Early Neonatal Period Research Articles

Study of Different Breastfeeding Parameters by Using Breastfeeding Assessment Tools in Urban Tertiary Care Hospital

Background: In India, only 56% of mothers breastfeed exclusively for the first six months, as recommended. Given India’s extraordinarily high rates of preterm births, infant mortality, neonatal deaths and maternal fatalities, exclusive breastfeeding becomes even more crucial. There are many advantages of breastfeeding, but there are lots of barriers that need to be addressed. These problems need a proper objective assessment. Aims: To assess optimum positioning and attachment in mother-infant dyads, infant breastfeeding behaviour in the early neonatal period and early breastfeeding skills in mothers. Methods: A prospective cross-sectional study was conducted in the postnatal ward of a tertiary care hospital. In total, 208 full-term neonates (Age - 24 hours to 7 days) who were admitted to a postnatal ward of a tertiary care hospital and who were on direct breastfeeding were observed for breastfeeding. Objective assessment of breastfeeding was done by using the Bristol Breastfeeding Assessment Tool, Infant Breast-Feeding Assessment tool and LATCH tool. Statistical analysis was done by using SPSS version 25 with appropriate statistical tests. Result: For the BBAT tool, 110 (52.9%) infants were well supported while feeding and 118 (56.7%) had proper latching or attachment. For IBFAT Score Analysis, 109 (52.4%) infants were effective vigorous feeders and 95 (45.7%) and 4 (1.9%) were moderately effective feeders and poor feeders, respectively. For LATCH Score Analysis, 173 (83.2%) mother-infant dyads achieved a high score and 35 (16.8%) achieved moderate score. Conclusion: Objective assessment of breastfeeding by using these tools will help to identify the problem related to breastfeeding for both baby and mother. Addressing a particular problem in a timely manner will help the mother and the baby to establish, initiate and sustain exclusive breastfeeding. Caesarean-delivered mothers as well as primiparous mothers both needed more focused counselling for breastfeeding positioning, motivation for early initiation breastfeeding, a strong supportive relationship, adequate assistance during the early neonatal period for breastfeeding and proper guidance to sustain exclusive breastfeeding.

Clinical and laboratory characteristics of newborns from mothers with gestational diabetes mellitus and COVID-19 during pregnancy

Data on the course of pregnancy complicated by SARS-CoV-2 infection, and the condition ofthe fetus and newborn are of great interest to neonatologists and pediatricians.Purpose. The study aimed at evaluating the clinical and laboratory features of the early neonatal period and individual health indicators in infancy in full-term newborns from mothers with gestational diabetes mellitus and COVID-19 during pregnancy.Materials and Methods. Two groups of full-term newborns whose mothers’ pregnancy was complicated by gestational diabetes mellitus were compared in matched pairs (each group included 80 patients). In the first group of newborns, COVID-19 was diagnosed in mothers during pregnancy, in the second group, COVID-19 was not observed in mothers. At the age of 9 months, an analysis of outpatient medical records was carried out and a questionnaire survey of mothers was conducted. The methods of collecting and processing information using the Microsoft Excel 2016 software package for Windows 7, IBM SPSS Statistics v22 were used. Results. COVID-19 infection during pregnancy is associated with a higher frequency of respiratory and neurological disorders in the newborn, and with problems of enteral feeding. In the peripheral blood, the indices fell within the limits of reference values, but there was a decrease in leukocytes, platelets and an increase in the fraction of segmented neutrophils. At the age of 9 months, the children of the main group had a larger body weight and head circumference, a higher incidence of chronic morbidity was noted, and the children were registered with a neurologist, cardiologist and endocrinologist.Conclusions. Clinical and laboratory features of early neonatal adaptation of children from mothers with gestational diabetes mellitus and COVID-19 during pregnancy were revealed. A more severe course of diabetic fetopathy has not been proven in children from women who suffered COVID-19 during pregnancy. The higher incidence of chronic morbidity in infancy requires further study.

