Клініко-діагностичні паралелі між станом плаценти та несприятливими наслідками глибоко недоношених дітей

Abstract

Premature newborns are a special category of children with their inherent morpho-functional immaturity and specific pathological conditions that cause significant differences in the survival, morbidity and their baby care consequences in comparison with children of other weight categories. The problems of premature babies are at the forefront of neonatal research and perinatal care. Purpose - to establish a link between the formation of adverse consequences in preschool children born prematurely, with a body weight of less than 1500 g, and placental changes. Materials and methods. The study involved 220 preschool children born prematurely. The results of a pathomorphological study of the placentae of mothers of 220 children were analyzed. Its results enabled to distinguish 5 groups of mothers according to the classification of changes in the placentae. In the course of the study, this category of children was under observation of the doctors the Prematurity and Hight-Risk Neonates Post-discharge Follow-ups Department in order to regular assess their health. Clinical indicators such as body weight, height, head circumference, neurological, general cognitive development and low severity dysfunction, the post-discharge history including respiratory diseases, skeletal system problems, hematological and metabolic disorders, were analyzed. Ophthalmological and audiological examinations were performed prospectively to assess vision and hearing. Depending on the severity of disabling pathology, children with severe disabling consequences (n=54) were isolated - 24.5%. Further analysis concerned the state of health of these children, divided into 5 groups according to the identified changes in the placentas of their mothers. Results. All the children involved in the study had a disease combination in the neonatal period that caused severe conditions. Pathological changes of the placenta significantly affected the course of the neonatal period. Thus, newborns with signs of inflammatory changes and immaturity were 10 times more likely to suffer generalized intrauterine infections and neonatal sepsis, they also significantly more frequently have intraventricular hemorrhages, periventricular leukomalacia, and bronchopulmonary dysplasia. The course of the neonatal period in groups of children with signs of premature aging of placenta and blood flow disorders was characterized by a low frequency of infections, but periventricular leukomalacia was diagnosed 5 times more often. Conclusions. It was found out that transplacental infection and pathological placenta immaturity had a negative impact on the health of children of groups III and IV, causing their birth 3 weeks prematurely, unlike the children in the comparison group. Newborns of groups III and IV needed resuscitation care in the delivery room 9 times more often, and the need for respiratory support was 10 times higher than in the comparison group, which predetermined a significantly longer duration of hospital stay for children of groups III and IV - on average 30-45 days longer compared to newborns of Group V. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the author. Key words: premature babies, Neonates Post-discharge Follow-ups Department, disability, long-term consequences.