OF DIAGNOSIS OF CONGENITAL TOXOPLASMOSIS

Diagnosis of congenital toxoplasmosis is one of the most pressing and complex problems of perinatology. Difficulties in the interpretation of serological tests, the lack of clearly defined steps in the detection of seroconversion in women leads to late diagnosis and the development of irreversible changes and severe complications from the newborn. When infected during pregnancy, the disease is extremely unfavorable for the fetus and can lead to miscarriage, stillbirth, intrauterine growth retardation or the formation of birth defects. This article presents a review of the literature on the modern diagnosis of congenital toxoplasmosis and presents his own clinical case of diagnostic search for this infectious disease in the newborn. Practitioners should keep in mind prenatal ultrasound markers, the main manifestations of the disease and methods of diagnosis, because timely recognized and confirmed congenital toxoplasmosis will have the best long-term treatment results and prognosis in the newborn.

DO PROBIOTICS HAVE A FUTURE IN NEONATOLOGY? (ANALYSIS OF THE LATEST DATA. PART 3)

The issue of feasibility and effectiveness of probiotics use in newborns is still discussable. A position letter of the Committee on nutrition of the European Society for Pediatric NutritionGastroenterology, Hepatology, and(ESPGHAN) and the Working group of the ESPGHAN on probiotics and prebiotics issues was published in May 2020 in “Pediatric Gastroenterology and Nutrition” magazine as for the use of probiotics in premature newborns. The third part of the literature continues with the position paper and the results of many randomized controlled clinical trials of probiotics. The article considers the answers to 6 clinical questions posed by the working group of the Committee to assess the feasibility of use, routes of administration, dosage and duration of use, as well as the effectiveness and quality of probiotic drugs. It was proved that probiotics, in general, could decrease the level of necrotising enterocolitis, sepsis, and mortality. On the other hand, an increasing number of commercial products containing probiotics of non optimal quality are available. In addition, a large number of departments in the world regularly suggest probiotic supplements as a treatment standard despite the absence of any solid evidence. Moreover, the emphasis was placed on issues of safety of probiotic supplements for premature newborns. Guarantee of quality of probiotic product is deliverance of probiotic strains by transfer genes of resistance to antibiotics, the ability to regularly detect sepsis while using probiotics.

STANDARDS OF MEDICAL CARE “INVASIVE CANDIDIASIS IN NEWBORNS”

Candida infection (candidiasis) is an important clinical problem in newborns who need treatment in modern intensive care units. Organ and/or systemic infections caused by these fungi are called invasive candidiasis (IC). Newborns are especially vulnerable to IC, and their incidence is 3-5 times higher than the corresponding rates in children or adults. Invasive fungal infections caused by Candida are the third most common late-onset infection in infants born with a birth weight <1500 g. IC in newborns is associated with approximately 20% mortality, and about half of survivors have serious long- term neurological damage. In recent years, new data have been obtained on the diagnosis, prevention and treatment of IC in newborns, which has determined a change in treatment recommendations. Accordingly, the need arose to ensure the compliance of our clinical practice with modern evidence-based approaches. Early diagnosis of candidiasis and prompt treatment with effective antifungal agents such as fluconazole, amphotericin B, and micafungin, when indicated, are critical to improving outcomes.

MODERN VIEW OF DIAGNOSIS AND APPROACHES TO THE TREATMENT OF CHRONIC PAIN IN CHILDREN WITH PARALYTIC SYNDROMES (LITERATURE REVIEW)

Over the past decades, more and more attention in medical science has been paid to the diagnosis and study of pain mechanisms in the pediatric population. According to experts in the field of chronic pain in children, it occurs in 12% of all pediatric patients, which negatively affects the quality of children’s life and life of their families. Today, a particularly important problem in most countries of the world is pain in children with paralytic syndromes of III - V level according to GMFCS. About 20-35% of children with paralytic syndromes suffer from chronic pain. Although there are means and knowledge on how to treat pain, children's pain is often not recognized, ignored, or even denied. More than 50% of children with paralytic syndromes suffer from moderate to severe pain daily and in several parts of the body. The International Association for the Study of Pain (IASP) defines pain as “an unpleasant, sensual, and emotional experience associated with actual or potential tissue damage or perceived tissue damage. The inability to communicate verbally does not negate the possibility that the individual is in pain and needs appropriate analgesic treatment. Pain is always subjective ... ". Determining the type of pain helps to identify its cause, which can guide the choice of treatment. The main cause of pain in children includes acute nociceptive pain (ie pain caused by activation of peripheral nerve endings, including somatic and visceral pain), neuropathic pain (ie due to damage or dysfunction of the somatosensory system), psychosocial - spiritual - emotional pain. Chronic pain is a continuous or intermittent pain that lasts longer than the expected normal recovery period. Chronic pain can also occur and persist in the absence of a specific pathophysiology or medical condition. The expression of pain depends on a child's age, cognitive development and socio-cultural context.

