Gastrointestinal insufficiency syndrome in intensive care of newborn: literature review.

The research analytical study of scientific publications in Cochrane Library, Medline, Scopus, Pubmed, Google Scholar databases for the period from 2008 to 2018 was conducted. Modern views on the course of critical states are increasingly considering this process as the uniform mechanism with universal pathogenetic links that lead to the formation of multiple organ lesions, including the digestive system lesions. The contingent of newborns is the patients of high risk of this syndrome occurrence. The frequency of gastrointestinal insufficiency in neonatology makes 80%. The anatomical and functional features of newborns contribute to the development of the syndrome of gastrointestinal insufficiency. There is no clear classification, diagnostic and treatment algorithm of this syndrome. The residual stomach volume measurements when feeding, the abdominal circumference and intraabdominal pressure measurements are used as markers of gastrointestinal insufficiency syndrome in newborns. The additional methods are available X-ray, dopplerographia, electrogastrographia, manometria, phonenterographia, the studies of the fatty-acid-binding proteins, zonulin, ß-defensins, calprotectin. The therapy of the gastrointestinal insufficiency syndrome in newborns include the evacuation of pathological intestinal content, detoxification, stimulation of intestinal motility, elimination of mesenteric blood flow violations, restoration of the intestinal microbiota, adequate energoplastic and cyto-energy homeostasis.

Expression of the Toll-like receptors 2 gene as a genetic determinant of the formation of newborns multiple organ failure syndrome.

Shkurupii DA. Expression of the Toll-like receptors 2 gene as a genetic determinant of the formation of newborns multiple organ failure syndrome. Turk J Pediatr 2019; 61: 500-504. Activation of the humoral immune response in newborns` multiple organ failure syndrome is associated with the production of interleukin-1ß, which is recognized via Toll-like receptors 2 (TLR2). The aim of this study was to determine the role of expression of the Toll-like receptors 2 gene in the pathogenesis of newborns with multiple organ failure syndrome. A prospective observational cohort study of 149 newborns was conducted. The main group (n = 113) were newborns with multiple organ failure syndrome, whereas the comparison group (n = 36) was newborns without this syndrome. The study included analysis of the expression of the TLR2 gene and its comparison with the concentration of interleukin-1ß, peripheral blood lymphocyte count and clinical signs of the course of the disease. It was found that the population risk of reducing TLR2 expression was 79.33% in the main group, and 27.62% in the comparison group. Increasing the expression of the gene TLR2 in newborns leads to an increase in the concentration of interleukin-1ß, an increase in the level of peripheral blood lymphocytes and is associated with the formation of microbial loci. Expression reduction of the TLR2 gene may lead to the development of multiple organ failure syndrome, systemic inflammatory response syndrome, increase in the number of affected organs, increased frequency of involvement in the immune system, and the need for aggressive respiratory therapy.

Prevention of ventilator-associated pneumonia in newborns.

OBJECTIVE: The aim of the study is to optimize the prevention of the development of ventilator-associated pneumonia in newborns by developing a method for tracheal rehabilitation and assessment of its effectiveness. PATIENTS AND METHODS: Materials and methods: A prospective cohort randomized clinical study was organized, particularly artificial ventilation of the lungs was conducted on 90 newborns. Patients were divided into two groups. In the main group (n = 50) an intubation tube of author's design was used, which design allowed prophylactic tracheal sanation on the outer wall of the intubation tube, which included vacuum aspiration of the tracheal secretion and irrigation with a solution of antiseptic decamethoxin 0.02% every 3 hours. In the comparative group (n = 40) the classical non-cuff structure of the intubation tube was used; preventive tracheal sanation on the outer wall of the intubation tube was not carried out. RESULTS: Results and conclusions: Preventive tracheal sanation on the outer surface of the intubation tube in newborns units that undergo artificial ventilation of the lungs exhibit high efficiency against the main types of microorganisms that are dangerous from the point of view of the development of ventilator-associated pneumonia. The use of prophylactic tracheal sanitization in newborns - patients of neonatal intensive care units, which undergoes artificial ventilation of the lungs, can significantly lower the frequency of the implementation of ventilator-associated pneumonia.

Nutritive support for newborns in critical conditions: semi-elemental formilas as a means of enteral nutrition.

