ELECTROCARDIOGRAPHIC CHANGES IN NEWBORNS FROM MOTHERS WITH METABOLIC SYNDROME.

OBJECTIVE: The aim: Analysis of electrocardiographic parameters in newborns from mothers with metabolic syndrome. PATIENTS AND METHODS: Materials and methods: We conducted a prospective cohort trial of 125 newborns, which included the study of their anthropometric, clinical and laboratory indicators and, in particular, ECG parameters. The main group consisted of 40 children, born from mothers with diagnosed metabolic syndrome, the comparison group included 2 subgroups: 28 term newborn and 57 preterm, from mothers without metabolic syndrome. RESULTS: Results: In newborns from mothers with metabolic syndrome on a fragmentary ECG we revealed abnormal depolarization, manifested by changes in the ventricular complex -QRS expansion (p<0.001), impaired conduction (p = 0.004), changes of T wave (p<0.001) and prolonged QT interval (p<0.001). There are such risk factors for QT prolongation in neonates: disease cardiovascular system and disorders of lipid metabolism in mother, asphyxia at birth and electrolyte disorders (hypernatremia OR 0.97), weight too high to gestational age at birth in newborn (OR 2.97), increased blood pressure in the neonatal period (OR 1.07), artificial feeding (OR 3.01). CONCLUSION: Conclusions: Metabolic syndrome in women during pregnancy has a pronounced effect on the cardiovascular system of the newborn. The detected signs of cardiac dysfunction on the ECG can serve as early integrated indicators of metabolic syndrome and cardiovascular disease in children.

Differential diagnostics of inherited metabolic disorders in newborns.

OBJECTIVE: The aim: To compose an applicable diagnostic checklist for neonatologists, pediatricians, and general practitioners who refer newborns with certain inherited metabolic diseases (IMDs) suspicion to confirmatory testing laboratories. PATIENTS AND METHODS: Materials and methods: Analyzed international and generally, known national clinical guides and recommendations devoted to IMDs diagnostics, treatment and follow up. RESULTS: Results: Considering integral character of the diagnostic work-up of inborn errors of metabolism, authors of this article composed an applicable checklist that comprises set of data necessary for interpretation the positive results of expanded newborn screening and making decision of appropriate biochemical and molecular tests are required for confirmatory follow-up testing to establish the diagnosis and prescribe pathogenetic therapy. CONCLUSION: Conclusions: Properly filled checklist allow metabolic professionals to select appropriate confirmatory tests and interpret results obtained. Early IMDs diagnosis and prompt treatment initiation are crucial for positive outcomes and proved to be an effective tool to decrease levels of child disability and infant mortality.

Effect of enos gene polymorphism on the course of early onset bacterial infections in premature infants.

OBJECTIVE: The aim of the study was to analyze the associations between 4a/4b polymorphism of the eNOS gene and impaired systemic hemodynamics in premature infants with early neonatal sepsis. PATIENTS AND METHODS: Materials and methods: We conducted a prospective cohort study, which included 120 premature babies with early neonatal sepsis, in 57 children the course of the disease was accompanied by arterial hypotension (AH) and in 61 children - not. In children of both groups, genotyping was performed to determine 4a/4b polymorphism of the eNOS gene. RESULTS: Results: It was shown that the heart rate, blood pressure, hourly diuresis, the level of total nitrates and nitrites in the urine, as well as a number of echocardioscopic and dopplerometric indicators in children with different eNOS gene genotypes are not different. CONCLUSION: Conclusions: There is no effect of 4a/4b polymorphism of the eNOS gene on the occurrence of hemodynamic disturbances in premature infants with sepsis.

Planning of effective evaluation of the activities of hospital district at the example of poltava region.

OBJECTIVE: Introduction: Increasing of the availability and quality of health care in rural areas is one of the priority directions of public health and regional development policy. The need for reforming of the network of secondary health care facilities is due to the fact, that they are unable to meet the needs of the population in this specialized type of medical care in the conditions of the existing structure and funding system. The aim: to analyze the existing legislation regulating the establishment and operation of hospital districts; to determine the methodology for monitoring and evaluating of the activity of the hospital district on the example of the Poltava region. PATIENTS AND METHODS: Materials and methods: In this work a set of methods is used: system approach, bibliosemantic, legal, logical modeling. RESULTS: Review: A managerial tool capable of tracking the process and demonstrating the impact of projects, programs and development policies is monitoring and evaluation. The basis of evaluation is the creation of different indicators and indexes. The system of these indicators provides an opportunity to assess the social, medical, economic and environmental aspects of development of hospital district. The monitoring and evaluation program should include monitoring of implementation (contributions and activities) and monitoring of the results of work of the hospital districts (short-term and long-term). CONCLUSION: Conclusions: Hospital districts are created with the aim of optimizing of the organization and functioning of the network of health facilities. The Management Board's decision should be based on valid, reliable information on the development of the hospital district. Compliance with the monitoring and evaluation methodology makes it possible to provide the health care system with qualitative and timely data at all stages of its reformation.

[Predicting the occurrence of severe intraventricular hemorrhages and ways to prevent their development in preterm infants].

OBJECTIVE: Introduction: Severe intraventricular hemorrhages (IVH) in preterm infants are one of the major public health problems, as they can cause neurological and cognitive impairment, as well as lethal outcomes. The aim: To prevent the development of IVH in preterm infants by developing an algorithm for identification of high risk infants and a bundle for the prediction and prevention of this pathology. PATIENTS AND METHODS: Materials and methods: A multicenter study (2013-2016) was conducted, which included 117 premature babies who were on treatment in 4 medical institutions in the Poltava region (Ukraine). The group of children with severe IVH included 76 children (weight 1037.8 ± 43.7 g, gestational age (GA) 27.1 ± 0.27 weeks; girls 36/47, 37 %), with IVH III-IV st. by Papile L.A. The comparison group consisted of 41 children (weight 1758 ± 59.8, GA 32.1 ± 0.30 weeks, girls 15/38, 46 %) without IVH. The effectiveness of a bundle for the prediction and prevention severe IVH was studied in the Poltava Regional Perinatal Center (high level, 2000 births per year) during 2014 - 2017. RESULTS: Results: The significant risk factors due to multiple regression logistic analysis are: gestational age (OR =0.28, р=0.000), anhydrous period less than 24 hours (OR =83,29; р=0.020), infusion of 0.9% sodium chloride solution during primary resuscitation (OR =16.73; р=0.042), episodes of arterial hypertension (OR =32.3; р=0.026), the number of leukocytes is ≥15x109/l at birth (OR=17.6; р=0.028). After the implementation of the Bundle, which included: an interdisciplinary check-list (between the obstetrician and the neonatologist), the algorithm for identifying children with high risk of IVH, a check-list for monitoring of the state of the child immediately after birth and an interprofessional check-list (between the doctor and the nurse), the IVH incidence decreased from 18.9 % to 11.4 %, p = 0.038, and the disability from 9.6 % to 2.4 %, p = 0.046. CONCLUSION: Conclusions: The Bundle is an effective tool for preventing of severe IVH in preterm infants.