Intensive Care For Newborns Research Articles

A case of neonatal sepsis, early diagnosis and preventive intensive care

Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

DIAGNOSTIC VALUE OF ADDITIONAL MARKERS FOR ACUTE KIDNEY INJURY IN PRETERM NEONATES WITH PATENT DUCTUS ARTERIOSUS

A case of successful comprehensive treatment of necrotizing enterocolitis in a newborn child

Necrotizing enterocolitis is an inflammatory disease caused by infection and hypoxic–ischemic damage of the intestinal mucosa, which leads to generalization with the development of a systemic inflammatory response. The pathogenetic mechanisms leading to intestinal wall damage are ischemia and pain. Therefore, the use of central neuraxial blocks, which provide the analgesic effect and preganglionic blockade of the sympathetic nervous system, is pathogenetically justified.
 The aim of the work is to acquaint practitioners with the case of successful comprehensive treatment using neuraxial blocks in a newborn with necrotizing enterocolitis.
 Materials and methods. The child was treated at the Department of Anesthesiology and Intensive Care for Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using hospital equipment.
 Results. A child was operated due to suspected intestinal perforation and pneumoperitoneum. It was found that throughout the small and large intestines had multiple hemorrhages and air bubbles in the subserosa, but no perforation sites were found. Subsequently, the child underwent conservative treatment with antibacterial therapy according to the de-escalation principle, antifungal therapy, intravenous immunoglobulins, total parenteral nutrition. In addition to this standard treatment, the child underwent caudal-epidural blocks twice a day for a week in the postoperative period for effective analgesia, improvement of microcirculation and splanchnic blood flow.
 Conclusions. Surgical intervention performed on a newborn child with the second stage of necrotizing enterocolitis (intestinal pneumatosis), when its perforation could not be excluded, did not significantly affect the course of the disease, so the positive outcome can be considered the result of successful comprehensive intensive care. In our opinion, the decisive factor that influenced the positive treatment outcomes (prevention of perforation and peritonitis) was the effect of neuraxial caudal epidural blocks, which contributed to the improvement of microcirculation in the splanchnic area, elimination of intestinal ischemia and effective anesthesia.

THE INFLUENCE OF PERINATAL RISK FACTORS ON THE DEVELOPMENT OF MECONIUM ASPIRATION SYNDROME IN NEWBORN: IMPORTANT IN THE ROUTINE PRACTICE OF DOCTOR-NEONATOLOGIST

The article summarizes the data on known risk factors for meconium aspiration syndrome (MAS) and those that continue to be studied to increase the effectiveness of the organization and provision of primary resuscitation for newly born, intensive care fornewborns with MAS, prevention of aspiration pneumonia and complications of MAS, including early and late neonatal sepsis. MAS hasnot lost its relevance in recent years, despite studies of this problem on all continents and in almost every country in the world, which is associated with a high incidence of MAS, aspiration pneumonia, persistent pulmonary hypertension, and pneumothorax. The frequency of meconium in amniotic fluid is from 10 to 24%, and the implementation of meconium aspiration syndrome occurs in 3-12% of cases. MAS increases the frequency of antenatal, intranatal fetal death, as well as neonatal mortality to 4.2% in the case of severe meconiumaspiration. Despite the scientifically proven link between the occurrence of meconium amniotic fluid and individual factors, includingpregnancy, infection and hypoxia, which play a key role in the development of MAS, the degree of influence of these factors at differentstages of pregnancy is still being studied. A study of the effect of hypoxia and infection on the imbalance between fetal defecation,urination, swallowing, respiratory tract secretion and amniotic fluid clearance. The differences between the value of physiological intrauterine defecation and pathological discharge of meconium in utero against the background of the infectious process in the mother (microbial colonization of the amniotic cavity funisitis), and fetal distress are shown. The role of delayed pregnancy, infection, andhypoxia during pregnancy in the development of MAS is emphasized, with an emphasis on the chronic course of these processes. It waspointed out that gestational age over 41 weeks cannot be considered a primary factor, in the risk of developing MAS, and the fact that body weight at birth is also important in the appearance of amniotic fluid contaminated with meconium and the development of MAS. If a pregnant woman has a microbial invasion of the amniotic cavity: chorioamnionitis or funisitis, the development of MAS is possible in a child born prematurely. Emphasized diagnostic value of intrauterine infection - a risk factor for MAS due to an increase in the normof several inflammatory mediators identified in umbilical cord blood. The influence of circulatory disorders occurring in utero under theinfluence of stress and shock factors (functional disorders in the mother-placenta-fetus system, hypertension, late hestosis in the mother,dehydration, infection, metabolic disorders, bad habits). The additional focus of neonatologists to ensure objective monitoring of thecondition of the fetus in maternity hospitals during the briefing, predicting the course of MAS will be insufficient justification for theindications for the use of oxytocin. Timely detection of new risk factors for MAS, the addition of importance in the development of MASwill help to improve and timely update birth protocols, in the presence of amniotic fluid contaminated with meconium, resuscitation andpost-resuscitation care for newborns, optimize clinical routes.