Ductus Arteriosus Stenting as a Method of Palliative Treatment of Truncus Arteriosus Type A3: Literature Review and Clinical Case

Introduction. Van Praagh A3 variant of truncus arteriosus (TA A3) is a condition when the one pulmonary artery branch origins from the TA, the other is filled through the patent ductus arteriosus (PDA).
 PDA constriction in the early neonatal period can cause absence of blood supply to the one pulmonary artery branch. To prevent this, prolonged infusion of prostaglandin E1, PDA stenting or systemic-to-pulmonary shunt are used. These methods allow to postpone total repair (TR) and reduce mortality risks associated with neonatal period.
 The aim. To analyze research papers dedicated to endovascular approach of TA A3 staged treatment and to present our own experience.
 Materials and methods. We conducted a systematic literature search and analyzed various options for the TA A3 staged treatment. After the review, we used endovascular approach as the first stage of treatment in our clinical case.
 We studied a newborn weighing 4 kg with TA A3 (left pulmonary artery branch origins from the non-coronary sinus of the truncal valve, right pulmonary artery branch filling through the PDA). Nakata index was 83 mm2/m2. McGoon ratio was 1. We decided to perform PDA stenting with the aim of postponing surgical correction until the patient’s optimal age and weight.
 Discussion. In total, the number of publications about TA A3 staged treatment is limited. Most institutions prefer TA A3 staged treatment in newborns, because it is associated with a lower risk of complications than early TR. In our clinical case, the first step was PDA stenting. The staged approach allowed us to perform TR with a good result at the age of 3 months. Before TR, Nakata index and McGoon ratio were increased to 248 mm2/m2 and 1.9, respectively.
 Conclusions. The current trend of TA A3 repair has few different options of staged treatment. Staged approach helps to get out of the newborn period and achieves the optimal condition for TR. Our patient successfully received PDA stenting as the first stage of treatment, which created conditions for the pulmonary artery branches growth. The second stage was TR with good long-term results. After analyzing the publications, we noted that the use of endovascular PDA stenting is a good and safe alternative to surgical palliative treatment.

Клінічне спостереження тератоми головного мозку новонародженого

A congenital brain tumor is a tumor detected before birth or during the first two months of life. The frequency of congenital brain tumors is extremely low - 0.34 per 1 million newborns, and no more than 1.5% of all neoplasms of the central nervous system in children, but the rapid growth of the tumor and the destruction of normal brain tissue give them a fatal prognosis. Purpose - to expand knowledge on the possibilities of antenatal diagnosis and the features of the management of the early neonatal period of congenital mіalformations based on the clinical observation of fetal brain teratoma. An overview of literature sources is provided on the prevalence of pathology, histological structure (teratomas, neuroepithelial and mesenchymal tumors), features of the clinical course that distinguish them from childhood tumors - mainly supratentorial localization, lack of growth restriction due to the mobility of the bones of the skull, prognosis and tactics of pregnancy and childbirth . Ultrasound examination is the main method of diagnosis of brain tumors, which are visualized in the form of a solid or cystic calcified formation or not, and manifestations of hypervascularization can also be absent or present. The features of the structure and development of the teratoma, which contains cells of all 3 germ layers and has properties of rapid destructive growth, are also described. Hydrocephalus accompanying congenital brain tumors can be caused both by compression of the ventricular system and intracranial hemorrhages. Thanks to modern diagnostic capabilities, most cases are detected in terms of possible termination of pregnancy, in the case of childbirth with such a pathology, in 60% of cases, a cesarean section is used. The given clinical case shows the possibilities of antenatal diagnosis of a brain tumor and even clearly establishing the depth of the lesion, at the same time as the lack of treatment options. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Pengaruh Inisiasi Menyusui Dini (IMD) Terhadap Hipotermi Pada Bayi Baru Lahir Peningkatan Produksi ASI Pada Ibu Post Partum

Infant deaths generally occur in the early neonatal period due to hypothermia. The incidence of hypothermia in newborns is quite high, globally ranging from 8.5-52%, an estimated 17 million newborns experience hypothermia in developing countries. The incidence of hypothermia in newborn babies is 92.3%, the infant mortality rate due to hypothermia is 6.3%. One intervention to minimize the incidence of hypothermia in newborn babies is to initiate early breastfeeding. The aim of the research was to determine the effect of early initiation of breastfeeding on hypothermia in newborn babies at the Bakti Timah Karimun Hospital. The research method used a pre-experiment with a one group pretest-posttest design. The sampling technique was purposive sampling with 14 respondents. The measuring instruments in this study were a digital axillary thermometer, standard operating procedures (SOP) for early breastfeeding initiation and observation sheets. Data analysis using paired sample t-test. The results of the paired sample t-test found a p-value = 0.000 (p<0.05), so it can be concluded that there is an influence of early initiation of breastfeeding on hypothermia in newborn babies in the Midwifery Room at Bakti Timah Karimun Hospital. Early initiation of breastfeeding can be used as an intervention for newborns to minimize the incidence of hypothermia

