EVALUATION OF DEVELOPMENTAL OUTCOMES WITH BAYLEY III TEST IN PRETERM INFANTS WITH RESPIRATORY DISTRESS SYNDROME.

Aim of our study was assessment of developmental outcome of neonates with respiratory distress syndrome, evaluation of the impact of RDS on child's health, growth and neurodevelopment at 2 years of age. Case control study included 138 children, from those, 74 preterm (gestational age 32-36 weeks), who were divided into 2 study groups: I groups - involved 38 preterm with RDS and II group - 36 preterm patients without RDS and other neonatal problems. Control group included 42 patients born term with uncomplicated history. To assess the impact of RDS without other co-factors, we excluded from the study children with congenital malformations, genetic and metabolic disorders; intracranial hemorrhage, neuromuscular diseases, severe hyperbilirubinemia, sepsis, congenital infections as well as family with drug or alcohol addiction, severe mental disorder, parents younger than 17 years of age at the time of the baby's birth. The study and control group were homogenous based on family social-economic status, parents education, mean parental age, mother health status, to minimize the bias. We assessed the health status, physical growth and development of children at mean age (corrected age) of 24+4 months. Physical growth was assessed based on the WHO Standard Deviation growth charts, health status based on detailed history and clinical examination, child development was assessed using Bayley Scales of Infant and toddler development III. We calculate composite scores for each sphere and compare mean composite scores of each group to each other. Statistical analyses were based on SPSS 17. The assessment of the health shows that children with RDS as well as prematurely born children without RDS have more respiratory infections during first years of life and more hospitalization than control group. The p-value is >0,5 comparing children with RDS and children with prematurity without RDS, but p < 0,05 if we compare the both group of premature with control group of term infants. Our study does not show that RDS affects significantly the prevalence of acute respiratory infections. The main causes of hospitalization in studied as well as in control group are respiratory tract infections and diarrhea. Growth assessment does not show significant difference in child's height and head circumference, while the percentage of children with underweight according corrected age was more evident in I and II group than in control (p=0,0401). The motor composite scores are lower in premature infants with RDS, but it does not show the significant difference (p=0.7755) compared to second group of premature infants without RDS, at the same time comparing both groups to controls show significant difference (P =0.0021). Mostly were affected fine motor abilities. Assessment of the cognitive scores does not show difference between study and control groups, while the language developmental scores in first and second group were significantly lower than in control (P < 0.0001), but there was no difference between I and groups. We found that premature children at 2 years of age despite RDS have lower scores comparing to term newborns in fine motor and language development. Prematurity increases risk for neurodevelopmental impairments that is important to identify and start early intervention to improve the outcomes. It is shown that neonatal complications (Jaundice, infections, asphyxia and etc.) affect development more than prematurity itself, it is very important to conduct big cohort studies on neonates with RDS to identify the risks associated with RDS and its severity.

[Comparison of PIM and SOFA scoring systems for mortality risk prognosis in critically ill children with sepsis].

The task of the study was the comparison of 2 scoring systems SOFA and PIM for mortality risk assessment in intensive care units. SOFA score is evaluated on admission and thereafter 72 and 120 h until ICU discharge in Children's Central Clinical Hospital from 2001 to 2005 years. Total 200 patients were studied. Mean age was 234.5+/-14.5. Mortality rate was 54 (27%). 89 (44.5%) were females and 111 (55.5%) were mails. Mechanical ventilation was performed in 72 (36%) patients. Septic shock was developed in 39 (19.5%) cases. Diagnose was confirmed by bacteriology in 68 (34%) cases. Higher score was in 93 (46.5%) cases, middle scores in 94 (47%) cases and low in 13 (6.5%) cases at the first day of admission. After 72 h. higher score was in 33 (16.5%) cases, middle in 113 (56.5%) cases and low in 54 (27.5%) cases. By evaluation with PIM--Higher score was in 58 (29%) cases, middle scores in 51 (25.5%) cases and low in 91 (45.5%) cases at the first day of admission. There is a correlation between the SOFA and PIM scores and paediatric mortality. Sofa scores predict mortality in ICU better then PIM scoring system. Kendall's tau of SOFA 0.64+/-0.3. Kendall's tau of PIM 0.45+/-0.2. Sofa scores is an excellent tool to describe the extent of organ dysfunction in critically ill patients.

Diagnostic value of C-reactive protein test at early-onset sepsis in preterm infants.

Bacterial sepsis of preterm infants is an urgent problem of pediatrics, as this population is at high risk for the development of sepsis. The aim of the present investigation was the evaluation of significance of C-reactive protein (CRP) test for identification of early-onset sepsis and assessment of the severity of infectious process. A total of 250 preterm infants, referred to the neonatal intensive care unit of M. Iashvili Central Pediatric Clinic at the first hours of life, have been studied during the period of 2002-2005. Level of C-reactive protein (CRP) was determined at first 24, 48 and 72 hours from the birth using the method of latex agglutination. Two groups of patients were separated. The first group was comprised of patients diagnosed with sepsis at the first hours of life on the basis of determination of CRP level, which was significantly elevated as compared with norm. Quantitative increase of CRP corresponded to the severity of the disease. The diagnosis has been confirmed by positive hemoculture later, after 72 hours. In patients of the second group CRP level corresponded to the normal values and the results of other examinations also indicated the absence of sepsis. In this group treatment with antibiotics was discontinued. The results of investigation allow to conclude that quantitative index of CRP is a rapid, sensitive diagnostic marker for identification of early-onset sepsis in preterm infants. Elevation of CRP level on the background of active therapy of sepsis is a negative prognostic sign. It is advisable to determine CRP level in dynamics to assess severity of the course of the disease.