Abstract
Objective: to reveal a relationship of placental inflammatory changes to bacterial infection in premature neonates with respiratory failure. Material and methods. Bronchoalveolar aspirate was bacteriologically studied in 157 premature neonates with respiratory distress syndrome (NRDS); the total and differential leukocyte counts were measured in their peripheral blood. The levels of the cytokines IL-1^3, IL-4, IL-6, and TNF-a were studied in different biological fluids of mothers and their babies; the placentas were also morphologically examined. Results. An analysis of bacterial cultures from the tracheobronchial tree revealed no growth of bacterial microflora in 61.8% of cases, Enterococcus faecalis and Staphylococcus epidermidis were isolated in 6.4 and 8.3% of the infants, respectively; Staphylococcus haemolyticus, Staphylococcus capitis, Enterobacter agglomerans, and hemolytic group A Streptococcus were seen in 1.9% each; moreover, 1.3% of the newborn infants were found to have Bacillus spp., Staphylococcus aureus, Escherichia coli, Acinetobacter spp., and Serratia marcescens. Other microorganisms and a microbial association were encountered in 8.9% of cases. Placental morphological examination revealed different inflammatory changes concurrent with chronic and acute placental insufficiency. The investigation demonstrated that the maternal peripheral plasma levels of IL-1^, IL-4, IL-6, and TNF-a were within the physiological range at the end of the first period of delivery. The amniotic fluid displayed elevated IL-6 and TNF-a concentrations and normal IL-4 and IL-1e levels, suggesting that there was an intrauterine inflammatory process. Conclusion. Premature birth is associated with various placental inflammatory changes, which causes intrauterine stimulation of macrophages in the chorionic villi. Specific immune defense mechanisms that prevent the development of a fetal infectious process, i.e. the maternal infectious process, may induce preterm birth, but fail to lead to fetal and neonatal diseases. The investigation has shown that NRDS is a major disease in premature neonatal infants. Key words: intrauterine infection, premature neonates, cytokines, neonatal res piratory distress syndrome.
Highlights
Цель исследования — выявить взаимосвязь воспалительных изменений в плаценте с бактериальной инфекцией у недо ношенных новорожденных с дыхательной недостаточностью
Bronchoalveolar aspirate was bacteriologically studied in 157 pre mature neonates with respiratory distress syndrome (NRDS); the total and differential leukocyte counts were mea sured in their peripheral blood
The levels of the cytokines IL 1β, IL 4, IL 6, and TNF α were studied in different biological fluids of mothers and their babies; the placentas were morphologically examined
Summary
Внутриутробные инфекции (ВУИ) являются од ной из главных причин мертворождений, заболеваемос ти и летальности новорожденных [1,2,3,4,5]. Необходимо отме тить, что проведение эффективного лечения инфекций во время беременности является сложной задачей [6]. Несомненно, главной причиной развития ды хательной недостаточности у недоношенных ново рожденных является РДСН [5, 7, 8]. В то же время опубликованы работы, в которых показано, что вос палительные изменения в плаценте в виде хориоам нионита, васкулит сосудов пуповины не осложняют течение РДСН [9, 10]. По данным многих авторов, регистрируется высокая часто та инфекционных плацентитов. При наличии у матери инфекционного процесса во время беременности суще ствует высокая вероятность развития инфекции у ново рожденного ребенка. Разрешение этой проблемы явля ется одной из приоритетных задач перинатологии
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