Disorder In Premature Infants Research Articles

Care bundle for preventing intraventricular hemorrhage in premature infants: a best practice implementation project.

Intraventricular hemorrhages remain a major problem in neonatology, because their complications affect neonatal morbidity, mortality, and long-term neurodevelopmental outcomes. The aim of this project was to prevent intraventricular hemorrhage in premature infants during their first days of life in a neonatal intensive care unit (NICU). This pre- and post-implementation clinical audit project used the JBI Evidence Implementation Framework and was conducted in a tertiary-level Spanish NICU with a consecutive sample. A baseline audit was conducted using 13 audit criteria derived from JBI summaries of the best available evidence. This was followed by the implementation of an action plan, which included a care bundle and health care professionals' education. These improvement strategies were then evaluated using a follow-up audit. The baseline and follow-up audits evaluated 54 and 56 infants, respectively. The follow-up audit showed 100% improvement for Criteria 2, 3, 6, and 7, which covered sleep safety and noise. Criteria 12 and 13, which covered cord clamping and positioning the infant, improved by 25.99%. Criterion 9, on antenatal corticosteroids, showed a slight improvement of 5.56%. This study increased compliance with an evidence-based, family-centered care approach to preventing intraventricular hemorrhage in premature infants. This was achieved by conducting a baseline and follow-up audit, implementing a training program, and keeping more comprehensive nursing records. Further studies could assess the long-term effectiveness of interventions and/or the incidence of intraventricular hemorrhage and neurodevelopmental disorders in premature infants. http://links.lww.com/IJEBH/A262.

Osteopenia of Prematurity and its Maternal and Nutrition-Related Factors Among Preterm Infants Admitted to the NICU Department of Afzalipour Medical Center

Background: Osteopenia is a relatively common disorder in premature infants. If this disease is not diagnosed and treated promptly, it will lead to impaired growth in infancy. The present study was performed to assess the relationship between osteopenia and neonatal/maternal factors among premature neonates hospitalized in the neonatal intensive care unit (NICU) of Afzalipour Medical Center. Methods: The present cross-sectional study was performed on 100 premature infants who were admitted to the NICU of Afzalipour Medical Center in Kerman in 2017 and 2018. Alkaline phosphatase was measured in one-month-old infants as a screening criterion for osteopenia and its relation with factors such as birth weight, weight gain, duration of hospitalization, duration of intravenous feeding, type of nutrition, volume of formula, and food supplement consumption was investigated. Results: Of the total 100 preterm babies, based on the criterion utilized for diagnosis of osteopenia (alkaline phosphatase above 900 units/L), 41 infants had osteopenia of prematurity (41% prevalence). Infants who used breastmilk alone mostly had osteopenia of prematurity. The prevalence of osteopenia was higher among girls compared with boys. The mean length of hospitalization was longer and the total parenteral nutrition venous feeding was longer among neonates with osteopenia compared with other neonates. The mean serum vitamin D levels were significantly lower in mothers of premature neonates with osteopenia compared with others. Conclusion: Infants who were fed exclusively with breast milk were more vulnerable to osteopenia, and supplements should be considered in these infants.

Identification of omega-3 oxylipins in human milk-derived extracellular vesicles with pro-resolutive actions in gastrointestinal inflammation.

Premature infants (PIs) are at risk of suffering necrotizing enterocolitis (NEC), and infants consuming human milk (HM) show a lower incidence than infants receiving formula. The composition of HM has been studied in depth, but the lipid content of HM-derived small extracellular vesicles (HM sEVs) remains unexplored. Identifying these molecules and their biological effects has potential for the treatment of intestinal disorders in PIs and could contribute to the development of HM-based fortified formulas. We isolated HM sEVs from HM samples and analyzed their oxylipin content using liquid chromatography coupled to mass spectrometry, which revealed the presence of anti-inflammatory oxylipins. We then examined the efficacy of a mixture of these oxylipins in combating inflammation and fibrosis, in vitro and in a murine model of inflammatory bowel disease (IBD). HM-related sEVs contained higher concentrations of oxylipins derived from docosahexaenoic acid, an omega-3 fatty acid. Three anti-inflammatory oxylipins, 14-HDHA, 17-HDHA, and 19,20-DiHDPA (ω3 OXLP), demonstrated similar efficacy to HM sEVs in preventing cell injury, inducing re-epithelialization, mitigating fibrosis, and modulating immune responses. Both ω3 OXLP and HM sEVs effectively reduced inflammation in IBD-model mice, preventing colon shortening, infiltration of inflammatory cells and tissue fibrosis. Incorporating this unique cocktail of oxylipins into fortified milk formulas might reduce the risk of NEC in PIs and also provide immunological and neurodevelopmental support.

