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Immature brain structures of very premature infants determine the features of the echographic picture at birth, as well as in the neoand postneonatal period. The article presents an analysis of the results of ultrasound studies of the brain (from birth to 18 months of corrected age) in comparison with the clinical and laboratory data of 489 very premature infants born with very low and extremely low body weight. The comparison of neurosonographic data and the results of clinical examination indicate that the echographic picture of the brain structures of very premature infants may differ from that of the mature infants and it does not require medical correction in the absence of neurological manifestations. The most characteristic echographic features in the first years of life are moderate dilatation of the intrathecal spaces, lateral ventricles and cisterns of the brain. Intraventricular hemorrhages in deeply premature infants occur with a high frequency, while degree III intraventricular hemorrhages, as well as periventricular and diffuse leukomalacia, are prognostically unfavorable factors leading to the development of severe neurological defects.

Цель исследования – изучение особенностей постнатальной адаптации у детей с экстремально низкой и очень низкой массой тела с функционирующим артериальным протоком в раннем неонатальном периоде. Материалы и методы. В сплошное проспективное исследование включили 98 детей, имеющих при рождении экстремально низкую (ЭНМТ) и очень низкую массу тела (ОНМТ), со сроком гестации 23-35 недель, весом при рождении 540-1500 г. Изучены клинико-анамнестические данные, параметры нейросонографии, эхокардиографии, значения уровня нейромаркеров (S100, NSE), уровня NTproBNP в раннем неонатальном периоде. Забор крови на исследование нейромаркеров и NTproBNP проводился однократно в раннем неонатальном периоде. Результаты. У подавляющего большинства глубоко недоношенных новорожденных в раннем неонатальном периоде продолжает функционировать артериальный проток (АП) (68,36 %). Персистирование АП свойственно недоношенным пациентам с отягощенным антенатальным анамнезом (ожирение и инфекции, передающиеся половым путем – ИППП). У недоношенных пациентов с функционирующим АП достоверно меньший срок гестации при рождении, но средняя нормальная масса тела по отношению к этому сроку гестации, в сравнении с новорожденными, у которых АП был закрыт к 72 часам жизни, для которых характерна низкая масса тела. Для недоношенных с открытым АП характерны респираторный ацидоз и развитие ателектазов легочной ткани. Значения NTproBNP (маркер нарушений внутрисердечной гемодинамики) и NSE и S100 (маркер перинатального повреждения ЦНС) были в пределах референсных значений у всех исследуемых недоношенных и не различались в группах. Заключение. Функционирование артериального протока характерно для глубоко недоношенных детей с отягощенным антенатальным периодом по эндокринной и инфекционной патологии матери, имеющих выраженные респираторные нарушения. Персистирование артериального протока в раннем неонатальном периоде у недоношенных с ЭНМТ и ОНМТ не приводило к увеличению NTproBNP и не влияло на уровень NSE и S100., The aim of the research – to study the features of postnatal adaptation in children with extremely low and very low body weight with a functioning arterial duct in the early neonatal period. Materials and methods. A continuous prospective study included 98 children with extremely low (ELBW) and very low body weight (VLBW) at birth, with a gestation period of 23-35 weeks, and a birth weight of 540-1500 g. Clinical and anamnestic data, parameters of neurosonography and hemodynamic significance of the arterial duct arteriosus (AP), as well as the values of the level of neuromarkers (S100, NSE), the level of NT proBNP in the early neonatal period were studied. Blood sampling for the study of neuromarkers and NT proBNP was carried out once in the early neonatal period. Results. In the vast majority of deeply premature newborns in the early neonatal period, ductus arteriosus continues to function (68.36 %). The persistence of ductus arteriosus is significantly characteristic of premature patients with a burdened antenatal history (obesity and sexually transmitted infections (STIs)). Premature patients with functioning ductus arteriosus are characterized by birth at an earlier gestation period, but with a higher body weight relative to this gestation period, compared with newborns whose ductus arteriosus was closed by 72 hours. Premature infants with ductus arteriosus are characterized by: respiratory acidosis and the development of pulmonary tissue atelectasis. The values of NTproBNP and NSE and S100 (marker of perinatal damage to the central nervous system) were within the reference values in all studied premature infants and did not differ in the groups. The functioning of the arterial duct is characteristic of deeply premature infants with a burdened antenatal period due to the somatic pathology of the mother, who have pronounced respiratory disorders. Persistence of the ductus arteriosus in the early neonatal period in premature infants with ELBW and VLBW did not lead to an increase in NTproBNP and NSE and S100.

In order to assess the immunity indicators of early premature children born in the period from 22 to 27 weeks the researchers conducted a dynamic examination of 24 newborns: 11 children with severe bronchopulmonary dysplasia (Group 1) and 13 children without bronchopulmonary dysplasia (Group 2). They used flow cytometry to determine monocyte counts (CD14+CD64+, CD14+HLA-DR+, CD11b+CD14+). The authors determined the peculiarities of the immune status of children with severe bronchopulmonary dysplasia. They found that the spectrum of monocyte-macrophage protection factors of the children with extremely low body weight was significantly reduced due to a decrease in cell adhesion and migration of the (CD14+CD64+) cells to the inflammation site, as well as the presentation of infectious pathogens – viruses or bacteria (CD14+HLA-DR+), which may be the reason for the development of bacterial complications and prolonged course of the inflammatory process, one of the main factors in the development of severe bronchopulmonary dysplasia. The revealed features of the immune status in infants with bronchopulmonary dysplasia can be used to evaluate the effectiveness of the therapy, which dictates the need for further studies.

