Newborns death risk factors after surgical interventions in the early neonatal period

Cover Page

Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription Access

Abstract

BACKGROUND: The mortality rate of children operated on in the early neonatal period remains high, despite the combined efforts of surgeons, anesthesiologists, clinical pharmacologists, and many other specialists.

AIM: to determine the risk of death of children in the period of birth, after surgical interventions carried out in the period of the neonatal period.

MATERIALS AND METHODS: A retrospective study was conducted between two groups of children treated at the Perinatal Center of the Pediatric University. The main group included 77 newborns operated on in the early neonatal period and died in the first 28 days of life. The control group included 287 children operated on in the perinatal period and survived 28 days.

RESULTS: In the main group, the percentage of defects detected prenatally was statistically significantly lower; statistically significantly more often multiple congenital malformations and congenital malformations of the cardiovascular system were diagnosed. Risk factors for the death of newborns after surgery performed in the perinatal period have been established: features of the somatic status of mothers (chronic nicotine intoxication, hypertension and arterial hypertension, chronic serum hepatitis B and C, pathology of the urinary system and thyroid gland, cervical ectopia), obstetric gynecological history (chronic inflammation of the organs of the lower floor of the genital tract, two or more abortions in multiparous women, placental insufficiency in history during a previous pregnancy, previous delivery by caesarean section), course of pregnancy (threatening abortion, acute respiratory viral infections, exacerbations of chronic infectious diseases, early toxicosis, carriage of Cytomegalovirus and Herpes simplex types 1 and 2, asymptomatic bacteriuria, gestational anemia, circulatory failure, fetal malnutrition, abnormalities in the amount of amniotic fluid diagnosed by ultrasound study in the 3rd trimester of pregnancy), childbirth (breech presentation of the fetus and meconium staining of amniotic fluid), afterbirth conditions (chlamydial and ascending infection).

CONCLUSIONS: In pregnant women with prenatally diagnosed congenital malformations of the fetus, it is necessary to conduct bacteriological studies, emergency histological examination of the placenta to identify possible microbial damage, as well as timely examination and treatment of newborns and upcoming / undergone surgery.

About the authors

Vitaly F. Bezhenar

Academician I.P. Pavlov First St. Petersburg State Medical University

Email: lida.ivanova@gmail.com

MD, PhD, Dr. Sci. (Med.), Professor, Director of the Department of Obstetrics, Gynecology and Reproductology

Russian Federation, Saint Petersburg

Lidiia A. Ivanova

Kirov Military Medical Academy

Author for correspondence.
Email: lida.ivanova@gmail.com

MD, PhD, Associate Professor, Department of Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Dmitry O. Ivanov

Saint Petersburg State Pediatric Medical University, Perinatal Сenter

Email: doivanov@yandex.ru

MD, PhD, Dr. Sci. (Med.), Professor, Chief Freelance Neonatologist of the Ministry of Health of Russia, Rector, Head of the Department of Neonatology with courses of Neurology and Obstetrics and Gynecology

Russian Federation, Saint Petersburg

Olga L. Krasnogorskaya

Saint Petersburg State Pediatric Medical University, Perinatal Сenter

Email: krasnogorskaya@yandex.ru

MD, PhD, Associate Professor, Head of the Department of Pathological Anatomy at the rate of Forensic Medicine

