Comparison of Uncontrolled and Device-Induced Therapeutic Hypothermia in Newborn Infants with Hypoxic Ischemic Encephalopathy

Background. Newborn infants who have undergone severe birth asphyxia have a high risk of neurological disorders and death. The most effective method for the treatment of hypoxic ischemic encephalopathy caused by intrapartum asphyxia is therapeutic hypothermia, or targeted temperature management. Currently, there are no large studies comparing its different methods, therefore the aim of our study was to compare the effectiveness of device-induced and uncontrolled therapeutic hypothermia in newborn infants who underwent intrapartum asphyxia.Materials and methods. Study design: we conducted a retrospective, longitudinal, cohort study in 39 newborn infants born in severe asphyxia and receiving uncontrolled therapeutic hypothermia (group 1), and in 48 newborn infants born in severe asphyxia and receiving device-induced therapeutic hypothermia (group 2). Statistical data processing was carried out using standard techniques.Results. The body temperature in newborn infants of both groups was reduced to 33.5 °C within the first hour, but when using uncontrolled therapeutic hypothermia, the body temperature fluctuated from 32 to 35 °C. Device-induced therapeutic hypothermia has a more effective neuroprotective effect as compared to uncontrolled hypothermia (p< 0.05) and more rapidly stabilizes metabolism in newborns due to a decrease in lactate levels (p < 0.05). In newborns device-induced therapeutic hypothermia stabilizes hemodynamics more quickly compared to uncontrolled therapeutic hypothermia (p < 0.05). Device-induced therapeutic hypothermia reduces the period of hospitalization in the neonatal intensive care unit (p < 0.05), the risk of cerebral edema (p < 0.05) and of the repeated episodes of seizures (p < 0.05). Conclusion. Using uncontrolled therapeutic hypothermia causes a high risk of unintentional fluctuations in rectal temperature towards both hypothermia and rewarming, which can aggravate the severe condition of newborn infants. Device-induced therapeutic hypothermia has a more effective neuroprotective effect

Features of the Neonatal Period in Perinatally HIV-Exposed Children Receiving Combined Сhemoprophylaxis of mother-to-child Transmission of HIV

The aim. To study the features of the course of the neonatal period in children, perinatally exposed to HIV, who receive an enhanced regimen of chemoprophylaxis of HIV mother-to-child transmission.Patients and methods. A retrospective longitudinal cohort study of mother – child pairs for the period from 2017 to 2019 was carried out. The clinical observation group included HIV-positive women with a high risk of vertical transmission of the immunodeficiency virus (n = 213) and their newborn children (n = 214), who were prescribed an enhanced chemoprophylaxis regimen of HIV transmission from mother to child. Results. According to the results of the study of HIV-positive mothers we revealed a high prevalence of secondary diseases and a high per partum viremia – 1700 (222–18342) copies/ml. 35.9 % of children were born prematurely, 27.5 % – had low birth weight by gestational age. In newborns, diseases of the respiratory (24.3 %) and nervous (17.2 %) systems prevailed. 17.2 % of children developed intrauterine infection; HIV RNA was detected in 3.7 %. Congenital malformations were observed in 7.4 % of children. Symptoms of enteropathy were noted in 24.7 % of newborns. A decrease in red blood counts was found in all children by the 28th day of life (pw < 0.001).Conclusion. The study confirms the need for increased attention and improvement of approaches to medical support of children who were perinatally exposed to high risk of vertical HIV infection

