The aim of the study was to evaluate neonatal outcomes in preterm infants.

Materials and methods. The study included 58 premature neonates divided into 2 groups: «A» (N=34) with an adverse neonatal period ending in death and «B» (N=24) who survived. Clinical assessment of the infant, measurement of blood gases, acid-base balance (ABB) and lactate, recording of lung ventilation parameters, calculation of mean airway pressure, oxygenation index (OI) and ventilation efficiency index (VEI), neurosonography and, in case of death, pathological and histological examination of the brain were performed.

Results. Elevated lactate was found in 24 patients (70.5%) in group A and in 12 patients (50%) in group B. The mean lactate levels in groups A and B were 8.1±3.3 and 6.3±2.8 mmol/L, respectively. In group A, 19 (55.9%) infants had severe acidosis, corresponding to a pH of 7.19 to 6.80. In group B, only 8 (33.3%) infants had a pH between 7.0 and 7.19. At birth, neonates in both groups were found to have a base deficit (BD), which was significantly lower in group A than in group B (P=0.004). There were no trends toward reduction of acidosis or normalization of ABB in infants in group A. Plasma BE levels in group B had returned to normal by 96 hours postpartum. The frequency of grade II, III peri/intraventricular hemorrhage (PIVH) and hemorrhage of other localization in group A were 8 (23.5%), 9 (26.5%), and 3 (8.8%), respectively. In group B, grade I PIVH and hemorrhage of other localization occurred in 5 (20.8%) and 1 (4.2%) cases, respectively. In neonates with grade II PIVH, severe lactic acidosis was diagnosed at birth: venous blood pH was 6.97 [6.8; 7.22], BE was (–21.6) [–30; –7.2] mmol/L, lactate level was 8.5 [6.3; 12.9] mmol/L, and pO₂ was 50.5 [20.5; 64] mm Hg. In infants with grade III PIVH, pH was –7.26 [7.12; 7.28], BE was (–8.1) [–8.9; –7] mmol/L, lactate was 7.6 [4.8; 8.9] mmol/L, and pO₂ was 33 [30; 50] mm Hg. Cell damage of varying severity affected all brain structures, as evidenced by absence or deformation of nuclei and nucleoli, and peripheral chromatin condensation. Morphological immaturity of brain structures was another negative factor.

Conclusion. Lactic acidosis diagnosed at birth in premature infants is one of the indicators of perinatal hypoxia severity. Critical pH, BE, and lactate levels, as well as lack of response to treatment, contribute to structural brain damage and worsen prognosis. Severe changes in oxygen and lactate levels that persist for two days after birth lead to severe PIVH and irreversible brain changes.

Polytrauma in children are among the most common causes of death in the pediatric intensive care unit (ICU).

The aim of this study was to evaluate the effect of systemic corticosteroids (SCS) on the progression, laboratory parameters, and outcomes of severe multiple injuries in children requiring ICU.

Materials and methods. A retrospective, observational, multicenter (case-control and cross-sectional) study included 203 patients from pediatric ICUs across the Russian Federation. The Abbreviated Injury Scale (AIS) score was 36.81 (25–48), and the Pediatric Trauma Score (PTS) was 5.2 (2–8). SCS were administered to 113 (55.7%) children, 19 (9.36%) of whom died.

Results. The most severe changes in laboratory parameters, such as an increase in amylase (35.3 vs. 18.3; P0.001) and activated partial thromboplastin time (APTT) (28.9 vs. 25.8; P0.001), were documented upon admission of children with multiple traumatic injuries to the hospital compared with subsequent days of treatment in the ICU. The average fluid volume (as a percentage of age-related fluid requirements) on the first day of treatment in the ICU was 118.53% and did not exceed 84.42% on subsequent days (P0.001). Higher systolic blood pressure (SBP) during the first three days of ICU treatment was observed in children treated without SCS. SBP tended to decrease by day 5, and then a tendency toward arterial hypertension emerged on days 6–7. In children treated with SCS, blood pressure remained stable during the first seven days in the ICU, contributing to a favorable outcome.

