[Clinical and neurophysiological objectification and evaluation of treatment efficacy in children with perinatal hypoxic-ischemic injury of the CNS].

OBJECTIVE: To objectify indications for treatment with pantogam in premature infants with perinatal hypoxic-ischemic injury of the CNS. MATERIAL AND METHODS: We studied 71 children, with GA (gestation age) 24-36 weeks (32,9±2,9 weeks), with perinatal hypoxic-ischemic injury of the CNS, I-II grades, and hyperexitability syndrome. The main group (33 patients) received pantogam in dose 50 mg/kg/day at the adjusted age (AA) 36-40 weeks from the conception. The comparison group included 38 patients. EEG day sleep monitoring was performed before and at the end of treatment. RESULTS: Shortening of sleep cycle was observed in 78,8% children of the main group and in 78,9% of the comparison group. Duration of transitional sleep over 1 min was 78,79% and 81,58%. At AA 44-46 weeks, the frequency of sleep disorders decreased to 45,45% (p=0,012) and 52,63% (p=0,05). Duration of transitional sleep over 1 min was 45,45% and 65,79%. Duration of the latent period of the 2nd stage of slow wave sleep was 6,4±2,57 and 12,5±7,18 min (p=0,0004). CONCLUSION: The treatment reduced sleep disorders, changed the duration of transitional sleep stage and latent period of the 2nd stage of slow wave sleep.

[Current approaches to cerebroprotective treatment of premature newborns in reanimation and intensive care departments].

This work was conducted in the frames of a multicenter clinical trial. The aim was to study efficacy of cytoflavin (infusion solution) in the prevention and treatment of posthypoxic CNS lesions in premature newborns. The study included 120 premature newborns (gestation period 28-36 weeks) who was born in severe distress and needed the intensive therapy after primary reanimation measures. Cytoflavin was prescribed in the first 2-4 h after the delivery to 61 newborns. The control group included 59 newborns who did not receive the drug. To assess treatment efficacy, the determination of some plasma neurospecific proteins (GFAP, NSE, MBP) was carried out along with standard clinical/instrumental and laboratory monitoring. The results revealed the marked cerebroprotective effect of cytoflavin. The significantly higher rate of normalization of KOC, pO2, PCO2 and elimination of lactate acidosis that led to the reduction of severity and frequency of ischemic and hemorrhagic CNS lesions as well as lower levels of plasma neurospecific proteins were seen in the main group compared to the control one.

[Problems and prospects of experimental modeling of hypoxy-ischemic lesions in the central nervous system].

Perinatal hypoxy-ischemic brain lesions are one of the main causes of mortality and dysfunction of the central nervous system in the neonatal period accounting for high disability rate among survivors. Numerous animal models were proposed to study this problem in ante-, intra-, and neonatal periods of ontogenesis. This paper is devoted to the analysis of the adequacy of these models. The processes of brain development in laboratory animals are considered along with etiopathogenetic factors that can be reproduced on the models of perinatal hypoxy-ischemic lesions in CNS. The available data on such models and their correspondence to known clinical syndromes are summarized. Current trends in the development of new models of hypoxy-ischemic brain lesions are discussed.

Neurological deficit and disturbances in higher nervous activity during modeling of perinatal hypoxic-ischemic damage to the central nervous system in rat pups.

Seven-day-old Wistar rat pups were subjected to unilateral occlusion of the common cerebral artery and maintained in oxygen-low atmosphere. Neurological and behavioral changes were monitored for 12 weeks. The survival rate of treated animals was 90%. Body weight gain in these rats was lower than in the control. Neurological deficit was maximum 1 week after treatment and slightly regressed by the 12th week. Locomotor activity in treated rats was higher than in controls. Administration of ketamine in subanesthetic doses caused permanent ipsilateral rotational asymmetry in animals. Spatial disorientation and cognitive deficit in rats with hypoxic-ischemic damage to the central nervous system were revealed in passive avoidance, Y-maze, and rotarod tests. The total area of the hemisphere decreased, while the area of the lateral cerebral ventricle increased at the side of occlusion over the first 4-5 weeks of postnatal development. The size of the ipsilateral hemisphere remained low in adult animals.

[An immunochemical analysis of the function of the hemato-encephalic barrier in acute fetal hypoxia and asphyxia neonatorum]. / Immunokhimicheskii analiz sostoianiia gematoéntsefalicheskogo bar'era pri ostroi gipoksii plodov i asfiksii novorozhdennykh.

The neurospecific protein alpha 1-globulin has been assayed in serum in order to evaluate the blood-brain barrier in newborns with acute intrapartum hypoxia. The study involved 35 term newborns with birth asphyxia of variable severity. The alpha 1-globulin levels correlated with severity of condition at birth, duration of intrauterine exposure to hypoxia and the presence of obstetric complications and clinical severity of cerebral circulatory disorders. A normal early adaptation and effective therapy reduced serum alpha 1-globulin levels 4-8-fold on the 3rd postnatal day and 6-16-fold on the 5th day. Deterioration of neurological symptoms was parallelled by a significant increase in protein levels (to 6400 ng/ml) at day 5. This evidence may confirm the fact that permeability of the blood-brain barrier is impaired by intrapartum hypoxia.

[Status of the blood-brain barrier in newborn infants of various gestational ages in the normal state and in pathology]. / Otsenka sostoianiia gematoentsefalicheskogo bar'era u novorozhdennykh detei razlichnogo gestatsionnogo vozrasta v norme i pri patologii.

The blood-brain barrier (BBB) was studied in 76 neonates of different gestation age in health and disease by means of detecting specific alpha-1-globulin in blood serum with the aid of ELISA. It has been established that by week 28 of the intrauterine development the process of the structural and functional establishment of the BBB had been over as evidenced by the lack of specific alpha-1-globulin in umbilical blood of the neonates of the given gestation age. Severe chronic intrauterine hypoxia combined with acute hypoxia resulted in brain damage and BBB opening for antigen penetration in the direction brain-blood. The measurement of the concentration of alpha-1-globulin in the course of observing the neonates made it possible to predict the degree of the CNS damage.

[Effects of hypoxia on the functional state of the thyroid gland in premature infants of different gestational age]. / Vliianie gipoksii na funktsional'noe sostoianie shchitovidnoi zhelezy u nedonoshennykh detei raznogo gestationnogo vozrasta.

Altogether 98 premature children of different gestation age were examined for the content of T3, T4 and TTH in serum of funic and venous blood on days 3, 5-7 and 30 and part of the children on day 60 of life. All the children were diagnosed to have hypothyroid condition, whose depth and duration were determined by gestation age, by the degree of hypoxia and gravity of the infectious process. With a purpose of the replacement therapy, 12 children were administered thyroidin in a dose of 5 micrograms per kg bw. During the treatment with thyroidin, all the children manifested a positive time-course of changes in the clinical picture and laboratory parameters.