PROFILE OF NITRIC OXIDE METABOLISM INDICATORS IN PRETERM INFANTS WITH PERINATAL CENTRAL NERVOUS SYSTEM INJURIES

Introduction. Premature infants often experience a heightened risk of brain damage, potentially leading to various disorders affecting motor, cognitive, behavioral, social, and sensory functions. The underlying pathological processes of hypoxic-ischemic central nervous system (CNS) injury predominantly stem from compromised cerebral blood flow and oxygen transport. Timely diagnosis and treatment options for prematurely born children with perinatal CNS damage remain limited. Nitric oxide, a universal regulator of physiological functions, plays a crucial role. Endothelial dysfunction, marked by the loss of the neurovascular protective functions of nitric oxide, could significantly contribute to the development of cognitive impairment in hypoxic-ischemic CNS damage. Objectives. The study aims to evaluate the specificities of nitrate metabolism indicators in premature infants with hypoxic-ischemic CNS lesions in the early neonatal period. This involves examining and comparing clinical indicators characterizing hemodynamics, as well as the levels of nitrites, nitrates, and nitrosothiols in urine among patients in the studied groups. Subjects and Methods. The study comprised 14 premature infants with hypoxic-ischemic CNS injury (main group), with a separate selection of 4 infants who did not survive during the neonatal period. The comparison group included 20 relatively healthy prematurely born children. Stratification was based on the results of a genetic study, specifically the determination of the rs61722009 polymorphism of the eNOS gene. The patients underwent routine clinical examinations, including blood pressure measurements, and assessments of nitrates, nitrites, and nitrosothiols in urine. Subgroups were identified as follows: 1st subgroup - 4bb (n=10), and 2nd subgroup - 4aa/4ab (n=10). Results. It was observed that newborns who did not survive had significantly lower systolic and diastolic blood pressure readings on the first day of life, in comparison to relatively healthy children in the two control subgroups (day 1 - p=0.018; p=0.027; p=0.036; p=0.053). Additionally, they exhibited lower heart rate indicators on the first day (p=0.001; p=0.002). However, overall, hemodynamic indicators in newborns with hypoxic-ischemic central nervous system damage did not show statistically significant differences from the corresponding indicators in relatively healthy children. The results indicate a significantly lower level of diuresis in children who died as a result of severe with hypoxic-ischemic central nervous system damage, probably due to the development of multiple organ failure immediately after birth. As a result, it was found that the levels of nitrites (p<0.001; p<0.0001) and nitrates (p<0.01; p<0.0001) were reduced in children with with hypoxic-ischemic central nervous system damage, compared to children in the control groups, regardless of genotype variant. While the level of nitrosothiols did not differ significantly, it was even much higher in children who did not survive, 3.55±0.39 vs 2.23±0.22; p=0.008. The differences found may indicate a disruption of the regulatory effect of nitric oxyde on vascular tone and the condition of neuroglia, particularly in children with hypoxic-ischemic central nervous system damage, as a result of its insufficient production, as well as insufficient mobilization from the depot due to nitrite and nitrate reductases. Conclusions. Hemodynamic patterns in children from the examined groups, except for those who did not survive, did not exhibit significant differences. The notably lower urine output in deceased children indicates the development of multiple organ failure due to severe hypoxia. In children with hypoxic-ischemic central nervous system damage, there is a reduction in the levels of nitrites and nitrates in urine compared to relatively healthy premature infants, while the level of nitrosothiols did not show significant differences and was even notably higher in children who did not survive. The outcome of studying the levels of nitrates, nitrites, and nitrosothiols in urine in a larger patient sample may lead to the development of an algorithm for early diagnosis and management, contingent on the severity of metabolic disorders resulting from hypoxia, considering the potential influence of nitric oxide on energy deficit and mitochondrial dysfunction.

