Experience in the treatment of early neonatal parasitic sepsis in the maternity hospital

Early neonatal sepsis mainly has bacterial etiology – 84%, less often fungal – 12%, otherwise – viral and parasitic etiology. According to the European Center for Disease Control and Prevention (CDC), the occurrence of sepsis in newborns is closely related to birth weight and gestational age, as well as skin color. It was established, in particular, that the most severe types of sepsis occur in children weighing 400–1500 g at birth and less than 30 weeks of gestation. Parasitic sepsis in newborns refers to severe forms of childhood sepsis, with mortality reaching high. The article presents the experience of successful treatment of 2 newborns in a maternity hospital both were non-transportable. At the beginning of treatment, the anamnesis of pregnancy was thoroughly studied. From the first day of the disease, both patients underwent a comprehensive instrumental (ultrasound, X-ray) and laboratory (PCR, ELISA, procalcitonin, coagulogram, CRP and general biochemistry tests) examinations. One child – prematurely born at 30 weeks of gestation with a weight of 1070 grams – was treated for intrauterine chlamydial sepsis. The second suffered from intrauterine toxoplasmotic sepsis and Rhconflict; the latter was treated in utero at 30 weeks of gestation. Both patients were treated by a multidisciplinary team and the children recovered. Conclusions. The results of treatment show effectiveness pathogen approach to the treatment of severe sepsis in newborns. The research was carried out in accordance with the principles of the Declaration of Helsinki. The permission of the parents of the children was obtained to conduct the research. The authors declare no conflicts of interest. Key words: newborn, intrauterine, parasitic sepsis, chlamydia, toxoplasmosis.

Pathophysiological mechanisms of development of epilepsy and special features of epileptogenesis in the immature brain

The article is devoted to the urgent problem of neonatology and pediatric neurology — seizures in newborns and young children. The work analyzes the scientific literature on the pathogenetic mechanisms of the development of the epileptic process, which is based on the anatomical and physiological mechanisms of the functioning of brain cells, in particular, in newborns and young children. New pathophysiological data on the increased excitability of the developing brain are described. It has been shown that the implementation of the mechanism of increased excitability of the fetal brain may be due to the peculiarities of the functioning of NMDA, AMPA, kainate receptors, and the peculiarities of the localization of ion channels in different brain structures. The paradoxical (exciting, depolarizing) role of gamma-aminobutyric acid, which is due to the peculiarities of the activation of chlorine co-transporters, is emphasized. The features of the epileptic process in newborns and young children have been determined. The reasons for the development of seizures in newborns are emphasized. The classification and clinical phenotypes of neonatal seizures are considered. It is emphasized that the convulsions in newborns rarely have a deployed clinical picture and are often represented by abortive or focal seizures, which is associated with the ontogenetic features of the fetal brain, namely: incomplete by the time of the birth of a cortical-neural organization, synaptogenesis and myelination of its structures, insufficiency of the development of commulectral intermetrous bonds , uneven representation in the cortex of ion channels with a relatively well-formed limbico-reticular system and its bond with a brain barrel. It was noted that despite various clinical manifestations, the newborn has four main types of seizures: subtitle (erased, abortive, fragmentary), tonic, clonic and myocloniс. No conflict of interest was declared by the authors. Key words: newborn, brain, pathophysiology, seizures, epilepsy, review.

A clinical case of management of a newborn with anterior mediastinal teratoma (not prenatally detected) in a city maternity hospital

Teratomas are tumors which are composed of tissues derived of more than one germ cell layer; they appear between 3-6 weeks of pregnancy and are present more often in females. A prognosis for life depends on the timely diagnosis of the mass and a possibility of surgical treatment. An article presents a case of a female neonate born with severe respiratory insufficiency. Antenatal ultrasound at 19-20 and 30-31 weeks exposed the myoma of the uterus and a probability of large birth weight. Immediately after birth a neonate requested urgent intubation, artificial lung ventilation, intensive therapy for hemodynamic stabilization. The thoracic surgeon suspected the presence of cystic adenomatous malformation upon the chest X-ray and clinical observation data and defined expectant management and prolongation of intensive therapy. Autoptical evidence is a large mediastinal teratoma 10×8×5 cm, weight 135.0 gram, moderate secondary hypoplasia of lungs. Histological processing revealed mass lesion of the anterior mediastinum in a capsule, which was presented with immature discohesive mesenchyme with lymphoid assembly, brain tissue and multiple cysts of different size with inclusions of cartilage tissue. Effective correct and precise antenatal visualization, which can defined the type of maternity hospital, postnatal MRT and timely provided therapy intervention surgical mass removal including — these are key factors of successful management newborns suffering from anterior mediastinal teratomas. 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. No conflict of interest was declared by the authors. Key words: newborn, mediastinal teratoma, diagnostics, therapy.

