Failure In Newborn Research Articles

Clinical case of pulmonary alveolar proteinosis in a newborn

Pulmonary alveolar proteinosis (PAP) is a rare disease characterized by the accumulation of protein-lipid complexes in the alveoli due to impaired utilization of surfactant by alveolar macrophages; it is most often idiopathic and occurs in healthy men and women aged 30–50 years. The congenital form of PAP is extremely rare, its diagnosis is complicated by the fact that it is impossible to conduct functional lung tests in newborns, and lung biopsy is used extremely rarely. Against this background, data obtained by computed tomography (CT) of the lungs of newborns are of particular importance. The article presents a clinical case of treatment of a newborn with respiratory failure (RF) and signs of pulmonary hypertension, who was admitted to the neonatal intensive care unit of the Children’s City Multidisciplinary Clinical Specialized Center for High Medical Technologies at the age of the first day of life. The article reflects the role of computed tomography in diagnosing the causes of respiratory failure in newborns, as well as the importance of anamnesis and a thorough clinical examination of patients. The presented clinical case demonstrates the need for a multidisciplinary approach to the diagnosis of newborns with pulmonary alveolar proteinosis.

Catheter ablation of typical right atrial flutter in a 20-day-old neonate with tachycardiomyopathy.

Fetal echocardiography can diagnose neonatal atrial flutter, which can cause heart failure in newborns. Little is known about catheter ablation in this population. Case report that aimed to review a successful ablation in a 20-day-old patient with refractory atrial flutter. This is the first report of a successful neonatal atrial flutter ablation without any early recurrence after the procedure. Atrial flutter ablation performed on newborns is a reliable and long-lasting treatment option.

Successful extracorporeal membrane oxygenation for postoperative cardiopulmonary failure in newborns with congenital diaphragmatic hernia: case reports and literature reviews.

Congenital diaphragmatic hernia (CDH) is a structural defect caused by inadequate fusion of the pleuroperitoneal membrane that forms the diaphragm, allowing peritoneal viscera to protrude into the pleural cavity. Up to 30% of newborns with CDH require extracorporeal membrane oxygenation (ECMO) support. As with all interventions, the risks and benefits of ECMO must be carefully considered in these patients. Cardiopulmonary function has been shown to worsen rather than improve after surgical CDH repair. Even after a detailed perioperative assessment, sudden cardiopulmonary failure after surgery is dangerous and requires timely and effective treatments. Three cases of cardiopulmonary failure after surgical CDH treatment in newborns have been reported. ECMO support was needed for these three patients and was successfully discontinued. We report our treatment experience. ECMO is feasible for the treatment of postoperative cardiopulmonary failure in newborns with CDH.

Acute renal failure in newborns in the practice of a pediatrician of the future

Aims: The treatment of an acute renal failure has not received much research in Kazakhstan, whether focusing on adults or children. As a result, there is a lack of awareness about the condition of the field's knowledge as well as its challenges and prospects. Thus the goal is to identify and assess the studies that are currently accessible concerning the treatment of acute kidney failure in newborns or infants in the context of Kazakhstan experience. Study design: Literature review Methodology: MEDLINE, Cochrane Reviews, and Pedro were among the databases used to conduct the literature search. The conjunctions "AND" and "OR" were used with certain keywords. The articles' time range was restricted between 2018 and 2022 in order to only present the most recent facts. Papers discussing acute renal failure in infants only in Kazakhstan were included in the inclusion criteria. Results: Regarding the treatment of AKI in neonates in Kazakhstan, there are incredibly few available studies. The majority of trials involved individuals who were older. ESRD was more widely covered in conjunction with dialysis than AKI. Women are more prone to experience AKI turning into full-blown CKD. Conclusion: To learn more about the state of acute renal failure in neonates in Kazakhstan, more field study is required. The frequency and prevalence of placing new-borns on dialysis should be updated and made publicly accessible. It is important to emphasise the causes and risk factors of AKI in babies of Kazakh ancestry in order to comprehend current trends. Scientific Novelty: This is the first study that attempts to cover the status of pediatric acute renal failure management within Kazakhstan. It will serve as a starting point for prospective research on pediatric illnesses within the country, so as to understand where the health sector of Kazakhstan stands on the global stage.

