Devyaltovskaya M.G.,Republican Scientific Practical Center Mother and Child |
Ulezko E.A.,Republican Scientific Practical Center Mother and Child
Voprosy Prakticheskoi Pediatrii | Year: 2014
The objective: To determine specificities of structural changes of the brain in infants with outcomes of pre- and perinatal lesion of the central nervous system based on findings of neural sonography, computed and magnet resonance tomography. Patients and methods. We performed neurovisualizing examination of structural changes of the brain in 318 children with outcomes of pre- and perinatal lesion of the central nervous system. 208 infants diagnosed with «cerebral palsy (CP)» and a «high risk for development of CP» comprised the basic group. The control group included 110 children diagnosed with «absence of expected normal physiological development». The infants were examined at the age of 3 and 6 months: they underwent computed and magnet resonance tomography of the brain and neural sonography. Results: In children of the basic group, changes of the liquor space (extension of the ventricular system) at the 3rd and 6th month of life were recorded in 56 and 52% of cases, respectively. At the age of 3 months, 72.1% of them had encephalomalacia; changes in the cerebral substance were found by 2.2 times more often, and congenital brain malformations - by 8.2 times more often than in infants of the control groups. At the age of 6 months, every third infant of the basic group had gliosis and calcinates in the cerebral substance, cystic-atrophic changes in 153 (74%) cases, and periventricular cysts - in 123 (59%). Conclusion: Detection of structural changes of the brain in infants at the age of 3 and 6 months provides an opportunity to predict the severity of outcomes of pre- and perinatal lesion of the nervous system.
Sankovets D.N.,Republican Scientific Practical Center Mother and Child |
Svirskaya O.Ya.,Republican Scientific Practical Center Mother and Child |
Gned'ko T.V.,Republican Scientific Practical Center Mother and Child
Voprosy Prakticheskoi Pediatrii | Year: 2015
The article deals with studying an effect of exchange blood transfusion on regional oxygenation in 4 newborns with moderate haemolytic disease due to rhesus conflict. All four patients were born naturally, terms of gestation varied from 36 to 39 wks, and their state at birth was assessed as 8/8 to 8/9 Apgar scores. All newborns received infusion and phototherapy; by the moment of exchange blood transfusion the postnatal age of patients varied from 245 to 265 min, and total bilirubin levels from 145.7 to 168 μmol/l. Near-infrared spectroscopy (cerebral oximetry) is a safe and promising method of noninvasive continuous monitoring of regional oxygen status in the newborn based on optic spectroscopy with infrared rays from 700 to 1000 nm. In this range, a light ray, on the one hand, penetrates through the scalp, calvarium and brain tissues, and on the other, it is selectively absorbed by specific chromophore molecules. All newborns during exchange blood transfusion and 30 min after underwent monitoring of regional oximetry with the use of a cerebral oximeter. The method of «2 volume» exchange transfusion was used, when blood is withdrawn through an umbilical arterial catheter, and infusion is performed through an umbilical venous catheter. As has been found, after exchange blood transfusion fractional extraction of oxygen by brain cells decreased by 2 times - from 0.3341 (0.2468-0.4793) to 0.1457 (0.0900-0.2877), and values of regional oxygenation (cerebral oxygen saturation - crSO2 and somatic - prSO2) improved and were 65.5 (45.5-74.0) vs. 77.5 (66.5-84)% and 39 (30.5-50.5) vs. 49 (32.5-67.5)%, respectively. These data are indicative of the fact that exchange blood transfusion contributes to improvement of regional oxygenation in newborns with haemolytic disease, and the use of the «2 volume» technique permits to avoid undesired severe fluctuations of arterial blood pressure and cerebral blood flow. Monitoring of cerebral oxygenation during exchange blood transfusion is a safe and non-invasive method for preventing development of severe complications.