Міокардіальна дисфункція як складова поліорганної невідповідності при неонатальному сепсисі

Abstract

The formation of myocardial dysfunction in neonatal sepsis remains a topical issue in current neonatal practice. Myocardial dysfunction with neonatal sepsis is found to promote a double increase of neonatal loss rate, and maintenance of an adequate cardiac output is very important predictor for survival of patients with neonatal sepsis. Purpose - to study clinico-paraclinical markers of myocardial dysfunction in case of an alternative term of neonatal sepsis debut for timely verification and rational correction of cardiovascular disorders. Materials and methods. Considering various terms of neonatal sepsis manifestation with its early and late variants, a comparative analysis of clinical-paraclinical markers of generalized infectious-inflammatory process was made in 26 neonates at the stage of obstetrical aid (retrospective analysis) and in the intensive care departments for neonates and their resuscitation (prospective follow-up). According to the results of the analysis of medical records of newborns, the diagnosis of early neonatal sepsis was established in 14 (53.8%) newborns who were included in the clinical group I of the study, and the diagnosis of late neonatal sepsis was established in 12 (46.2%) newborns who were included in the clinical group II. Results. After birth general condition of patients from the group I was assessed as of moderate severity - in 1 (7.1%) and severe - in 13 (92.9%) neonates; in the group II the 2 neonates (16.7%) were in the condition of moderate severity (р>0.05) and 10 (83.3%) neonates were in severe condition (р>0.05). Assessment of cardiovascular constituent in the neonatal groups of comparison according to the constellation scale nSOFA in the means values did not differ reliably, though it was indicative of a tendency to deeper disorders in case of late neonatal sepsis. Conclusions. Sepsis-induced myocardial dysfunction is manifested by increase in the content of cardio-specific markers (creatine phosphokinase, МВ fraction, troponin I). An increased content of troponin I in the blood higher than that of the norm in case of late neonatal sepsis possesses a high inclination (83.3%) to the formation of myocardial dysfunction. 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 interests was declared by the authors. Keywords: neonates, neonatal sepsis, myocardial dysfunction.