SAFETY AND QUALITY OF INTRAVENOUS LIPIDS FOR NEWBORNS: EFFECTS ON CRITICAL DISEASES AND METABOLIC DISORDERS (PART II)

Premature birth and its complications cause stress in newborns, which restrains their physical growth for several weeks after birth and is associated with chronic morbidity and neurological disability in the future. Preterm infants face such difficulties as respiratory distress, cardiovascular disease, gastrointestinal dysfunction and very low birth weight. Most complications in newborns are associated with oxidative stress that develops during the early period of growth. The formation of free radicals entails oxidative damage to many organs and systems of the body and is the main factor responsible for the development of typical diseases of preterm infants, such as bronchopulmonary dysplasia, patent ductus arteriosus, retinopathy of prematurity, necrotizing enterocolitis, intraventricular hemorrhage, and respiratory distress syndrome.
 Premature infants depend on adequate early parenteral nutrition, which not only guarantees they will survive but also ensures positive health outcomes later in life. Early use of intravenous lipids helps to prevent essential fatty acid deficiencies, provides energy and substrates for cell membrane synthesis, which are important for the growth and development of infants with very low and extremely low birth weight. This publication represents data on the effect of intravenous lipids on critical conditions and metabolic disorders in newborns. Literature sources are analyzed and the existing evidence of the possible influence of lipid emulsions on critical diseases in newborns is presented: intraventricular hemorrhage; necrotizing enterocolitis, patent ductus arteriosus and thrombocytopenia; glucose metabolism (hypo- and hyperglycemia); hyperbilirubinemia and chronic liver damage. The literature review is aimed at finding optimal strategies for the use of lipid emulsions in intensive care of newborns to improve the quality of care for premature infants. The purpose of this work is to analyze the results of published studies and systematize data on the feasibility and safety of lipid emulsions used in newborns with critical diseases of the perinatal period.

Vladimir Alexi‐Meskishvili (1941–2021)

Vladimir Alexi‐Meskishvili (1941–2021)