The problem of premature infants is well recognized in Russia and all over the world. The article discusses the mortality level and structure of extremely premature infant during 2015–2019. The aim of the study was to identify significant cause-effect relations for high mortality of premature infants and infants with extremely low body weight (ELBW) according to reports from obstetric departments, pediatric outpatient clinics, children's hospitals, statistical agencies, queries results from Territorial Compulsory Medical Insurance Fund (TCMIF) in Saint Petersburg and Russian Association of Human Reproduction (RAHR). The main demographic indices are presented by the Petrostat association. Russian Federal State Statistics Service (Rosstat) forms provided by the Center for Analysis and Prediction of Maternal and Child Health of the Saint Petersburg Health care Committee (No. 32 “Information on medical care for pregnant women, women in labour and new mothers” (approved by order of Rosstat No. 591 of 27.11.2015); No. 19 “Information on children with disabilities” registered in children's clinics (approved by order of Rosstat No. 866 of 27.12.2016); No. 14 “Information on the activities of medical facilities units providing inpatient medical care” (approved by order of Rosstat No. 723 of 05.12.2014); No. 30 “Information on the medical facility” (approved by order of Rosstat No. 483 of 03.08.2018 “On the approval of statistical tools for the organization of federal statistical observation in the field of healthcare by the Ministry of Health of the Russian Federation”) presented by Saint Petersburg Medical Informational and Analytical Center (MIAC)), and answers from TCMIF in Saint Petersburg and RARCH have been investigated. The authors have analyzed the fertility and mortality rates of premature infants, the group of children with ELBW has been established. High mortality levels have been revealed in the first weeks of life (22–23), they were mainly associated with infectious processes. The authors associate the premature delivery increase with the widespread implementation of assisted reproductive technology (ART). ART can be performed either via compulsory medical insurance funds, or other non-government sources. The assumption was proposed that there are possible violations of ART indications, contraindications, and the number of procedures. The ART efficacy is difficult to estimate as well due to insufficient information provided by Rosstat report form No. 32. The need of implementation of the new statistical form that will cover the data on the of ART administration, the possibility of efficacy estimation of modern invasive methods for infertility treatment and mandatory submission of reports about the use of these methods by medical facilities is discussed.

Objective: to study long-term neuropsychiatric outcomes in deeply premature infants with neonatal complications Material and methods . The authors analyzed long-term neuropsychiatric outcomes during a three-year follow-up of 97 children born with a weight less than a 1000g in the department of catamnesis of premature children. Results. The authors found the following predictors of the development of chronic pathology in a premature children: extremely low body weight at birth, long-term (more than 30 days after birth) use of additional oxygen, intraventricular hemorrhages of 3—4 degree and periventricular leukomalacia, the formation of broncho-pulmonary dysplasia in combination with low rates of physical (less than 10 centiles) and psychomotor development by 12 months of corrected age. The most significant factors that have a protective effect on the brain include: breastfeeding, protective regimen, developmental techniques, minimization of post-neonatal infection, prevention of broncho-pulmonary dysplasia. Conclusion. The study of the health of deeply premature children during their first three and even more years of life is necessary to develop measures to improve antenatal, obstetric and neonatal care in order to increase survival and reduce disability among premature babies.

Introduction . The respiratory syncytial virus is one of the leading causes of lower respiratory tract infections in premature children. An effective way to prevent respiratory syncytial viral infection is passive immunization with palivizumab. However, its capabilities and results in children born with very low and extremely low body weight have not been sufficiently studied. Objective. To evaluate the effectiveness of passive immunization in the prevention of respiratory syncytial viral infection in children born with very low and extremely low body weight. Children characteristics and research methods . The authors studied the frequency and severity of respiratory diseases in 450 patients born with very low and extremely low body weight. 385 children (Group 1) received palivizumab, 65 children (Group 2) did not receive palivizumab. In both groups there was the same frequency of bronchopulmonary dysplasia (68,8 and 69,0%, respectively) Results. There were no complications after palivizumab administration; 32 (8,3%) children had mild catarrhal phenomena without hyperthermia, 3 (0,8%) children had local skin reactions. During observation period up to 9±1 months the authors noted a lower incidence of respiratory diseases (p=0,0002) in Group 1 as compared with Group 2, including moderate forms of ARVI (p=0,0078); none of the children got sick due to the respiratory syncytial virus. In Group 2 the virus was detected in 3 out of 7 children with a severe respiratory infection. The immunized children were less likely to be hospitalized (p=0,0175), including in the intensive care unit and intensive care unit (p=0,0034) and to be prescribed antibiotic therapy (p=0,0045). There was the higher risk of recurrent diseases in both groups. The patients with bronchopulmonary dysplasia with comorbid conditions were at higher risk of recurrent diseases in both groups. Conclusion. Children born with very low and extremely low body weight shall be given passive immunoprophylaxis against RSV infection.