Pathogenesis, Prognosis and Outcomes of Multiple Organ Failure in Newborns (Review)

Multiple organ failure (MOF) is the leading cause of neonatal mortality in intensive care units. The prevalence of MOF in newborns is currently unclear, since its incidence varies in asphyxia, sepsis, prematurity, and comorbidity, and depends on the level of development and funding of health care in different countries. Sepsis and acute respiratory distress syndrome prevail among the causes of MOF in this category of patients.Aim of the review. To summarize the available literature data on the pathogenesis, therapeutic strategies and outcomes of MOF in newborns.Material and methods. We searched PubMed, Scopus, Web of Science, and RSCI databases using the following keywords: «newborns, multiple organ failure, etiology, pathogenesis, premature, diagnosis, treatment, respiratory support, cardiotonic support», without language limitations. A total of 144 full-text sources were selected for analysis, 70% of which were published in the last five years and 50% were published in the last three years. Criteria for exclusion were low information value and outdated data.Results. The prevalence of MOF in neonates is currently unclear. This could be due to common association of neonatal MOF (as well as the adult one) with various diseases; thus, its incidence is not the same for asphyxia, sepsis, prematurity, and comorbidities. There is no precise data on neonatal mortality in MOF, but according to some reports, it may be as high as 13-50%.In newborns, MOF can be caused by two major causes, intrapartum/postnatal asphyxia and sepsis, but could also be influenced by other intranatal factors such as intrauterine infections and acute interruption of placental blood flow.The key element in the pathogenesis of neonate MOF is cytokinemia, which triggers universal critical pathways. Attempts to identify different clinical trajectories of critical illness in various categories of patients have led to the discovery of MOF phenotypes with specific patterns of systemic inflammatory response. This scientific trend is very promising for the creation of new classes of drugs and individual therapeutic pathways in neonates with MOF of various etiologies.The pSOFA scale is used to predict the outcome of neonatal MOF, however, the nSOFA scale has higher validity in premature infants with low birth weight.Central nervous system damage is the major MOF-associated adverse outcome in newborns, with gestational age and the timing of treatment initiation being key factors affecting risk of MOF development in both full-term and premature infants.Conclusion. The study of cellular messengers of inflammation, MOF phenotypes, mitochondrial insufficiency, and immunity in critically ill infants with MOF of various etiologies is a promising area of research. The pSOFA scale is suggested for predicting the outcome of MOF in full-term infants, while the nSOFA scale should be used in premature infants with low birth weight.

Acute Renal Failure in Newborns with Birth Asphyxia

Introduction: Perinatal asphyxia is one of the common causes of neonatal morbidity and mortality. It can affect almost all the body organs and most frequently affected organs are kidneys. Acute Renal Failure is the commonest renal complication, manifested by changes in urine output and blood chemistries.
 Aims: To evaluate the renal function in asphyxiated newborns.
 Methods: This cross-sectional study was conducted, from August 2021 to February 2022, on 95 term neonates admitted in Neonatal Intensive Care Unit of Nepalgunj Medical College, Kohalpur for birth asphyxia as per World Health Organization definition. All neonates with Hypoxic Ischemic Encephalopathy were staged by Sarnat and Sarnat staging. After 48 hours of life, blood sample was sent for investigations. Urine output was monitored and neonates were managed according to the hospital protocol.
 Results: Male to female ratio was M:F 1.90:1. Percentage of acute renal failure was higher in babies with higher Hypoxic Ischemic Encephalopathy grades. It was seen in 12% in Grade I, 82% in Grade II and 100% in Grade III. Renal failure had significant association with Hypoxic Ischemic Encephalopathy staging(p<0.05).The means of serum creatinine significantly increased with the increase in Hypoxic Ischemic Encephalopathy grades (p<0.05). Mean serum creatinine among Grade I, Grade II and Grade III newborns were 0.9±0.44, 2.2±.93and 2.9±0.38 mg/dl respectively. Mean urinary output significantly decreased as the grades of Hypoxic Ischemic Encephalopathy increased (p<0.05) with mean urine output 1.5±0.38, 1.3±0.53and 1.1±0.39 ml/kg/hour respectively in Grade I, Grade II and Grade III.
 Conclusion: Neonates with higher grades of Hypoxic Ischemic Encephalopathy had higher values of serum creatinine. Urine output decreased as the grading of asphyxia increased