Conclusion. The use of SCS in children with severe polytrauma from the first day of ICU treatment contributed to the stabilization of hemodynamic parameters and improved control of shock signs. A positive response to SCS in these patients can be considered a marker for a favorable disease course during ICU treatment. 

Aim of the study. To improve outcomes in children with severe community-acquired pneumonia (CAP) by including succinate-containing crystalloid solution (SCCS) in the treatment plan.

Materials and methods. The study included 100 patients diagnosed with CAP. SCCS was administered to 24 patients from the prospective (main) group, divided into 2 equal subgroups of 12 subjects who received SCCS with the infusion rate of 2.5 ml/kg/h (subgroup 1) and 5.0 ml/kg/h (subgroup 2). Treatment of 76 patients in the retrospective (control) group did not include SCCS.

Results. Greater decreases in D-dimer (by 418.5 ng/mL vs. 137.0 ng/mL, P=0.026) by day 3 and in fibrinogen (by 1.7 g/L vs. 0.2 g/L, P0.001) by day 3 and (3.8 g/L vs. 0.5 g/L, P=0.002) by day 5 of hospitalization were found in children from the main group vs. the control group. Fibrinogen levels decreased in both study subgroups, although subgroup 1 had significantly higher fibrinogen levels on day 2 of ICU stay (P=0.034). A significant increase in activated partial thromboplastin time (aPTT) of 9.7 seconds was observed on day 3 in the main group versus 2.9 seconds in the control group (P0.001). There was a direct correlation between fibrinogen level and neutrophil count on day 2 of ICU stay (R=0.479, P=0.033). 

Conclusion. The use of SCCS in the treatment of severe CAP helps to prevent thrombotic complications, reduces hypoxia-induced changes in the coagulation system, and enhances the effects of unfractionated heparin. SCCS infusion at a rate of 5.0 mL/kg/h effectively reduces the levels of hypercoagulation markers, while its administration at a rate of 2.5 ml/kg/h potentiates the effects of unfractionated heparin. The effects of SCCS on hemostasis in severe CAP are equivalent to those of a moderate anticoagulant.

Pancreatic ultrasound is employed to assess the structure of the organ and diagnose various conditions. However, analyses of pancreatic images of high-risk newborn infants are scarce.

Aim of the study: to investigate pancreatic echogenicity in high-risk neonates and evaluate the association between pancreatic echogenicity and clinical diagnosis.

Materials and methods. This prospective observational case-control ultrasound study included 105 neonates admitted to the neonatal intensive care unit or outpatient. The patients were divided into two groups: group 1 (high-risk), which included 55 high-risk neonates, and group 2 (control), which included 50 neonates of comparable age with no history of high-risk pregnancy or delivery who were presented for medical consultation. Abdominal ultrasound examinations were performed, with a focus on the pancreas. Pancreatic echogenicity was classified as hyperechoic, isoechoic, or hypoechoic, relative to the liver.

Results. No significant difference in pancreatic size was observed between the high-risk and control groups. A significant predominance of hyperechogenicity over hypoechogenicity or isoechogenicity was found in the high-risk group. A significant difference in echogenicity was found between the high-risk and control groups (P=0.0001). Neonates in the control group were more likely to have pancreatic isoechogenicity (60%) compared to hyperechogenicity (34%) or hypoechogenicity (6%). In the high-risk group, neonates had a higher frequency of pancreatic hyperechogenicity (72.72%) compared to hypoechogenicity (10.9%) or isoechogenicity (16.36%). Notably, 83.3% of infants born to diabetic mothers had a hypoechogenic pattern. Certain high-risk infants, such as preterm infants and those with perinatal asphyxia, had a higher frequency of hyperechogenicity (83.3%). The percentage of hypoechoic pattern was comparable in male and female newborns (50%); isoechoic pattern was more prevalent in females (77.3%) than in males (22.2%), while males had a more frequent hyperechoic pattern (57.5%).

Conclusion. Evaluation of the pancreas in high-risk neonates and monitoring of long-term outcomes are of critical importance, especially in the infants of diabetic mothers. 