New insights into the pathogenesis of necrotizing enterocolitis and the dawn of potential therapeutics

Necrotizing enterocolitis (NEC) is a devastating gastrointestinal disorder in premature infants that causes significant morbidity and mortality. Research efforts into the pathogenesis of NEC have discovered a pivotal role for the gram-negative bacterial receptor, Toll-like receptor 4 (TLR4), in its development. TLR4 is activated by dysbiotic microbes within the intestinal lumen, which leads to an exaggerated inflammatory response within the developing intestine, resulting in mucosal injury. More recently, studies have identified that the impaired intestinal motility that occurs early in NEC has a causative role in disease development, as strategies to enhance intestinal motility can reverse NEC in preclinical models. There has also been broad appreciation that NEC also contributes to significant neuroinflammation, which we have linked to the effects of gut-derived pro-inflammatory molecules and immune cells which activate microglia in the developing brain, resulting in white matter injury. These findings suggest that the management of the intestinal inflammation may secondarily be neuroprotective. Importantly, despite the significant burden of NEC on premature infants, these and other studies have provided a strong rationale for the development of small molecules with the capability of reducing NEC severity in pre-clinical models, thus guiding the development of specific anti-NEC therapies. This review summarizes the roles of TLR4 signaling in the premature gut in the pathogenesis of NEC, and provides insights into optimal clinical management strategies based upon findings from laboratory studies.

Respiratory distress syndrome in preterm infants: possible impact of surfactant application techniques.

Prematurity is one of the most important issues in perinatology. The most frequent postnatal pathology connected with prematurity is respiratory distress syndrome (RDS) caused by surfactant deficiency due to lung immaturity. RDS is one of the most frequent causes of mortality and morbidity with short- and long-term consequences. The aim of the study was to compare the effectiveness of individual surfactant supply techniques in the treatment of respiratory disorders in premature infants. In the period from the year 2009 to 2013, there were 198 very premature infants that received surfactant included to this retrospective study. They were divided into three groups based on the surfactant application method: Premature newborns with substitute ventilation, with supply of surfactant through a traditional endotracheal tube - Average gestational age 26.6 weeks; Mean birth weight 911 g; Average Apgar score 4 in 1st minute, 6 in 5th minute. Premature newborns with exogenous surfactant supplementation - InSure method - Average gestational age 28.3 weeks; Average birth weight 1117 g; Mean Apgar score 6 in 1st minute, 7 in 5th minute. Premature newborns with exogenous surfactant supplementation - Less Invasive Surfactant Administration (LISA) method - Mean gestational age 29.9 weeks; Average birth weight 1444 g; Average Apgar score 7 in 1st minute, 8 in 5th minute. Noninvasive methods of respiratory support and minimally invasive surfactant administration (MISA) significantly reduced the incidence of severe RDS, compared to the traditional method. Non-invasive methods of respiratory support and MISA like LISA and InSure methods were safe and effective in the treatment of RDS.

Adenosine Alleviates Necrotizing Enterocolitis by Enhancing the Immunosuppressive Function of Myeloid-Derived Suppressor Cells in Newborns.