CLINICAL AND LABORATORY ASPECTS IN DIAGNOSTICS OF THE FUNCTIONAL STATE OF THE HEPATOBILIARY SYSTEM IN PRETERM INFANTS

Resume. The insufficient information content of existing methods of diagnosis and treatment, the high incidence of complications, and the growing prevalence of digestive diseases in children in Ukraine justify the necessity for in-depth research in order to deepen understanding of the pathophysiological mechanisms underlying organ pathology with the ultimate goal of improving medical care for newborns.
 The aim of this study is to assess clinical and laboratory parameters characterizing the functional state of the hepatobiliary system in preterm infants.
 Participants and methods. The main group included 68 preterm infants of gestational age 32-33/6 weeks who had clinical signs of severe perinatal pathology; the comparison group involved 27 basically healthy infants of gestational age 34-36/6 weeks. A comprehensive examination of newborns with an assessment of the severity of perinatal pathology and a set of generally accepted biochemical blood parameters was performed. The research was conducted in compliance with the basic provisions of GCP (1996), the Council of Europe Convention on Human Rights and Biomedicine (April 4, 1997), the World Medical Association Declaration of Helsinki on the Ethical Principles of Scientific Medical Research Involving Human Subjects (1964-2008). The research protocol was approved by the Commission on Biomedical Ethics of Bukovinian State Medical University (Protocol No. 5 of 12.09.2015). Statistical processing of the study results was performed using the STATISTICA software (StatSoft Inc., USA, Version 10) MedCalc program (https://www.medcalc. org/index.php). Comparison of quantitative indicators with a normal distribution was performed using the Student's t-test at a statistical significance of p<0.05.
 Results and Discussion. With a burdened somatic history, unfavorable factors of pregnancy and childbirth in the mother, severe forms of diseases in preterm infants in the early neonatal period are accompanied by clinical signs of disorders of the functional state of the hepatobiliary system, in particular, an enlargement of the liver, hepatosplenic syndrome, edema, meteorism, jaundice, hemorrhagic manifestations, such as gastrointestinal bleeding, acholic stools, and hypoglycemia. Laboratory markers of severe functional hepatoniliary disorders include decreased levels of total protein, bilirubin, and glucose; increased levels of urea and cholesterol; reduced enzymatic activity of aspartate aminotransferase and lactate dehydrogenase. A significant decrease in the activity of the enzymes alanine aminotransferase and γ-glutamine transaminase and a decrease in the activity of alkaline phosphatase and Ca2+ level were also observed.
 Conclusions. The obtained results of clinical and laboratory parameters indicate the necessity to study the main pathophysiological syndromes of hepatobiliary system dysfunction in perinatal pathology, considering morphological and functional characteristics in preterm infants.

Neonatal Respiratory Distress in a Poor Resource Setting: From Epidemiology to Outcome

Background: Neonatal respiratory distress one of the main causes of neonatal morbidity and mortality. It is a diagnostic and therapeutic emergency whose etiology is dominated by respiratory pathologies.
 Objective: To study the epidemiological, clinical, diagnostic, therapeutic, and outcomes aspects of neonatal respiratory distress in order to help reduce its impact on neonatal morbidity and mortality.
 Methods: A retrospective descriptive cross-sectional study covering the period from 1st January 2017 to 31 December 2018 was conducted in the Neonatology Unit of the Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle of Ouagadougou, Burkina Faso (West Africa). The clinical records of newborns admitted for respiratory distress (n=305) were included in the study. Results: Over the two-year period, the frequency of neonatal respiratory distress was 39.1% (305/780). Factors of respiratory distress were early neonatal period (80%), male sex (60.7%), full-term birth (82.3%), and normal birth weight (66.3%). The Silverman and Andersen score was mild (20.4%), moderate (68.5%), and severe (11.1%). The main causes of respiratory distress were neonatal septicemic infection (59.3%) and perinatal asphyxia (30.5%). Treatment mainly includes cardiopulmonary resuscitation, maintenance of fluid and electrolyte balance, and oxygen therapy. There were 83 deaths, giving a case-fatality rate of 27.2%. Major causes of death were sepsis (13.1%) and perinatal asphyxia (9.8%).
 Conclusion: Neonatal respiratory distress is common in our neonatal unit. In order to reduce neonatal morbidity and mortality linked to this condition, action must be taken to combat neonatal sepsis, perinatal asphyxia, and preterm birth.

