Course Of Neonatal Period Research Articles

Characteristics of the period of early adaptation and key predictors of its complicated course in underweight and small for gestational age newborns

Objective. To assess the characteristics of early neonatal adaptation in underweight and small for gestational age newborns and to determine the key predictors of its complicated course.Materials and methods. The study was conducted at the Republican Scientific and Practical Center “Mother and Child” and included a group of 115 full-term newborns. The main group consisted of 77 newborns with low body mass index (BMI) at birth, among whom 2 subgroups were distinguished: study group 1 (Gr1) ‒ 52 underweight and small for gestational age newborns with adaptation disorders, study group 2 (Gr2) ‒ 25 newborns without signs of maladaptation. Lipid status indicators, levels of adipokines and vitamin D were studied in mother-child dyads. To control the correct operation of the identified predictors and the regression model, an examination sample including 38 underweight newborns was studied.Results. Maternal history of placental insufficiency, fetal growth retardation, and hypertensive disorders was associated with a significant increase in the risk of maladaptation in the early neonatal per (p = 0.036, p < 0.001, and p = 0.029, respectively). Pregravid body weight and BMI of the Gr1 women were significantly higher (p = 0.026 and p = 0.035). It has been found that the most significant quantitative neonatal factors associated with the risk of maladaptation in underweight for gestational age newborns, were gestational age (p = 0.002), z-score BW at birth (p=0.003), mean corpuscular volume erythrocyte (p = 0.001), cord blood leptin level (p = 0.033). A multifactor model has been developed to determine the probability of a complicated course of the early neonatal period in underweight for gestational age newborns. AUC = 0.95 ± 0.025 (0.902–0.998), p < 0.001. A high degree of reproducibility of the developed model was established on the examination sample of underweight newborns.Conclusion. The search for objective criteria for the development of neonatal maladaptation is an important and complex task of modern neonatology. A comprehensive assessment of the totality of ante-, intraand postnatal predictors has a high accuracy in predicting the likelihood of a complicated course of the neonatal period.

Characteristic features of functional status of lymphocytes in premature newborns

Aim. To characterize the functional properties of peripheral blood lymphocytes in association with peculiarities of the period of neonatal adaptation of premature newborns.
 Materials and methods. Sixty-one conditionally healthy premature infants with gestation period of 28-37 weeks and their mothers as well as 12 full-term newborns were examined. The functional status of small lymphocytes was assessed by the activity of chromatin of their nuclei. For this purpose, there were used cytochemical and fluorometric methods with acridine orange staining of the smears obtained from leukocytic suspension that was followed by measuring intensity of luminescence in the light wave diapason of 530-580 nm. The study was implemented thrice on the days 6th, 16th, and 26th of infants life.
 Results. During the neonatal period, premature infants demonstrated the growth of the absolute and relative number of lymphocytes. The mentioned indices have an inverse dependence on the period of gestation. Activity of chromatin of small lymphocyte nuclei in newborns is significantly higher than in adults. Its maximum values are registered in prematurely born infants. Newborn small lymphocytes are characterized by marked functional heterogeneity. Unfavorable course of neonatal period in these patients is accompanied by lower values of the absolute number of lymphocytes and activity of their nuclei chromatin.
 Conclusions. The index of activity of small lymphocyte nuclei chromatin can be used to predict the course of neonatal period in prematurely born infants.

Особливості перебігу вагітності, пологів, стану плода й новонародженого у вагітних–переміщених осіб (Ретроспективний аналіз)

The less investigated problem of modern obstetrics is psychological condition of women during pregnancy and labors, who were affected by negative influence of nowadays, especially the military aggression, because precisely stress hormones determine the failure of adaptation, metabolic disorders and, as a result, an activation of infectious and chronic diseases, which determined the direction, the aim and the task of the work. The objective: to investigate peculiarities of course of pregnancy and labors, condition of a fetus and a newborn in pregnant women – displaced ones (IDP) in order to develop the improved methods of obstetric and perinatal complication prophylaxis in such women. Materials and methods. In order to achieve the object view, retrospective clinic and statistic analysis of 225 case histories of pregnancies and labors of IDP (the main group) and 51 pregnant women (control group), who continuously has been living in the territories controlled by Ukraine and did not stay in the military actions area during the process of investigation, were conducted. Pregnant women from the main and control groups were giving birth in the Delivery Departments of Central Cities Multyfield Hospitals of Belokurakino and Rubizhne of Luhansk Region in 2014–2017 years. Results. Pregnancy in IDP women is coursing under the maximal psycho emotional tension and stress, which promote complications development during gestation and labors. The risk factors which affects of the manifestation of pregnancy complications are: violations in psycho emotional condition of pregnant women, high infectious morbidity during puberty period, presents of chronic somatic pathology and high rate of inflammatory diseases of the female reproductive organs. Develop of placental-associated complications of pregnancy are typical in majority of IDP pregnant women: threatening of early and late spontaneous abortions, preterm labors, early gestosis, placental dysfunction and asiderotic anemia. Violations of labor act complications such as preterm and early rupture of amniotic membranes, weakness of labor activity and traumas of maternal ways, which lead to increase of specific gravity of complicated labors up to 20.3% and operative deliveries by the means of the Caesarian Section up to 23.6%, are most common for the main group of pregnant women. Newborns of the IDP women had an average weight less than 217 grams after delivery, in the asphyxia of different degrees one in eleven children was born. 34.8% of IDP women newborns had a pathological course of neonatal period which caused the further supervision on the 2nd level of neonatal care and was the reason of extra charges from the side of the parents. Conclusion. It is desirable to provide a full-fledged psychological support and routine treatment of chronic extragenital diseases at the periconceptional stage in IDP women. The preventive measures during pregnancy must foresee the violation of psychological condition correction and development of placental-associated complications. Key words: pregnancy, labors, complication, psychological violations, forced displaced people.

