Possibilities of prognosis and improvement of treatment results in children with congenital malformations of the gastrointestinal tract

Abstract

The category of newborns with congenital malformations is considered the most difficult to treat. The influence of “stress”factors on the body in a short period of time triggers a pathogenetically determined chain reaction that leads to the development of multiple organ failure syndrome. The forecasting methodology determines the timeliness and directions of intensive care to approach and achieve positive results in this group of patients.The aim of the study: is to show the diagnostic and practical value of metabolic markers and functional indicators of homeokinesis in newborns with congenital malformations of the gastrointestinal tract.Materials and methods. An observational study of 81 patients in the neonatal period. The prognostic assessment of functional parameters and biochemical markers was performed by ROC analysis.Results. In newborns with malformations of the gastrointestinal tract, the course of the pre-and early postoperative period is associated with cardiopulmonary maladaptation, which requires the protection of vital functions. By the end of the first week, priority is given to therapy aimed at restoring the motility of the gastrointestinal tract. The prognostic value of the adverse outcome was determined: stress index greater than 3503 Sp = 98.36% (95%CI 86.3–99.2) and Se = 99.2% (95%CI 87.3–100), lactatemia level greater than 3.3 mmol/L Sp = 73.7% (95% CI 59.6–84.7) and Se = 93.6% (95% CI 78.9–100). The control of the infectious process and the selection of antibacterial therapy is important, since the risks of developing septic shock are high. Prolonged epidural analgesia is the optimal method of analgesia and is indicated in suspected cases of failure to achieve 75% of the volume of enteral nutrition by the week of the postoperative period Sp 85.42% (95%CI 48.2–97.7), Se 46.8% (95% CI 62.0–84.2).Conclusions. Prognostic models allow predicting the outcome of critical conditions and timely adjusting the volume of therapy.