Vein of Galen aneurysmal malformation

The vein of Galen aneurysmal malformation (VGAM) is arare aneurysmatic cerebrovascular malformation in newborns and children. The VGAM results from an arteriovenous fistula between the persistent vein of Markowski (embryonic precursor of the vein of Galen) and deep choroidal arteries. The VGAM is the most common noncardiac cause of high-output cardiac failure in newborns. It may also cause hemorrhage, seizures, and liquor malabsorption resulting in hydrocephalus. Preferred treatment of VGAM is transarterial embolization (TAE) to reduce the arteriovenous shunt volume and allow normal brain development.

Laryngeal Masks in Neonatal Resuscitation-A Narrative Review of Updates 2022.

Positive pressure ventilation (PPV) is crucial to neonatal cardiopulmonary resuscitation because respiratory failure precedes cardiac failure in newborns affected by perinatal asphyxia. Prolonged ineffective PPV could lead to a need for advanced resuscitation such as intubation, chest compression, and epinephrine. Every 30 s delay in initiation of PPV increased the risk of death or morbidity by 16%. The most effective interface for providing PPV in the early phases of resuscitation is still unclear. Laryngeal masks (LMs) are supraglottic airway devices that provide less invasive and relatively stable airway access without the need for laryngoscopy which have been studied as an alternative to face masks and endotracheal tubes in the initial stages of neonatal resuscitation. A meta-analysis found that LM is a safe and more effective alternative to face mask ventilation in neonatal resuscitation. LM is recommended as an alternative secondary airway device for the resuscitation of infants > 34 weeks by the International Liaison Committee on Resuscitation. It is adopted by various national neonatal resuscitation guidelines across the globe. Recent good-quality randomized trials have enhanced our understanding of the utility of laryngeal masks in low-resource settings. Nevertheless, LM is underutilized due to its variable availability in delivery rooms, providers’ limited experience, insufficient training, preference for endotracheal tube, and lack of awareness.

Vein of Galen aneurysmal malformation: rationalizing medical management of neonatal heart failure.

Neonates who present in high output heart failure secondary to vein of Galen aneurysmal malformation can be difficult to manage medically due to the complex physiology that results from the large shunt through the malformation. Though the cardiac function is often normal, right ventricular dilation, severe pulmonary hypertension, and systemic steal can result in inadequate organ perfusion and shock. This report recommends medical management for stabilization of neonates prior to definitive management with endovascular embolization. IMPACT: Vein of Galen aneurysmal malformation (VGAM) is a rare intracranial arteriovenous malformation, which can present in the neonatal period with high output heart failure. Heart failure secondary to VGAM is often difficult to manage and is associated with high mortality and morbidity. Despite optimal medical management, many patients require urgent endovascular embolization for stabilization of their heart failure. This report offers discrete recommendations that can be used by clinicians as guidelines for the medical management of heart failure in newborns with VGAM.