FEATURES OF CARDIOVASCULAR ADAPTATION IN NEWBORNS BORN FROM MOTHERS WITH METABOLIC SYNDROME

Introduction. Overweight and obesity, the manifestations of metabolic syndrome during pregnancy, and their consequences are huge public health challenges. The effect of a mother`s metabolic syndrome on the condition of a newborn is insufficiently studied. The aim is to establish the features of cardiovascular adaptation of premature infants born from mothers with metabolic syndrome, and to identify metabolic maternal and infant risk factors that are mostly associated with high blood pressure and cardiopathy. Material and methods. A cohort prospective study was conducted, which included 97 premature newborns who were treated in the intensive care unit. Two groups were formed: the main group included premature infants born from mothers with metabolic syndrome (n = 40), and the comparison group included premature infants born from mothers without metabolic syndrome (n = 57). Results. Infants born from mothers with metabolic syndrome had significantly higher blood pressure than normal according to the gestational age of a child (45.5 ± 0.13 vs. 42.56 ± 0.13 mm Hg, p <0.001). High blood pressure in infants was significantly associated with maternal lipid metabolism disorders (OR 30.9) and hypertension (OR 4.8). The study found a significant positive relationship between blood pressure and overweight in an infant (Coef. 0.168), and a significant negative relationship with glucose level in blood serum (Coef. -0.037). It was found that cardiomyopathy is significantly more common in children of the main group (p = 0.010), its development is associated with the presence of diabetes in a mother (OR 7.57). The more components of the metabolic syndrome a woman has, the more likely a child is to have cardiomyopathy. The risk of developing cardiomyopathy is significantly influenced by a number of risk factors on the part of a newborn. Conclusions: High blood pressure in premature infants is significantly associated with a complex of components of the metabolic syndrome in mothers (hypertension and / or preeclampsia, obesity, diabetes and disorders of lipid metabolism in a mother (OR 14.71, p <0.001)). The role of carbohydrate metabolism disorders in a child in the development of high blood pressure has been demonstrated. It is proved that the development of cardiopathy in newborns is associated with risk factors from both a child and a mother, which indicates a complex effect of metabolic factors on the adaptation of the cardiovascular system.

MEDICAL AND PSYCHOLOGICAL SUPPORT OF WOMEN WITH THE THREAT OF PRETERM BIRTH IN THE LAST TRIMESTER OF PREGNANCY AND AFTER DELIVERY

Introduction. Throughout life, everyone faces a variety of emotionally complex situations. Pregnancy is one of such situations for a woman. It’s a very strong level of experience and a specific set of sensations in life, the study of which has recently received close attention. Circumstances that have developed in Ukraine in connection with environmental disadvantages mainly determine the low health index of pregnant women, and create preconditions for the increasing frequency of premature pregnancies in future generations. This problem is of great medical and social importance. More than a third of babies born prematurely lag behind in physical and psychomotor development. Considering the above mentioned, it can be argued that the creation of a system of medical and psychological support for pregnant women with a risk of preterm birth in the last trimester of pregnancy is relevant, necessary and timely. The purpose of the study is to develop a set of measures for medical and psychological support of women at risk of preterm birth in the last trimester of pregnancy and after childbirth based on a systematic approach to the study of individual psychological, pathopsychological and psychosocial characteristics. Material and methods. During 2016-2019 the study was conducted based on Storozhynets Central District Hospital in the Chernivtsi region. 150 pregnant women in the third trimester of pregnancy (23-37 weeks) and their husbands were examined. The main group (MG) included 120 women with the risk of premature birth in the last trimester of pregnancy. The comparison group (CP) included 30 women with a physiological course of pregnancy. The main therapeutic group (MTG) consisted of 42 women with a risk of preterm birth in the last trimester of pregnancy with maladaptive (MTG1) and destructive (MTG2) types of interaction in the triad "mother-child-father", who agreed to participate in medical and psychological care. The correctional group (CG) included 12 women with a risk of preterm birth in the last trimester of pregnancy with maladaptive and destructive types of interaction in the triad "mother-child-father", who refused to participate in the proposed measures. Results. Analysis of the evaluation of the developed system of medical and psychological support of the family during pregnancy showed the following (p <0.001): a) improvement of psycho-emotional state, well-being and overcoming emotional stress demonstrated by MTG1 women (up to 43.7 ± 0.8 and 42.5 ± 1.5, respectively, and after 20.8 ± 1.5 and 22.1 ± 1.2, respectively), the level of depression and anxiety on the Hamilton scale (up to HDRS 11.4 ± 1.2 and HARS 12.5 ± 1.2 after HDRS 4.2 ± 0.4 and HARS 5.7 ± 0.4) and female MTG2 indicators of RA and PA on the Spielberger-Khanin scale (up to 51.7 ± 0.8 and 50.7 ± 1.5, respectively, and after 21.4 ± 1.8 and 23.1 ± 1.5, respectively), the level of depression and anxiety on the Hamilton scale (up to HDRS 16.3 ± 1.2 and HARS 18.3 ± 1.2 after HDRS 7.6 ± 0.7 and HARS 6.9 ± 0.6). Among CG women indicators RA and PA on the Spielberger-Khanin scale (up to 47.7 ± 0.8 and 46.6 ± 1.5, respectively; after 45.8 ± 1.5 and 42.1 ± 1.2, respectively), the level of depression and anxiety on the Hamilton scale (before HDRS 13.8 ± 1.2 and HARS 15.4 ± 1.2; after HDRS 12.2 ± 0.4 and HARS 14.7 ± 0.4) were higher. b) there was an increased level of social support on the last two scales - "support of colleagues" and "support of public organizations" among MTG1 and MTG2 women (up to 25.3%, after 55.2% / up to 14.8%, after 45, 2%, respectively) compared with CG women (up to 18.5%, after 24.5%). c) there was a complete reduction of the deformation of marital relations in the majority of MTG1 (83.3%) and MTG2 (75%) women in contrast to the examined CG. Conclusions. The implementation of the system of medical and psychological support for women with a risk of preterm birth in the last trimester of pregnancy and after childbirth allowed to optimize the choice of adequate behavioral strategies in a family, improve emotional state and well-being, optimize women's attitudes to pregnancy and harmonize family interaction (72.5%) ˂0.001), to harmonize the relationship in the triad "mother - child - father" in the postpartum period (66.4%) (p˂0.001).