Obstetrical and perinatal consequences of childbirth in women with antenatally undiagnosed fetal growth restriction

Fetal growth restriction (FGR) is one of the most studied topics in the medicine of the mother and fetus. However, not identified antenatally FGR can have an increased risk of both perinatal morbidity and mortality, as well as adverse long-term consequences. The identification of FGR during pregnancy will contribute to the reduction of both perinatal morbidity and perinatal mortality.
 Aim. Based on a retrospective analysis, assess the obstetric and perinatal consequences of childbirth in women with antenatally undiagnosed fetal growth restriction.
 Materials and methods. An analysis of 488 cases of childbirth in women with singleton pregnancy, who gave birth to a live child, was conducted. In all cases, the gestational age was ≥22 weeks with a fetal weight less than the 10th percentile for the corresponding gestational age. Depending on the antenatally established diagnosis of FGR, two study groups were formed: group I consisted of 204 (41.8 %) cases with antenatally diagnosed FGR, group II – 284 (58.2 %) cases in which signs of FGR were identified after the birth of the child. Maternal characteristics, neonatal outcomes, and evaluation of short-term infant outcomes were analyzed.
 Results. Both groups were dominated by women with first births, the number of which was almost the same. Somatic pathology was almost 2 times more common in women of group I, 17.2 %, compared to 9.2 % of women in group II (p < 0.01), this indicates that the majority of women who were not diagnosed with FGR during pregnancy belong to the low-risk group. Fetuses with impaired blood flow in the umbilical cord arteries were twice as common in group I, 49.5 % versus 23.9 % in group II (p < 0.0001), and the frequency of absent/reversible end flow in the umbilical arteries in group I compared to group II, prevailed 3 times (p < 0.0001), indicating more serious lesions of the placenta and, as a result, early manifestation of the fetal condition disorder. The frequency of premature abdominal delivery was 3.75 times higher in group I compared to group II. The most frequent indication for cesarean delivery in both groups was signs of fetal distress syndrome. Analysis of neonatal outcomes showed that the average birth weight was significantly lower in group I and was 2180 ± 55 g against 2420 ± 61 g in group II (p < 0.0001). The need for hospitalization of newborns in the intensive care unit had no statistical difference between the groups (p > 0.05). However, the complications of the early neonatal period and the total length of stay in the hospital were greater in children of the I group, compared to the II group (p < 0.0001).
 Conclusions. The results of the conducted research indicate a low level of prenatal diagnosis of fetal growth restriction. Most pregnant women with antenatally undiagnosed fetal growth restriction belong to the group of low perinatal risk. The most frequent indication for cesarean section operation, regardless of the date of delivery, in both groups were signs of fetal distress, the frequency of which was 1.5 times higher in the antenatally diagnosed fetal growth retardation group. Newborns with an undetected growth anomaly before delivery have an increased risk of fetal distress, the severity of which is determined by the degree of deterioration of fetal oxygenation, and not by weight percentile, which requires more careful observation of fetuses with signs of growth restriction.

Lacticaseibacillus rhamnosus and breastmilk are associated with a decreased risk of atopic dermatitis in very low birth weight premature infants.

In this study, we analyse the influence of nutrition during the early neonatal period on the development and prevention of atopic dermatitis (AD) in children with a history of very low birth weight (VLBW). A retrospective cohort study was performed of VLBW preterm infants to assess the risk of their developing AD during childhood, according to nutrition with breastmilk and/or probiotic supplementation during the neonatal period. The analysis focused on nutritional and early childhood follow-up data for 437 newborns, of whom 184 received probiotics up to 36 weeks postmenstrual age. AD was present in 23.5% of the study sample. Of the children who did not develop AD, 44.9% had received probiotics from birth to 36 weeks of gestational age. Therefore, the administration of probiotics to infants at less than 36 weeks postmenstrual age is associated with a protective effect against the development of AD (odds ratio (OR) 0.57; 95% confidence interval (CI) 0.34-0.93). Moreover, a protective interaction was observed between probiotic administration and breastmilk (OR 0.46; 95% CI 0.25-0.82). The adjusted data in the regression model allow us to observe a statistically significant association with the protective effect of Lacticaseibacillus rhamnosus with the development of AD at school age (OR 0.55; 95% CI 0.30-0.99). Probiotic supplementation in VLBW newborns is associated with a decreased risk of subsequent development of AD. Breastmilk strengthens the protective effect of probiotics against the development of AD.