Serum KIM-1 and Cyctatin levels as predictors of acute kidney injury in asphyxiated neonates

Introduction: Asphyxia may lead to serious complications among them acute kidney injury (AKI) is the most common. Early diagnosis of AKI can help prevent impaired acid-base, fluid and electrolytes balance that may lead to life-threatening complications. The current study has aimed to assess efficacy of KIM-1 and Cystatin-C in early diagnosis of AKI among asphyxiate neonates. Methods: This is a case-control study conducted on 45 asphyxiate neonates, which 24 were in the control group and 23 in the case group.Creatinine, KIM-1 and Cystatine-C were measured for participants within 8- and 4 days after birth and compared between cases and controls. Results: The mean level of Cr-Standardized KIM1 8 hours and 4 days after birth was significantly higher in case group compared to the control (p-value 0.67 ng/ml allows to predict kidney failure in newborns with 57.1‌% sensitivity and 86.4‌% specificity. Conclusion: Our study showed that high-specificity Kim-1 is a good biomarker for early detection of acute renal failure in asphyxiated infants, but similar expectations of cystatin cannot be expected for at least the first 8 hours after birth.

The Truncated Splice Variant of the Granulocyte-Macrophage-Colony-Stimulating Factor Receptor β- Chain in Peripheral Blood Serves as Severity Biomarker of Respiratory Failure in Newborns

Background: The granulocyte-macrophage-colony-stimulating factor (GM-CSF) plays an important role in surfactant homeostasis. β_C is a subunit of the GM-CSF receptor (GM-CSF-R), and its activation mediates surfactant catabolism in the lung. β_IT is a physiological, truncated isoform of β_C and is known to act as physiological inhibitor of β_C. Objective: The aim of this study was to determine the ratio of β_IT and β_C in the peripheral blood of newborns and its association with the degree of respiratory failure at birth. Methods: We conducted a prospective cohort study in newborns with various degrees of respiratory impairment at birth. Respiratory status was assessed by a score ranging from no respiratory impairment (0) to invasive respiratory support (3). β_IT and β_C expression were determined in peripheral blood cells by real-time PCR. β_IT expression, defined as the ratio of β_IT and β_C, was correlated with the respiratory score. Results: β_IT expression was found in all 59 recruited newborns with a trend toward higher β_IT in respiratory ill (score 2, 3) newborns than respiratory healthy newborns ([score 0, 1]; p = 0.066). Seriously ill newborns (score 3) had significantly higher β_IT than healthy newborns ([score 0], p = 0.010). Healthy preterm infants had significantly higher β_IT expression than healthy term infants (p = 0.019). Conclusions: β_IT is expressed in newborns with higher expression in respiratory ill than respiratory healthy newborns. We hypothesize that β_IT may have a protective effect in postnatal pulmonary adaptation acting as a physiological inhibitor of β_C and, therefore, maintaining surfactant in respiratory ill newborns.

Outcomes of intrauterine interventions for the treatment in fetal urinary tract obstructions

Introduction: The leading cause of chronic renal failure in newborns, which occurs soon after birth is obstructive uropathies. Objectives: To prove the effectiveness of nephroamniotic shunting based on the evaluation of perinatal outcomes of this procedure, as well as a comparative analysis of the use of the stent manufactured by "Cook" (Ireland), 3.0 Fr/100 mm and the stent “SDE–MED”, 3.0 Fr/50 mm with the original shape of pigtails. Methods: After checking the safety of the stent “SDE-MED”, 3.0 Fr/50 mm developed by FGBU Mother and Child Care Research Institute with the original shape of pigtails in an animal experiment, the stent was used in clinical practice for intrauterine shunting in cases of unilateral or bilateral hydronephrosis of grade III to IV and posterior urethral valve disorder. In the final part of the study, a comparison of the outcomes of nephroamniotic shunting using two different stents was made. Results: The “SDE–MED” 3.0 Fr/50 mm stent provided more effective fixation in the fetal kidney cavity system in comparison to the stent manufactured by “Cook” (Ireland) 3.0 Fr/100 mm. Conclusion: Intrauterine shunting surgery of the upper urinary tract is a pathogenetically justified method of treating urinary tract obstructions and can be used to correct all types of fetal renal obstructions.

Acute liver failure in newborns.