HYPOXIC-ISCHEMIC ENCEPHALOPATHY IN NEONATES BORN TO SEVERE BIRTH ASPHYXIA

This article provides a literature review on the topic of hypoxic-ischemic encephalopathy (HIE). Hypoxic-ischemic brain damage of newborn belongs to one of the most important problems of anesthesiology and resuscitation of newborn babies. Despite progress, perinatal hypoxic-ischemic encephalopathy remains an important cause of child mortality and damage to the central nervous system resulting in a disability of children. HIE clinical signs are nonspecific, so the diagnosis is based on the combination of medical history, physical and neurological examination, laboratory data and neuroimaging techniques. Pathological stage runs when after undergoing asphyxia is the main purpose neuroprotective therapy. The first 6 hours of life of the child, born in asphyxia, is a therapeutic window for the stabilization of the vital functions of the body, during which therapeutic measures are most effective in reducing apoptosis of brain cells. The only method, relatively widely used and effective in infants with severe birth asphyxia, is controlled hypothermia. Published clinical studies show a statistically significant reduction in mortality and severe neuropsychiatric disability at 18 months of life in infants treated with hypothermia. The use of stem cells, the use of hypothermia in combination with xenon or erythropoietin improves neurological outcome: fewer deaths and serious damage to the nervous system. However, these techniques to date are in the experimental stage. Currently, the main task of neonatologists, anesthesiologists and intensive care specialists is not only saving newborn lives, but also creating conditions for proper growth and development of the child

Comparative characteristics of clinical, laboratory and instrumental indicators in children with seasonal influenza depending on the virus strain

Introduction. According to the literature, it is known that clinical signs and symptoms of influenza may differ depending on age, the state of the human immune system, the serotype of the virus and its virulence. Intoxication, catarrhal and hyperthermia are main symptoms of influenza, but the disease does not always proceed classically, it may hide under the mask of other infections.   The aim was to conduct a comparative analysis of clinical, laboratory and instrumental parameters in children with influenza A(H1N1) and A(H3N2).   Materials and methods. A single-stage retrospective comparative study was carried out with the participation of 96 children from 1 month of age up to 13 years old with a diagnosis of influenza, who were hospitalized at the Irkutsk Regional Infectious Clinical Hospital from December 2018 to January 2019. Clinical and laboratory features of the course of influenza in children were determined depending on a viral strain.   Results. The structure of morbidity: influenza A(H1N1) – 70 people (73 %), influenza A(H3N2) – 20 children (21 %), influenza A clinically unvaccinated – in 3 people (3 %), mixed viral infection influenza H1N1 + adenovirus infection – 2 cases (2 %), mixed viral infection H1N1 flu + RS-virus – 1 case (1 %). In the clinic of both strains of the virus, symptoms prevailed: runny nose, dry cough, fever, intoxication. Muscle pain and pharyngeal hyperemia were significantly more common in influenza A(H1N1), the duration of symptoms did not differ. Lymphocytosis was more often observed in influenza A(H1N1), monocytosis – in influenza A(H3N2) (р < 0.05). In 64 % of cases, patients with influenza A(H1N1) had a high leukocyte index of intoxication (odds ratio – 2.2).   Conclusion. The symptoms of different influenza A viral strains virus in children are the same, however, muscle pain and hyperemia of the pharynx prevails in children with influenza A(H1N1)