ACUTE KIDNEY INJURY IN PREMATURE CHILDREN WITH HEMODYNAMICALLY SIGNIFICANT OPEN ARTERIAL DUCT

Introduction. Hemodynamically significant patent ductus arteriosus (HSPDA) leads to the “steal” phenomenon of the systemic circulation and renal hypoperfusion, which can contribute to the development of acute kidney injury (AKI).
 Aim of the study. To assess the frequency and severity of AKI according to the criteria of neonatal modification of KDIGO in premature infants with HSPDA.
 Material and research methods. We examined 74 premature infants (gestational age 29-36 weeks) who were treated in the department of anesthesiology and intensive care of newborns. The duration of observation was ten days from the first day of life. The patients were divided into three groups depending on the presence of patent ductus arteriosus (PDA) and its hemodynamic significance: group I - 40 children with HSPDA, group II - 17 children with PDA without hemodynamic disorders, group III - 17 children with closed arterial duct. Clinical examination and treatment of premature infants was carried out according to the generally accepted methods. In HSPDA, ibuprofen was used to close the ductus arteriosus for 32 premature babies, and restrictive infusion therapy for 8 ones.
 Doppler echocardiography was performed at 5-11 hours of life and then daily to determine the PDA, its size and hemodynamic significance. Diagnosis and stratification of the severity of acute kidney injury were carried out according to the criteria of neonatal modification KDIGO, for which the concentration of serum creatinine was studied on the first, third, fifth, seventh, tenth days and the level of urine output every 6-12 hours.
 Research results. AKI on the third day of life was diagnosed in 52.5% of children with HSPDA, which is 2.2 times more often than in children with PDA without hemodynamic significance (p <0.05) and 4.4 times more often than with closed arterial duct (p<0.007). On the fifth day of life, AKI was detected in two more children and their total number increased to 57.5%. On the seventh and tenth days of life, AKI in children with HSPDA was more common than in children with a closed duct (50.0% versus 11.8%, p<0.008, and 29.4% versus 0%, p<0.02, respectively).
 Analysis of the severity of acute kidney injury showed the effect of HSPDA on this parameter. The presence of HSPDA was a factor that led to the development of stage II AKI on the third and fifth days of life. In addition, with HSPDA, the frequency of stage III AKI increased 2.7 times within four days, while the percentage of stages I-II AKI decreased by 1.5 times.
 The frequency and severity of AKI in children with HSPDA depended on the size of the ductus arteriosus. With PDA up to 2 mm in diameter, on the third and fifth days of life, AKI was diagnosed in every fifth patient of stage I only, and on the tenth day of life - only in one patient. Meanwhile, in the majority of children with a PDA diameter of more than 2 mm, AKI was diagnosed on the third, fifth and seventh days; only on the tenth day of life, the number of such patients decreased 1.3 times. But the proportion of severe acute kidney injury practically did not change - acute kidney injury of stages II-III was observed on the first day in every second child with a large PDA diameter.
 The serum creatinine level on the third and tenth days directly depended on the size of the PDA on the first day (ρ = 0.493, p˂0.001 and ρ = 0.432, p˂0.002, respectively). With HSPDA, this dependence was more pronounced (ρ = 0.732, p˂0.001 and ρ = 0.731, p˂0.001, respectively) than in the group with PDA without hemodynamic significance (ρ = 0.285, p<0.05 and ρ = 0.324, p>0.05, respectively). The serum creatinine concentration directly correlated with the closure time of the PDA. Analysis of the connection between the rate of closure of the PDA and the presence of AKI in the HSPDA group showed that in the case of late closure of the ductus arteriosus (at 3-5 days of life), 16 (94.1%) premature infants suffered from kidney damage versus 1 (5.9%) case among children, in which the duct closed in the first two days (OR = 36.57; CI: 4.02-332.34 p<0.001). A close correlation was also established between the rate of closure of the PDA and the maximum stage of the AKI (ρ = 0.700, p˂0.001).
 Conclusions. HSPDA contributes to the development of AKI in premature infants. The diameter and rate of closure of the ductus arteriosus determine the frequency and severity of AKI in premature infants with HSPDA. Additional research is needed to diagnose acute kidney injury in premature babies with HSPDA earlier.