CLINICAL CASE OF ARTERIAL HYPERTENSION IN A NEWBORN

Aim. To use personal clinical experience in monitoring and treating a newborn with persistent arterial hypertension (AH) due to left renal artery stenosis to demonstrate the current state of this problem in the context of limited experience of work with such rare pathologies in children.Materials and methods. The research was based on the examination and treatment of a newborn with persistent AH due to left renal artery stenosis. The complex of diagnostic procedures included: clinical and laboratory examinations, X-ray examination methods (with the use of contrast agents), magnetic resonance imaging, ultrasound examination and Dopplerography, and histological examination of surgical material.Results. Conservative treatment of the patient's AH with the use of antihypertensive agents did not achieve desired results.Taking into account possible etiologic and pathogenetic factors of AH in newborns, Doppler examination was performed to exclude congenital heart defects (coarctation of the aorta). Pathology was excluded.Cortisol and 17-OH progesterone levels were determined to exclude suprarenal pathology and showed the following: cortisol level was 173.9% higher than the maximum permissible level; 17-OH progesterone level was 9.9% higher than the norm.Considering the presence of neurological symptoms, an MRI of the brain with angiography was performed. No pathology was detected.Due to the presence of persistent arterial hypertension, which did not respond to medication, a CT with contrast was ordered, during which were revealed CT-signs of critically small diameter of the left renal artery (probable dissection) with pronounced cystic and ischemic changes of the lateral half of the left kidney without excretory function at 15 min. The main treatment measures included the following: adequate preoperative preparation, anesthetic support and the selection of an adequate and effective operative method to eliminate the pathology. The only available method of surgical intervention was nephrectomy - removal of the left kidney.Analyzing the results of the investigation, it can be stated that nephrectomy is the pathogenetic method of treatment of this pathology. Steady stabilization of arterial blood pressure was achieved within 1 hour after the operation.Conclusions. 1. When persistent AH is detected in a newborn, the presence of organic pathology should be excluded. 2. If the patient has organic pathology that causes a persistent increase in arterial blood pressure, the root cause of the pathology should be eliminated if possible. 3. Conservative treatment of persistent AH in children caused by renovascular or renal factors does not provide significant results and is not appropriate. 4. Nephrectomy is the pathogenetic method of treating AHT in a newborn with renal artery stenosis.

MANIFESTATIONS OF ACUTE APPENDICITIS IN A CHILD WITH MULTISYSTEMIC INFLAMMATORY SYNDROME ASSOCIATED WITH SARS-COV-2: A CLINICAL CASE

The pandemic of the coronavirus disease caused by SARS-CoV-2, continues. The airborne way stays the main one in transmission of coronavirus infection. However, the fecal-oral transmission mechanism plays a significant role. Gastrointestinal symptoms of SARS-CoV-2 infection include loss of appetite, diarrhea, vomiting, and abdominal pain, which can often mask other conditions and require diagnostic search and differential diagnosis.The presence of multisystem inflammatory syndrome, according to the international classification, indicates a critical course of infection caused by SaRS-CoV-2, and can develop in children a few weeks after infection. The acute symptoms from the digestive tract side are one of the criteria of the multisystem inflammatory syndrome.The article presents a clinical case of acute appendicitis in a child with multisystem inflammatory disease associated with SARS-COV-2 infection, evaluates the dynamics of the main manifestations following the treatment, and analyzes the literature on such cases, emphasizing the features and difficulties of diagnostic search.