Efficacy of bowel ultrasound to diagnose necrotizing enterocolitis in extremely low birthweight infants.

BACKGROUND: Bowel ultrasound (US) is one of the methods used to enhance diagnostic accuracy of necrotizing enterocolitis (NEC) and its associated complications in premature newborns. AIM: To explore the diagnostic accuracy of BUS in extremely low birth weight (ELBW) infants with NEC. METHODS: A single-center retrospective case-control study included 84 extremely low birth weight (ELBW) infants. The infants were divided into three groups: Group 1 -infants with NEC (n = 26); Group 2 -infants with feeding problems (n = 28); Group 3 -control group (n = 30). RESULTS: The specific BUS findings in premature newborns with NEC (stage 3) included bowel wall thinning, complex (echogenic) ascites, and pneumoperitoneum, p <  0.05. The diagnostic effectiveness of these sonographic signs was 96.8% (sensitivity 75.0% and specificity 97.6%), p <  0.05. These findings with high specificity were associated with the need for surgical intervention, poor outcomes, or increased mortality. Stage 2 NEC which did not require surgery showed impaired differentiation of the bowel wall layers, absent or decreased bowel peristalsis, pneumatosis intestinalis, portal venous gas, or simple ascites, with a diagnostic accuracy of 82.9% (sensitivity 55.6%, specificity 91.4%, p <  0.05). CONCLUSIONS: BUS can be used as an adjunct to abdominal radiography to aid in the diagnosis of infants with suspected NEC by providing more detailed evaluation of the intestine.

Exhaled breath condensate analysis from intubated newborns by nano-HPLC coupled to high resolution MS.

Invasiveness of examination and therapy methods is a serious problem for intensive care and nursing of premature infants. Exhaled breath condensate (EBC) is the most attractive biofluid for non-invasive methods development in neonatology for monitoring the status of intubated infants. The aim of the study was to propose an approach for EBC sampling and analysis from mechanically ventilated neonates. EBC collection system with good reproducibility of sampling was demonstrated. Discovery-based proteomic and metabolomic studies were performed using nano-HPLC coupled to high resolution MS. Label-free semi-quantitative data were compared for intubated neonates with congenital pneumonia (12 infants) and left-sided congenital diaphragmatic hernia (12 infants) in order to define disease-specific features. Totally 119 proteins and 164 metabolites were found. A number of proteins and metabolites that can act as potential biomarkers of respiratory diseases were proposed and require further validation.

[Determination of proteomic and metabolic composition of exhaled breath condensate of newborns].

Here, the possibility of proteomic and metabolomic analysis of the composition of exhaled breath condensate of neonates with respiratory support. The developed method allows non-invasive collecting sufficient amount of the material for identification of disease-specific biomarkers. Samples were collected by using a condensing device that was incorporated into the ventilation system. The collected condensate was analyzed by liquid chromatography coupled with high resolution mass spectrometry and tandem mass spectrometry. The isolated substances were identified with a use of databases for proteins and metabolites. As a result, a number of compounds that compose the exhaled breath condensate was determined and can be considered as possible biomarkers of newborn diseases or stage of development.

Studying the Proteomic Composition of Expired Air Condensate in Newborns on Breathing Support.

This study was designed to collect and perform a proteomic analysis of expired air condensate in newborns receiving respiratory support at the Department of Resuscitation and Intensive Care. The proteomic composition of expired air condensate was evaluated in newborns at various stages of development and with different abnormalities.

Proteomic Analysis of the Urine for Diagnostics in Newborns.

Proteomic analysis of the urine was used for noninvasive diagnostics of abnormalities in newborns treated in the neonatal intensive care unit. This approach can be used to differentiate between infectious and noninfectious respiratory disorders.

[The methodology of therapeutic hypothermia in children born in a state of asphyxia].

This guideline provides the diagnostic and treatment algorithm for newborns with gestational age over 35 weeks and weighing more than 1800g who has severe asphyxia in birth with the threat of severe or medium-severe hypoxic-ischemic encephalopathy.

[Efficiency of hydroxyethyl starch use for arterial hypotension and shock in early postoperative period].

UNLABELLED: It is common knowledge that arterial hypotension is a one of most prevalent pathology of early neonatal period and it causes severe neurological complications. Purpose of the prospective randomized open study was to assess the efficacy of HES 130/0.4 (6% Voluven) as a start medicine for arterial hypotension in early neonatal period in comparison with normal saline solution (0.9% NaCl). MATERIALS AND METHODS: the study was held from January 2010 to September 2011. Newborns of the ICU with arterial hypotension on the first day of life were included into the study. Acute haemorrhage was an exclusion criterion. Routine monitoring of arterial pressure, heart rate and diuresis was carried out in all newborns. pH, pCO2, pO2 blood glucose, lactate and BE levels were measured before and after the treatment. Echocardiography, examination of regional blood flow in anterior cerebral artery, renal artery and mesenteric artery was held HES 130/0.4 (6% Voluven) and saline solution (0.9% NaCl) were used Parameters of haemostasis, biochemical and haematological analysis monitored after the solutions use. Time of arterial pressure normalization and duration of the treatment positive effect were recorded Episodes of hypotension, amount of cardiotonics per day and per 7 days and duration of cardiotonics administration were recorded as well. RESULTS: 6% Voluven infusion both to 0.9% NaCl infusion normalizes the regional circulation. Furthermore it increases the blood pH and diuresis. Lactate level normalization occurred only after 6% Voluven infusion. There was not change of serum sodium level. Liver enzymes, C-protein, prothrombin index were same in both groups of patients. 6% Voluven use in newborns with extremely low birth weight was accompanied with increasing of creatinine level, prolongation of activated partial thromboplastin time and increasing of intraventricular hemorrhage rate. Newborns with weight over 1000 gram did not have these complications. Voluven advantage in comparison with saline solution is a decreasing of cardiotonics administration in patients with weight over 1000 gram. CONCLUSIONS: 6% Voluven is more effective than 0.9% NaCl for increasing of cardiac output, myocardial contractile ability and diuresis, normalization of liquid balance and lactate level, decreasing of cardiotonics amount. 6% Voluven can be recommended for arterial hypotension treatment in newborns with weight over 1000 gram both to normal saline solution especially in case of shock.

[High-frequency oscillatory lung ventilation in complex therapy for congenital pneumonia and hyaline membrane disease in newborns].

Fifty-eight neonatal infants with hyaline membrane disease (HMD) and congenital pneumonia were examined in the critical status. In 32 of them, high-frequency oscillatory lung ventilation (HFOLV) was employed. The use of HFOLV was found to reduce the length of stay in neonates on toxic oxygen concentrations by more than 2 times and to accelerate the normalization of ventilation-perfusion relationships by more than 3 times. A study of the basic parameters of central and regional hemodynamics showed that HFOLV failed to affect the patients' hemodynamic status. The efficiency of correction of severe respiratory disorders in neonatal infants with HMD was ascertained to increase with the combined use of the Russian surfactant and HFOLV. A formula was developed to calculate the starting amplitude of oscillations when HFOLV was employed. The maximum allowable values of mean airway pressure at which HFOLV could be discontinued were determined, which prevented the regimens from toughening when HFOLV was changed to the routine artificial ventilation. The use of HFOLV was established to reduce the risk of severe cerebral structural and vascular lesions and mortality rates.