Necrotizing enterocolitis (NEC) is a common disorder in premature infants that is characterized by hyperinflammation and severe necrosis in the intestine. The pathogenesis of NEC remains to be elucidated. In this study, we demonstrate that adenosine, a metabolite more abundant in infants than in adults, plays an important role in the prevention of NEC. Administration of adenosine or its analog, adenosine-5'-N-ethyluronamide (NECA), dramatically relieved the severity of NEC in neonatal mice. Meanwhile, adenosine treatment significantly enhanced the immunosuppressive function, antibacterial activity, and migration of myeloid-derived suppressor cells (MDSCs). However, depletion of MDSCs or inhibition of their migration using the CXCR2 inhibitor SB225002 almost completely abrogated the protective effect of adenosine on NEC. Mechanistic studies showed that MDSCs in newborns expressed abundant adenosine receptor A2B (A2BR) that elicits intracellular cAMP signaling and its downstream target NF-κB. Importantly, intestinal tissues from patients with NEC showed significantly lower infiltration of A2BR-positive MDSCs than those from healthy donors. These observations revealed that adenosine-induced MDSCs represent an essential immune axis for intestinal homeostasis in newborns.

Development of Sensory Processing in Premature Infants and Implications for Evidence-Based Music Therapy in the NICU

The purpose of this article is to provide an overview of the development of sensory processing in premature infants with implications for music therapists providing evidence-based care in a NICU. An overview of sensory processing and sensory processing disorders in premature infants is included, with specific emphasis on development of sensory systems of premature infants. Implications for developmentally appropriate music as therapy for premature infants are identified. Evidence-based NICU-MT can be combined with nursing care to reduce the risks of sensory processing disorder for the developing premature infant.

Platelet counts and C-reactive protein in preterm infants with patent ductus arteriosus

Introduction: Patent ductus arteriosus (PDA) is a common disorder in premature infants which causes heart failure. Platelets and C-reactive protein (CRP) play an important role in closure. Objectives: The purpose of this study was to evaluate serum CRP and plasma platelet count in preterm infants with PDA compared to infants without PDA. Patients and Methods: This case-control study was conducted on premature infants with PDA admitted to Imam Khomeini hospital in Ahvaz, Iran (2020-2021). A group of 120 infants with inclusion criteria was selected and divided into two groups of 60 subjects. The preterm infant with PDA and without PDA was defined as the case and control group, respectively. Platelet count, serum CRP, and an echocardiogram were assessed in all infants. The subjects were matched by gender, gestational age, and birth weight. Results: The mean platelet count was 194.67±74.03 (×103 /mm3 ) in the neonate with PDA, and it was significantly lower than in neonate without PDA (P=0.04). The mean of serum CRP was significantly different in neonates with PDA (11.62±5.96 mg/L) compared to neonates with closed arterial ducts (8.52±3.97 mg/L; P=0.002). Additionally, PDA was associated with high platelet distribution width (PDW). Conclusion: The findings of this study revealed that PDA is associated with a low-number of platelets and high serum levels of CRP in preterm neonates. It is suggested that further studies with a higher sample size on platelet count and/or function be performed in PDA patients to understanding more about the cause of PDA and to discover novel and beneficial aims in these cases

Severe Retinopathy of Prematurity Associated With Neurodevelopmental Disorder in Children.

ObjectiveThis study aimed to investigate whether severe retinopathy of prematurity (ROP) could be an association factor for neurodevelopmental disorders in premature infants without other risk factors—such as congenital anomalies, birth injuries, and neurological diseases—that may cause developmental delay.MethodsWe used health claims data recorded between 2007 and 2018 in the Korean National Health Insurance Service (KNHIS) database. We recruited a total of 18,256 premature infant born between 2007 and 2008 without congenital anomaly or birth injury (with ROP 6,995, without ROP 11,261) and divided them into four groups as follows: Group A, 209 extremely premature infants [gestational age (GA) < 28] with mild ROP; Group B, 75 extremely premature infants (GA < 28) with severe ROP; Group C, 6,510 other premature infants (28 ≤ GA <37)with mild ROP; and Group D, 201 other premature infants (28 ≤ GA < 37) with severe ROP. Using regression analysis, we analyzed whether there was a correlation between ROP prevalence, severity, and developmental delay in premature infants without other risk factors.ResultsThe prevalence of developmental delay, according to GA and ROP severity, was higher in patients with severe ROP than in the other patients. The prevalence gradually decreased after birth. Among extremely premature infants with ROP, those with severe ROP had a 3.082-fold higher association with neurodevelopmental complications than those with mild ROP (p < 0.001). Compared with other premature infants with ROP, those with severe ROP had a 3.269-fold higher association with neurodevelopmental complications than those with mild ROP.ConclusionThe severity of ROP may be associated with neurodevelopmental disorders in premature infants.

