Опыт применения обогащённого иммуноглобулина в адъювантной терапии у недоношенных детей с экстремально низкой массой тела и очень низкой массой тела

Abstract

The immune system of a premature newborn is characterized by quantitative and functional features that do not allow it to respond optimally to numerous pathogenic microorganisms against which during contact and during the first hours after birth they come into contact with a huge number of exogenous antigens of a viral, bacterial and fungal nature that were not previously known to him. This proves the relevance of the search for new directions for the effective prevention of mortality and severe morbidity in premature infants by changing the approach to the complex treatment of children with extremely low and very low body weight. Objective. To evaluate the effectiveness and safety of enriched intravenous immunoglobulins (IVIG) in children with extremely low body weight and very low birth weight in infants with lung infections in adjuvant therapy. Material and methods. A retrospective study and statistical analysis of the primary medical documentation “History of the development of the newborn” and “History of childbirth” of 49 preterm infants born with extremely low and very low body weight with intrauterine and neonatal pneumonia was carried out, the second group consisted of 66 children with a similar pathology, in the treatment of which enriched immunoglobulin therapy was not used. The collection of retrospective material was carried out from January 1st to December 31st, 2019 on the basis of the perinatal center of the Karasai central district hospital of the Almaty region. Results and discussion. We analyzed 49 stories of the development of newborn children with intrauterine and neonatal pneumonia, all children received a standard treatment package, including antibacterial, infusion and symptomatic therapy. As an immunomodulatory therapy, children received the Pentoglobin drug, which was registered and allowed from 0 months. The use of intravenous immunoglobulins has been studied as a method of treating intrauterine pneumonia and preventing the death of newborns children. The criteria for prescribing the drug were a sepsis clinic, a septiclike condition, pneumonia that did not give rise to initial antibiotic therapy, progressing according to the X-ray picture, laboratory changes (leukopenia, leukocytosis, neutropenia in combination with high CRP). Conclusions. The clinical efficacy of the use of an immunomodulating drug from the groups of enriched intravenous immunoglobulins in 49 premature infants with extremely low and very low body weight, with severe intrauterine and neonatal pneumonia was shown. It has been established that the inclusion of enriched intravenous immunoglobulin in the complex therapy of patients with severe neonatal pneumonia leads to a relief of clinical manifestations, a decrease in the risk of resistance of microorganisms to antibiotics and the risk of death. Keywords: premature infants, extremely low body weight, very low body weight, neonatal pneumonia, enriched intravenous immunoglobulins.