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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.

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.