BackgroundKidney transplantation from donors who weigh ≤5 kg is performed at only a few transplant centers owing to the high complication and low graft survival rates associated with this approach.MethodsWe retrospectively compared the results of kidney transplantation at our center between January 2015 and December 2019 based on the following pediatric donor criteria: donor body weight ≤5 kg (n=32), 5 kg< donor weight ≤20 kg (n=143), and donor weight >20 kg (n=110). We also perform subgroup analysis of kidney transplantation outcomes from ≤5 kg donors, using conventional (dual separate and classic en-bloc KTx)/novel (en-bloc KTx with outflow tract) surgical methods and allocating to adult/pediatric recipients.ResultsThe death-censored graft survival rates from extremely low body weight ≤5kg at 1 month, and 1, 3, and 5 years were 90.6%, 80.9%, 77.5%, and 73.9%, respectively, which were significantly lower than that from larger body weight pediatric donors. However, the 3-, and 5-year post-transplantation eGFRs were not significantly different between the pediatric and adult recipient group. The thrombosis (18.8%) and urinary leakage (18.8%) rates were significantly higher in the donor weight ≤5 kg group. Compared with 5 kg< donor weight ≤20 kg group, donor weight ≤5kg group was at elevated risk of graft loss due to thrombosis (OR: 13.4) and acute rejection (OR: 6.7). No significant difference on the outcomes of extremely low body weight donor kidney transplantation was observed between adults and pediatric recipients. Urinary leakage rate is significantly lower in the novel operation (8.7%) than in the conventional operation group (44.4%).ConclusionsAlthough the outcomes of donor body weight ≤5kg kidney transplantation is inferior to that from donors with large body weight, it can be improved through technical improvement. Donors with body weight ≤5 kg can be considered as an useful source to expand the donor pool.

Respiratory therapy is the main component of intensive care for premature newborns, it has a great influence on nursing outcomes.Characteristics of children and research methods. The authors carried put a retrospective analysis of the intensive care effectiveness in 44 infants with extremely low body mass at birth.Results. They found the cases of bronchopulmonary dysplasia and evaluated the treatment effectiveness depending on the weight and gestational age. The children with birth weight of 500–699 grams demonstrated low efficiency of intensive care and adverse course of bronchopulmonary dysplasia. This group of premature infants was characterized by a prolonged stay in the intensive care unit, mechanical ventilation, low body mass dynamics, and, as a result, had a high mortality rate in the late neonatal period compared to the group of children born with a birth weight of more than 700 g (p Conclusion. Effective nursing of preterm infants with a birth weight less than 700g requires a combination of an individual approach to the auxiliary ventilation methods and a non-invasive ventilation regimen along with pharmacotherapy that stimulates the respiratory center of the newborn and promotes the maturation of surfactant to prevent complications of respiratory therapy.

The purpose of the study is to analyze the history and structure of the pathology of premature infants with extremely low body weight and very low body weight under dynamic follow up in the monitoring department for children of the perinatal risk group. Using the method of continuous sampling we analyzed observation maps of 95 premature infants with extremely low body weight and very low body weight of gestation age from 24 to 36 weeks.All newborns have a low Apgar score at birth and at the 5th minute, and Apgar score was lower in children with extremely low body weight as compared with children with very low body weight. All children had congenital anomalies of the organs and systems, marked signs of immaturity, with prevailing changes in the cardiovascular system, passability of the renal pelvis, and congenital deformity of thigh.Among the conditions that occurred in the perinatal period, the authors diagnosed intraventricular hemorrhage in 50.5% of patients, 89.6% of them had hemorrhage of grade II – III, all children had respiratory distress syndrome. Bronchopulmonary dysplasia was diagnosed in 60% of premature infants, its moderate and severe forms in 1/3 of the patients. All children had anemia, and 13.7% of children had a neonatal syndrome from mothers with diabetes mellitus. 1/3 of premature infants had retinopathy; its frequency did not depend on the body weight at birth. All children had a combination of pathologies. Bronchopulmonary dysplasia was combined with respiratory distress syndrome and anemia in 100% of children. The combination of bronchopulmonary dysplasia with intraventricular hemorrhage was more often recorded in patients with extremely low body weight than in patients with very low body weight.

To evaluate the immunity indexes in the children who were born with bronchopulmonary dysplasia (BPD) of varying severity at very early delivery terms (22-27 weeks), dynamic examinations were performed in 35 infants: 17 children were with severe BPD; 18, with mild-severity and moderately severe BPD. The comparison group consisted of seven children born at 22-27 weeks of gestational age without signs of BPD. Relative numbers of lymphocyte subpopulations (CD3+, CD4+, CD8+, CD19+, CD16+CD56+, CD4+CD25+), and monocytes (CD14+CD64+, CD14+HLA-DR+) were determined by flow cytometry. The level of cytokines (IL-6, IL-8, IL-4) was measured by enzyme immunoassay technique. The features of immune status in children with BPD of severe, mild and moderate severity were discerned. It was found that the predictors of severe BPD development in the children born at very early terms, are: increased content of IL-8 at birth and at the age of 1 month, reduced level of expression on monocytes (CD64, HLA-DR) on the 1 month of life, and CD14+CD64+cells at 38-40 weeks post conception. The revealed features of immune status in newborns with BPD can be used to assess the effectiveness of the therapy, which requires further research in this direction.