Effect of non–invasive ventilation on central and brain hemodynamics in term newborn infants with hypoxic – ischemic encephalopathy

The aim of the research. To study the effect of invasive and non-invasive lung ventilation in full-term infants with moderate and severe HIE on cerebral perfusion and central hemodynamics.Materials and methods To study the effect of non – invasive lung ventilation on central hemodynamics and cerebral perfusion, 60 infants with moderate and severe YIE were examined, thirty of them had early tracheal extubation 72 hours after birth and were transferred to non–invasive nasal lung ventilation with intermittent positive pressure (NIPPV), another 30 new-borns formed a comparison group. They had a traditional MV.Results No differences were found between the mean blood pressure and heart rate in the newborn core and comparison group, both during the first day of stay and during the fourth day, when the core group infants were extubated and transferred to NIPPV, but the mean BP level increased significantly after the core group infants were transferred to NIPPV, compared to the values of this indicator during the first day (p<0.05).The study of central hemodynamics indices in the new-born infants of the main group within a day after extubation and transfer to NIPPV did not reveal any differences in comparison with the new-born comparison groups. Stroke volume, heart index and left ventricular ejection fraction did not differ in the main group and comparison group.When studying the effect of non-invasive lung ventilation on brain perfusion, no reliable differences between the study groups were also found.Conclusions. No statistical difference was found between НI and EF in the main group and the comparison group, respectively. Non-invasive ventilation in NIPPV mode does not affect cerebral perfusion indices compared to conventional ventilation NIPPV and can be used in intensive care of new-borns with HIE

THE ANALYSIS OF THE EFFECTIVENESS OF THE PERINATAL CENTER IN PROVIDING QUALITY MEDICAL CARE

Introduction. Among the problems of health care during the reform period, the problem of quality management of medical care and effective management of the medical organization is particularly highlighted. The purpose of the study is to determine the main priorities of effective management of the medical organization of obstetric and gynecological profile to ensure the proper quality of medical care to the population. Materials and methods. We carried out quantitative and qualitative evaluation of the perinatal center in the period 2015-2017. Studied the efficiency of the administration of the human resources capacity of health organizations quality indicators of the hospital bed Fund and the financial-economic activity of enterprises. Results. The effective activity of the institution in the conditions of the established perinatal center is Shown due to the chosen strategy and tactics of the phased development of new obstetric, neonatal, inpatient-replacement technologies, the provision of highly specialized care with the use of modern equipment and medicines, which allowed to expand the range and volume of Advisory and diagnostic and treatment services, to reduce the level of perinatal and maternal losses. Discussion. The strengths of the organizational activities of the perinatal center management include: the inclusion of women’s consultation in the structure of the perinatal center, ensuring the continuity of care for gynecological and pregnant patients; state social support for motherhood and childhood, changing the conditions and procedure for the provision of free medical care to the population; functioning on the basis of the perinatal center of the Department of pathology of newborns, Department of resuscitation and intensive care of newborns, consultative and diagnostic and gynecological departments. The weak side of the organization can be attributed to the shortage of highly qualified personnel (doctors, nurses and Junior medical staff). Conclusion. In order to effectively use the resources of the institution, it is important to change the approach to the provision of material resources and their rational use in the process of the institution’s activities. The chosen strategy and tactics of management decision-making makes it possible to improve the quality and availability of medical care for pregnant women, mothers, maternity and newborn children.

STATE OF CELL ENERGY SUPPLY AND ITS AND CORRECTION IN INTENSIVE CARE FOR GASTROINTESTINAL INSUFFICIENCY SYNDROME IN NEONATES

In order to improve the intensive care for newborns with gastrointestinal insufficiency syndrome by providing the grounds to use amber acid, we carried out a randomized clinical trial involving 110 newborns with gastrointestinal insufficiency syndrome. The main group included newborns who received infusion with sodium succinate (n = 66) as a part of integrated therapy; the control group included the newborns who were not administered the above mentioned medication (n = 44). At the beginning of the study we observed a tendency towards the formation of lactate acidosis in the examined newborns, while no significant correlation was established between the severity of the gastrointestinal insufficiency syndrome and the indicators of cell energy supply. At the end of the study, the cell energy supply indicators varied in both groups by reducing the level of lactic acid, its ratio regarding pyruvic acid and increase in the activity of succinate dehydrogenase in newborns, who received amber acid in addition to the standard treatment. At the same time we observed a direct significant correlation between the severity of the syndrome of gastrointestinal insufficiency and the level of lactic acid. Thus, the examined newborns with gastrointestinal insufficiency syndrome are found to start developing cell energy disorders that is reflected in the progression and severity of the syndrome. Administration of amber acid medications helps to improve the state of cell energy supply, reducing the manifestations of lactate acidosis and declining the severity and progression of gastrointestinal insufficiency syndrome.

