РЕЗЮМЕ
- Babintseva АG, Godovanets YuD, Khodzinska YuYu, Popeliuk NO, Koshurba IV. International recommendations on neonatal management with congenital diaphragmatic hernia: literature review. Modern pediatrics. Ukraine. 2021; 3 (115): 51–60. DOI: 10.15574/SP.2021.115.51
Congenital diaphragmatic hernia (CDH) is a defect of diaphragm development which is characterized by herniation of the abdominal content into the chest resulting in pulmonary hypoplasia and pulmonary hypertension of various degrees. Mortality and sickness rates among survived children with this pathology remain high all over the world.
Prenatal diagnostics of high quality will h
elp to find neonates with severe CDH and promote mobilization of human and material resources for optimal management at the tertiary level of giving medical aid. Attention of specialists in prenatal ultrasound diagnostics should be drawn to the necessity of measuring observed/expected lung to head ratio and location of the liver in fetus.Optimal treatment of neonates during preoperative period is focused on mild ventilation, avoidance of oxygen toxicity, baro/volutrauma of a hypoplastic lung and cardiac support. Administration of pulmonary vasodilator therapy including inhaled nitric oxide and extracorporal membrane oxygenation is pathogenetically substantiated for patients with pulmonary hypertension, and surgical correction should be delayed till stabilization of patient's condition.Echocardiography is a critically important diagnostic method. It enables to determine severity of pulmonary hypertension and myocardial functional disorders, to find targeted systemic methods of treatment that improve hemodynamic function or decrease pulmonary vascular resistance.
Considering an insufficient level of evidence of the existing international recommendations, large scale multicenter randomized studies on investigation of the best methods to prevent, diagnose and treat neonates with CDH are essential.
- Ластівка ІВ, Бабінцева АГ, Анцупова ВВ, Перижняк АІ, Кошурба ІВ, Брішевац ЛІ. Клінічний випадок геміфаціальної мікросомії у новонародженого хлопчика від матері з Z-21. Неонатологія, хірургія та перинатальна медицина. 2021. 11 (40). DOI: 10.24061/2413-4260.xi.2.40.2021.10
Геміфаціальна мікросомія (ГФМ) – термін, який використовується для ідентифікації деформацій обличчя, пов'язаних з порушенням розвитку перших і других пар зябрових дуг, що характеризуються недорозвиненням однієї половини обличчя. Одним із типів геміфаціальної мікросомії є окуло-аурікуло-вертебральна дисплазія або синдром Гольденхара.
Захворюваність на ГФМ становить 1:3500-1:7000 живонароджених та зустрічається у 1 випадку на 1000 дітей із вродженою глухотою. Співвідношення хлопчиків та дівчат становить 3:2. Етіологія та тип успадкування вивчені недостатньо. Існує три можливі патогенетичні моделі: судинні аномалії та крововиливи в черепно-лицьовій області, пошкодження хряща Меккеля та аномальний розвиток клітин черепно-мозкового нервового гребеня. Фактори зовнішнього середовища, внутрішні материнські фактори матері та генетичні фактори (мутації OTX2, PLCD3 та MYT1) можуть також зумовити розвиток геміфаціальної мікросомії.
У статті продемонстровано клінічний випадок геміфаціальної мікросомії у новонародженого хлопчика від матері з Z-21 у вигляді деформації лівої вушної раковини з атрезією слухового ходу та «хибними» вушками справа, що поєднано з уродженою аномалією серця (дефект міжпередсердної перетинки) та головного мозку (гіпоплазія мозолистого тіла). Акцентована увага на необхідності залучення мультидисциплінарної команди спеціалістів у веденні даного пацієнта як у неонатальному періоді, так і у системі подальшого катамнестичного спостереження.