Aim. To establish the clinical and genetic determinants of the formation of delayed speech development in infants with very low and extremely low birth weight and to develop a prediction algorithm for this condition. Materials and methods. A cohort prospective study was conducted, which included 155 infant with very low and extremely low birth weight. Their speech development in 6, 12, 18, 24 and 36 months of life was studied and determinants determined. Results. It was found that 30.9% of children at the adjusted age of 24 months and almost 25% of children born with low and extremely low body weight at the age of 36 months have delayed speech. Important factors that promote delayed speech turned out to be severe intraventricular hemorrhages, postponed anemia in the first year of life, physical development and socio-economic status of the family. Forcasting model for delayed speech in early age for children born with low and extremely low body weight is devised. Conclusion: proposed model has high specificity (84.88%) and restrained sensitivity (55.88%) that testifies about ability to use it in practical medicine.

World statistics and scientific research show that premature birth of children is accompanied by a high risk of not only somatic, but also neurological pathology and mental disorders development. Therefore, the clinical prognostic model development for the research of delayed infant statokinetic development, which was born prematurely, may be the basis for creating a preventive program of early intervention.Purpose — to determine the clinical and genetic delayed statokinetic development formation determinants of children born with a body weight less than 1500 g; to develop an algorithm for early prediction of adverse effects.Materials and methods. A cohort prospective study was conducted, which included 155 children with very low and extremely low body weight. Their statokinetic development at 6, 12, 18, 24 and 36 months of adjusted age was studied and the determinants were established. Genetic methods included studies of the GSTP1, GSTT1, GSTM1, ACE, AGT2R1, and eNOS genes polymorphism.Results. It was defined that at 24 months of adjusted age 19% have delayed statokinetic development, at 36 months — 16% of examined children have very low and extremely low body weight. Important predictors that contribute a delayed statokinetic development were severe intraventricular hemorrhages, anemia in the second year of life, significant delay in physical development at 6 months and socio-economic status of the family. The greatest delay in the motor sphere was found in children with a dominant genetic model (GG+AG vs. AA) of the GSTP1 gene.Conclusions. The developed model for predicting motor developmental delay at an early age has a high specificity (92.44%) and moderate sensitivity (53.33%), which indicates the possibility of its use for forecasting and personalized method of treatment.The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies., Мировая статистика и научные исследования показывают, что преждевременное рождение детей сопровождается высоким риском возникновения у них не только соматической патологии, но и неврологических и психических нарушений. Поэтому, разработка клинической прогностической модели развития задержки статокинетического развития в раннем возрасте у преждевременно рожденных детей, может стать основой для создания профилактической программы раннего вмешательства.Цель — определить клинико-генетические детерминанты формирования задержки статокинетического развития детей, родившихся с массой тела менее 1500 и разработать алгоритм раннего прогнозирования неблагоприятных последствий.Материалы и методы. Проведено когортное проспективное исследование, в которое включено 155 детей с очень низкой и экстремально низкой массой тела. Изучено их статокинетическое развитие в 6, 12, 18, 24 и 36 месяцев скорректированного возраста и установлены определяющие его детерминанты. Генетические методы включали исследование полиморфизма генов GSTP1, GSTT1, GSTM1, ACE, AGT2R1 и eNOS.Результаты. Выявлено, что в 24 месяца скорректированного возраста задержку статокинетического развития имеют 19%, в 36 месяцев – 16% обследованных детей, родившихся с очень низкой и экстремально низкой массой тела. Важными предикторами, способствующими задержке статокинетического развития, оказались тяжелые внутрижелудочковые кровоизлияния, перенесенная анемия на втором году жизни, значительная задержка физического развития в 6 месяцев и социально-экономический статус семьи. Наибольшую задержку в моторной сфере имели дети с доминантной генетической моделью (GG+AG vs. AA) гена GSTР1.Выводы. Разработанная модель прогнозирования задержки моторного развития в раннем возрасте имеет высокую специфичность (92,44%) и умеренную чувствительность (53,33), что свидетельствует о возможности ее применения с целью прогнозирования и персонализированного подхода к лечению.Исследование выполнено в соответствии с принципами Хельсинской Декларации. Протокол исследования утвержден Локальным этическим комитетом указанного в работе учреждения. На проведение исследований получено информированное согласие родителей, детей., Світова статистика та наукові дослідження свідчать, що передчасне народження дітей супроводжується високим ризиком виникнення в них не лише соматичної патології, але й неврологічних і психічних порушень. Тому розроблення клінічної прогностичної моделі розвитку затримки статокінетичного розвитку в ранньому віці дітей, які народилися передчасно, може стати підґрунтям для створення профілактичної програми раннього втручання.Мета — визначити клініко-генетичні детермінанти формування затримки статокінетичного розвитку дітей, народжених із масою тіла менше 1500 г; розробити алгоритм раннього прогнозування несприятливих наслідків.Матеріали та методи. Проведено когортне проспективне дослідження, до якого залучено 155 дітей з дуже малою та надзвичайно малою масою тіла. Вивчено їх статокінетичний розвиток у 6, 12, 18, 24 та 36 місяців скоригованого віку; встановлено детермінанти, що його визначають. Генетичні методи включали дослідження поліморфізму генів GSTP1, GSTT1, GSTM1, ACE, AGT2R1 та eNOS.Результати. Виявлено, що у 24 місяці скорегованого віку затримку статокінетичного розвитку мають 19%, у 36 місяців — 16% обстежених дітей, які народилися з дуже малою та надзвичайно малою масою тіла. Важливими предикторами затримки статокінетичного розвитку виявилися тяжкі внутрішньошлуночкові крововиливи, перенесена анемія на другому році життя, значна затримка фізичного розвитку у 6 місяців і соціально-економічний статус родини. Встановлено, що найбільша затримка в моторній сфері була в дітей з домінантною генетичною моделлю (GG+AG vs. AA) гена GSTР1.Висновки. Розроблена модель прогнозування затримки моторного розвитку в ранньому віці має високу специфічність (92,44%) і помірну чутливість (53,33), що свідчить про можливість її застосування для прогнозування та персоналізованого підходу до лікування.Дослідження виконано відповідно до принципів Гельсінської Декларації. Протокол дослідження ухвалено Локальним етичним комітетом зазначеної в роботі установи. На проведення досліджень отримано інформовану згоду батьків дітей.