The Value of Diffusion Kurtosis Imaging in Detecting Delayed Brain Development of Premature Infants.

Objective: Preterm infants are at high risk of the adverse neurodevelopmental outcomes. Our aim is to explore the value of diffusion kurtosis imaging (DKI) in diagnosing brain developmental disorders in premature infants.Materials and Methods: A total of 52 subjects were included in this study, including 26 premature infants as the preterm group, and 26 full-term infants as the control group. Routine MRI and DKI examinations were performed. Mean kurtosis (MK), radial kurtosis (RK), fractional anisotropy (FA), and mean diffusivity (MD) values were measured in the brain regions including posterior limbs of the internal capsule (PLIC), anterior limb of internal capsule (ALIC), parietal white matter (PWM), frontal white matter (FWM), thalamus (TH), caudate nucleus (CN), and genu of the corpus callosum (GCC). The chi-squared test, t-test, Spearman's correlation analysis, and receiver operating characteristic curve were used for data analyses.Results: In the premature infant group, the MK and RK values of PLIA, ALIC, and PWM were lower than those in the control group (p < 0.05). The FA values of PWM, FWM, and TH were also lower than those of the control group (p < 0.05). The area under curves of MK in PLIC and ALIC, MD in PWM, and FA in FWM were 0.813, 0.802, 0.842, and 0.867 (p < 0.05). In the thalamus and CN, the correlations between MK, RK values, and postmenstrual age (PMA) were higher than those between FA, MD values, and PMA.Conclusion: Diffusion kurtosis imaging can be used as an effective tool in detecting brain developmental disorders in premature infants.

The Effect of the Vitamin D Receptor on Bone Metabolism Disorders in Premature Infants Born Using In Vitro Fertilization

Aim. To study the effect of the vitamin D receptor on bone metabolism disorders in premature infants born using in vitro fertilization (IVF). Material and methods. A study was conducted on 189 premature infants, divided into 2 groups. The first group is premature babies born using the IVF method. The second group – children were born naturally. The VDR receptor gene was analyzed depending on the observation groups. Results. It was found that in children born with IVF, the signs of osteopenia were more pronounced. Genetic studies have shown that the frequency of mutant allele *B and homozygous mutant genotype B/B of the VDR gene is more common in premature babies born with IVF. Mutant homozygous genotype B/B occurs in the main group of children with a frequency of 35%, which is significantly higher than in the control group of children (17%). Changes in bone metabolism are one of the important causes of musculoskeletal system disorders, which is closely associated with the molecular genetic polymorphism of the VDR gene. Conclusion. The studies conducted led to the following conclusion: the frequency of the mutant allele *B and homozygous for the mutant allele genotype B/B, occurs more often in premature babies born using IVF. The frequency of the *B allele in the group of premature babies born using IVF is 50%, which is higher than in the group of premature babies born naturally (40%). However, the identified genetic differences are not associated with the IVF procedure. These are combinations of gene alleles inherited from the parents. Knowledge of hereditary risk factors for low vitamin D3 levels can be of great practical importance for predicting bone metabolism disorders in premature infants.