Epigenetic age acceleration, neonatal morbidities, and neurobehavioral profiles in infants born very preterm

ABSTRACT Epigenetic age acceleration is a risk factor for chronic diseases of ageing and may reflect aspects of biological ageing. However, few studies have examined epigenetic ageing during the early neonatal period in preterm infants, who are at heightened risk of developmental problems. We examined relationships between neonatal age acceleration, neonatal morbidities, and neurobehavioral domains among very preterm (<30 weeks gestation) infants to characterize whether infants with early morbidities or different neurobehavioral characteristics had accelerated or decelerated epigenetic ageing. This study uses data from the Neonatal Neurobehavior and Outcomes in Very Preterm Infants (NOVI) study, restricted to infants with data on variables assessed (n = 519). We used generalized estimating equations to test for differences in age acceleration associated with severe neonatal medical morbidities and neurobehavioral characteristics. We found that infants with neonatal morbidities, in particular, bronchopulmonary dysplasia (BPD), had accelerated epigenetic age – and some evidence that infants with hypertonicity and asymmetric reflexes had increased and decreased age acceleration, respectively. Adjustment for gestational age attenuated some associations, suggesting that the relationships observed may be driven by the duration of gestation. Our most robust finding shows that very preterm infants with neonatal morbidities (BPD in particular) exhibit age acceleration, but most neonatal neurobehavioral characteristics and morbidities are not associated with early life age acceleration. Lower gestational age at birth may be an upstream factor driving these associations.

Silverman–Andersen respiratory scale in a comprehensive assessment of respiratory distress syndrome of premature newborns: clinical and prognostic role in the early neonatal period

The article provides epidemiology, main international recommendations and domestic clinical experience of the early use of the Silverman–Andersen respiratory scale in the comprehensive assessment of neonatal respiratory distress syndrome (NRDS). The modern anatomical and histological prerequisites and clinical and pathophysiological features of respiratory failure, pathognomonic for the development of NRDS in the early neonatal period, are considered. The important clinical and prognostic role of the initial use of the Silverman–Andersen scale in assessing the development/progression of NRDS in premature infants of small gestational age with the targeted choice of starting non-invasive ventilation in the conditions of the neonatal intensive care unit of the maternity hospital of the perinatal center of the S.S. Yudin City Clinical Hospital (Moscow).

Congenital malformations of the neural tube spina bifida in the Republic of Tajikistan

Objective. Determine the prevalence of the congenital neural tube defect, Spina bifida.Materials and methods. This study utilized data from epidemiological monitoring of statistical registration forms, the National Register of Congenital Malformations F32, and the Report on Medical Assistance provided to Pregnant Women, Postpartum Women, and Newborns from 2016 to 2021.Results. Throughout the study duration, a total of 1,442,030 newborns were recorded in the republic. Of these, 11,320 had congenital malformations of the CNS, with 9,682 being born alive. Neural tube defects were diagnosed in 1,447 (14.9%) of these children: 102 (7.0%) had anencephaly (Q00), 112 (7.7%) had encephalocele (Q01), and 667 (46.0%) had Spina bifida (Q05). Notably, in the post-COVID years of 2020 and 2021, births of children with Spina bifida decreased by almost half compared to prior years, a statistically significant difference (P&lt;0.001). Concurrently, there was a rise in antenatal death rates for these children, reaching 15.5% and 18.3% for the two respective years.Conclusion. Spina bifida has a multifactorial etiology. Its population prevalence does not exceed 1.5‰, majority of lethal outcome occurs in early neonatal period in the first 168 hours of life accounting for 96.5%.

Climatic factors and prolonged neonatal jaundice

Prolonged neonatal jaundice (PrNJ) in full-term newborns(NB) is defined if it persists beyond the 14th day after birth. Clinical experience shows that seasons of the year influence the frequency and severity of neonatal jaundice (NJ). Objective: To establish the role of climatic factors on PrNJ expression in term neonates. Material and methods: The study was conducted at the Neonatology Department of University Hospital "Medica Ruse" with 92 full-term newborns who were with PrNJ. The follow-up of NJ was carried out with transcutaneous bilirubinometry. The NBs are residents of Ruse region, Republic of Bulgaria. Results: We found that air temperature directly affects the levels of bilirubin(BR) for the entire neonatal period and the duration of PrNJ. The amount of rainfall during the first two weeks after birth directly correlated with bilirubinemia at end of neonatal period and the duration of PrNJ. A higher level of atmospheric pressure during the early neonatal period was associated with lower BR levels at the same and a shorter duration of PrNJ. The degree of cloudiness after postnatal day 14 is inversely related to the levels of BR and the duration of the PrNJ. Sunshine during the first two weeks affects the levels of BR on the end of neonatal perod and the prolongation of PrNJ. Conclusion: According to our data climatic factors: air temperature, amount of rainfaull, atmospheric pressure, degree of cloudiness, duration of sunshine affect the degree of manifestation and duration of PrNJ.