Acute liver failure is a condition that is defined as a sudden, complete, or nearly complete loss of liver functions without any previous liver disease, usually accompanied by encephalopathy, which can be reversible, but with a mortality rate of 55-70%. Acute liver failure newborns is an acute liver failure in the first 28 days of life. The Pediatric Acute Liver Failure Working Group identified the presence of coagulopathy as the main finding for the identification of acute liver failure in childhood following vitamin K administration. Although the incidence of acute liver failure is reported to be 17/100 000 in all ages, its incidence is not known exactly in newborn and childhood. The most common cause of acute liver failure in the newborn period is the gestational alloimmune liver disease that was previously known as neonatal hemochromatosis. This is followed by viral infections, metabolic diseases, hemophagocytic lymphohistiocytosis, and other rare causes. In the neonatal period, acute liver failure is a rare condition with a high mortality rate. For this reason, the vital signs of the patients should be closely monitored and supportive treatments should be planned according to the follow-up and the etiology of the disease should be clarified urgently. In this process, acyclovir treatment until herpes simplex virus infection is excluded and lactose-free feeding until galactosemia is excluded are recommended as life-saving treatments. In the literature, since there is a limited number of studies related to neonatal acute liver failure, prospective studies investigating the factors affecting treatment and prognosis are needed.

Association of Gene Variants of Plasmic (<i>FGB</i> -455 G>A (rs1800790), <i>F2</i> 20210 G>A (rs1799963), <i>F5</i> 1691 G>A (rs6025), <i>F7</i> 10976 G>A (rs6046), <i>F13</i> G>T (rs5985)), Thrombocytic (<i>ITGA2</i> 807 C>T (rs1126643), <i>ITGB3</i> 1565 T>C (rs5918)), Fibrinolytic (<i>PAI-1</i> -675 5G>4G (rs1799889)) Hemostasis Components with Arterial or Venous Thrombosis in Newborns: Case-Controlled Study

Background. The severity of thrombosis clinical course, poor prognosis, upcoming disability and permanent organ failure in newborns necessitate further search and study of thrombotic conditions predictors in order to prevent them. Aim of the study is to analyze the frequency of gene variants of plasmic, thrombocytic and fibrinolytic hemostasis components and determine their role in the thrombosis development in newborn children. Methods. The study included 46 full-term newborns with thromboses of different localization – cases group. Inclusion criteria were: child age 28 days or less, gestational period >37 weeks, informed consent on participation in the study. The control group included children of I and II health groups. Vascular thrombosis was diagnosed via instrumental imaging methods: vascular ultrasound, computer tomography, magnetic resonance imaging. Thrombophilic anamnesis and pregnant woman’s health condition was analyzed according to pregnancy medical records. The molecular genetic testing included 8 single nucleotide polymorphisms definition of the following genes: FGB -455 G>A (rs1800790), F2 20210 G>A (rs1799963), F5 1691 G>A (rs6025), F7 10976 G>A (rs6046), F13 G>T (rs5985), ITGA2 807 C>T (rs1126643), ITGB3 1565 T>C (rs5918), PAI-1 -675 5G>4G (rs1799889). Results. Molecular genetic predictors of thrombosis in newborns have been revealed: variants of fibrinogen gene FGB -455 G>А (AP, %=66), plasminogen activator inhibitor gene PAI-1 -675 4G > 4G (AP, % = 89), genotype associations PAI-1 -675 4G/>4G /F7 10976 G>G (AP, % = 82), PAI-1 -675 4G>4G / F13 34 G>G (AP, % = 63)PAI-1 -675 4G>4G / F7 10976 G>G / F13 34 G>G(AP, % = 61), and integrin alpha 2 gene ITGA2 807 T/T (AP, % = 93). Maternal factor of thrombosis development in children is impaired uteroplacental circulation in pregnant woman (AP, % = 66). Conclusion. The role of gene variants of plasmic, thrombocytic and fibrinolytic hemostasis components in development of thrombosis in newborns was determined, as well as quantitative estimation of their contribution was presented.

