Introduction. Intrauterine hypoxia and asphyxia during childbirth are the leading causes of infant mortality in the structure of certain conditions arising in the perinatal period.Purpose. To study the involvement of negative events for the fetus in the ante- and intranatal periods in the occurrence of perinatal asphyxia in newborns and identify the main modifiable risk factors that will allow formulating preventive strategies in the development of child hypoxia.Materials and methods. A retrospective assessment of the course of the ante- and intranatal period was carried out according to 50 case histories. Nominal data are presented with indication of absolute and relative values. Sets of quantitative indicators are described by the values of the median (Me) and the lower and upper quartiles (Q1–Q3). The χ2 test was used to compare unrelated samples. Differences were considered statistically significant at p < 0.05. Statistical data processing was carried out using the Microsoft Office 2021 software package.Results: In the group of children with moderate and severe asphyxia at birth, the median gestational age was 36 and 33 weeks. The main ante- and intranatal risk factors for asphyxia of newborns were established in the following percentage: fetoplacental insufficiency – 32%; premature rupture of membranes and medical abortions in history, 30% each; first pregnancy, anemia, obesity, hypertension, smoking, maternal age > 35 years, 18% each; isthmic-cervical insufficiency – 16%; history of antenatal death, threatened miscarriage, vaginitis, 14% each; acute respiratory infections during pregnancy, assisted reproductive technologies (IVF), uterine fibroids – 12% each; oligohydramnios – 8%; polyhydramnios – 6%.Conclusion. The structure of factors that can contribute to the development of asphyxia in newborns is diverse. Understanding the involvement of modifiable risk factors determines the need to build a strategy and tactics to reduce their impact on the development of the pathology under consideration.
Background. Dysfunctions of hemostasis include conditions occurring both with hemorrhagic syndrome and in the form of thrombosis, the number of which is growing due to the intensification of the therapy. The relevance of the topic is determined by the prevalence of these pathological conditions in newborns, the peculiarities of the hemostasis system in the neonatal period, as well as the difficulties of diagnosis and interpretation of laboratory parameters. Aim. Studying the features of clinical manifestations and genetic markers in newborns with clinical thrombosis on the background of primary thrombophilia. Materials and methods. A retrospective continuous analysis of the case histories of newborn children with thrombophilia who were hospitalized at the Krasnoyarsk Regional Clinical Center for Maternity and Childhood Protection in the period from January 2014 to January 2020 was carried out. Results. The debut of thrombosis in newborns is represented mainly by venous thrombosis of various localizations. Genetic mutations were identified in these patients, which are mainly associated with the work of the folate and methionine cycles (MTHFR: g.677CT, MTHFR: g.1298AC, MTRR: g.66AG and MTR: g.2756AG). A complicated course was noted in the presence in the genome of the combinations MTHFR: g.677CT, MTR: g.2756AG and MTRR: g.66AG and/or homozygous carriage of MTHFR: g.677CT, MTHFR: g.1298AC. The main trigger was peripheral vascular catheterization. Conclusion. A decrease in the levels of natural anticoagulants in newborns with some physiological features of hemostasis deserves close attention of neonatologists and clinicians, requires an integral assessment of the hemostasis system and additional examinations, including the analysis of genetic changes not only in the hemostasis system, but also in folate and methionine cycles.
Intrauterine hypoxia and asphyxia during childbirth are among the leading causes of neonatal deaths in the structure of «Separate conditions arising in the perinatal period» according to the Ministry of Health of the Russian Federation. The main causes of asphyxia are chronic intrauterine hypoxia and acute fetal hypoxia (most often in the intrapartum period). The article observes current data on antenatal and intrapartum risk factors for the development of asphyxia in newborns. Risk factors (modifiable and non-modifiable) triggering intrauterine hypoxia are discussed, as well as methods of management and prevention of asphyxia to prevent the subsequent development of hypoxic-ischemic encephalopathy. The importance of the problem under consideration is due to the need to find promising «tools» for managing neonatal and infant mortality, as well as preventing the long-term consequences of hypoxic brain damage.
Purpose. To assess frequency and severity of myocardial damage in premature infants with transient myocardial ischemia in the early neonatal period.Materials and methods. The study includes 73 newborns of a gestational age of 31–36 weeks with respiratory failure and oxygen dependence in the first 2 hours of life. Newborns are divided into groups: Group 1: classic electrocardiographic criteria of transient myocardial ischemia and an increase in the level of troponin I in the blood; Group 2: electrocardiographic criteria for transient myocardial ischemia and a normal level of troponin I; Group 3: no ECG changes and normal troponin I level. We assessed blood gases, conducted electrocardiography, determined troponin I in the blood on the 1st and 7th day of life, assesses duration of oxygen therapy in all the children.Results. Group I: troponin I concentration on the 7th day of life – 0.415 [0.222; 0.639] ng/ml, Group II – 0.073 [0.051; 0.104] ng/ml and Group III – 0.017 [0.006; 0.051] ng/ml. Transient myocardial ischemia was detected in 41% of examined patients, and destructive myocardial changes – in 21.9%. An analysis of the gas composition of blood in the first 2 hours demonstrated that there was a significant predominance of the level of bases in the children of Group I. The duration of artificial ventilation in children of Group I was 56 [3; 96] hours, exceeding the indicators of children of Group II (9 [8; 11]) by 5 times, and Group III (20.5 [13; 72]) – by 2.5 times. Also newborns in Group I experienced a maximum need for oxygen therapy through a mask.Conclusion. 21.9% of premature infants experience destructive myocardial changes against the background of transient myocardial ischemia; newborns with transient myocardial ischemia and destructive changes have a significantly more pronounced metabolic acidosis in the first hours of life and a longer need for oxygen therapy.
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