[Prognostic criteria of the premature infants weaning from mechanical ventilation during trigger ventilation].

UNLABELLED: Modern mechanical ventilation modes do not prevent ventilator-associated lung injury therefore respiratory cessation must be stopped as soon as possible. However extubation recommendations absence makes difficulties in process of weaning the infants from the mechanical ventilation. RESEARCH OBJECTIVE: To assess the prognostic criteria of the extubating and weaning from mechanical ventilation in premature infants during trigger ventilation (PSV/PSV + VG). METHODS: 66 Pediatric patients were divided into two groups during the period of weaning from mechanical ventilation: PSV + PG ventilation mode was used in the group 1 (n = 33), and PSV in the group 2 (n = 33). Basic characteristics were same in both groups: gestational age 31.1 +/- 2.5 weeks, mass of body 1586.2 +/- 356.8 grams. Extubation was successful if reintubation was not needed during 48 hrs. RESULTS: 90% of successful extubations were done when the compliance was over 1.1 ml mbar(-1). Compliance decrease under 0.75 ml mbar(-1) was an adverse prognostic criterion of the weaning from mechanical ventilation and extubation. Index breathing rate/breathing volume (RVR) can be used as general criterion of the weaning from mechanical ventilation. Progressive RVR increase to 8 is an adverse prognostic criterion of PSV/ PSV + VG mode use during the period of weaning from mechanical ventilation. Parameters of mechanical ventilation which maintain acceptable gas composition of blood and SpO2 mast be considered before extubation. CONCLUSION: Positive dynamics and stabilization of compliance and resistance are essential criteria of the successful weaning from mechanical ventilation and extubation. RVR can be used as objective criterion of an extubation.

[Impact of herpesvirus infections on the level of proinflammatory cytokines in premature neonatal infants].

The aim of this study was to estimate the frequency of HSV and/or CMV among the pathogens causing intrauterine infections (IUI) and to investigate their impact on the level of proinflammatory cytokines in premature neonatal infants. Examinations were performed in 3 neonatal groups: 1) premature neonates with clinical manifestations of IUI; 2) those without IUI; 3) full-term newborns. In group 1, viral (HSV and/or CMV) and bacterial infections were detectable with the same frequency. Quantitative analysis of plasma IL-6 and IL-8 levels and the induced production of these cytokines by blood cells in vitro showed that in Group 1 neonates, IL-6 and IL-8 concentrations were substantially higher and the induced production of these cytokines was lowerthan those in Group 3. The detection of HSV and/or CMV markers in premature newborn infants was attended by a statistically significant rise in plasma IL-6 levels; the identification of the opportunistic bacterial microflora correlated with the higher concentration of IL-8. In Group 1, wiferon produced an immunomodulatory effect, by lowering IL-8 concentrations to the level observed in Group 3.

[Immune reaction to anesthesia and surgical injury in neonatal infants].

The impact of surgical injury and anesthesia on cellular and humoral immunity parameters was studied in neonatal infants with surgical pathology. These were found to have immunosuppressive activity, which appeared as evolving absolute lymphopenia and a reduction in the serum concentration of IgG. The magnitude of these changes depends on the functional state of the immune system in the preoperative period and is higher in infants with signs of an infectious-inflammatory process in the preoperative period, which increases the risk of septic complications. Preoperative immune replacement therapy with intravenous immunoglobulins (Pentaglobin) in neonates with severe developmental defects stops a fall in the level of cytotoxic lymphocytes in the early postoperative period.

[Detection of the markers of herpes simplex virus and cytomegalovirus in newborns and infants].

A total of 111 children suspected for herpesvirus infection were examined. In blood and urine samples the infectious activity of herpes simplex virus (HSV) and cytomegalovirus (CMV) was detected by the rapid culture method (RCM) and the presence of virus DNA--by the polymerase chain reaction (PCR). HSV and/or CMV were detected by two laboratory methods in 57 examined children (51%). Of these, in 18 children (16.2%) both HSV and CMV were detected. The coincidence of the results of the detection of HSV and CMV by these two methods was observed in 72.4% and 75.2% of cases respectively. The comparative analysis of the detection of anti-CMV IgG and IgM was made with the use of commercial test systems produced bythe following manufacturers: "Vector-Best" and "Bioservice" (Russia), "HUMAN" and "Boehringer" (Germany). The effective detection of both anti-CMV (IgG and IgM) was ensured by the test systems "Boehringer". The test system "Vector-Best" for anti-CMV IgG proved to be not inferior as regards sensitivity and specificity. The German test systems demonstrated the highest specificity in the detection of low-avid antibodies. The data obtained in this study indicate that the detection rate of HSV and CMV markers in newborns and infants suspected for herpesvirus infection was, on the average, 20 - 40%. Reliable diagnostics in newborns and infants is possible only in the presence of the combination of at least 2 serological tests (the determination of antivirus IgM and IgG avidity) and 2 methods for the detection of direct herpesvirus markers (PCR and RCM).

[Development of a PCR-based method for diagnostics of mycoses]. / Razrabotka i aprobatsiia sistem PTSR-detektsii dlia vyiavleniia invasivnykh mikozov.

Since the express-diagnostics of mycoses in immune-deficit patients still remains an acute problem, we developed an effective test system (Kan-Am) to detect DNA Candida albicans, which is a leader in the list of causative agents of candidosis. A comparison study of three PCR-systems used to detect a broad spectrum of fungoid pathogens was carried out, and a universal system (FungAm), which ensures the detection of DNAs of above 78 strains of 25 types of pathogenic fungi, was selected. The results of clinical testing of the species-specific and universal PCR-systems are well confirmed by the culture method, and they are indicative of the efficacy of applying them for the diagnostics of mycoses in neonatology. The use of the mentioned systems is a promising factor for the express-diagnostics of mycoses in immunodeficiency patients. The high sensitivity of the method makes it possible to detect 10 to 100 cells of a causative agent in 100 mcl of the examined biological material, which is compatible with the culture method. A kit of dry reagents (IonoMix) designed for an accelerated sample preparation and isolation, from them, of DNAs on the basis of Chelex-100 and of proteinase K was worked out; the kit is portable and meant for a long-term storing.