Hipoksik iskemik ensefalopatili infantlarda tam kan sayımı parametreleri ve ekokardiyografi bulgularının prognostik değeri

Purpose: The aim of this study was to investigate the prognostic value of complete blood count parameters, presence of pulmonary hypertension (PH) and valve failure in newborns with hypoxic ischemic encephalopathy (HIE). Materials and Methods: 115 term newborns with Sarnat Stage 2 and 3 with HIE and 90 healthy newborns were included in this retrospective study. Echocardiographic examination, red blood cell distribution width (RDW), platelet distribution width (PDW), and C-reactive protein (CRP) values at the first six hours and at 72 hours after the cooling treatment were compared with controls.Results: There was a relationship between presence of mitral regurgitation (MR), aortic regurgitation (AR), and persistent PH and death. The mean RDW, PDW and CRP levels at the first six and after 72 hours were significantly higher in infants with HIE when compared with the control group, and these parameters were significantly increased in the stage 3 group. A significant relationship was found between the increase in RDW and CRP values and the presence of MR, AR and mortality.Conclusion: The degree of PH and presence of valvular insufficiency are important parameters in determining prognosis in HIE. Also, simple blood tests such as RDW and CRP and the echocardiographic evaluation are found to be correlated with hospitalization period and mortality and may be a guide in prognosis.

Volume Guarantee High-Frequency Oscillatory Ventilation in Preterm Infants With RDS: Tidal Volume and DCO2 Levels for Optimal Ventilation Using Open-Lung Strategies.

High frequency oscillatory ventilation with volume-guarantee (HFOV-VG) is a promising lung protective ventilator mode for the treatment of respiratory failure in newborns. However, indicators of optimal ventilation during HFOV-VG mode are not identified yet. In this study, we aimed to evaluate optimal high-frequency tidal volume (VThf) and the dissociation coefficient of CO2 (DCO2) levels to achieve normocapnia during HFOV-VG after lung recruitment in very low birthweight infants with respiratory distress syndrome (RDS). Preterm babies under the 32nd postmenstrual week with severe RDS that received HFOV-VG using open-lung strategy between January 2014 and January 2019 were retrospectively evaluated. All included patients were treated with the Dräger Babylog VN500 ventilator in the HFOV-VG mode. In total, 53 infants with a mean gestational age of 26.8 ± 2.3 weeks were evaluated. HFOV mean optimal airway pressure (MAPhf) level after lung recruitment was found to be 10.2 ± 1.7 mbar. Overall, the mean applied VThf per kg was 1.64 ± 0.25 mL/kg in the study sample. To provide normocapnia, the mean VThf was 1.61 ± 0.25 mL/kg and the mean DCO2corr was 29.84 ± 7.88 [mL/kg]2/s. No significant correlation was found between pCO2 levels with VThf (per kg) or DCO2corr levels. VThf levels to maintain normocarbia were significantly lower with 12 Hz frequency compared to 10 Hz frequency (1.50 ± 0.24 vs. 1.65 ± 0.25 mL/ kg, p < 0.001, respectively). A weak but significant positive correlation was found between mean airway pressure (MAPhf) and VThf levels. To our knowledge, this is the largest study to evaluate the optimal HFOV-VG settings in premature infants with RDS, using the open-lung strategy. According to the results, a specific set of numbers could not be recommended to achieve normocarbia. Following the trend of each patient and small adjustments according to the closely monitored pCO2 levels seems logical.

Clinical features of severe respiratory failure in children at 37 weeks’ gestational age

