Background. Breast milk is the optimal nutrition for late preterm babies, but mothers of these babies frequently experience difficulties with breastfeeding associated with lactation onset and establishment.Objective. The aim of the study is to examine factors associated with successful breastfeeding of late preterm infants in neonatal hospital.Methods. The retrospective study included medical records of late preterm infants (gestational age of 34–36 weeks) admitted to neonatology department within one calendar year.Maternal and infant factors on exclusive breastfeeding were considered at hospital discharge. Exclusive breastfeeding was defined as absence of any other food or drink, even water, except breast milk (expressed or donor), whereas enteral fluid for rehydration, as well as drops and syrups (vitamins, minerals, medicines) were allowed. Determination of independent predictors was performed via multifactorial binary logistic regression.Results. 84 (41%) of children received exclusive breastfeeding at hospital discharge, others were on formula or mixed feeding. Multifactorial analysis has shown that gestational age of 36 weeks (compared to 34 weeks, odds ratio (OR) 2.16; 95% confidence interval (CI) 1.18–3.98) and breastfeeding onset in 6 first hours of life (OR 2.38; 95% CI 1.19–4.75) were associated with relatively high probability of exclusive breastfeeding at hospital discharge, and twins (OR 0.31; 95% DI 0.15–0.65) — with low probability.Conclusion. Breastfeeding of late preterm babies with maternal milk (expressed milk included) in the first hours of life positively affects the lactation establishment and the provision of exclusively breast milk to these patients in neonatal hospital. The risk group for early cessation of breastfeeding may include late premature infants with gestational age less than 36 weeks and twins.
This review article summarizes current data on malnutrition etiology and pathogenesis in infants. Topical requirements for revealing this condition, its diagnosis and severity assessment via centile metrics are presented. The characteristics of the most common clinical phenotypes of postnatal growth insufficiency in infants (premature infants with different degree of maturation, including patients with bronchopulmonary dysplasia) are described. Differential approaches for malnutrition nutritional correction in these children are presented. The final section of the article describes special nutritional needs for children with congenital heart defects in terms of hemodynamic disorders nature and severity. Modern nutritional strategies for preparation of these patients to surgery and for their postoperative period are presented. The use of high-calorie/high-protein product for malnutrition correction in the most vulnerable patients with described in this review phenotypes is worth noticing.
This article describes two clinical cases of surgical treatment of children with an unobliterated bile duct. The first boy, aged 21 day, was admitted to the hospital with complaints of constant “wetness” in the umbilicus area and a lack of effect of conservative treatment. The fistulography showed communication with the iliac lumen what confirmed involution violation of the omphalomesenteric duct and the formation of complete umbilicus fistula. An unobliterated bile duct was incised and umbilical ring plasty with a surgical stapler was made under general anesthesia. The second child, aged 10 days, was transferred from a cardiosurgical hospital after the staged correction of a congenital heart defect. He had the intussusception of small intestine loops through the umbilical ring, with signs of ischemia. In anamnesis few days before, a yellow-green discharge from the umbilical wound was noted. The additional examination revealed that it was a complication of unobliterated complete omphalomesenteric fistula. Transumbilical incision and resection of intestinal necrotic area with further anastomosis were made; revision and sanitation of abdominal organs and layer-by-layer suturing of the wound were performed too. The postoperative course was uneventful. The described clinical cases demonstrate that primary care specialists (especially of non-surgical profile) have to be cautious about pathological processes in the umbilical region in newborns. If the conservative treatment is ineffective and in order to verify the diagnosis, consultation with a pediatric surgeon is recommended. If the X-ray contrast fistulography is indicated, it should be performed at a specialized hospital.
Purpose. To present data on testing the program, which allows optimizing audiological monitoring in children with risk factors for the development of hearing loss and deafness.Characteristics of children and research methods. 217 children who underwent audiological monitoring at the consultative аnd diagnostic center in Morozov Children’s City Clinical Hospital were examined. The research was a prospective longitudinal study with cross-sectional elements. The children were divided into 2 groups. The first group (main) consisted of 136 children who underwent audiological monitoring based on the developed program, and the second (comparison) included 81 children (the program was not applied). Statistical software packages SPSS and Epi info were used to process the obtained data.Results. In the main group, the most common age of children with primary treatment was (3.0 ± 0.5) months, and in the comparison group — (6.0 ± 0.5) months. In the main group, in the period of (3.0 ± 0.5) months of life, out of 129 children, neurosensory hearing loss was detected in 27 (21.0%), in the period of (6.0 ± 0.5) in 19 of 134 (14.0%), and in the periods of (9.0 ± 0.5) and (12.0 ± 0.5) in 19 (13.4%) and 5 of 136 children, respectively. In 22 children out of 136, hearing decline was transient. In the comparison group at the age of (3.0 ± 0.5) months, neurosensory hearing loss was detected in 2 children, at (6.0 ± 0.5) months in 4 out of 15, at (9.0 ± 0.5) in 1 child out of 25, and at (12.0 ± 0.5) in 9 patients out of 35 children.Conclusion. The application of the developed program will allow neonatologists and primary care physicians to fully comply with the deadlines for audiological monitoring.
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