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

PREDICTIVE FACTORS AND CLINICAL AND PARACLINICAL FEATURES OF URINARY TRACT DYSFUNCTION IN PRETERM INFANTS

Mortalidade infantil por causas evitáveis

Infant mortality refers to deaths of children under one year of age, subdivided into neonatal mortality (early and late neonatal) and post-neonatal mortality, being considered an indicator for assessing the population's health situation. The study aimed at describing the infant mortality rates due to preventable causes, in children under one year of age and in the state of Alagoas, during 2017. A descriptive and cross-sectional ecological study was carried out, with a quantitative approach on mortality rates in the age group of children under one year old, based on secondary data available in the Mortality Information System, by the Informatics Department of the Unified Health System (Departamento de Informática do Sistema Único de Saúde, [DATASUS]). This study was carried out from November to December 2019. During this period, in the state of Alagoas, 793 deaths due to preventable causes among children under five years of age were recorded in the Informatics Department of the Unified Health System. 83.98% (n=666) of these deaths corresponded to children under one year of age, with death cases in the early neonatal period being the most prevalent, followed by deaths in the post-neonatal and late neonatal periods. Among the cities in Alagoas, Maceió ranks first and Arapiraca is in second place in relation to the infant mortality rate.

The effect of the combined use of the mineral feed additive "Calvolit" and the probiotic additive Biolatic G-500 on the clinical blood parameters of calves with nonspecific dyspepsia

Nonspecific dyspepsia is a common pathology of the early neonatal period, characterized by widespread and severe course, severe intoxication and dehydration. Due to diarrheal syndrome, leukocytes, immunoglobulins, water, macro- and microelements are excreted from the body of young animals. It is possible to restore the lack of inorganic substances by introducing mineral supplements into the treatment regimen, and normalize the digestive processes through the use of probiotics. Considering that the data from their combined use in the treatment of nonspecific dyspepsia of young animals are extremely scarce and sometimes contradictory, the goal was set to establish the degree of influence of the combined use of the mineral feed additive "Calvolit" and the probiotic supplement Biolatic G–500 on the main clinical blood parameters of calves in the treatment of nonspecific dyspepsia. The object of the study was 30 calves of a three-day-old black-and-white Holstein breed, selected according to the principle of pairs of analogues that had a body weight from 30.0 to 35.0 kg at birth. Three groups were formed from them. The first (control) group (n=10) included healthy animals (normotrophics) with no clinical signs of dyspepsia. The second (n=10) and third (n=10) groups were formed from animals with a characteristic clinical picture of a simple form of dyspepsia. The animals of the second group were assigned a treatment regimen used on the farm. In addition, Biolatic G-500 preparations at a dose of 5.0 g (0.5 tablespoons) and the mineral feed additive Calvolit at a dose of 30.0 g per head per day were introduced into the treatment regimen for animals of the third group. The control of the clinical condition of the animals was carried out taking into account the clinical blood test. It was found that the combined use of the probiotic drug "Biolatic" (Biolatic) G-500 and the mineral feed additive "Calvolit" as part of the treatment regimens for nonspecific dyspepsia contributes to the acceleration of normalization of clinical blood parameters and leukocyte profile of young animals.

Сепсис-асоційоване ураження нервової системи в передчасно народжених дітей із дуже малою масою тіла

The immaturity of the organs and systems of preterm born children significantly complicates the differentiation between physiological and pathological changes in the brain. The etiology of brain damage in premature babies is complex and multifactorial, and even with the most favorable course of the neonatal period, they require additional respiratory support, a large number of invasive medical interventions and have a high risk of infectious complications. Sepsis-associated encephalopathy (SAE) is defined as diffuse or multifocal cerebral damage that is caused by a systemic response to infection even without clinical or laboratory evidence of direct brain infection. Purpose - to determine the clinical features of sepsis-associated brain damage in prematurely born children &lt;32 weeks gestation with a birth weight &lt;1500 g. Materials and methods. 38 prematurely born children, who were divided into two groups, were examined. The Group I (n=14) included children who were diagnosed with sepsis in the early neonatal period. The Group II (n=24) included prematurely born, in which no septic lesions were observed. Results. Children of both groups were born in a state of severe and moderate asphyxia. Analysis of associations between maternal, obstetric, and antenatal factors showed a significant prevalence of such factors as prelabor rupture of membranes, сervical weakness, rupture of the fetal bladder, and placement of an obstetric pessary in children with sepsis. All children with sepsis had pneumonia, acute kidney injury, and brain injury in the neonatal period. In the neurological status of children with very low birth weight who underwent SAE, the seizure syndrome, 3-4 grade intraventricular hemorrhages, periventricular leukomalacia, complications in the form of post-hemorrhagic ventriculomegaly were significantly more common. Conclusions. In children with very low birth weight who underwent SAE, convulsive syndrome, 3-4 grade intraventricular hemorrhages, and periventricular leukomalacia were significantly more common. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Paediatric quality of life in toddlers and children who underwent arterial switch operation beyond early neonatal period.