Clinical and haematological features of newborns of mothers with hypertensive disorders in pregnancy in Lagos, Nigeria

Background: Newborns of mothers with hypertensive disorders in pregnancy have an increased risk of preterm delivery, low birth weight, perinatalasphyxia and haematological derangements such as polycythaemia, thrombocytopenia and neutropenia. These morbidities are associated with uteroplacental insufficiency. The haematological derangements however have not been studied in detail in African neonates. Objective: To determine the clinical and haematological features of newborns of hypertensive mothers Methods: Cross-sectional study involving 250 newborns; 125 newborns each of hypertensive mothers (cases), and normotensive mothers (controls). The babies were examined following delivery, their clinical data were recorded, and umbilical cord blood samples were analysed for haematological indices. Results: Preterm deliveries were significantly higher amongst infants of hypertensive mothers (31.2%)compared with controls (12.0%);p = 0.000. Similarly, the birth weight, length and head circumference of the cases were significantly lower than the controls; p = 0.008, 0.003 and 0.004 respectively. Low fifth minute APGAR scores occurred more frequently in cases (8.0%) than controls (0.8%), p=0.010; whilst the mean haematocrit was also significantly higher in cases than the controls, p = 0.013. The median absolute neutrophil count and platelet count were significantly lower in cases than controls; p=0.023 and 0.047 respectively. Thrombocytopenia was identified in 40.0% of the cases compared to 27.2% of the controls, p = 0.041 Conclusion: The present study has shown that newborns of hypertensive mothers have an increased risk of neonatal morbidities such as preterm birth, LBW and thrombocytopenia compared to the newborns of mothers with normal blood pressure in pregnancy, hence close attention needs to be paid to them with emphasis on their haematological system. Key words: newborn, pregnancy, hypertension, hypertensive disorders, haematological, clinical

An Overview of Neonatal Admissions at College of Medical Sciences (COMS)

Objective: To know the profile of newborn admissions and its outcome and the factors associated with neonatal mortality. Methods: The study included both intramural and extramural cases of 180 newborn babies admitted in nursery over a period of 6 months from 01/08/06 to 31/01/07. The relevant data were recorded on a pre-designed proforma meticulously. Results: There were 180 newborn babies during the study period. The mean birth was 2.7 kg.. Majority, 77.8 %( 140) of the babies weighed equal to or more than 2.5 kg. Low birth weight (LBW) was seen in 22.2 %( 40) babies. There were 80 %( 144) full term babies and 20 %( 36) preterm babies. Majority of the mothers in the age group between 20-30 years had incomplete antenatal check- ups. There were 86 %( 155) normal vaginal deliveries, 4.5 %( 8) forceps deliveries and 9.5 %( 17) caesarean sections. Birth/perinatal asphyxia 39(22%), prematurity 36(20%) and neonatal septicemia 30(17%) comprised of leading admissions. There were 27deaths (15%) in total.13 (7%), 8(5%) and 6(3%) babies died of severe perinatal asphyxia, neonatal septicemia and prematurity respectively. Most of the deaths occurred during the first 72 hours. Conclusions: The mean birth weight is good. The major causes of neonatal death are birth/perinatal asphyxia, prematurity and neonatal septicemia. The factors influencing neonatal mortality are low and poor antenatal care, meconium stained liquor, delay in coming to the hospital, PROM, eclampsia. The study emphasises the importance of regular antenatal care, timely referral of pregnant women with complications to appropriate centers and conducting delivery in a clean environment for lowering neonatal mortality. Key words: newborn, admission, neonatal outcome, asphyxia doi:10.3126/jnps.v27i2.1413 J. Nepal Paediatr. Soc. Vol.27(2) p.73-74

Teat seeking success of newborn piglets after drying or warming

At birth, 98 piglets were either completely dried with paper towels, or moved under a heat lamp, or left untouched. The three treatments were randomly assigned, within birth order trios, to 11 litters of pigs. Sixty percent of all piglets contacted the udder within 10 min and 91% had nursed within 70 min. Treatment or birth order did not affect the mean time from birth to first udder contact (20 min; SEM 3.5) or the mean time from birth to first suckle (40 min; SEM 4.8). Average daily gain to 24 h or 21 d was not significantly affected by treatment. Mortality to 3 d was 6% for the towel-dried group, 0% for the pigs placed under the heat lamp and 21% for the untouched group. We conclude that drying or warming at birth did not affect suckling success of active piglets, but there was an indication that survival was improved. Key words Newborn, piglet, drying, warming, suckling, survival