Purpose is to determine the clinical features of severe respiratory failure in newborns whose gestational age was 37 weeks. Methods Design – it was a retrospective, controlled, non-randomized, single-center study. 40 patients satisfied the inclusion and exclusion criteria. 7 (1.1%) children died. Depending on their gestational age, patients were divided into two groups. The basic group (n= 279) included newborns whose gestational age was 37 weeks. Children born at 34–36 weeks of pregnancy were in the group of comparison (n= 361). Patients from the both groups underwent a comparable intensive treatment and had similar values of initial treatment of ALV such as respiratory volume of at least 6 ml/kg, PEEP of 4–6 cm H2O, PRVS mode. BioStat was used for statistical analysis. Results . The rate of episodes of severe respiratory failure is quite comparable between the basic group and the group of comparison. Non-invasive ALV was more frequently used by patients from the basic group (χ2=4.23; p=0.05). Fetal growth restriction and higher pressure in the pulmonary artery was an important feature of respiratory failure course in children whose gestational age was 37 weeks as it resulted in a significantly higher rate of pulmonary hemorrhage episodes (χ2=9.608; р=0.02). Respiratory issues typical of the children can be seen only in those born by Cesarean section. Conclusion . The features of severe respiratory failure at 37 weeks’ gestational age include the children’s development when Cesarean section is used, fetal growth restriction and higher pressure in the right ventricle with more frequent episodes of pulmonary bleeding.

Extracorporeal membrane oxygenation as rescue therapy for severe hypoxemic respiratory failure.

Extracorporeal membrane oxygenation (ECMO) has been used for more than 50 years as salvage therapy for patients with severe cardiopulmonary failure refractory to conventional treatment. ECMO was first used in the 1960s to treat hypoxemic respiratory failure in newborns. On the basis of its success in that population, ECMO began to be used in the early 1970s to treat adult hypoxemic respiratory failure. However, outcomes for adults were, somewhat perplexingly, quite poor. By the 1980s, use of ECMO for severe hypoxemia was rare outside of the pediatric population. ECMO technology, however, continued to evolve and improve. Multiple case reports and small series describing ECMO use as rescue for adults with severe hypoxemia from various lung pathologies have appeared in the literature over the past three decades. Adult respiratory distress syndrome (ARDS) is often the final common pathway of various pathologies affecting adults and causing hypoxemic respiratory failure. It is prevalent in intensive care units throughout the world and has, since it was first described in 1967, carried a high mortality. No specific therapy for ARDS has been found, and current care is supportive, primarily by mechanical ventilation. Results from recent randomized controlled trials, however, suggest that ECMO may have a place in the treatment of these patients. This article reviews these studies and recommends adding severe ARDS to the list of established indications for ECMO in patients with hypoxemic respiratory failure.

Value of the natriuretic peptide level in diagnostics of newborns with heart failure

The article contains the first-ever data on correlation of the level of N-terminal fragment of natriuretic peptide in the serum of fullterm newborns with circulatory failure and persistent pulmonary hypertension syndrome; while the N-terminal fragment of natriuretic peptide can serve as a marker of circulatory failure in newborns. The study demonstrates that the dynamics of this peptide allows us to evaluate the effectiveness of the therapy.

СИНДРОМ ЭНДОГЕННОЙ ИНТОКСИКАЦИИ И ПОЛИОРГАННАЯ НЕДОСТАТОЧНОСТЬ И ЛЕТАЛЬНОСТЬ У НЕДОНОШЕННЫХ НОВОРОЖДЕННЫХ

В статье обсуждается целесообразность и возможность использования самых простых и доступных анализов и индексов крови беременных женщин для определения их влияния на развитие полиорганной недостаточности и летальности у недоношенных новорожденных с очень низкой и экстремально низкой массой тела.Приведенные в статье индексы и показатели крови объединяет доступность, простота их определения. Использованы распространенные шкалы для определения полиорганной недостаточности у новорожденных.Раскрыто влияние показателей крови беременной женщины (лейкоциты, абсолютное количество нейтрофилов, лейкоцитарный индекс интоксикации и индекс Гаркави) на развитие полиорганной недостаточности и летальности у недоношенных новорожденных. Выявлена связь повышенного количества лейкоцитов, высокого лейкоцитарного индекса интоксикации, и низкого уровня индекса Гаркави у беременных накануне родов с летальностью новорожденных, что может являться следствием дистресса и формирования анергии, как у матери, так и у ребенка. Статистически выявлены достоверные отличия исследуемых показателей.