ELECTROCARDIOGRAPHIC CHANGES IN NEWBORNS FROM MOTHERS WITH METABOLIC SYNDROME

OBJECTIVE

The aim: Analysis of electrocardiographic parameters in newborns from mothers with metabolic syndrome.

PATIENTS AND METHODS

Materials and methods: We conducted a prospective cohort trial of 125 newborns, which included the study of their anthropometric, clinical and laboratory indicators and, in particular, ECG parameters. The main group consisted of 40 children, born from mothers with diagnosed metabolic syndrome, the comparison group included 2 subgroups: 28 term newborn and 57 preterm, from mothers without metabolic syndrome.

RESULTS

Results: In newborns from mothers with metabolic syndrome on a fragmentary ECG we revealed abnormal depolarization, manifested by changes in the ventricular complex -QRS expansion (p<0.001), impaired conduction (p = 0.004), changes of T wave (p<0.001) and prolonged QT interval (p<0.001). There are such risk factors for QT prolongation in neonates: disease cardiovascular system and disorders of lipid metabolism in mother, asphyxia at birth and electrolyte disorders (hypernatremia OR 0.97), weight too high to gestational age at birth in newborn (OR 2.97), increased blood pressure in the neonatal period (OR 1.07), artificial feeding (OR 3.01).

CONCLUSION

Conclusions: Metabolic syndrome in women during pregnancy has a pronounced effect on the cardiovascular system of the newborn. The detected signs of cardiac dysfunction on the ECG can serve as early integrated indicators of metabolic syndrome and cardiovascular disease in children.

INHERITED EPIDERMOLYSIS BULLOSA IN NEWBORN (CASE STUDY)

Inherited epidermolysis bullosa (IEB) is a group of genetically and clinically heterogeneous diseases characterized by the formation on the skin and mucous membranes blisters and erosion due to injury. Different forms of IEB can be accompanied by various extracutaneous complications, such as blisters and erosion on the cornea and mucous membranes, stenoses and strictures of the respiratory system, gastrointestinal tract, urinary system, muscle dystrophy, and malignant tumors. Therefore diagnosis and prescribing appropriate treatment and follow-up care is an important task for neonatologists and pediatric dermatologists. Because the manifestations of IEB are numerous, a specialized center is required for optimal care, where multidisciplinary care will be provided (neonatologists, pediatric surgeons, pediatric dermatologists, etc.). The purpose of this case report is to pay attention of specialists to a disease that is rare, to present clinical case of IEB in newborn who was admitted to the intensive care unit of newborns of Vinnitsa Regional Children's Clinical Hospital.

OBTURATION INTESTINAL OBSTRUCTION IN THE COURSE OF NECROTIZING ENTEROCOLITIS IN NEWBORN CHILDREN

OBJECTIVE

The aim: To analyze our own results of diagnosis and treatment of newborns with NEC and obturation intestinal obstruction in order to determine theoretically important and practically significant recommendations on this issue, to optimize preventive measures for reducing intestinal obstruction cases in NEC and improving treatment outcome among newborns.

PATIENTS AND METHODS

Materials and methods: Our supervision involved 143 newborns with NEC for the period from 2006 to 2020, including 79 boys (55.24%) and 64 girls (44.76%). Gestational age was 26-42 weeks. The majority of children were premature infants and numbered 121 children (84,62%). The assessment of clinical manifestations, progression of the disease, physical examination of newborns were used to help in diagnosing. All children underwent general clinical tests and instrumental methods of diagnosis including ultrasonography (abdominal organs and retroperitoneum, echocardiography, neurosonography) and X-ray examination (two-dimensional plain abdominal radiography, X-ray contrast study of the gastrointestinal tract). According to the survey, all patients were examined by allied health professionals.

RESULTS

Results: Obturation intestinal obstruction associated with NEC was diagnosed in 26 children (18.18%). 12 children were in serious condition, representing 46.15%. The condition of other 14 children (53.85%) was assessed as critical one. The first signs of intestinal obstruction were observed in children with NEC at the end of the first week or at the beginning of the second week of life. Intestinal obstruction was acute in 21 children (80.77%); 5 children (19.23%) had relapsing course. Blood test results showed the inflammatory process and were not specific. According to the results of our observation, the dynamics of platelets is indicative as there is a correlation between the deterioration in the child's condition and the onset of symptoms of intestinal obstruction and thrombocytopenia. There was an imbalance in protein and electrolyte metabolism - a decrease in the level of albumin, indicators of K, Na, Ca, and an increase of C-reactive protein by several times. Ultrasonography of the abdominal organs showed irregular intestinal pneumatization, dilated intestinal loops with stagnant intestinal contents, pendulum peristalsis, infiltrative bowel wall thickening, free fluid in the abdominal cavity. Plain radiography revealed typical manifestations of small intestinal obstruction with multiple air-fluid levels. In 15 newborns (57.69%), conservative treatment was effective, in particular intestinal obstruction was relieved; 11 newborns (42.31%) underwent surgery. The mortality was 36.36% (4 children died). Postoperative complication in the form of bowel stenosis in the area of the direct anastomosis was observed in 3 patients approximately 2 weeks after the surgery.

CONCLUSION

Conclusions: 1. NEC can lead to the development of obturation intestinal obstruction in newborns. Obturation intestinal obstruction was a form of NEC course in 18.18% of children under our observation. 2. Obturation intestinal obstruction in NEC in newborns is a reversible condition and requires conservative therapy. If symptoms of obstruction persist within 3 days after the start of conservative therapy, surgical treatment is indicated. 3. In case of obturation intestinal obstruction, it is advisable to perform resection of necrotic bowel, formation of a double enterostomy. 4. Enterostomy closure by placing T-shaped intestinal anastomosis should be performed 4 weeks after the primary surgery. 5. The use of modern techniques for early diagnosis and timely treatment of obturation intestinal obstruction in NEC can reduce mortality and the number of postoperative complications. 6. Newborns with NEC should be under the supervision of surgeons, which will help timely determine the indications for surgical intervention.

NEWBORNS WITH KASABACH-MERRITT PHENOMENON-ASSOCIATED KAPOSIFORM HEMANGIOENDOTHELIOMA: A REPORT OF 6 CASES

Combination of kaposiform hemangioendothelioma (KHE) and Kasabach-Merritt phenomenon (KMP) in newborn children is a life-threatening constellation. The purpose of the study is the choice of the diagnostic and treatment methods in these patients and evaluating the effectiveness of treatment using radiological methods of investigation. The study enrolled 6 newborn patients with KHE within a period 2013 - 2018. MRI (CT) performed to make the diagnosis and evaluate treatment response. Hypervascular mass accompanied by reticular lymphedema, hyper intensive in T2 WI; isointensive in T1 WI, intense contrast enhancement, heterogeneous diffusion restriction were unique MRI characteristics of KHE. The sustained remission was achieved with treatment by propranolol (n=2), vincristine (n=1), and their combination (n=3).