Preterm infants performed significantly (p≤0.05) worse than the full-term infants on cognitive scale, receptive language, gross motor and fine motor scales. No significant differences were found between preterm and full-term infants on the expressive language scale. Two-way ANOVA revealed no significant (p≤0.05) differences between female premature infants and full-term female infants on the gross motor scale in comparison to male infants. It has been proposed that the prematurity has a specific, but not a global, negative effect on the neurocognitive development in the first year of life with the gender effect on the development of gross motor skills.
Background. Nowadays there is no consensus on the tactics and optimal protocol for Continuous Positive Airway Pressure (СРАР) at transient tachypnea of newborns (TTN) in delivery room. Objective. The aim of the study is to examine the efficacy and safety of standardized protocol of CPAP therapy for newborns with TTN in delivery room. Methods. The clinical study (implementation of standardized CPAP protocol) included full-term infants (gestational age — 37–41 weeks) with diagnosed TTN and CPAP therapy during first 60 minutes of life. Similar inclusion criteria were applied for the historical control group (born within previous year for whom CPAP was implemented according to “usual” protocol). Initiation of mononasal CPAP in main group was carried out when respiratory disorders were assessed according to Downes scale ≥ 3 points with control points at 20–40–60 minutes via the same scale, in control group at ≥ 4 points — for all cases, and according to the doctor's decision at 1–3 points. Mean airway pressure was maintained at 8 and 5–10 cm H2O, CPAP duration was 20–60 and 5–30 min, respectively. The major endpoints: the frequency of patient transfer from delivery room to intensive care unit or hospitalization to the neonatal pathology department, as well as total period of hospitalization. Moreover, frequency of invasive manipulations (intravenous catheterization, parenteral feeding), antibacterial therapy, cerebral injuries (cerebral ischemia, intracerebral hemorrhage), nasal passages injuries, pneumothorax (in the first 24 hours of life) were recorded during the entire hospitalization period. Results. 140 newborns with TTN were included in the clinical study, 30 were excluded from the study, specifically 13 due to violation of the CPAP protocol. The historical control group included 165 newborns. This groups were comparable for most baseline (before the start of CPAP) indicators except for maternal COVID-19 frequency during pregnancy and twin newborns frequency. This groups were comparable for most baseline (before the start of CPAP) indicators except for the frequency of maternal COVID-19 cases during pregnancy and the frequency of twin newborns. Hospitalization rate in intensive care units (18.2 versus 70.3%; p < 0.001) and neonatal pathology departments (31.8 versus 80.0%; p < 0.001), as well as total period of hospitalization (3 versus 10 days; p < 0.001) were lower in the standardized CPAP therapy group. Lower frequency of invasive manipulations, antibacterial therapy, and cerebral ischemia was recorded in this group. The safety of СРАР administration in delivery room was confirmed by the absence of nasal passages injuries in both groups, as well as comparable frequency of pneumothorax. Conclusion. The use of standardized CPAP protocol in delivery room for full-term newborns with TTN had higher rate of favorable hospitalization outcomes. Study limitations require validation of all the findings in independent studies.
Transient tachypnea of the newborn is a parenchymal lung disease characterized by respiratory distress in the first hours after birth. The consequences of underestimating the severity of the disease, incorrectly chosen respiratory support technique or its untimely use at the stage of the delivery room are the increase in respiratory failure, transfer to the intensive care unit, and the need for more invasive and expensive methods of treatment. In the study, we set the task to determine the risk factors that allow us to predict the severity of the course of transient tachypnea of the newborn at the stage of the delivery room.Purpose. Analysis of risk factors that determine the severity of transient tachypnea in the newborn and predicting the tactics of their treatment.Methods. Retrospective analysis of full-term newborns (n = 201) diagnosed with transient tachypnea of the newborn in 2020, who received any type of respiratory support in the first hours of life.Results. Most patients with transient tachypnea of the newborn required respiratory support at the stage of the delivery room, which we associate with a combination of risk factors in the history of pregnancy and childbirth. A high incidence of cerebral pathology in the studied newborns was revealed. According to our data, the following factors can be considered as predictors of the severity of the condition and hospitalization in the intensive care unit from the delivery room of patients with transient tachypnea of the newborn: delivery by Casarean section, low Apgar score at 1 and 5 minutes, Downs scale score of 4–5 points, and the need for respiratory support during the delivery room stage.Conclusions. The results of the study proved a high frequency of transient tachypnea of the newborn registered in full-term infants, allowed to identify risk factors for a severe course of transient tachypnea of the newborn and hospitalization in the intensive care unit.
One of the most common respiratory diseases in term and late preterm infants is the Transient tachypnea of the newborn (TTN). The clinical picture of TTN is characterized by respiratory disorders with the development of hypoxemia, which is especially important for the functioning of the central nervous system and may cause its damage. One of the methods for functional assessment of the supply of oxygen to the brain is the determination of cerebral oxygenation (CO) using the Near-infrared spectroscopy (NIRS). The purpose of this research was to assess the CO in TTN using the NIRS technology. Materials and methods used: a single-center prospective cohort study was conducted from June 01 till Dec. 31, 2021. The study group consisted of 75 full-term newborns with the development of a clinical picture of TTN and a Downes score of ≥3 pts within 60 minutes after birth. Exclusion criteria: other causes of respiratory disorders. The control group consisted of 20 full-term healthy newborns after the C-section recruited by continuous sampling within 3 days from Dec. 21 to 23, 2021. The study of CO was performed only at the stage of the delivery room using the SenSmart™ Model X-100 device; the single-channel monitoring was performed with an SenSmart™ 8004CB-NA sensor (both - by Nonin Medical, Inc., USA). Results: based on the results of the analysis of the data obtained, an increase in the CO indicators in the study group was demonstrated from 72% at the 10th minute to 81% at the 60th minute of life with a further decrease to 80% to 79%. In contrast to healthy newborns, who’ve also showed an increase in CO from 75% at the 5th minute, and reaching a plateau level of 80% already at the 15th minute with a further decrease in indicators to 79% to 77%, a statistically significant difference between the groups was found at the 10th minute with a higher CO level in the group of healthy children (79 (78-82)% vs. 72 (70-73)%, p=0.007). Despite the fact that there was no statistically significant correlation between the severity of respiratory disorders, the development of cerebral ischemia and the CO indicators, there is a general trend towards a decrease and a slow increase in the CO level in full-term patients with TTN. Conclusion: the study showed that in the process of developing TTN, not only the respiratory function suffers, but also the processes of oxygenation of the brain. A prolonged period of low CO levels may have adverse outcomes for the CNS, the life and health of the child in general, this therefore requires further research.
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