Etiological structure of intrauterine infections in pregnant and newborns with a complicated course of the early neonatal period

Aim of research – the study of the etiological structure of intrauterine infection in pregnant and estimation of their influence on the early neonatal period.Materials and methods. The material for the study was venous blood of pregnant, umbilical blood, breast maternal milk, mother’s saliva, newborn’s saliva of 114 pairs “mother-newborn”, divided in two groups – control one of physiological course of pregnancy, childbirth and early neonatal period and the main one with clinical symptoms of IUI. The diagnosis was proved by laboratory serological examinations for determining concentrations of IgM to Mycoplasma hominis, Chlamydia trahomatis, Ureaplasma urealyticum, to the herpes simplex virus and concentration and avidity index of specific IgG to HSV, to the virus of 6 type herpes, to the cytomegalovirus. The cytoscopic method was used together with serological ones to diagnose the cytomegaloviral infection.Research results. The increased concentration of IgM antibodies to M. hominis was revealed in the biological material (venous and umbilical blood) of pairs “woman-newborn) with the complicated course of the neonatal period in 9,1 % of examined persons, in 45,4 % of pairs – IgM to U. urealyticum, and in 81,8 % -to Ch. Trahomatis. IgM to the virus of herpes simplex virus (HVS) were revealed in 19,35 % of samples of venous blood, in 9,67 % of saliva samples and in 6,45 % of samples of breast milk of women; and IgM concentrations to HVS were (0,342±0,06) IU/ml, (0,117±0,04) IU/ml) and (0,438±0,001) IU/ml, respectively. Most samples of the biomaterial included low-avid IgG antibodies to the herpes simplex virus, 76 % of samples of women’s venous blood, 64 % of samples of breast milk and 38,7 % contained low-avid IgG to 6 type herpes virus. The cytomegaloviral infection in this group was diagnosed in 24 % of women and 32 % of newborns. The associated bacterial and viral infection were revealed in 65 % of examined pairs “mother-newborn” with the complicated course of the neonatal period, the triple infection with chlamydias, herpes simplex virus and cytomegalovirus was noted in 14 %; the association of herpes simplex virus, cytomegalovirus and ureaplasma was detected in 5 %. The double chamydia and herpes viral infection of 6 type were observed in 15 % of examined persons, at that these infections were added with ureoplasma in 7 %, with mycoplasma – in 5 %. The mix-infection of urogenital agents – chlamydias and ureaplasma was associated with the cytomegalovirus in 4 % of cases.Conclusions1. As a result of the realized study, the diagnosis was confirmed in all newborns with a suspected intrauterine infection.2. Mix-infections – Chlamydia, associated with viruses of the herpetic group occupy the leading place in the etiological structure of IUI agents, and the neonatal period is most complicated in children with double or triple infection.3. The leading clinical symptoms in children with IUI are the intrauterine development delay, intrauterine pneumonia, conjugated icterus, conjunctivitis

THE INFLUENCE OF THE FETAL INFLAMMATORY RESPONSE SYNDROME ON POSTNATAL ADAPTATION OF THE NEWBORNS

The fetal inflammatory response syndrome associates with inflammation in placenta which expansion determinates the course of neonatal period. The authors show the role of the inflammation of the fetal part of placenta in the development of systemic fetal inflammatory response syndrome, endothelial activation and neuro-endocrine-immune imbalance. It is possible to conclude that this disorders play important role in manifestation of the clinical symptoms of antenatal infection in the early neonatal period.

Late psychological consequences of cerebrospinal meningitis in children 5-13 years old

Follow-up data of 175 full-term 5 to 13-year-old children were analysed. The experi mental group consisted of 85 children who had cerebrospinal meningitis before their second birthday. Two control groups consisted of 190 children who had no sign of nervous disease in postnatal life; 100 of these children had a history of complicated pregnancy and/or course of neonatal period. In 90 children the course of pre- and perinatal periods was uncomplicated. Psychological examinations concentrated upon evaluating intelligence (using WISC), visual perception (the Bender test) and psycho motoric drive (observations, proofs of immobility and data from interviews with one or both parents). Results of the study indicate that children with cerebrospinal men ingitis suffered before their second birthday usually had disturbed cognitive develop ment (achieved lower levels of intelligence development, often demonstrated serious discrepancies between Verbal and Performance DQs, had delayed and/or disturbed perceptual development) and showed drive disturbances. Developmental delays and disturbances found in children with a history of cerebrospinal meningitis were the results of damage to their CNS. The author believes that serious developmental delays and disturbances were rather the consequences of pathologies in the course of pre- and perinatal periods, as well as genetic irregularities, than diseases suffered in the past per se.