FEATURES OF CENTRAL NERVOUS SYSTEM DEFEAT IN NEWBORNS WITH INTRAUTERINE VIRAL INFECTIONS

Abstract

Introduction. Intrauterine infections with central nervous system lesions remain an urgent problem of modern perinatology, neonatology and pediatrics and belong to a group of diseases whose diagnosis is associated with certain difficulties. The number of pathogens of intrauterine infections with an ante, intra- and perinatal infection is practically unlimited. However, one of the first places belongs to the causative agents of viral infections, the prevalence of which is not specified in connection with the difficulties of diagnosis. The purpose of the study was to determine the features of central nervous system damage in newborns with intrauterine infections based on the results of the verification of etiologic pathogens, the evaluation of risk factors for perinatal history and the specific features of the clinical course of intrauterine infections. Materials and methods. Clinico-laboratory examination of 834 mothers and their sick newborns with suspicion of intrauterine infections in the first 3 days of life was performed. The subject of the study was a group of 224 patients with newborns with congenital viral infections. The control group consisted of 30 conditionally healthy newborns. The methods were general clinical and special studies (luminescence microscopy, culture method, polymerase chain reaction, serodiagnostics). Materials for examination in children and mothers were blood from the umbilical and peripheral veins, feces. Statistical processing was carried out with the calculation of parametric and nonparametric criteria. Results of the research. Among the total number of examined newborns with suspected congenital infection, congenital viral infections were verified in 224 (31.6%). Among them, term infants - 132 (58.9%), premature babies - 92 (41.1%). Among 224 children, 77 (34.4%) mixed virus infections, 62 (27.7%) viral and bacterial infections, 53 (23.6%) mixed-virus-TORCH infections and monoviral infections - in 32 (14.3%). It was proved that all children had different clinical variants of neurological disorders. Among the factors of perinatal risk are acute respiratory infections in pregnant women, the threat of abortion, anemia of pregnant women, early delivery, placental dysfunction, preeclampsia, birth asphyxia. When the etiologic pathogen was verified, the influenza A virus was defined in 15.6%, parainfluenza in 20.5%, adenovirus in 40.6%, the PC virus in 27.2% and enterovirus in 48.2%, cytomegalovirus - in 56.6%, the herpes simplex virus - in 22.6%. It is proved that along with severe lesions of the central nervous system in the form of cerebral edema, intracranial hemorrhages, meningoencephalitis, hypoxic-ischemic lesions with oppression syndrome, hypertensive hydrocephalic syndrome or indistinct neurologic symptoms at birth and in the first day of life in the form of moderate muscular dystonia and tremors. Characteristic signs on the neurosonogram in monovirus infections were predominantly hypoxic-ischemic structural changes, with mixed forms of viral infections, signs of intraventricular hemorrhages of I or II degree, subependimal cysts and signs of ventriculitis predominated. Conclusions. High frequency (31.6%) of virus isolation in patients with newborns at risk for intrauterine infection and their mothers, features of the clinical course of intrauterine viral infections with central nervous system damage motivate early clinical and laboratory diagnosis.