- Babintseva АG, Godovanets YuD, Agafonova LV, Koshurba IV. Peculiarities of the urinary system functional state in neonates and its role in maintenance of the body homeostasis (literary review). Neonatology, surgery and perinatal medicine. 2019; 1(31): 61–66. DOI: 10.24061/2413-4260.IX.1.31.2019.10
The urinary system activity is of great importance for homeostasis maintenance, which is determined by its participation in elimination of final metabolites, foreign and toxic substances from the body; providing stable blood volume and extracellular fluid; constant concentration of osmotic active substances and ions; regulation of acid-alkali balance, arterial pressure, erythropoiesis, blood clotting, modulation of hormone action; participation in the processes of protein, lipid and carbohydrate metabolism. Clinicians should know peculiarities of formation of the main kidney functions in neonates depending on gestation term and day of life, which can enable to diagnose renal damage in time. Antenatal development of the urinary system occurs during embryonic and fetal periods. During the embryonic period all the nephron structures are formed, and during the fetal period the system is maturing. In case of disorders of normal embryogenesis of the urinary system during the first three months of gestation severe embryopathy is formed. Its severity depends on the damage of an appropriate gene. During later periods fetopathy develops under the effect of various factors promoting disorders of the processes of renal differentiation, and renal pathology is characterized by dys- and hypoplasia. A leading factor of the kidney growth during postnatal ontogenesis is enlargement of the amount of cells but not their sizes.
The article presents analysis of neo-natal mortality 2014–2016 years in Chernivtsi. In the structure of neonatal mortality is dominated by the loss of premature infants, namely low weight to 1000 g and low weight to 1500 g. The nosological structure took first place losses from respiratory distress syndrome (WBS). The number of children with congenital malformations increased. The opening of the perinatal center in the Chernivtsi region will enable to accelerate the introduction of modern methods of diagnosis and treatment of newborns, to carry out organizational measures to create a unified program for follow-up and rehabilitation of children with perinatal pathology.
- Babintseva A, Agafonova L, Koshurba I, Frunza A, Bevtsik A. Neonatal acute kidney injury: predictive and diagnostic value of urinary protein biomarkers. Buletin de perinatologie. 2017; 4 (76): 45-49. 20.500.12710/17672
The prevalence of acute kidney injury (AKI) reaches ~30% in neonates admitted to a tertiary level neonatal intensive care unit. Novel urinary biomarkers are useful for the prediction and diagnosis of AKI.
The objective of this work was to determine the predictive and diagnostic value of urinary protein biomarkers for AKI in critically sick full-term newborns.
Materials and methods. A prospective cohort study of 150 full-term neonates was performed. Group I included 55 healthy newborns, group II – 50 critically ill newborns without AKI, group III – 45 critically ill newborns with AKI. Creatinine levels in serum (SCr), urinary concentration of total protein (UTPr), urinary albumin (UAlb), urinary immunoglobulin G (UIgG), urinary α1-microglobulin (Uα1-MG) and β2-microglobulin (Uβ2-MG) were measured on the 3rd day of life. In case the data were available, 2×2 tables were constructed to derive sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR), negative likelihood ratio (NLR) and cut-off level of urinary protein biomarkers. The area under the receiver operating characteristic (AUROC) curve was used to deduce the diagnostic accuracies of them.
Results. Considering AUROC values, the results of the conducted statistical analysis demonstrated that the biggest diagnostic value concerning AKI determination in critically ill term newborns was peculiar for the model with determination of UIgG level (AUROC 0.79; 95% СІ 0.69-0.88, р<0.001 with сut-off level ≥ 5.1 mg/L). Similar diagnostic value was found in the models with determination of Uα1-MG (AUROC 0.73; 95% СІ 0.64-0.84, р<0.05 with сut-off level ≥ 42 mg/L) and UTPr (AUROC 0.73; 95% СІ 0.62-0.83, р<0.05 with сut-off level ≥ 186 mg/L). The model with determination of UAlb (AUROC 0.64; 95% СІ 0.53-0.76, р<0.05 with сut-off level ≥ 23.0 mg/L) possessed the least diagnostic value. The laboratory test with determination of Uβ2-MG level demonstrated the absence of diagnostic value concerning AKI determination in term newborns (AUROC 0.56; 95% СІ 0.5-0.68, р>0.05 with сut-off level ≥ 2.95 mg/L).
Conclusions:1. A comprehensive clinical-paraclinical examination should be performed for timely diagnostics of AKI in critically ill term newborns with determination of early markers of renal dysfunction including urinary protein biomarkers.
2. Considering the values of AUROC the level of diagnostic value of the presented biomarkers concerning detection of AKI was determined: UIgG > Uα1-MG, UTPr > UAlb with absent diagnostic value of Uβ2-MG.
3. None of the presented diagnostic models demonstrated high discriminating ability with high values of Se and Sp at the same time concerning detection of AKI in critically ill newborns.
