ETIOLOGY AND PATHOGENESIS OF THE CONGENITAL PNEUMONIA IN NEWBORNS (LITERATURE REVIEW - PART 1)

This article focuses on the incidence of intrauterine pneumonia among newborns, with an emphasis on premature babies. So, at the beginning of the 21st century, there is a clear trend in all countries to an increase in the number of births of premature patients. Among the variety of intrauterine infections in premature infants, intrauterine pneumonia deserves close attention. The article presents the main risk factors for preterm birth. The modern views on the etiology of intrauterine pneumonia in newborn infants are presented in detail. The main causative agents of this pathological process are given. The causes of lung lesions in newborns, especially premature babies, are indicated. Clear parallels are drawn between low gestational age and newborn’s body weight with the consequences of previous hypoxia (acute and / or chronic), as well as with the emergence and rate of development of intrauterine infection and its influence on the formation and development of the fetal immune system. The combined effect of unfavorable factors subsequently leads to the manifestation of pronounced immunosuppression in the newborn and creates the preconditions for the generalization of the pathological process.

Intrauterine infection verification in neonatal mortality

Aim. To verify contribution of intrauterine infections to early neonatal mortality, using autopsy and molecular genetic findings.Materials and methods. The study was carried out at the premises of the Research Institute of Maternity and Childhood Protection and the Pathology Department of the Khabarovsk Perinatal Center. An analysis was made of the data on medical history, pregnancy course and outcome, morphological placental study in seven cases of early neonatal death. Genomes of Chlamydia trachomatis, Trichomonas vaginalis, Mycoplasma genitalium, Mycoplasma hominis, Ureaplasma species (Ureaplasma urealyticum + Ureaplasma parvum), Streptococcus agalactiae, Staphylococcus spp., Pseudomonas aeruginosa, Klebsiella pneumoniae, Haemophilus influenza, Listeria monocytogenes, Cytomegalovirus, Herpes simplex virus, Human herpesvirus type 4, and Human herpesvirus type 6 were detected by polymerase chain reaction (PCR) in samples of placental tissue.Results. Samples of six out of seven placentas (85.7%) in early neonatal death cases were found to present with genomes of opportunistic microorganisms, which are part of biocenosis of the woman’s urogenital tract and enter the placenta and the fetus by an ascending pathway (S. agalactiae, Ureaplasma spp., M. hominis), as well as genomes of opportunistic herpesviruses (Cytomegalovirus, Human herpesvirus type 6), which constantly persist and reproduce in human lymphocytes and are transmitted mainly by a transplacental route. Infectious and inflammatory changes in placenta and membranes resulting in respiratory disorders, fetal hypoxia and asphyxia were found in all cases of opportunistic pathogen detection.Conclusion. This is indicative of the ability of the said opportunistic organisms to contribute to the pathogenesis of neonatal death. Contribution of intrauterine infections to early neonatal death cases is made up of both congenital neonatal infection cases and cases of infectious and inflammatory processes in placenta and membranes leading to respiratory distress, the immediate cause of death.

Vertical transmission of SARS-CoV-2: A systematic review

In this study, we discuss vertical transmission of SARS-CoV-2, and assess various maternal and neonatal outcomes based on the current evidence available. This systematic review using PRISMA guidelines revealed a total of 47 eligible studies describing 1188 SARS-CoV-2 positive pregnant women and 985 neonates for review. Utilizing the ‘Shah’s Classification System for Maternal-Fetal-Neonatal SARS-CoV-2 Intrauterine Infections’ by Shah et al., we found vertical transmission confirmed in 0.3% ( n = 3), probable in 0.5% ( n = 5), possible in 1.8% ( n = 17), unlikely in 80.3% (724) and not infected in 17% ( n = 153).

Incidence of healthcare-associated infections among puerperas and newborns in Russian Federation

One of the leading problems of modern public health is healthcare-associated infections (HAIs), which lead to significant social and economic damage, and affect the quality of medical care. The proportion of HAIs in obstetric institutions among all the Ministry of Defense of the Russian Federation for 9 years decreased by 1.7 times. The number of puerperas of HAIs decreased by 1.4 times, and HAIs of newborns decreased by 1.6 times. The proportion of puerperal sepsis in the structure of purulent-septic infections of puerperas is 1.7 ± 0.5 %, and sepsis of newborns is 4.4 ± 1.5 %. The average incidence of puerperas of IUPS was 2.0 ± 2.1 per 1,000 births. The incidence of HAIs in newborns was 2.0 ± 1.8 per 1,000 newborns. The ratio of HAIs of newborns to intrauterine infections on average was 1: 9, and in some regions 1:2–1:150. The obtained data on the incidence of HAIs in puerperas and newborns indicates the insufficiency of a systematic approach to recording, analyzing and predicting the incidence of HAIs, which requires a detailed development of standard epidemiological definitions of the case HAIs of puerperas and newborns, intrauterine infections of newborns, as well as a detailed analysis of risk factors for the development of HAIs in obstetric facilities.