Background. The development of premature infants is slower than that of term ones, often due to nutritional status disorders in preterm infants. Objective. Our aim was to study the nutritional status, physical, and psychomotor development of infants. Methods. Nutritional status — the composition (the ratio of fat and fat-free tissues) and the value of lean body mass (LBM) — was assessed by plethysmography and densitometry; physical development — by measuring the mass and length of the body, the circumference of the head and chest, calculating the body mass index (BMI); psychomotor development — assessing compliance with the schedule of neuropsychological development of infants (GNOM). The examination was carried out at 12–14 and 16–18 weeks of the corrected age for preterm and actual age for full-term infants. Initially, the diet of infants was assessed by determining the amount, content of macronutrients and energy in the breast milk and/or milk formula and complementary food consumed. The diet was considered to be balanced if the diet parameters diverged not more than 10% of the norm. Results. The study included 23 preterm infants with extremely low (ELBW), 20 — with very low (VLBW), 34 — with low body weight (LBW), and 33 full-term infants. At 12–14 weeks of the corrected age, the magnitude of LBM in infants with ELBW — 3,397 (3,096; 3,608) and with VLBW — 3,824 (3,797; 3,899) was lower than in infants with LBW — 4,497 (4,034; 4,651) and full-term infants — 4,511 (3,887; 4,647) (Kruskal–Wallis test, p = 0.048). Protein balanced diet was in 2 (9%) infants with ELBW, energy balanced diet — in 1 (4%) infant. Among infants with ELBW, 17/23 (74%) referred to the risk group, 6/23 (26%) — to the developmental disorder group. Compared with infants with ELBW and VLBW, infants with LBW and full-term infants had a higher LBM and, correspondingly, higher body weight and BMI. Improvement of the nutritional status after 4–6 weeks due to correction of protein and energy consumption in infants with ELBW was accompanied by some increase in lean body mass, while its proportion was much higher and the proportion of fat mass was lower, which was accompanied by an improvement in the psychomotor development in individual infants: 5/23 (22%) became age-appropriate, and in the risk group of developmental disorders, the proportion of infants decreased from 17 (74%) to 13/23 (57%). The obtained results testify to the influence of nutritional status on the physical and psychomotor development of infants. Conclusion . The importance of dynamic assessment of the nutritional status of premature infants with individualized correction of their diet for improving the physical and psychomotor development of the child during the first year of life is shown.

To evaluate the immunity indexes in the children who were born with bronchopulmonary dysplasia (BPD) of varying severity at very early delivery terms (22-27 weeks), dynamic examinations were performed in 35 infants: 17 children were with severe BPD; 18, with mild-severity and moderately severe BPD. The comparison group consisted of seven children born at 22-27 weeks of gestational age without signs of BPD. Relative numbers of lymphocyte subpopulations (CD3+, CD4+ , CD8+ , CD19+ , CD16+CD56+, CD4+CD25+), and monocytes (CD14+CD64+ , CD14+ HLA-DR+) were determined by flow cytometry, The level of cytokines (IL-6, IL-8, IL-4) was measured by enzyme immunoassay technique. The features of immune status in children with BPD of severe, mild and moderate severity were discerned. It was found that the predictors of severe BPD development in the children born at very early terms, are: increased content of IL-8 at birth and at the age of 1 month, reduced level of expression on monocytes (CD64, HLA-DR) on the 1 month of life, and CD14+CD64+ cells at 38-40 weeks post conception. The revealed features of immune status in newborns with BPD can be used to assess the effectiveness of the therapy, which requires further research in this direction.

