The aim of the study was to analyze and identify risk factors for the development of moderate and severe bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis in preterm neonates in intensive care unit and during any kind of respiratory support. Materials and methods: A simple retrospective-prospective blind controlled non-randomised study included 28-32 weeks of gestational age 122 newborns with respiratory distress syndrom, who were treated in the neonatal intensive care units of two medical institutions of Dnipro from 2016 to 2020. Among 122 children neonates were divided into two groups according to particularities of respiratory support, prior type of noinvasive ventilation and infusion volume per day. The uni-variate Cox regressions using clinical variables identified specific clinical variables associated with development of moderate and severe BPD, retinopathy of prematurity, necrotizing enterocolitis, mortality rate (based on odds ratio and 95% confidence interval (95% CI). Then, significant clinical variables were used to build a multivariate Cox regression models. by backwards elimination of non-significant clinical variables. To estimate discriminative ability of comorbidities predictors we conducted ROC-analysis. Results: The patients with moderate and severe BPD significantly longer were mechanically ventilated and received О2 more than 30% in inhaled gas mixture, therefore every day of MV and/or additional oxygen >30% led to increase in probability of BPD development by 15% (p=0,01), АUC=0,78 (95% CI 0,66-0,89). Significant predictors of moderate and severe retinopathy of prematurity were body weight (AUC 0,64 (95% CI 0,51-0,77) (p=0.03), duration of non-invasive ventilation by NIV PC (AUC 0,68 (95% CI 0,54-0,83) (p <0.01), CPAP (AUC 0.63) (95% CI 0.49-0.76) (p = 0,04) and caffeine administration (AUC 0,68 (95% CI 0,59-0,77) (p=0.01). Patients who developed NEC had a statistically significantly lower daily infusion volume AUC 0,68 (0,59-0,77) p <0.01, later onset of enteral nutrition AUC 0,68 (95% CI 0,59-0,77) p <0.01, lower hemoglobin levels on the first, third and seventh days of life AUC 0,67 (95% CI 0,57-0,77) p <0.01, as well as the level of leukocytes AUC 0,65 (95% CI 0,56-0,75) p = 0,01 and platelet count AUC 0,67 (0,58-0,77) (p <0.01) during the first 7 days of life. Conclusions: The results of the study revealed risk factors for intensive care in general and respiratory support in particular, which significantly increase the risk of developing comorbidities of prematurity. Among them are relatively controlled, it is the duration of mechanical ventilation and NIV, which increase the risk of BPD and retinopathy of prematurity. Other risk factors which we can manage include nutrition state, anemia and supplemental oxygen.
Annotation. Bronchopulmonary dysplasia and necrotizing enterocolitis have become modern problems of effective care of premature neonates. These two pathologies significantly delay the discharge of a premature baby from the hospital, lead to significant economic costs and worsen the quality of life of these patients. The aim of the study was to identify controlled predictors of bronchopulmonary dysplasia, however, in the analysis of the initial status of patients obtained useful results for the parallel treatment of necrotizing enterocolitis. The study recruited 133 neonates with a gestational age of 28–32 weeks with a diagnosis of respiratory distress syndrome on the basis of two NICU in Dnipro in the period from 2016 to 2020. According to the results of the study in the structure of treatment of premature neonates there were significant risks of bronchopulmonary dysplasia: the duration of respiratory support by mechanical ventilation, non-invasive ventilation, additional oxygenation, nebulizer therapy, and for necrotizing enterocolitis – lower fluid intake, hemoglobin level in 1, 3, 7 days of life, moderate and severe asphyxia. Some of the approaches in therapy are cross-cutting, such as the prevention of anemia in respiratory distress syndrome, fluid intake differences and intensive care methods reducing the duration of respiratory support for the prevention of late neonatal sepsis, we can create an algorithm that takes into account all the risks and enhance outcome for these patients. The perspectives for future work – research of neurological status of former premature neonates and finding out predictors of cerebral palsy.
Bronchopulmonary dysplasia in premature neonates leads to physical and mental developmental disorders and behavioral problems and associated with frequent rehospitalizations and long hospital stay. Study objective: to study the predictors of bronchopulmonary dysplasia development in premature neonates in structure of intensive care. Study design: A retrospective cohort analysis was performed in 127 children recruited from two NICU of Dnipro between January 2016 to March 2020. Inclusion criteria: preterm neonates 28-32 gestation weeks with respiratory distress syndrome (RDS). Results demonstrated that every day of mechanical ventilation, supplemental oxygen with FiO2 more than 30% and cardiac drugs usage increased risk of bronchopulmonary dysplasia development by 15-20%. In conclusion, finding out predictors of bronchopulmonary dysplasia helps to improve and prudently use usual treatment regimens in premature neonates and decrease the frequency of moderate and severe bronchopulmonary dysplasia.
On 24 February 2022, Russia launched a large-scale offensive in Ukraine, resulting in significant casualties to civilians, including children. As part of a seven-stream trauma education initiative, a novel pediatric trauma fundamentals course (PTF) was developed to provide standalone pediatric trauma education by our academic/NGO partnership. The objective of the program was to develop, implement, and evaluate a novel PTF educational course in the active armed conflict zone of Ukraine.