How Gut Microbiota Supports Immunity, Growth and Development of Preterm Infants: A Narrative Review

ABSTRACTBackground: Gut microbiota, a complex ecosystem consisting of abundant microorganisms, plays a role in preterm infants’ immunity, growth, and development. Dysbiosis or disruption of the gut microbiota can precipitate various diseases, such as allergy or autoimmune disorders in premature infants. Purpose: This study aimed to review gut microbiota in preterm infants and its role in supporting the infants’ immunity, growth, and development. Discussion: Bifidobactericeae is the predominant microbiota in GI tract of preterm infants. However, various factors can influence this gut microbiota e.g., genetics, lifestyle of the mothers (smoking, diet, use of antibiotic, obesity), birth mode, type of feeding, and environmental factors. Gut dysbiosis can result in impaired immune system which predisposes the preterm infants to infections, even fatal adverse event. Furthermore, the growth and development might be affected as well as lead to various neurodevelopmental and psychiatric disorders. Human milk is a prebiotic source which can stimulate the growth of Baifidobactericeae and Bacteroidetes. If the human milk is inadequate or unavailable, the recommended interventions for gut dysbiosis in premature infants are probiotics, prebiotics, or both supplementations (synbiotics). The administration of prebiotics and probiotics associates with lower morbidity and death rates in preterm infants, as well as shorter duration of hospital stay and duration to achieve full enteral feeding. Conclusions: Immunity as well as growth and development of preterm infants are affected greatly by gut microbiota The less diverse microbiota in preterm infants’ gut predispose them to various health problems. Hence, this problem should be managed properly, one of which is prebiotic and probiotic supplementation Keywords: Gastrointestinal Microbiome, Premature, Immunity, Growth, Development

Effects of Calcium and Phosphorus Supplementation on Metabolic Bone Disorders in Premature Infants

Effects of Calcium and Phosphorus Supplementation on Metabolic Bone Disorders in Premature Infants

Competing Risk Analysis of the Health Status of Neonates with Respiratory Distress Syndrome

Introduction: Respiratory distress syndrome (RDS) is not only the most common respiratory disorder in premature infants but also the main cause of neonatal mortality. Methods: Competing risk framework was used to examine and identify potential prognostic factors of the health status of preterm infants with respiratory distress syndrome. Preterm infants with RDS admitted to the neonatal intensive care units (NICUs) of selected hospitals in Ethiopia were followed for 28 days and only neonates with complete cases were included in the analysis. The Fine-Gray or sub-distribution hazard model was used to identify significant prognostic factors. Three outcome variables (death due to RDS, death due to other causes and discharged alive) were considered. Results: The Fine-Gray model fit results revealed that anemia, multiple pregnancies, birth-weight and gestational age were the prognostic factors significantly associated with the death of neonates due to Respiratory distress syndrome problem while Pneumonia, meningitis, anemia and gestational age of neonates were the significant prognostic factors for death of neonates due to other causes. Moreover, pneumonia, birth weight and gestational age were identified as the prognostic factors associated with neonates being discharged alive. Conclusion: Offering intensive and adequate treatments for neonates with lowest birth-weights and gestational age may be useful to reduce neonatal mortality and increase the incidence of being discharged alive.

Sensory processing disorders in premature infants

&amp;lt;jats:p&amp;gt;Introduction. Children born prematurely have an increased risk of immediate medical complications, as well as socioemotional, cognitive, linguistic and sensory processing disorders later in life. Studies have examined the effects of prematurity on developmental outcomes, such as cognition, however, there is a need for a more detailed examination of sensory processing disorders in preterm infants. Not only is prenatal neurosensory development interrupted in utero, but these children may also experience intense stimulation in the neonatal unit, which can further alter the development and function of the sensory system. Objective. The paper presents an overview of research on sensory processing disorders in premature infants, with special emphasis on the impact of the environment of the neonatal unit. Method. Insight into the relevant literature was performed by specialized search engines on the Internet and insight into the electronic database. Results. Sensory processing disorders affect 39% to 52% of newborns born prematurely, with some evidence to suggest that children born before 32 weeks are most at risk. The literature to date has consistently reported difficulties in sensory modulation of preterm infants, within the tactile, vestibular, auditory, oral, and visual domains. Conclusion. Sensory processing disorders in preterm infants appear to occur as a result of their immature neurological and biological system and being in the environment of a neonatal intensive care unit, which is unable to meet the sensory needs of preterm infants. Altered sensory experiences, during periods of neurodevelopmental vulnerability and fragility, can result in sensory processing disorders, which may include enhanced responses or less response to stimuli (hyper or hyposensitivity).&amp;lt;/jats:p&amp;gt;

Myofibroblast contraction is essential for generating and regenerating the gas-exchange surface.