Aim. To establish the clinical and genetic determinants of the formation of delayed speech development in infants with very low and extremely low birth weight and to develop a prediction algorithm for this condition.Materials and methods. A cohort prospective study was conducted, which included 155 infant with very low and extremely low birth weight. Their speech development in 6, 12, 18, 24 and 36 months of life was studied and determinants determined.Results. It was found that 30.9% of children at the adjusted age of 24 months and almost 25% of children born with low and extremely low body weight at the age of 36 months have delayed speech. Important factors that promote delayed speech turned out to be severe intraventricular hemorrhages, postponed anemia in the first year of life, physical development and socio-economic status of the family. Forcasting model for delayed speech in early age for children born with low and extremely low body weight is devised.Conclusion: proposed model has high specificity (84.88%) and restrained sensitivity (55.88%) that testifies about ability to use it in practical medicine., Цель: определить клинико-генетические детерминанты формирования задержки речевого развития (РР) детей, родившихся с очень низкой и экстремально низкой массой тела, разработать алгоритм прогнозирования указанного состояния.Материалы и методы. Проведено когортное проспективное исследование, в которое включено 155 детей с очень низкой и экстремально низкой массой тела при рождении. Изучено их РР в 6, 12, 18, 24 и 36 месяцев жизни и установлены определяющие его детерминанты.Результаты. Выявлено, что в 24 месяца скорректированного возраста задержку РР имеют 30,9% детей, в 36 месяцев — почти 25% детей, родившихся с очень и экстремально низкой массой тела. Важными модулями, способствующими задержке РР, оказались тяжелые внутрижелудочковые кровоизлияния, перенесенная анемия на первом году жизни, физическое развитие, социально-экономический статус семьи. Разработана модель прогнозирования задержки РР в раннем возрасте у детей с очень низкой и экстремально низкой массой тела при рождении.Выводы. Предложенная модель имеет высокую специфичность (84,88%) и умеренную чувствительность (55,88%), что свидетельствует о возможности ее применения в практической медицине., Мета: встановити клініко-генетичні детермінанти формування затримки мовленнєвого розвитку (МР) дітей, які народилися з дуже та надзвичайно малою масою тіла, та розробити алгоритм прогнозування вказаного стану.Матеріали і методи. Проведено когортне проспективне дослідження, в яке включено 155 дітей з дуже малою та надзвичайно малою масою тіла. Вивчено їх МР у 6, 12, 18, 24 та 36 місяців життя та встановлені детермінанти, що його визначають.Результати та висновки. Виявлено, що у 24 місяці скорегованого віку затримку МР мають 30,9% дітей, у 36 місяців — майже 25% дітей, які народилися з дуже малою та надзвичайно малою масою тіла. Важливими модулями, які сприяють затримці мовленнєвого розвитку, виявилися важкі внутрішньошлуночкові крововиливи, перенесена анемія на першому році життя, фізичний розвиток, соціально_економічний статус родини. Розроблена модель прогнозування затримки МР у ранньому віці у дітей з дуже і надзвичайно малою масою тіла при народженні.Висновки. Запропонована модель має високу специфічність (84,88%) та помірну чутливість (55,88%), що свідчить про можливість її застосування у практичній медицині.

Nursing outcomes were evaluated in 110 extremely low birth weight infants to study the characteristics of a maternal reproductive history, the conditions of fetal development, and their early neonatal period. The babies from women with a history of miscarriage were significantly frequently recorded to have severe bronchopulmonary dysplasia, generalized pyoseptic diseases, CNS lesions as grades II—III intraventricular bleeding.

Background: Premature infants with extremely low and very low birth weight with a severe overlapping perinatal pathology often feature slower growth rate within the first year of life and require special nutritional support. Objective: Our aim was to study physical development of infants with protein-calorie deficiency in the setting of using a specialized protein- and calorie-rich pediatric milk product for enteral feeding. Methods: We analyzed tolerability and efficacy of clinical nutrition within the framework of a prospective two-month-long case series. We assessed actual children’s diets and the chemical composition thereof. We determined body weight and length, body mass index (BMI), adipodermal flap thickness over the triceps. Anabolic effect of clinical nutrition was assessed on the basis of transthyretin concentration dynamics. Results: The study involved 30 infants with protein-calorie deficiency (7 term infants and 23 premature infants) with a severe perinatal pathology. High tolerability of the formula under analysis was registered in most patients. Termination of functional gastrointestinal tract disorders (posseting, colics, flatulence, constipations) was observed in 23 (87%) patients. In most cases, the use of a protein- and calorie-rich formula as a part of a therapeutic diet helped to satisfy children’s protein demand and improve their weight/length parameters: BMI increased in 19 (72%) children, body weight — in 16 (63%), body length — in 24 (92%), adipodermal flap thickness over the triceps — in all the children (100%). We observed transthyretin concentration increase from 162 (157; 171) in the beginning of the study to 187 (170; 208) mg/l in the end thereof (p = 0.028). Conclusion: A specialized protein- and calorie-rich product for enteral feeding may be used for feeding infants with protein-calorie deficiency born with a severe a perinatal pathology, including premature infants.

В статье представлена сравнительная характеристика методов заместительной почечной терапии, применяемых у новорожденных различного гестационного возраста и массы тела, обсуждается клинический случай применения проточной модификации перитонеального диализа у новорожденного с массой тела при рождении 660 г и острым почечным повреждением., The article presented the comparative characteristics of methods of kidney replacement therapy in newborns. We present the clinical case of continuous flow peritoneal dialysis in a newborn with extremely low birth weight (660 g birth weight) with acute renal injury.