Aim of the study. To evaluate the feasibility of using non-invasive hemodynamic monitoring technology based on Doppler ultrasound during open-heart surgery in children.

Material and methods. Prospective, observational, single-center cohort study included 20 patients aged 10 to 34 months undergoing surgery for congenital heart defects. Ten patients underwent atrial septal defect closure (ASD group), other 10 patients had ventricular septal defect closure (VSD group). Cardiac output (CO) was measured in all patients to guide inotropic and infusion therapy adjustments at three control time points: (1) after intubation and before skin incision, (2) during the immediate post-bypass period with the chest open after weaning from cardiopulmonary bypass (CPB), and (3) after sternal closure and before transfer to the intensive care unit (ICU).

Results. At time point 1, the CO values for both the ASD and VSD groups were within the normal reference range: 5.2 L/min [4.7; 5.5] and 5.1 L/min [4.6; 5.6], respectively. At time point 2, CO was measured in 15 of 20 patients, including 8 patients in the ASD group and 7 in the VSD group. Coverage was 75% because of the challenges of measuring 5 patients on the operating table. In the immediate post-bypass period, two patients with VSD (25%) developed hypotension with CO reduced to 3.6 L/min, which is lower than the age-related hemodynamic reference value (5.1 L/min). Inotropic support in these two patients was increased by switching from dopamine, 7 mcg/kg/min, to adrenaline at a dose of 0.05 mcg/kg/min, resulting in improvement of hemodynamic parameters and an increase in CO to 5.2 L/min and 5.0 L/min, respectively, compared to normal agerelated reference values (4.1; 6.1 L/min). After sternal closure, CO values in both groups did not differ significantly from age-related reference values.

Conclusion. The USCOM cardiac output monitoring device can be used to manage intraoperative hemodynamics and adjust inotropic therapy even during open chest surgery. However, its routine use in all stages of surgery with median sternotomy is difficult because it requires more time to align the aortic valve projection.

The aim of this study was to evaluate the efficacy and safety of a standardized protocol of delivery room CPAP therapy in late preterm infants with acute neonatal respiratory failure (ARF) caused by various conditions.

Material and methods. A retrospective comparative study of the efficacy of the standardized CPAP protocol in the cohorts of late preterm infants (34–36 weeks) was conducted at the Yekaterinburg Perinatal Center. The comparison group (C, N=256) included infants who received CPAP therapy in the delivery room during 12 months in 2020 before the introduction of the standardized protocol. The study group (S, N=169) included infants treated with standardized CPAP in April-December, 2022. The following subgroups were identified in groups C and S based on the cause of ARF: transient tachypnea of the newborn (TTN; C: N=100; S: N=89), respiratory distress syndrome (RDS; C: N=84; S: N=39), and congenital infection (CI; C: N=54; S: N=37). Other causes of ARF in groups C and S were found in 18 and 4 infants, respectively.

Results. Switching to the standardized CPAP protocol reduced the duration of mechanical ventilation by an average of 24 h (P=0.013), the incidence of documented cerebral ischemia (CI) from 64.1% to 53.2% in all subgroups (P=0.022), the length of stay in the neonatal ward from 12 to 11 days (P=0.001), and the length of stay in the hospital from 16 to 14 days (P=0.001) as well as the incidence of CI in the STTN subgroup vs CTTN (38.2% vs. 61.0%, P=0.002). No significant differences were found in the RDS and CI subgroups. The frequency and duration of binasal CPAP and lung ventilation in the neonatal ICU did not differ between subgroups. Pneumothorax within the first 24 h occurred in one patient in group C and in two patients in group S (P=0.339), all of whom were diagnosed with congenital infection. No damage to the nasal passages was observed in any group. 

Conclusion. The use of a standardized protocol of CPAP therapy for neonates born after 35 weeks of gestation with respiratory failure of any etiology can significantly reduce the severity and duration of illness and should be considered as a basic respiratory strategy in the delivery room when indicated.