A majority (~95%) of the gas-exchange surface area is generated through septa formation during alveologenesis. Disruption of this process leads to alveolar simplification and bronchopulmonary dysplasia (BPD), a prevalent disorder in premature infants. Although several models have been proposed, the mechanism of septa formation remains under debate. Here we show that inactivation of myosin light chain kinase (MLCK), a key factor required for myofibroblast contraction, disrupted septa formation, supporting the myofibroblast contraction model of alveologenesis. The alveoli simplification phenotype was accompanied by decreased yes-associated protein (YAP), a key effector in the Hippo mechanotransduction pathway. Expression of activated YAP in Mlck-mutant lungs led to partial reversal of alveolar simplification. In the adult, although Mlck inactivation did not lead to simplification, it prevented reseptation during compensatory regrowth in the pneumonectomy model. These findings revealed that myofibroblast reactivation and contraction are requisite steps toward regenerating the gas-exchange surface in diseases such as BPD and chronic obstructive pulmonary disease (COPD).

Childhood sleep disorders in premature infants that hospitalized in neonatal intensive care unit in neonatal period

Aim: Children requiring intensive care in the neonatal period have more fine motor injuries, learning difficulties, eating disorders and sleeping problems. Sleep disorder rate is about 10-30% in children who had no problem in newborn period. We aimed to investigate the rate of sleep disorder in children who were hospitalized in the neonatal intensive care unit during the neonatal period. Material and Methods: Fourty-six patients hospitalized in neonatal intensive care unit and still followed in outpatient policlinic at Cukurova University were enrolled in to the study. Children’s Sleep Habits Questionnaire was performed to evaluate sleep resistance, delay in fall into sleep, duration of sleep, sleep anxiety, parasomnia, midnight awakening and daily sleepiness.Results: Children were 6.64±1.18 years old. They were healthy and had no neurological sequela. None of the parents complained about sleep disorders. However, 20 of the 46 (43.47%) children had sleep disorder (Sleep disorder group). Twenty-six children had no sleep disorder (No sleep disorder group). There isn’t any statistically difference between the groups that terms of gestational age, birth weight, ventilator support, gender (p>0.05).Conclusion: Although there isn’t any significant difference between groups, sleep disorder rate is higher compared to normal population’s rates reported in the previous studies. Infants discharged from neonatal intensive care unit should be under evaluation also for sleep disorder.

Effects of calcium and phosphorus supplementation on metabolic bone disorders in premature infants

Introduction: Every year, 15 million babies are born prematurely around the world of which more than 1 million die as a result of prematurity. Premature infants are considered to be at high risk for developing osteopenia due to their reduced bone mineral content. Mothers milk containing 25-35 mg/dl of calcium and 10-15 mg/dl of phosphorus simply does not contain enough minerals to support skeletal growth of growing premature infants. Supplement of calcium and phosphorus along with breast milk can reduce the rate of osteopenia and improve the growth of premature infants. Objective of the study: To determine the efficacy of calcium and phosphorus supplementation for prevention of metabolic bone disease and improvement of growth in preterm infants. Methodology: A randomized clinical trial study was conducted at Department of Neonatology, BSMMU, from 16th August 2016 to 27th August 2017. It involved monitoring 50 premature neonates over a period of six weeks. The babies who were fed with breast milk were randomly divided into two equal groups. One group received supplement of calcium and phosphorus along with breast milk. Serum calcium, phosphorus and alkaline phosphatase levels as well as growth parameters (including weight, length, and head circumference) were measured at enrollment and at 6 weeks post birth. At the end of 6 weeks, wrist X-ray was done for evaluation of osteopenia. Data was analyzed using SPSS 20. Results: Radiological and biochemical evidence of metabolic bone disease were found in 6 (28%) supplemented group and 7 (35%) non-supplemented group (p=0.45). S. calcium, S. inorganic phosphate and S. alkaline phosphatase level were comparable at enrollment between two groups. At 6 weeks S. calcium, S. inorganic phosphate level were more and S. alkaline phosphatase level were less in supplemented group but no significant change was observed between two groups. The mean of weight, length and head circumference were also comparable at enrollment between two groups. At 6 weeks’ growth velocity considering weight, length and head circumference were more at supplemented group but no significant change were observed between two groups. Conclusion: Infants of supplemented group showed better growth velocity and lower incidence of metabolic bone disorders than non-supplemented group. But this difference between supplemented group and non-supplemented group were not statistically significant. However, his study does not provide any evidence to suggest the effectiveness of supplementary calcium and phosphorus in osteope