NITROGEN MONOXIDE AS A FACTOR OF ACTIVATION OF THE PROOXIDANT SYSTEM ON THE BACKGROUND OF SUBSIDIES OF HIGH CONCENTRATIONS OF OXYGEN IN NEWBORNS WITH RESPIRATORY DISTRESS

Data about the peculiarities of metabolism of endogenous NO in modern literature are quite controversial, especially in newborns with respiratory distress who need artificial lung ventilation. Investigating of the peculiarities of peroxidation processes on the background of excessive accumulation of nitrogen monoxide metabolites due to the inhalation of different concentrations of oxygen among newborns with severe respiratory insufficiency.84 newborns who were admitted to the department of intensive care of newborns were under investigation. They were randomized into groups according to their oxygen saturation index of the inhaled mixture. The exhaled breath condensate was tested for nitrogen monoxide metabolites, malonic aldehyde, aldehyde and ketone derivatives of the 2,4-dinitrophenyl hydrazine of a neutral and basic (aggregates of protein molecules) nature.Obtained results indicated that nitrogen monoxide (active oxidant) directly affects the increase of activity of processes of proteins and lipids peroxidation by increasing the total oxidation potential. Excessive endogenous NO formation under the conditions of subsidizing of high concentrations of oxygen leads to an increase in excessive formation of nitrogen monoxide and is a risk factor for the initiation of oxidative stress processes.Thus, nitrogen monoxide is one of the factors of activation of free radical oxidation at the level of alveolar-capillary space among newborns with respiratory distress. In intensive care for newborns with severe respiratory failure, the use of excessive oxygen concentrations should be avoided, as on the background of increased endogenous NO formation, there is a risk factor for the toxic effect of oxygen on the biological structures due to the increased formation of active forms of oxygen with the development of oxidative stress.

COMPLICATIONS AND OUTCOMES OF PREGNANCY IN CHRONIC KIDNEY DISEASE

Pregnancy in women with kidney disorders, even with preserved renal function, is associated with higher than in the population rates of obstetric and perinatal complications, such as eclampsia, preterm delivery, surgical deliveries and intensive care for newborns. This article presents our own data on complications and outcomes of pregnancies in 156 women with various stages of chronic kidney disease (CKD). From these, 87 patients had CKD stage I, 29 with CKD stage II and 40 with CKD stages III, IV, V. For the first time in Russia, the authors summarize their unique experience in management of pregnancy with CKD, underline a high probability (27,5%) of its primary detection during pregnancy, discuss the algorithms of assessment, prevention and treatment of various gestational complications in CKD (pre-eclampsia, urinary tract infections, feto-placental insufficiency, anemia, acute renal damage), as well as the influence of pregnancy on renal function at long-term post-delivery. A direct correlation between the CKD stage, frequency of pre-eclampsia, feto-placental insufficiency, preterm deliveries, surgical deliveries by caesarean section and babies’ status at birth is demonstrated. Based on their ample clinical material, they confirmprobability of favorable pregnancy outcomes in CKD patients with stable renal function without severe arterial hypertension during pregnancy: for a baby in 87%, for the mother in 90% (maintenance of the same CKD stage). The risk of persistent deterioration of renal function during pregnancy and puerperium in women with CKD is higher in CKD stage IV, as well as in the case of early development of pre-eclampsia; it also correlates with severity of the latter. The probability of a favorable obstetric and nephrological outcome is higher when the pregnancy is planned and intensively co-managed by an obstetrician/gynaecologist and a nephrologist from early weeks of gestation onwards.