The availability of central venous access is the cornerstone of contemporary pediatric oncology and hematology. As a result, the percentage of pediatric patients receiving infusion chemotherapy who require a central line remains high. Central venous catheter insertion can be associated with procedural complications, including life-threatening ones.

Aim — to investigate the potential factors leading to complications during central venous catheterization in order to develop preventive strategies.

Materials and methods. The study included 1,512 original cases of patients aged 1 month to 20 years treated at the D. Rogachev National Research Medical Center between 2019 and 2022. The following 10 complications were examined: failed first venipuncture attempt, guidewire/catheter malpositioning, guidewire knotting, lifethreatening arrhythmias, guidewire entrapment in the trabecular network of the right ventricle, arterial puncture, pneumothorax, hemothorax, puncture of lung parenchyma, Horner's syndrome. In addition, four rare complications were noted, including phrenic nerve injury, cardiac tamponade, alveolar hemorrhage, and arterial pseudoaneurysm.

Results. The primary cause of all complications was direct mechanical injury to anatomical structures by a needle or guidewire/catheter. When inadvertent vascular injury and bleeding occur, the resulting hematoma may lead to further damage by compressing soft tissues. Excessively deep insertion of the guidewire may cause its knotting or cardiac arrhythmias. Adequate physician training and strict adherence to procedural protocols are essential to avoid these complications.

Conclusion. Central venous catheterization remains a procedure with potential complications. Although ultrasound guidance does not eliminate all risks, it increases the likelihood of successful venipuncture at the first attempt, thereby reducing complication rates. Recognizing the potential causes of procedural complications during central venous access placement, including uncommon ones, facilitates early diagnosis and appropriate medical intervention. 

The aim was to demonstrate an alternative approach to respiratory therapy in respiratory failure complicated by pulmonary hypertension when conventional ventilation and high-frequency oscillatory ventilation are ineffective.

Patient and study methods. We analyzed laboratory data, ventilatory parameters and hemodynamic parameters during ventilation in a child with birth weight of 1300 grams and respiratory failure complicated by pulmonary hypertension. Dynamic selection of parameters and modes of pulmonary ventilation with transition to Airway Pressure Release Ventilation (APRV) mode is presented. Chest radiography and echocardiography were used.

Results. The use of APRV mode when traditional approaches were ineffective allowed «stabilization» of the lungs by alveolar recruitment without deep sedation and muscle relaxation. On day 20 after birth, the infant was weaned. On day 29, the infant was transferred to the neonatal pathology unit for further management, and on day 49, the infant was discharged in stable condition.

Conclusion. In neonates with severe respiratory failure, the use of the APRV mode as an alternative to ineffective conventional ventilation requires further investigation and the development of guidelines for its use.

Aim: to evaluate the effect of extracorporeal membrane oxygenation (ECMO) as a life support in the treatment of a patient with refractory ventricular tachycardia developed after Fontan procedure. 

Patient and treatment. A 4-year-old child developed refractory ventricular tachycardia (up to 250 bpm) and hemodynamic depression 18 hours after the Fontan procedure. After the failure of cardiopulmonary resuscitation and antiarrhythmic therapy, resternotomy with central venoarterial (VA) ECMO support was performed, followed by diagnostic angiocardiography. Contrast-enhanced cavopulmonary angiography revealed stenosis of the left pulmonary artery, which was treated with balloon angioplasty and stenting.

Results. Ventricular tachycardia resolved and sinus rhythm was restored within 24 hours after left pulmonary artery stenting, supported by continuous ECMO and antiarrhythmic therapy. On day 3, transthoracic echocardiography showed good single ventricle contractility after a trial weaning from ECMO. As a result, the ECMO support was removed and the sternum sutured. The patient was discharged from the hospital on day 47 in stable condition.

Conclusion. The prompt initiation of VA ECMO support in a 4-year old patient with refractory ventricular tachycardia post-Fontan procedure along with the complex management of post-procedural residual tachycardia using a combination of antiarrhythmic agents helped restoring sinus rhythm and could contribute to preventing neurological complications.