Diminished DEFA6 Expression in Paneth Cells Is Associated with Necrotizing Enterocolitis.

Background Necrotizing enterocolitis (NEC) is the most common gastrointestinal disorder in premature infants with a high morbidity and mortality. Paneth cell dysfunction has been suggested to be involved in the pathogenesis of NEC. Defensin alpha-6 (DEFA6) is a specific marker for Paneth cells acting as part of the innate immunity in the human intestines. The aim of this study was to investigate the expression of DEFA6 in infants with NEC. Materials and Methods Infants who underwent bowel resection for NEC at level III NICU in Sweden between August 2004 and September 2013 were eligible for the study. Macroscopically vital tissues were selected for histopathological evaluation. All infants in the control group underwent laparotomy and had ileostomy due to dysmotility, and samples were taken from the site of the stoma. DEFA6 expression was studied by immunohistochemistry. Digital image analysis was used for an objective and precise description of the samples. Results A total of 12 infants were included in the study, eight with NEC and four controls. The tissue samples were taken from the colon (n = 1), jejunum (n = 1), and ileum (n = 10). Both the NEC and control groups consisted of extremely premature and term infants (control group: 25–40 gestational weeks, NEC group: 23–39 gestational weeks). The postnatal age at the time of surgery varied in both groups (control group: 4–47 days, NEC group: 4–50 days). DEFA6 expression in the NEC group was significantly lower than that in the control group and did not correlate with gestational age. Conclusion The diminished DEFA6 expression in Paneth cells associated with NEC in this study supports the hypothesis that alpha-defensins are involved in the pathophysiology of NEC. Future studies are needed to elucidate the role of alpha-defensins in NEC aiming at finding preventive and therapeutic strategies against NEC.

THE EFFECT OF HYPOXIC BRAIN DAMAGE ON THE SURVIVAL OF PREMATURE INFANTS

The central nervous system injuries are a common neonatal pathology, hypoxia being one of the main causes of cerebral dysfunction. The purpose of this study was studying the incidence of hypoxic cerebral disorders in premature infants with an extremely low body weight and a very low birth weight and revealing the risk factors that adversely affected the disease outcome. The subject of the study was preterm infants whose gestational age did not exceed 31 weeks. The main criterion for inclusion into the study was the presence of hypoxic-ischemic and hypoxic-hemorrhagic brain damage. To reveal the perinatal risk factors, the somatic health of mothers, and pregnancy and childbirth peculiarities were studied. The structure of children’s pathology and intensive care techniques were analyzed. Cerebral disorders were verified in 42 out of 176 patients (23.5 %). 2–3rd-degree intraventricular hemorrhage was diagnosed in 34 newborns (80.9 %), severe ischemia in 8 children (19.1 %). To determine the structure of the disease outcome, all children were divided into deceased and survivors. A fatal outcome was observed in 14 cases (33.3 %). The mothers of deceased children were more likely to have obstetric and concomitant extragenital pathologies. Analysis of pediatric pathology showed that the hemodynamically significant functioning arterial duct and severe asphyxia in childbirth were much more frequent in deceased children. Intensive therapy of deceased children included «hard» parameters of artificial ventilation and high doses of cardiotonic drugs. Thus the presented risk factors can be considered as predictors of an unfavorable outcome in children with this pathology.