В педіатричній практиці синдром дегідратації доволі поширений. У дітей найбільш вірогідними причинами втрати рідини є синдром гастроентериту й діарея різного походження. Ці причини часто супроводжуються поносом та блювотою, що призводять до втрати води та електролітів у різних пропорціях. На противагу терапії критичних станів, таких як гіповолемічний і септичний шок, немає жодного стандартизованого підходу до корекції дегідратаційного синдрому середнього та легкого ступеня тяжкості. Значно недооцінена роль пероральної регідратації на догоспітальному та госпітальному етапах. Ця стаття свідчить про зацікавленість в уніфікації підходів до лікування таких станів, дає можливість ознайомитися з узагальненим поглядом на лікування та профілактику різних побічних реакцій на фоні пероральної та/або парентеральної регідратації. Наш огляд нагадує практикуючому лікарю про особливості дегідратаційного синдрому у дітей різного віку, важливість урахування під час діагностики патогенезу різного типу зневоднення, демонструє важливість знань у сфері інфузійних середовищ у розрізі збалансованої за обсягом та складовими терапії, а також висвітлює цільові рідинні простори організму у разі патологічних втрат. Досліджується концепція фізіологічного інфузійного розчину на засадах доказової медицини. Даний огляд є консультативним, заснований як на національному досвіді лікування синдрому дегідратації, так і на аналізі закордонних ресурсів.
Background. Retinopathy of prematurity (RP) is the main reason for visual disability in premature survivors. RP increases chances for re-hospitalization and re-admission for special help by 1.5–4 times. It can lead to blindness in childhood. Risk factors for RP are mechanical ventilation and oxygen as well as weight gain problems in the postnatal period. The purpose was to assess the influence of different elements of intensive care on the development of severe RP, particularly, respiratory support strategies. Materials and methods. Simple retro-prospective blind non-randomized trial in two separate medical centers of Dnipro enrolled 122 premature neonates with the gestational age of 28–32 weeks from 2016 till 2020. The endpoint for assessment was the development of moderate and severe RP. We performed a univariate logistic regression analysis to analyze the odds ratio and 95% confidence interval (95% CI) for main risk factors. The confidence p level was 0.05. Results. Eighteen percent of premature neonates presented with moderate or severe RP on the 14th day of intensive care according to routine ophthalmologic examination. The moderate and severe RP was associated with an increase in length of noninvasive respiratory care by 4 times (p = 0.01), prolonged conventional ventilation by two-fold (p = 0.33), CPAP length by 4.5 times (p = 0.05), longer usage of additional oxygen (FiO2 > 30 %) by 4 times (p = 0.01). AUC for all these predictors ranged from 0.63 to 0.68. We found the following main predictors of retinopathy. According to statistics, every single day of respiratory support increases the chance of moderate or severe RP by 7–9 % depending on ventilation method, and caffeine citrate usage increases this chance by 6 times. Every 100 g of weight decrease is associated with a 16% increase in RP development risk (p = 0.03). Conclusions. Any respiratory support increases the risk of moderate and severe RP. Thus, the usage of these intensive care modalities can’t be preventive. Attentive modes of weight control should help in the prophylaxis of RP development as well as usual ophthalmologic examinations.
Объективный структурированный клинический экзамен стал вызовом для современного медицинского образования, но и создал новые возможности для развития преподавательского состава кафедры, мотивации врачей-интернов, успешно занял достойное место в системе оценки знаний и умений. Для успешной реализации этого длительного проекта изменений следует обязательно обмениваться опытом с другими кафедрами, специалистами, менеджерами здравоохранения. Поддерживать обратную связь со студентами, врачами-интернами и выпускниками, которые эффективно и глубоко оценивают результаты такой аттестации. Привлекать к работе во время экзамена врачей, вышедших на пенсию, военных с реальным опытом боевых действий, волонтеров, других студентов, которые обучаются в академии и проявляют желание участвовать в подобных мероприятиях. Объективный структурированный экзамен предоставляет возможность объединить наши усилия для реформирования клинического мышления будущих врачей-специалистов, что необходимо для их ответственной и очень тяжелой работы в реальных условиях.
Non-invasive ventilation in the treatment of premature infants is an important link in the process of treating this group of patients. The current practice of a pediatric anesthesiologist requires more research into different modes of non-invasive ventilation. In general, non-invasive ventilation has been widely practiced in the last 11 years. Therefore, the main results were researched during this time period. The main method of the research was stratification by purpose, size of research groups and results: the frequency of reintubation, the development of bronchopulmonary dysplasia, necrotizing enterocolitis, mortality, stay of patients in NICU. The main sources have been obtained from the databases of the National Libraries of Europe (the largest percentage of research in Spanish, French and English), the National Medical Academy of America, a number of science-metric sources of Ukraine by the PubMed search method and as a result of the patent search. Not enough for the reliability of multicenter randomized studies in this issue due to the small amount of groups. No studies have been conducted on the influence of non-invasive ventilation on the incidence of broncho-pulmonary dysplasia, and a number of studies are unreliable, as the analysis did not take into account the large differences between the physiology of the pathological process in pre-term gestational periods. This review makes it possible to compare the two main noninvasive ventilation methods for premature children, to incorporate these methods into their practice and to find research opportunities in this direction, since many issues remain open. Also, this overview highlights the main features of the use of non-invasive ventilation in this particular group of patients.
