Introduction. The influence of uncontrolled exposure to pain in newborns in the first days of life on the long-term consequences for both the brain and the development of the nervous system as a whole is of interest. The aim of the study was to assess the intensity of pain in preterm infants who need respiratory care in the early neonatal period and to determine its impact on the development of the child by the end of the first month of life. Materials and methods. From December 2018 to December 2019, 92 preterm infants requiring respiratory support in the early neonatal period were examined. Pain intensity was assessed on the EDIN6 scale, and neuro-muscular maturity was assessed on the J. Ballard scale. The preterm infants were divided into 2 groups: Group I 34 children who underwent invasive ventilation (body weight 1120 [865; 1390] g, gestational age 29 [26; 31] weeks); group II 58 newborns who used non-invasive respiratory therapy (CPAP) (body weight 1160 [875; 1400] g, gestational age 29 [28; 31] weeks). Group I newborns had a lower Apgar score at 5 minutes (p = 0.001) and a higher Silverman score (p = 0.001). Results and discussions. In all newborns, the maximum pain intensity score on the EDIN6 scale was registered on the 3rd day of life: in group I, it was 9, and in group II points (p = 0.041), which corresponds to moderate pain. Group I children underwent more manipulations (20.8 2.14 vs 17.7 2.05; p = 0.016). An increase in the average airway pressure of 10 cm H2O in group I children and 6.5 cm H2O in group II patients is accompanied by an increase in the intensity of pain to severe and moderate, respectively. In both groups of children, an inverse correlation was found between the number of manipulations, head circumference (R = 0.64; p = 0.004) and the J. Ballard score on the 28th day of life (R = 0.57; p = 0.008). The number of painful manipulations in the early neonatal period, exceeding 21 procedures per day, increases the risk of delayed child development by more than 3.5 (p = 0.009; OR = 3.68; CI = 1.128.36). Conclusion. The number of manipulations performed and the value of the average airway pressure are the main factors affecting the intensity of pain in preterm infants and determining their development in the neonatal period.
Non-immune hydrops of the fetus is a heterogeneous pathology, which is usually the final stage in the development of intrauterine diseases, manifested by clinically pronounced hydration in the absence of signs of immune sensitization. This pathology is characterized by relatively high mortality in both antenatal and postnatal periods. The causes of non-immune hydrops of the fetus are very diverse, arrhythmias being one of common causes of non-immune hydrops. As are a starting factor for the development of non-immune hydrops in utero they are more often observed in the period from 29 to 32 weeks of gestational age. The reasons for a fetus to be prone to develop arrhythmias in the later stages of pregnancy are unknown. However, they may be due to changes velocity of impulse propagation along the aberrant pathways of the cardiac conducting system. Nevertheless, it is this factor that further leads to the accumulation of fluid in serous cavities and tissues, the most common form of arrhythmia in the fetus being supraventricular tachycardia. The article describes a clinical case of non-immune hydrops in a preterm infant with supraventricular paroxysmal tachycardia is presented. The close relationship between rhythm disturbance in the fetus as well as the emergency and further increasing of non-immune hydrops is noted. The symptoms of this pathology are discussed, the data of functional and laboratory diagnostic methods. Attention is paid to parameters of mechanical ventilation of the lungs; scheme of cardiotonic support in the treatment of this case of non-immune hydrops is given.
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