The aim of this study was to evaluate the quality of life (QOL) of children who underwent the arterial switch operation (ASO) for Transposition of Great Arteries in our population and, specifically, to explore early modifiable factors and the influence of parental and socioeconomic factors on the QOL of these children. Cross-sectional study using Paediatric Quality of Life Inventory™ 3.0 Cardiac Module was carried out on 3- to 12-year-old children who had undergone ASO between the years 2012-2018. Socioeconomic status was calculated using the modified Kuppuswamy scale (2019). Other clinical factors with possible bearing on the outcome were also analysed. Immediate survival after surgery was 196 out of 208 (94.2%) with an attrition of 19 patients (9.6%) over the follow-up period. Most surviving children (98.9%) had started formal schooling in age-appropriate classes. Two children had severe neuromotor impairment. The median cumulative health-related QOL score of the children was 97.9 (interquartile range 4.2) at 5.6 ± 1.27 years of life. The median scores each of the health-related QOL parameters, viz, heart problem symptoms, treatment compliance, perceived physical appearance, treatment-related anxiety, cognitive problems, and communication was 100 with negative skewing. Excellent QOL was observed in most children after ASO with the median total paediatric QOL scores in all domains of 97.9. Social factors did not show a statistically significant influence on the QOL parameters in the current cohort. The gradually declining trend across the age groups emphasizes the need for continued follow-up for early identification of possible correctable factors and initiating intervention to ensure good QOL into teenage and adulthood.

Isolated choroid plexus cysts and health and developmental outcomes in childhood and adolescence – A systematic review

ObjectivesChoroid plexus cysts (CPCs) are incidental findings on ultrasound examination of the fetal brain. It is not known if isolated CPCs are associated with any adverse health or neurodevelopmental outcomes during the life course. This systematic review aimed to collate and synthesize the evidence on whether or not isolated choroid plexus cysts are associated with an increased risk of adverse health or developmental outcomes during childhood and adolescence. MethodsA search strategy was developed specifically for this study and applied to four electronic databases Medline (Ovid), Embase (Ovid), Web of Science, and Google Scholar. Studies were assessed and selected for inclusion if there was a measurement of CPC (including single or multiple; unilateral or bilateral; isolated or presenting alongside other markers) during the antenatal or early neonatal period (<7 days) with follow-up of children and adolescents for health and developmental outcomes measured at any time from age 1 month onwards. Study quality was assessed using the Newcastle-Ottawa Quality Assessment Scale. Due to heterogeneity in the types of outcome measures included and the timing of measurement of outcomes across the studies, it was not possible to pool data across studies and a narrative description of findings was presented. ResultsEight studies (three cohorts and five case series) met the inclusion criteria. Different methods were used for outcome assessment, such as in-person assessment, parent questionnaires, medical records, and telephone interviews with parents. Six studies measured outcomes only once during the specified duration of follow-up; two studies carried out paediatric reviews of the children several times during follow-up. There were no differences in developmental outcomes or physical health between babies with CPCs reported in the three cohort studies, and no abnormalities were detected in the children that were followed up in four of the five case series studies. Most of the included studies were graded as low quality due to the small sample size, high risk of selection bias, unclear definitions of CPC or lack of a comparison group. ConclusionsThe studies conducted to date do not provide evidence of adverse physical health outcomes or neurodevelopmental delays in babies with CPCs. However, most of these studies were small and included a narrow range of outcomes. Further research is needed to explore the relative incidence of outcomes such as ASD, ADHD, epilepsy and educational attainment in children with CPCs.