Особенности клинического течения тяжелой дыхательной недостаточности у новорожденных 37 недель гестационного возраста

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.Цель. Определение клинических особенностей течения тяжелой дыхательной недостаточности у новорожденных 37 недель гестационного возраста. Методы. Дизайн исследования – ретроспективное, контролируемое, нерандомизированное, одноцентровое. Критериям включения и исключения соответствовало 640 пациентов. Погибло 7 (1,1%) детей. Пациенты, в зависимости от гестационного вораста, были разделены на две группы. Основная (n=279) новорожденные с гестационным возрастом 37 недель. Группа сравнения (n=361) новорожденные с гестационным возрастом 34–36 недель. У детей в обеих группах были сопоставимая интенсивная терапия и параметры стартовой ИВЛ: дыхательный объем не более 6 мл/кг, РЕЕР 4–6 см вод., режим PRVS. Статистическая обработка проводилась на основе статистической программы «BioStat». Результаты. Частота развития эпизодов тяжелой дыхательной недостаточности вполне сопоставима у новорожденных основной группы и группы сравнения. У пациентов основной группы чаще использовались неинвазивная ИВЛ (χ2=4,23, p=0,05). Важной особенностью течения дыхательной недостаточности у детей 37 недель гестационного возраста является наличие задержки внутриутробного развития и более высокое давление в системе легочной артерии, способствующее достоверно более высокой частоте развития эпизодов легочного кровотечения (χ2 = 9,608; р = 0,02). Респираторные проблемы, характерные для новорожденных 37 недель гестационного возраста реализуются только у новорожденных, извлеченных путем кесарева сечения. Выводы. Особенностью течения тяжелой дыхательной недостаточности у новорожденных с гестационным возрастом в 37 недель являются их развитие при родоразрешении путем кесарева сечения, наличие задержки внутриутробного развития и более высокие значения давления в правом желудочке с более частым развитием эпизодов легочного кровотечения

Сравнительная оценка прогностической способности шкал nSOFA и NEOMOD у недоношенных новорожденных

BACKGROUND: A life-threatening organ dysfunction is a strong predictor of in-hospital mortality and adverse outcomes in pediatric patients and full-term neonates. Predictors of outcomes of multiple-organ failure in preterm newborns have not yet been sufficiently determined. AIM: To compare the discriminatory ability of neonatal sequential organ failure (nSOFA) and NEOMOD organ dysfunction scales as predictors of poor outcomes in very preterm newborns. MATERIALS AND METHODS: This prospective observational study included 109 newborns with a birth weight of 1071 (7721451) g and gestational age of 29 (2632) weeks; 22 (20.4%) of them died. RESULTS: The area under the receiver operating characteristic curve was 0.796 (95% confidence interval (CI) 0.7630.827) for the nSOFA scale and 0.771 (95% CI 0.7210.817) for the NEOMOD scale. CONCLUSIONS. Both scales are suitable for measuring the severity of organ dysfunction in preterm newborns. nSOFA appears to predict mortality in preterm newborns.Актуальность. Наличие угрожающей жизни органной дисфункции надежный предиктор госпитальной смертности и неблагоприятных исходов у педиатрических пациентов и доношенных новорожденных. Прогнозирование исходов полиорганной недостаточности у недоношенных новорожденных пока недостаточно разработано. Цель сравнительная оценка дискриминационной способности шкал органной дисфункции nSOFA и NEOMOD в качестве предиктора неблагоприятного исхода у глубоко недоношенных новорожденных. Материалы и методы. Дизайн исследования проспективное обсервационное. В разработку включено 109 новорожденных с массой тела при рождении 1071 (7721451) г, гестационный возраст 29 (2632) нед., 22 (20,4 %) из них умерло. Результаты. Площадь под ROC кривой для шкалы nSOFA составила 0,796 (95 % доверительный интервал (ДИ) 0,7630,827), для шкалы NEOMOD 0,771 (95 % ДИ 0,721 0,817). Выводы. Обе шкалы подходят для измерения тяжести органной дисфункции у недоношенных новорожденных. Использование nSOFA представляется обоснованным для прогнозирования летальности у недоношенных новорожденных

Palivizumab: Four seasons in Russia

In 2010, the Russian Federation (RF) registered palivizumab - innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization. © 2014, Izdatel'stvo Meditsina. All rights reserved

Palivizumab: Four seasons in Russia

In 2010, the Russian Federation (RF) registered palivizumab - innovative drug, based on monoclonal antibodies for passive immunization of seasonal respiratory syncytial virus (RSV) infection in children of disease severe progress risk group, which include primarily premature infants, children with bronchopulmonary dysplasia and hemodynamically significant congenital heart disease. Currently, palivizumab is included in the list of recommended medicines and medical care standards of different countries, including Russia. In the review the results of Russian research on the progress of RSV infection, its epidemiology and immunization experience gained over the 2010-2014 period are summarized in relation to the foreign data. During the four epidemic seasons palivizumab immunization covered more than 3,200 children of severe RSV infection risk group with a progressive annual increase in the number of patients who received the drug. Geography of palivizumab immunization is also greatly expanded in our country during this time. If during the first two seasons measures of immunization were taken mainly in Moscow and St. Petersburg, at the present time, thirty one territorial entities of the Russian Federation have the experience in the drug application. Analysis of the results of RSV infection immunization (made in several regions) confirms the high clinical efficacy and palivizumab safety already demonstrated in international studies. In addition, the analysis presents the potential to improve the efficiency of the integrated RSV infection immunization programs, realizing in the establishment of high-risk child group register, adequate counseling for parents, as well as the development of the routing of patients and coordination of interaction between different health institutions during the immunization. © 2014, Izdatel'stvo Meditsina. All rights reserved