Бронхолегочная дисплазия (БЛД) – это хроническое полиэтиологическое заболевание морфологически и функционально незрелых легких, наиболее часто встречающееся у недоношенных новорожденных, которым требуется респираторная поддержка и оксигенотерапия для купирования острой дыхательной недостаточности. Самыми важными факторами риска данного заболевания являются агрессивные факторы респираторной терапии, оказывающие прямое повреждающее воздействие на структуры бронхолегочной системы. Цель исследования – оценить роль факторов респираторной терапии в формировании БЛД у недоношенных новорожденных с очень низкой и экстремально низкой массой тела при рождении. Материал и методы. В исследование были включены 97 недоношенных новорожденных со сроком гестации, Bronchopulmonary dysplasia is a chronic polyetiological disease of morphologically and functionally immature lungs, most common in premature infants who require respiratory support and oxygen therapy to relieve acute respiratory failure. The most important risk factors for this disease are aggressive factors of respiratory therapy, which have a direct damaging effect on the structure of the bronchopulmonary system. Aim of research – to evaluate the role of respiratory therapy factors in the formation of bronchopulmonary dysplasia in preterm infants with very low and extremely low birth weight. Material and methods. The study included 97 premature newborns with a gestation age

Objective: Effect of nutritional support for preterm infants with very low (VLBW) and extremely low body (ELBW) weight with hypoxic damage of the central nervous system (CNS) of varying severity is not well elucidated. The aim of this investigation is to study clinical, laboratory, neurosonography and electroencephalography characteristics of preterm infants with VLBW and ELBW with hypoxic of CNS on complex comprehensive nutritional support, diagnostic criteria of which were infants body weight gain, increase in growth and head circumference Methods: Criteria of including into the study were VLBW and ELBW of an infant at birth and hypoxic damage to the CNS. Overall, 254 preterm infants born at the term of 23-24 weeks of gestation with body weight at birth less than 1500 grams were included into the prospective study. All patients underwent anthropometric and clinical observation of height, weight, head circumference and body mass index till 50 weeks of postconceptual age with following evaluation by central curves; standard laboratory and biochemical blood analyses, neurosonography and electroencephalography. Data analysis of further growth of observed infants after discharge from hospital was made in 2017-2019 years on the basis of studying of stationary cards. Results: In the ELBW group with severe level of hypoxic damage to the CNS, optimum gain was 20-22 g/kg/daily, which allowed to avoid complications on the alimentary tract; in the VLBW group with severe degree it was 16-18g/kg/daily during the first three months of life. In the ELBW and VLBW groups of children with moderate degree of hypoxic damage the desired gain did not differ and was at the level of 20-25 g/kg/daily. Physiological body weight gain in infants with VLBW and ELBW according to gestational time is connected with favorable somatic and neurological prognosis in these infants. Calculation of calorie intake, selection of the type of feeding for infants with ELBW and with VLBW according to recommendations made by ESPGHAN (2010) ensures positive anthropometric data dynamics without metabolic disruptions. Conclusion: Physiological body weight gain according to gestation period is connected with favorable somatic and neurological prognosis in these infants.

The article predicts the results of retrospective evaluation from 2008 to 2010. 98 mothers with genital and extragenital diseases, who had preterm infants with very low birth weight (BMI) and extremely low birth weight (BMI). Premature births directly reflect the health status of a pregnant woman. The main causes of premature births, is an infection, severe somatic condition of the mother, complications of pregnancy. The study involved 98 patients, and statistical analysis is made basic findings of the operation. The presence of psychological stress during pregnancy in mothers of children with very low body weight and extremely low body weight has been revealed. Data on the somatic status of mothers are given.

Статья посвящена оценке влияния милкинга на частоту гемотрансфузий у недоношенных новорожденных с очень низкой (ОНМТ) и экстремально низкой массой тела (ЭНМТ) при рождении. Материал и методы. В исследование включены 565 детей с массой тела при рождении, The article is devoted of assessment of cord milking on the blood transfusion rate in premature newborns with very low (LBW) and extremely low birth weight (ELBW). Material and methods. 565 the newborn with birth weight

Objective. The study was conducted to analyze and improve the quality of case follow-up of children with birth weight < 1000 g and gestational age ≤ 28 weeks. Materials and Methods. The study group comprised 42 children, for whom case follow-up was conducted, which included control of disease rate, sensory functions, psychomotor and social-emotional development, comorbid conditions until at least 18 months of corrected age. The comparison group included 36 children with a standard observation. Results. The study showed a reduction in the incidence of postneonatal mortality by half, as well as decrease in the prevalence of cerebral palsy by 7.5 %. Qualitative clinical examination enables to detect timely abnormalities in sensory, motor, cognitive and socio-emotional development, to apply the techniques of early rehabilitation and to reduce disability in extremely premature infants.

The aim of our research is in improvement of diagnostics of diffuse lung atelectasis (DLA) in preterm infants with extremely low body weight by X-ray data by the way of objectivization of its severity grade.Methods of research: We analyzed the data of X-ray photographs of breast organs (BO) of 13 preterm infants with extremely low body weight that DLA was diagnosed in. Among them were 8 boys and 5 girls. X-ray photographs of 15 children with extremely low body weight without DLA were studied as the group of comparison.Results: Statistical analysis of the data that characterized DLA in preterm children with extremely low body weight was carried out. At the study of X-ray photographs of BO of the control group, there were not detected the focal shades along the lung fields, diaphragm cupolas were placed not higher than 6 rib and cardiothoracic index did not exceed 55.In studied group the prevalence of focal shades up to the one third of lung field was observed in 2 children (15,38 %), up to two thirds of lung field– 5 preterm infants (38,46 %) and along all lung fields in 6 children (46,15 %).The displacement of right cupola of diaphragm to the 6 rib was observed in 3 children (23,08 %), to the level of 5 rib – 4 children (30,77 %), to the level of 4 rib and higher – 6 children (46,15 %).Cardiothoracic index within 55-57 was observed in 4 preterm infants (30,77 %), in 5 children (38,46 %) index was 58-60 and in 6 children exceeded 61.Conclusion: The researches allowed divide the diffuse lung atelectasis in preterm infants with extremely low body weight in three severity grades by X-ray data, Метою нашого дослідження було покращення діагностики розсіяних ателектазів легень (РАЛ) у недоношених новонароджених з екстремально низькою масою тіла за рентгенограмметричними даними шляхом об’єктивізації ступеня його тяжкості. Проведені дослідження дозволили розподілити РАЛ у недоношених новонароджених з екстремально низькою масою тіла за рентгенограмметричними даними на три ступені тяжкості