Russian Federation, Saint Petersburg

References

  1. Averin VI, Korostelev OYu, Dardynskiy AV, Zapolianski AV. One-stage radical correction of persistent cloaca. Surgery Eastern Europe. 2012;(1):83–87. (In Russ.)
  2. Averin VI, Podgaysky VN, Nesteruk LN, et al. First experience of graft revascularization at esophagoplasty in children in non-standard cases. Surgery news. 2012;20(1):80–84. (In Russ.)
  3. Bokeriya LA, Alekyan BG, Pursanov MG, et al. Gibridnye operatsii pri sindrome gipoplazii levogo serdtsa i kriticheskikh obstruktivnykh porazheniyakh voskhodyashchei aorty. The bulletin of Bakoulev center. Cardiovascular diseases. 2010;11(S3):4. (In Russ.)
  4. Govorukhina OA, Prokopenya NS, Kharitonchik VA, Khomich VM. Diagnostics and surgical treatment of hirsprung disease in newborns and patients in the first months of life. Meditsinskii zhurnal. 2022;(2):4–11. (In Russ.)
  5. Gorbatikov KV, Totolin IS, Karpov EA, et al. Treatment of congenital heart defects with a combination of interrupted aortic arch, operational technology. Medical science and education of Ural. 2018;19(2):6–9. (In Russ.)
  6. Dzehtyarou YuG. Congenital anorectal anomalies: diagnosis, treatment. Meditsinskii zhurnal. 2014;(2): 53–59. (In Russ.)
  7. Efimochkin GA, Barbukhatti KO, Karakhalis NB, et al. Transposition complex with aortic arch obstruction: outcomes after one-stage repair in newborn period. Innovative Medicine of Kuban. 2017;7(3):6–13. (In Russ.)
  8. Karavaeva SA. Khirurgicheskoe lechenie nekroticheskogo ehnterokolita [dissertation abstract]. Saint Petersburg, 2002. (In Russ.)
  9. Kozlov YuA, Bregel LV, Rasputin AA, et al. Laparoscopic Santulli intestinal anastomosis in an infant with cystic fibrosis. Pediatrics. Journal named after G.N. Speransky. 2021;100(60):187–191. (In Russ.) doi: 10.24110/0031-403X-2021-100-6-187-191
  10. Kozlov YuA, Koval’kov KA, Chubko DM, et al. Intestinal strictures in newborn babies after necrotizing enterocolitis (post-NEC intestinal strictures). Russian Journal of Pediatric Surgery. 2016;20(5):228–234. (In Russ.)
  11. Kozlov YuA, Novozhilov VA, Koval’kov KA, et al. Results of the treatment of spontaneous intestinal perforation in preterm children. Russian Journal of Pediatric Surgery. 2017;21(6):284–290. (In Russ.)
  12. Kucherova IYu, Kryuchko DS, Movsesyan RR. Opyt anesteziologicheskogo posobiya u nedonoshennykh detei vo vremya operatsii klipirovaniya otkrytogo arterial’nogo protoka. The Peer-reviewed Scientific and Practical Journal. The Bulletin of Bakoulev Center. Cardiovascular Diseases. 2008;9(S6):225. (In Russ.)
  13. Maksimenko AV, Shipov DO, Motrechko AA, et al. Opyt ballonnoi val’vuloplastiki u patsientov s atreziei legochnoi arterii i intaktnoi mezhzheludochkovoi peregorodkoi. Pediatriya i detskaya khirurgiya. 2018;(2): 30–35. (In Russ.)
  14. Orlov YuO, Shaversky AV, Marushchenko LL, Zyabchenko VI. Intracranial tumors in newborns. Ukrainskii nevrologicheskii zhurnal. 2014;(2):63–68. (In Russ.)
  15. Ostreykov IF, Mel’nikova NI, Babaev BD, Shtatnov MK. Fungal infections in children with surgical disease in the ICU. Russian Journal of Anaesthesiology and Reanimatology. 2017;62(4):310–315. (In Russ.)
  16. Prokopenya NS, Govorukhina OA, Averin VI. Lechenie kresttsovo-kopchikovykh teratom u detei. Surgery Eastern Europe. 2012;(3):232–233. (In Russ.)