OBJECTIVE: Introduction: The goal is to increase the efficiency of nutritional support in intensive care of newborns by substantiating the choice of the enteral blend. PATIENTS AND METHODS: Materials and methods: A prospective cohort study was conducted, which included 173 newborns. The main group consisted of 143 patients of intensive care units. The comparison group - 30 virtually healthy newborns. Physical parameters, changes in protein metabolism, serum immunoglobulins, functioning of the gastrointestinal tract and hepatobiliary system in the development of critical conditions and depending on the type of enteric urine formula were determined. RESULTS: Results: At the beginning of newborn enteral nutrition in the main group, (46.15% of cases), there were signs of gastrointestinal malformation, distributions were detected in protein metabolism, decreased serum immunoglobulin fractions, gastroduodenal cytoprotection, increased alkaline phosphatase activity. Against the background of the use of semi-elemental hydrolysable formulas a greater frequency of excretions was observed, the assimilation orientation of protein metabolism, increased levels of serum immunoglobulin fractions, reduction of gastroduodenal cytoprotection, reduction of laboratory characteristics cholestasis and damage to hepatocytes. CONCLUSION: Conclusions: In newborns in critical conditions, adaptation to the onset of enteral nutrition is accompanied by a catabolic direction of metabolism. The use of semi-elemental formulas increases the efficiency nutritional support in the intensive care of newborns.

Early enteral nutrition as a part of intencive care of abdominal surgical pathology.

INTRODUCTION: Patients with abdominal surgical pathology always have gastrointestinal failure. Under such conditions, the enteral administration of nutrients may be started by trophic nutrition; however, starting nutritional mixtures for it have not been clearly defined. The aim of this study was optimization of energetic and plastic supply of patients with abdominal surgical pathology by studying the efficacy of the clinical nutrition means. MATERIALS AND METHODS: An observational analytical observational prospective case-control study of clinical nutrition efficacy has been conducted in 112 patients aged 18 to 45, who underwent intencive care after urgent abdominal surgical interventions. The patients were divided into two groups: in the treatment group (n=64), trophic nutrition by a semi-elemental nutritional formula was initiated within 12 hours after completion of surgery, and in the control group (n=48), the conventional clinical nutrition tactics was used. The levels of serum albumin, glycosaminoglycans, alkaline phosphatase and urine diastase activities were assessed; the lengths of patients' stay in the intensive care unit was recorded. RESULTS AND CONCLUSIONS: The application of early enteral nutrition in the regimen of trophic nutrition with the use of a semi-elemental nutritional formula allowed to improve protein provision (serum albumin level - 38.68±1.55 g/l vs 32.04±1.5 g/l) (?<0.05), to decrease the functional load on the cytoprotective system of the gastrointestinal mucosa (level of glycosaminoglycans 0.11±0.079 g/l vs 0.181±0.113) (?<0.05), to decrease the severity of cholestasis (alkaline phosphatase activity 620.6± 6.22 nmol/s/l vs 723±7.2 nmol/s/l (?<0.05), to achieve relative functional rest of the pancreas (44.5±1.7 g/(h x l) vs 62.6±2.1 g/(h x l)) (?<0.05) and allowed to decrease the length of patients' stay in the intensive care unit (115.9±2.69 hours vs 130.8±3.06 hours) (?<0.05).

[Condition and consequences of zinc metabolic disorder in patients with neurosurgical pathology requiring intensive care].

INTRODUCTION: diseases that require neurosurgical intervention for many years constitute the major cause of disability and death in the world. These patients develop the disorder of zinc supply which is a universal bioregulator. The aim of the research is the assessment of zinc metabolism and effects of its disorder in patients with neurosurgical disorders that require intensive care. MATERIALS AND METHODS: observational analytical retrospective research ( « Case control study ¼ type) of zinc exchange status in 60 patients was conducted. Study group included 40 patients of neurosurgical profile who needed intensive care. Control group consisted of 20 conventionally healthy volunteers. Presence of clinical and laboratory signs of zinc deficiency, presence or absence of gastrointestinal failure, level of consciousness, need for mechanical ventilation, and severity of patient's condition were assessed. Statistical analysis of the results was performed using the methods of descriptive statistics, nonparametric comparison of two groups in terms of qualitative and quantitative indicators, establishing correlation relationships. RESULTS AND CONCLUSIONS: in neurosurgical patients requiring intensive care, on the third day of treatment reduction in plasma zinc was observed, causing the clinical signs of zinc deficiency, even without achieving the minimum diagnostically significant threshold of its content in blood of 13 mcM/l. Zinc deficiency contributes to gastrointestinal, cerebral and immune insufficiency, increases the need for artificial lung ventilation and aggravates the severity of patient's condition. At the same time, high mortality of neurosurgical patients requiring intensive care is not directly related to the level of zinc in the blood plasma.