Мнение врачей различных специальностей о вакцинации: опасения и ожидания

Purpose of the study. To study the view of the Irkutsk physicians of different specialities on the vaccination.Materials and methods. We assessed the degree of awareness of 324 physicians of different specialities on the preventive vaccination based on the data of cross-sectional descriptive multicenter research. All the respondents were divided into three groups: group 1 (n = 218) – physicians prescribing vaccination for children (pediatricians, neonatologists); group 2 (n = 54) – physicians prescribing vaccination for adults (general practitioners, obstetricians-gynecologists); group 3 (n = 52) – physicians who can consult on the problems of vaccinations (neurologists and other physicians). Statistical analysis of the research results was carried out using Statistica 6.0. Critical level of statistical significancep assumed equal 0,05.Results. Physicians aged 21 to 50 years old prevailed (251/324 – 77,5%). Pediatricians (89/159 – 56%; χ2 = 5,94; df = 1; p < 0,05) and neurologists (19/27– 70,4%; χ2 = 4,46; p < 0,05) state their «sufficient» level of awareness on the vaccination. Obstetricians-gynecologists (28/42 – 66,6%; χ2 = 4,78; p < 0,05) state their «insufficient» level of awareness on the vaccination. Physicians of group 1 more often inform patients about the importance of vaccination (χ2 = 7,9, p < 0.01 and χ2 = 6,3, p < 0,05, respectively) and consider it necessary to vaccinate children additionally from current infections, unlike physicians of group 2 (χ2 = 27,6; df = 1; p < 0,0001). Most of the respondents (211/324 – 65,1%) agree with the necessity of introduction of a law on parental responsibility in case of vaccine-controlled disease for his child.Conclusion. Monitoring the adherence of physicians to immunologic prophylaxis for themselves and their patients will allow timely identification and elimination of emerging contradictions and problems, as well as to maintain a high level of confidence in vaccination among the population.  Цель: изучение отношения к вакцинации врачей разных специальностей г. Иркутска.Материалы и методы. По данным кросс-секционного описательного многоцентрового исследования проведена оценка информированности в вопросах вакцинопрофилактики 324 врачей разных специальностей. Из указанной выборки респондентов были выделены 3  группы: группа 1 (n = 218) – врачи, назначающие вакцинацию детям (педиатры, неонатологи); группа 2 (n = 54) – врачи, назначающие вакцинацию взрослым (терапевты, акушеры-гинекологи); группа 3 (n = 52) – врачи, которые могут консультировать по вопросам вакцинации (неврологи, хирурги и другие специалисты). Статистический анализ результатов проведён с использованием программы «Statistica 6.0». Критический уровень значимости при проверке статистических гипотез о существовании различий показателей между группами p принят равным 0,05.Результаты. Среди респондентов преобладали специалисты в возрасте от 21 до 50 лет (251/324 – 77,5%). О «достаточном» уровне знаний по вопросам вакцинации заявляют врачи-педиатры (89/159 – 56%; χ2 = 5,94; df = 1; p < 0,05) и врачи-неврологи (19/27 –70,4%; χ2 = 4,46; p < 0,05). «Недостаточными» признали свои знания врачи акушеры-гинекологи (28/41 – 66,6%; χ2 = 4,78; p < 0,05). Специалисты группы 1 чаще информируют пациентов о важности прививок (χ2 = 7,9, р < 0,01) и считают необходимым прививать детей дополнительно – от актуальных инфекций, в отличие от врачей из группы 2 (χ2 = 27,6; df = 1; р < 0,0001). Многие опрошенные (211/324 – 65,1%) согласны с необходимостью юридической ответственности родителя в случае возникновения у его ребёнка заболевания, контролируемого вакцинопрофилактикой. Заключение. Мониторинг приверженности врачей к иммунопрофилактике для себя и своих пациентов позволит своевременно выявлять и устранять возникающие противоречия, а также поддерживать высокий уровень доверия к вакцинации у населения

Views of the physicians of different specialities on the vaccination: concerns and expectations

Purpose of the study. To study the view of the Irkutsk physicians of different specialities on the vaccination.Materials and methods. We assessed the degree of awareness of 324 physicians of different specialities on the preventive vaccination based on the data of cross-sectional descriptive multicenter research. All the respondents were divided into three groups: group 1 (n = 218) – physicians prescribing vaccination for children (pediatricians, neonatologists); group 2 (n = 54) – physicians prescribing vaccination for adults (general practitioners, obstetricians-gynecologists); group 3 (n = 52) – physicians who can consult on the problems of vaccinations (neurologists and other physicians). Statistical analysis of the research results was carried out using Statistica 6.0. Critical level of statistical significancep assumed equal 0,05.Results. Physicians aged 21 to 50 years old prevailed (251/324 – 77,5%). Pediatricians (89/159 – 56%; χ2 = 5,94; df = 1; p < 0,05) and neurologists (19/27– 70,4%; χ2 = 4,46; p < 0,05) state their «sufficient» level of awareness on the vaccination. Obstetricians-gynecologists (28/42 – 66,6%; χ2 = 4,78; p < 0,05) state their «insufficient» level of awareness on the vaccination. Physicians of group 1 more often inform patients about the importance of vaccination (χ2 = 7,9, p < 0.01 and χ2 = 6,3, p < 0,05, respectively) and consider it necessary to vaccinate children additionally from current infections, unlike physicians of group 2 (χ2 = 27,6; df = 1; p < 0,0001). Most of the respondents (211/324 – 65,1%) agree with the necessity of introduction of a law on parental responsibility in case of vaccine-controlled disease for his child.Conclusion. Monitoring the adherence of physicians to immunologic prophylaxis for themselves and their patients will allow timely identification and elimination of emerging contradictions and problems, as well as to maintain a high level of confidence in vaccination among the population