  17. Protasevich TS, Bontsevich NS, Svirkova AA. Analiz sluchaev vrozhdennogo pilorostenoza u detei. Proceeding of the international science and practice conferences with international participation “Aktual’nye voprosy pediatrii”; 2017 Apr 8; Perm. Perm: Knizhnyi format, 2017. P. 191–194. (In Russ.)
  18. Razumovsky AY, Mokrushina OG, Shumikhin VS, et al. Pediatric surgeons choose endosurgery. Russian journal of thoracic and cardiovascular surgery. 2016; 21(1–2):52–59. (In Russ.)
  19. Sadykova AZh, Boranbaeva RZ, Kusainov AZ, et al. Analiz chastoty i prichin ostrogo povrezhdeniya pochek u novorozhdennykh s vrozhdennymi porokami razvitiya. Farmatsiya Kazakhstana. 2022;(3):89–96. (In Russ.) doi: 10.53511/pharmkaz.2022.74.15.015
  20. Sadykova AZh, Boranbaeva RZ, Sarsenbaeva GI, et al. Chastota i faktory riska ostrogo povrezhdeniya pochek v neonatal’noi kardiokhirurgii. Farmatsiya Kazakhstana. 2022;(1):28–36. (In Russ.) doi: 10.53511/pharmkaz.2022.64.56.006
  21. Svirsky AA, Sevkovsky IA, Averin VI, et al. Necrotizing enterocolitis of newborns — pressing issues and factors prognosticating treatment outcome. Russian Journal of Pediatric Surgery, Anesthesia and Intensive Care. 2016;6(3):19–26. (In Russ.)
  22. Truba IP, Lazoryshynets VV, Sekelyk RI, et al. Aortic arch hypoplasia in combination with other congenital heart defects in infants: results of a one-stage repair. Cardiology in Belarus. 2021;13(6):885–894. (In Russ.) doi: 10.34883/PI.2021.13.6.003
  23. Trunina II. Gipotrofiya, vnutriutrobnye infektsii i sindromal’naya patologiya kak faktory riska neonatal’noi kardiokhirurgii. Children’s Heart and Vascular Diseases. 2012;(3):23–30. (In Russ.)
  24. Kholostova VV, Dronov AF, Smirnov AN, et al. Surgical treatment of Hirschprung’s disease total form in children. Pirogov Russian Journal of Surgery. 2014;(7): 44–54. (In Russ.)
  25. Aggarwal A, Kumar P, Chowdhary G, et al. Evaluation of renal functions in asphyxiated newborns. J Trop Pediatr. 2005;51(5):295–299. doi: 10.1093/tropej/fmi017
  26. Alten JA, Cooper DS, Blinder JJ, et al. Neonatal and Pediatric Heart and Renal Outcomes Network (NEPHRON) investigators. Epidemiology of acute kidney injury after neonatal cardiac surgery: a report from the multicenter neonatal and pediatric heart and renal outcomes network. Crit Care Med. 2021;49(10): 941–951. doi: 10.1097/CCM.0000000000005165
  27. Bell EF. Preventing necrotizing enterocolitis: what works and how safe? Pediatrics. 2005;115(1): 173–175. doi: 10.1542/peds.2004-2360
  28. Mol BWJ, Roberts CT, Thangaratinam S, et al. Pre-eclampsia. Lancet. 2016;387(10022):999–1011. doi: 10.1016/S0140-6736(15)00070-7
  29. Bhatia J. Strategies to prevent necrotising enterocolitis. Chin Med J. 2010;123(20):2759–2765.
  30. Brennan KG, Parravicini E, Lorenz JM, Bateman DA. Patterns of urinary neutrophil gelatinase-associated lipocalin and acute kidney injury in neonates receiving cardiopulmonary bypass. Children (Basel). 2020;7(9):132. doi: 10.3390/children7090132
  31. Clyman R, Wickremasinghe A, Jhaveri N, et al. Enteral feeding during indomethacin and ibuprofen treatment of a patent ductus arteriosus. J Pediatr. 2013;163(2): 406–411. doi: 10.1016/j.jpeds.2013.01.057
  32. Gaudin A, Farnoux C, Bonnard A, et al. Necrotizing Enterocolitis (NEC) and the tisk of intestinal stricture: The value of C-reactive protein. PLoS One. 2013;8: e76858. doi: 10.1371/journal.pone.0076858