ЛІКУВАЛЬНА ТАКТИКА ТА ІНТЕНСИВНА ТЕРАПІЯ В ДООПЕРАЦІЙНОМУ ТА РАННЬОМУ ПІСЛЯОПЕРАЦІЙНОМУ ПЕРІОДАХ У НОВОНАРОДЖЕНИХ ДІТЕЙ З ГАСТРОШИЗИСОМ.

<p> Дана робота присвячена аналізу проведення інтенсивної терапії новонароджених дітей з гастрошизисом в до- та післяопераційному періодах.Показано переваги даної'тактики та її ефективність в зниженні летальності дітей з гастрошизисом.<br /><br /></p>

Cardiotocography in the prognosis of perinatal outcome.

ABSTRACTAim:The objective of the study was to examine whether cardiotocography can (CTG) predict asphyxia of the embryo, manifested as hypoxic-ischemic encephalopathy (HIE), and to what extent one can rely on CTG record.Material and methods:Retrospective research was carried out at the Clinic for Gynecology and Obstetrics UKC Tuzla and medical documentation from the history of mothers and newborns was used. The study group consisted of 68 pregnancies and newborns who developed HIE. The control group consisted of 40 pregnancies, which resulted in birth of healthy newborns – without signs of asphyxia. CTG records were analyzed, Apgar score, the ways of finishing delivery.Results:Pathological CTG records (bradycardia 100, tachycardia 180, silent type of curve, late decelerations) were found in 45 (66,17%) cases of the study group in comparison to 11 (27,5%) in the control group. In the study group Apgar score in 5th minute lower than 7 had 17,46% newborns and the highest incidence of the normally finished deliveries. We conclude that cardiotocography is one of the reliable methods of fetal monitoring in pregnancy and delivery, and that pathological CTG record very likely indicates the possible presence of perinatal asphyxia.Conclusion:Achieving a low degree of correlation between pathological intrapartum cardiotocography findings and long-term outcome of children can be achieved by rapid and adequate obstetric intervention and the relatively short duration of fetal acidosis, and optimal procedures during intensive care of newborns.

Ultrasound evaluation of uterine scar after cesarean section.

Introduction:The rate of attempted vaginal birth after previous cesarean delivery has decreased, while the success rate of such births increased. Advances in surgical techniques, the development of anesthesiology services, particularly endotracheal anesthesia, very quality postoperative care with cardiovascular, respiratory and biochemical resuscitation, significantly reduce maternal mortality and morbidity after cesarean section. Progress and development of neonatal services, and intensive care of newborns is enabled and a high survival of newborn infants. Complications after cesarean section were reduced, and the introduction of prophylaxis and therapy of powerful antibiotics, as well as materials for sewing drastically reduce all forms of puerperal infection.Goal:Goal was to establish a measurement value of the parameters that are evaluated by ultrasound.Material and methods:Each of the measured parameters was scored. The sum of points is shown in tables. Based on the sum of points was done an estimate of the scar on the uterus after previous caesarian section and make the decision whether to complete delivery naturally or repeat cesarean section. We conducted a prospective study of 108 pregnant women. Analyzed were: shape scar thickness (thickening), continuity, border scar out, echoing the structure of the lower uterine segment and scar volumeResults:The study showed that scar thickness of 3.5 mm or more, the homogeneity of the scar, scar triangular shape, qualitatively richer perfusion, and scar volume verified by 3D technique up to10 cm are attributes of the quality of the scar.Conclusion:Based on the obtained results we conclude that ultrasound evaluation of the quality of the scar has practical application in the decision on the mode of delivery in women who had previously given birth by Caesarean section.