The study estimated outcomes of 22–27 weeks of pregnancy according to the analysis of new statistic forms. The official statistic data on births and deaths of children with extremely low body weight in Russian Federation, federal Districts and Subjects in 2009 were used in this work. Mortality decreased in children 750–999 g and in a less degree in children 500–749 g. Dynamics of results showed the necessity of development and delivery to health care institutions of Russian Federation the new forms of statistic reports for monitoring, analysis and improvement of health care quality in delivery and management of extremely premature infants.

Objective. The study was conducted to analyze and improve the quality of case follow-up of children with birth weight < 1000 g and gestational age ≤ 28 weeks. Materials and Methods. The study group comprised 42 children, for whom case follow-up was conducted, which included control of disease rate, sensory functions, psychomotor and social-emotional development, comorbid conditions until at least 18 months of corrected age. The comparison group included 36 children with a standard observation. Results. The study showed a reduction in the incidence of postneonatal mortality by half, as well as decrease in the prevalence of cerebral palsy by 7.5 %. Qualitative clinical examination enables to detect timely abnormalities in sensory, motor, cognitive and socio-emotional development, to apply the techniques of early rehabilitation and to reduce disability in extremely premature infants., Цель: исследование проведено с целью анализа и усовершенствования качества диспансерного наблюдения за детьми, рожденными с массой тела < 1000 г и гестационным возрастом ≤ 28 недель. Материалы и методы. Основную группу составили 42 ребенка, за которыми проводилось катамнестическое наблюдение, включавшее контроль заболеваемости, сенсорных функций, психомоторного и социально-эмоционального развития, коморбидных состояний как минимум до 18 месяцев скорректированного возраста. В группу сравнения были включены 36 детей, за которыми велось стандартное наблюдение. Результаты. Исследование продемонстрировало снижение частоты постнеонатальной смертности вдвое, а также снижение частоты развития церебрального паралича на 7,5 %. Качественная диспансеризация позволяет своевременно выявить отклонения в сенсорном, моторном, когнитивном и социально-эмоциональном развитии, применить методы ранней реабилитации и снизить уровень инвалидизации чрезвычайно недоношенных детей., Мета: дослідження проведене з метою аналізу та вдосконалення якості диспансерного нагляду за дітьми, народженими з масою тіла < 1000 г та гестаційним віком ≤ 28 тижнів. Матеріали і методи. Основну групу становили 42 дитини, за якими проводилось катамнестичне спостереження, що включало контроль захворюваності, сенсорних функцій, психомоторного та соціоемоційного розвитку, коморбідних станів щонайменше до 18 місяців скоригованого віку. До групи порівняння були включені 36 дітей, яким здійснювався стандартний нагляд. Результати. Дослідження продемонструвало зниження частоти постнеонатальної смертності вдвічі та частоти розвитку церебрального паралічу на 7,5 %. Якісна диспансеризація дозволяє своєчасно виявити відхилення в сенсорному, моторному, когнітивному та соціоемоційному розвитку, застосувати методи ранньої реабілітації та знизити рівень інвалідизації надзвичайно недоношених дітей.

Background Functional neuroimaging techniques are widely used to elucidate changes in brain activity, and various questionnaires are used to investigate psychopathological features in patients with eating disorders (ED). It is well known that social skills and interpersonal difficulties are strongly associated with the psychopathology of patients with ED. However, few studies have examined the association between brain activity and social relationships in patients with ED, particularly in patients with extremely low body weight. Methods In this study, 22-channel near-infrared spectroscopy was used to quantify regional hemodynamic changes during a letter fluency task (LFT) in 20 female patients with ED with a mean body mass index of 14.0 kg/m2and 31 female controls (CTLs). Symptoms were assessed using the Eating Disorder Inventory-2 and Beck Depression Inventory. We hypothesized that frontal activity in patients with ED would be lower than in CTLs and would show different correlations with psychopathological features compared with CTLs. Results The LFT performance and score on the social insecurity subscale of the Eating Disorder Inventory-2 were significantly higher in the ED group than in the CTL group. The mean change in oxygenated hemoglobin (oxy-Hb) in bilateral frontal regions during the LFT was significantly smaller in the ED group than in the CTL group. Social insecurity score was positively correlated with the concentration of oxy-Hb in the bilateral orbitofrontal cortex in the ED group but not in the CTL group. Conclusions These results suggest that activity of the orbitofrontal cortex is associated with social insecurity and disturbed in patients with ED. Therefore, disturbed orbitofrontal cortex activity may underlie the lack of insight and social isolation that is characteristic of patients with ED.