State of plasma hemostasis in newborn infants

Aim. To study the features of the plasma hemostasis in newborns with congenital IUI.Material and methods. The observation of 52 newborns with intrauterine infections was conducted. All the children were divided into two groups. The first group included 36 (69, 2%) patients with a severe IUI and the second - 16 (30,8) patients with a very slow course of the pathological process.Results and discussion. The results of the study showed that IUI in children has a generalized form of the course, with symptoms of microcirculatory dysfunction of the internal organs and systems.Conclusion. The study of the plasma component of hemostasis showed multidirectional changes in it in the form of activation of plasma clotting factors, at the same time there was an increase in the duration and time of blood clotting, indicating the development of consumption coagulopathy in this category of patients, whose severity depends on the course of fetal infections and tropism of the pathogen to the organs and tissues. Identified changes in the plasma component in children with intrauterine infections dictate the need for timely adequate corrective therapy.

Features of gas composition and acid-base state of blood in newborns with intrauterine infections

Aim. To study the features of the gas composition and acid-base state in newborns with specific intrauterine infections.Material and methods. The examination was conducted based on the neonatal pathology unit of the SI NMCShifobakhsh.The degree of oxygenation of blood and skin was determined using daily pulse-oximetry. The partial pressure of gases and the study of the acid-base state (CBS) of blood was carried out using Convergys/liquid device.Result and discussion. The results of our study of blood gases and the acid-base indicator of blood in newborns with severe IUI showed noticeable hypoxemia, moderate hypercapnia, and a deficiency of buffer States, which indicate a violation of gas exchange function in the lungs with the development of compensatory respiratory-metabolic acidosis in children of this group. In patients with a very severe course of IUI, as the syndrome of respiratory disorders and the severity of hyperventilation syndrome increased, deeper changes in blood gas parameters and the acid-base state of the blood were noted. It indicates significant damage to the ventilation function of the lungs, diffuse perfusion processes, gas, and acid-base homeostasis.Conclusions. Impairment of the function of organs and systems that developed against the background of a severe or very severe course of IUI, depending on the degree of severity of deviations in blood gas parameters and acid-base balance, shows the need for adequate corrective therapy.

Congenital CMV Infection Presenting with Massive Intracerebral Hemorrhage

Cytomegalovirus (CMV) is among the most common of intrauterine infections against which we have no effective preventative or therapeutic options. The developing nervous system is a frequent target of CMV and while most injuries are subclinical, severe insults leading to microcephaly and migration defects are well known. A 20-week gestational age fetus was found to have several abnormalities on prenatal ultrasound, the most prominent of which was a large echogenic focus in one cerebral hemisphere. Congenital CMV infection was identified by amniocentesis and maternal serology. The pregnancy was ended by early induction of labour for a 368g stillborn infant. Postmortem examination revealed massive intracerebral hemorrhage as the correlate for the sonographic finding. The microscopic examination of the brain was also striking for extensive polymicrogyria, a high burden of CMV and abundant angiocentric CMV pathology. Catastrophic intracerebral hemorrhage has not been previously reported in association with congenital CMV infection. The present case expands the range of potential injuries the developing brain is subject to in the setting of CMV infection and raises the possibility of a direct vascular injury.Learning ObjectivesConsider intracerebral hemorrhage in the range of potential outcomes in congenital CMV infectionDescribe how polymicrogyria may result from an insult during proliferation and migrationDiscuss possible mechanisms of injury to the developing brain by CMV

HYDRANCEPHALY : RARE ENTITY WITH INCIDENCE LESS THAN 1 IN 10000 LIVE BIRTHS

Hydranencephaly is a rare entity with incidence of 1 in 10000 live births and is characterized by near total absence of cerebral cortex and basal ganglia which are replaced by cerebrospinal fluid. Various aetiologies of hydranencephaly have been suggested which include: Infarction, leukomalacia, diffuse hypoxic-ischemic brain necrosis, intrauterine infections leading to necrotizing vasculitis. Ultrasonography, Computed Tomography and Magnetic Resonance Imaging can easily detect and diagnose hydranencephaly. We present a case of 2-month-old term infant diagnosed with hydranencephaly on computed tomography.

Spontaneous Broad Ligament Hematoma after Vaginal Delivery Requiring Hysterectomy

Background Broad ligament hematomas are rare in the setting of vaginal delivery. When they do occur, patients typically present with acute hemodynamic instability. No cases of infected broad ligament hematomas have been reported. Case A 22-year-old G2 P1011 status post vaginal delivery complicated by chorioamnionitis and pre-eclampsia presented 5 days postpartum with subjective complaints of fever, vomiting, and increased vaginal bleeding. She was treated with antibiotics and uterine evacuation was planned for presumed retained products. After dilation and curettage, the patient was transferred to our facility, as her clinical status did not improve, and was later found to have an infected broad ligament hematoma requiring hysterectomy. Conclusion Though uncommon, broad ligament hematomas should be considered in postpartum women presenting with anemia and vaginal bleeding, even without hemodynamic instability. Recent intrauterine infections may predispose to hematoma infection.