Early use of continuous positive airway pressure (CPAP) is equal to the prophylactic administration of a surfactant to prevent neonatal respiratory distress syndrome (nRDS) in high-risk infants. However, almost half of the smallest infants still require intubation and mechanical ventilation in the first 72 hours after birth. It is known that ineffective initial CPAP is associated with a poorer prognosis. Therefore, the search for reliable prognostic risk factors for ineffective CPAP in very preterm neonates whose respiratory support is started with CPAP is still relevant today. The results of a retrospective cohort study conducted at the Lviv Regional Clinical Hospital (Ukraine), which included 151 children with birth weight <1500 g and gestational age <32 weeks, showed that CPAP failure occurred at a median age of five hours in 31% of infants initially treated with CPAP and average (SD) FiO2, while the failure point was 0.48 (0.15). The prevalence of the main risk factors for severe nRDS did not differ significantly between two groups (CPAP success and CPAP failure). The risk of CPAP failure was significantly associated with surfactant treatment (OR – 7.46; 95% CI: 2.3–24.2), severe RDS (OR – 12.17; 95% CI: 3.8–39.3), requirement in resuscitation after birth (OR – 3.10; 95% CI: 1.2– 8.1), initial CPAP pressure (OR – 0.38; 95% CI: 0.15–0.99). Earlier administration of exogenous surfactant to children at high risk of developing severe RDS could prevent the need for mechanical ventilation.
Respiratory pathology in the recent years remains an urgent problem in clinical pediatrics. The aim of the research was to improve primary prophylactic measures associated with the development and progression of recurrent bronchial obstruction syndrome in young children, who had suffered respiratory disorders in neonatal period. Algorithm of primary prophylactic measures implied adequate balanced nutrition, sanation of living conditions, restriction of contact with infectious agents, sanation of chronic foci of infection, systematic training and general fitness.
The investigation included 160 young children (1 day – 3 years of age). The basic group (n=80) involved children, who had experienced respiratory disorders in neonatal period and received appropriate respiratory therapy (artificial ventilation and / or spontaneous breathing with continuous positive airway pressure and supply of free oxygen), control group – children, who did not have respiratory disorders and respiratory therapy (n=80).
Conducted investigation throughout 12-month monitoring enabled to record the development of recurrent bronchial obstruction syndrome in 43 children (respectively, 30 – 37.50% patients of the basic group versus 13 – 16.25% of control group; p<0.05). However, the results, which would confirm the efficacy of suggested primary rehabilitation measures (р>0.05), could not be obtained.
Conclusions: comparative analysis within groups did not show a reliable difference in the development of recurrent bronchial obstruction syndrome in children (р>0.05), which can be explained by partial following of doctor’s recommendations. There is the need in further study of the issue involving more patients for a longer period of monitoring.
Вітряна віспа є одним з висококонтагіозних гострих інфекційних захворювань, які можуть перебігати тяжко, ускладнюючись залученням вісцеральних органів і центральної нервової системи, з розвитком загрозливих для життя станів у ВІЛ-інфікованих дітей. У наведеному клінічному випадку описано тяжкий перебіг генералізованої форми вітряної віспи з розвитком пневмонії, ускладненої гострим дистрес-синдромом. Тяжкість хвороби обумовлена ВІЛ-статусом дитини та відсутністю антиретровірусної терапії, що й призвело до летального завершення.
Висновки. Постмортальним дослідженням підтверджено VZV-інфекцію з вираженими альтеративними змінами внутрішніх органів і змінами в лімфатичних вузлах, характерними для ВІЛ-інфекції.
Ключові слова: дитина; ВІЛ; вірус Varicella Zoster; пневмонія; патоморфологія.
The incidence of miscarriage has been increased all over the world. In this situation more often children need artificial ventilation of the lungs (AVL) and form risk group for recurrent and chronic bronchopulmonary pathology development . Interconnection of prematurity – acute pulmonary disorders – the further formation of bronchopulmonary disease is no longer in doubt. It is observed a correlation between the administration of artificial ventilation in the neonatal period and the subsequent formation of bronchopulmonary pathology. Our studies have shown that in the case of developing bronchial asthma in a child born prematurely and suffering from acute pulmonary disorders in the period of newborn birth, the risk of developing a severe variant of the disease is extremely high . The obtained data showed that asthma in such children is characterized by a severe course, often the so-called variant "difficult asthma" (with frequent exacerbations in the form of an asthmatic condition) is often observed [5, 10]. We have been followed up 27 children with bronchial asthma, whom after birth prolonged ventilation (more than 7 days) was performed due to pulmonary sickness.
The course of asthma in these children is characterized by frequent exacerbations and perscription of high doses of β2-agonists and hormonal drugs. This cohort of patients requires special care both on the part of parents and nursing staff.
The reason should be sought, analyzing the features of the ante and perinatal period of the child's development [1, 4]. Frequent causes of miscarriage are inflammatory processes of diverse nature and etiology. In the process of inflammation, the number of cytokines, oxidants, and lytic
enzymes increases in the mother's body. In immature children, control over the inflammation process is inadequate [8, 12]. Low levels of antioxidants, antiprotease and anti-inflammatory cytokines can negatively affect the balance between inflammatory and anti-inflammatory cytokines, which in turn causes persistent inflammatory reaction and damage . Chronic inflammation causes hyperreactivity of the respiratory tract, which can not but affect the development and progress of bronchial asthma in the future . It is precisely this situation that determined the relevance and purpose of our study.
Aim is to study the frequency and the features of the course of broncho-pulmonary pathology in young children who were on artificial ventilation of the lungs in the neonatal period.
About 200 million cases of viral community-acquired pneumonia occur every year-100 million in children and 100 million in adults [3, p. 1265]. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Presence of viral epidemics in the community, patient's age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia [1, p. 5]. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries. In addition to well-known symptoms, such children are also characterized by disorders of the autonomic nervous system. There are the cause of a decrease in the quality of life in children, which leads to a lengthening of the recovery period of adaptation after the disease.