Características de madres gestantes y sus recién nacidos en relación con la edad de las madres en el departamento de Caldas (Colombia), 2003-2008

Antecedentes: Las edades maternas extremas se han considerado como la principal causa de alteraciones en el recién nacido, destacándose problemas en la talla, el pesoy el perímetro cefálico.Materiales y métodos: Estudio de corte trasversal con14124 recién nacidosde madres de todas las edades registrados en la base de datos del CLAP (Centro Latinoamericano de Perinatología) en el departamento de Caldas (Colombia, Suramérica), durante el períodode 2003 a 2008, de la cual se analizaron44 variables consideradas significativas para la realización del estudio.Resultados: Se encontró que las maternas con edades superiores a los 35 años constituyen el grupo etario con mayor número de alteraciones en los neonatos, como son el bajo peso, que se asoció con mayor muerte perinatal; mayor número de patologías crónicas asociadas a bajos Apgar al nacimiento y mayores probabilidades de necesidad de reanimación para los recién nacidos. Las maternas menores de 18 años presentaron productos con menor talla y perímetro cefálico, sin encontrarse relación con problemas posteriores.

1230 Changing Pattern of Neonatal Mortality of VLBW Infants in Croatia in 1998-99 and Ten Years Later - Population Survey

Aim: Analysis of VLBW newborns' mortality and comparison over ten-year period.Methods: Data were collected from nurseries and NICUs, embracing all VLBW newborns in Croatia.Results: Total of 663 VLBW newborns born in 1998- 99, and 345 who were born in 2008, are analyzed. Early neonatal mortality (ENM) and mortality to discharge from hospital (MDH) are shown in the table. Table Table Full size table Conclusions: ENM and MDH are reduced over the time.Efforts of neonatal services to reduce neonatal mortality could be realized as excess of “later mortality”, neonatal services in BW groups of 500- 599 g, 700-899 g reduced ENM substantially more than MDH.Apart of increased knowledge and experience in intensive care of newborns, as well as better equipment in maternities and NICUs, important increase in proportion of VLBW newborns who were born in maternities with NICU occurred, from 61% in 1998-99 to 81% in 2008. Extent of contribution of increased regionalization of perinatal care to reduction of neonatal mortality is unknown.

Dealing with doubt: Making decisions in a neonatal ward in The Netherlands

Neonatology provides intensive care for newborns. Most of the patients in a neonatal ward have been born prematurely. In this article decision-making concerning children born very prematurely (at fewer than 28 weeks, 12 or more weeks too early) is described. Three phases of daily practice are discussed: birth, treatment and referral or death. The article is based on ethnographic research conducted in the neonatal ward of the Amsterdam University Hospital. This ward's policy is to refrain from starting life-prolonging treatment for some children. This is done when staff members consider their chances too small. When life-prolonging treatment is started it is done provisionally and with trial-like features. Staff members want to judge the acceptability of the child's future quality of life. If they think it is unacceptable, they want to stop life-prolonging treatment. Parents play an important role in decision-making because their consent is needed for such decisions. More importantly, staff members need parental input about what, for that particular child and those parents, is seen as a good, bad or acceptable quality of future life. Decision-making shows a specific characteristic. Parents are informed about their child in sober terms and because they have considerable opportunities to influence decision-making it is argued that the processes taking place in the ward reflect the Dutch ‘negotiation culture’.

Predicting the future for newborns requiring intensive care

When intensive care for newborns was introduced thirty years ago its primary goal was to improve the rates of survival of sick and premature infants. Medicine has been successful in attaining this goal; however, as more infants survive, the cost of intensive care and the additional cost of services and care for handicapped survivors continue to escalate. In order to curb the increasing cost of newborn intensive care, heightened initiatives directed at the prevention of premature births will be necessary.

Mixed Blessings: Intensive Care for Newborns

Mixed Blessings: Intensive Care for Newborns