[The effect of controllable moderate hypothermia on hemostasis in newborns with hypoxemic ischemic encephalopathy.]

THE PURPOSE: To study effect of controllable moderate hypothermia on system of hemostasis in newborns with hypoxemic ischemic encephalopathy. MATERIALS AND METHODS: The retrospective analysis was carried out concerning 38 medical records of newborns with acute hypoxia of fetus (group I), 12 medical records of newborns with acute hypoxia of fetus against the background of chronic hypoxia of fetus (group II), 20 healthy newborns (group III) and 20 healthy adults. The thromboelastography was implemented in three stages: at first, third and sixth days of life of newborns. CONCLUSION: The thromboelastography is to be implemented in newborns with hypoxemic ischemic encephalopathy due to occurrence of of hemostasis shifting to hypocoagulation and high risk of bleeding. In healthy full-term children a physiological hypercoagulation was established as compared with adults without alterations of processes of lysis of clots. In newborns with chronic hypoxia of fetus against the background of applied medical hypothermia, in comparison with healthy newborns, decreasing of number of thrombocytes are observed and possibly lower functional activity of thrombocytes up to third day and also lower activity of plasma component of hemostasis at retained elasticity and strength of developed clots. The sixth day, after heating, the system of hemostasis is normalized and number of thrombocytes is restored. In newborns, having acute hypoxia of fetus against the background of chronic hypoxia of fetus higher risk of bleeding is noted at minimal difference according results of thromboelastography.

[Thoracotomy and thoracoscopy in the treatment of patent arterial duct in infants weighing less than 2500 g].

BACKGROUND: Thoracoscopic clipping of the patent ductus arteriosus is an alternative to conventional surgical closure via thoracotomy in low birth weight infants. The aim of this study is to compare of these two groups of patients for the last 11 years. METHODS: We reported the data of 127 small children's who underwent standard transaxillary thoracotomy (101 patients - Group I) and video-assisted thoracoscopic surgery for patent ductus arteriosus clipping (26 patients - Group II). The two groups were compared for patients demographics, operative report and postoperative parameters. RESULTS: The groups were similar in terms of demographics and preoperative parameters. There was significant difference in mean operative time between open and thoracoscopic procedure (44.65 min vs 38.46 min; p<0.05). Duration of care in neonatal intensive unit and length of hospital stay were significantly shorter in the Group II (16.44 d vs 8.77 d; p<0.05 and 40.13 d vs 33.65 d; p<0.05). Early complication rates were equivalent between groups (6.93% vs 3.85%; p>0.05). Rate of long-term complications was dominated in the thoracotomy group (19.80% vs 0%; p=0127). CONCLUSION: Thoracoscopic ligation of the patent ductus arteriosus in infants less than 2500 g gave results better than open surgery.