  33. Gist KM, Blinder JJ, Bailly D, et al. Neonatal and Paediatric Heart and Renal Outcomes Network: design of a multi-centre retrospective cohort study. Cardiol Young. 2019;29(4):511–518. doi: 10.1017/S1047951119000210
  34. Gordon PV. Understanding intestinal vulnerability to perforation in the extremely low birth weight infant. Pediatr Res. 2009;65:138–144. doi: 10.1203/PDR.0b013e31818c7920
  35. Greenberg JH, Zappitelli M, Jia Y, et al. Biomarkers of AKI progression after pediatric cardiac surgery. J Am Soc Nephrol. 2018;29(5):1549–1556. doi: 10.1681/ASN.2017090989
  36. Kai K, Sameshima H, Ikeda T, Ikenoue T. Severe variable deceleration is associated with intestinal perforation in infants born at 22–27 weeks’ gestation. J Matern Fetal Neonatal Med. 2009;22(3):259–264. doi: 10.1080/14767050802379049
  37. Karagianni P, Briana DD, Mitsiakos G, et al. Early versus delayed minimal enteral feeding and risk for necrotizing enterocolitis in preterm growth-restricted infants with abnormal antenatal Doppler results. Am J Perinatol. 2010;27(5):367–373. doi: 10.1055/s-0029-1243310
  38. Kelleher J, Salas AA, Bhat B, et al. Prophylactic indomethacin and intestinal perforation in extremely low birth weight infants. Pediatrics. 2014;134(5): 1369–1377. doi: 10.1542/peds.2014-0183
  39. Leaf A, Dorling J, Kempley S, et al Early or delayed enteral feeding for preterm growth-restricted infants: a randomized trial. Pediatrics. 2012;129(5):1260–1268. doi: 10.1542/peds.2011-2379
  40. Marelli AJ, Mackie AS, Ionescu-Ittu R, et al. Congenital heart disease in the general population: changing prevalence and age distribution. Circulation. 2007;115(2): 163–172. doi: 10.1161/CIRCULATIONAHA.106.627224
  41. Nakajima Y, Masaoka N, Yamamoto T. Obstetrical risk factors for focal intestinal perforation in very low birth weight infants. J Perinat Med. 2011;39(2):179–184. doi: 10.1515/jpm.2010.129
  42. Phad N, Trivedi A, Todd D, Lakkundi A. Intestinal strictures postnecrotising enterocolitis: Clinical profile and risk factors. J Neonatal Surg. 2014;3(4):44. doi: 10.47338/jns.v3.134
  43. Pumberger W, Mayr M, Kohlhauser C, Weninger M. Spontaneous localized intestinal perforation in very-low-birth-weight infants: a distinct clinical entity different from necrotizing enterocolitis. J Am Coll Surg. 2002;195(6): 796–803. doi: 10.1016/S1072-7515(02)01344-3
  44. Rao SC, Basani L, Simmer K, et al. Peritoneal drainage versus laparotomy as initial surgical treatment for perforated necrotizing enterocolitis or spontaneous intestinal perforation in preterm low birth weight infants. Cochrane Database Syst Rev. 2011;(6):CD006182. doi: 10.1002/14651858.CD006182.pub2
  45. Raval MR, Hall NJ, Pierro A, Moss RL. Evidence-based prevention and surgical treatment of necrotizing enterocolitis — A review of randomized controlled trials. Semin Pediatr Surg. 2013;22(2):117–121. doi: 10.1053/j.sempedsurg.2013.01.009
  46. Selewski DT, Jordan BK, Askenazi DJ, et al. Acute kidney injury in asphyxiated newborns treated with therapeutic hypothermia. J Pediatr. 2013;162(4):725–729. doi: 10.1016/j.jpeds.2012.10.002
  47. Wadhawan R, Oh W, Vohr BR, et al. Spontaneous intestinal perforation in extremely low birth weight infants: association with indometacin therapy and effects on Jones and Fisher 6 neurodevelopmental outcomes at 18–22 months corrected age. Arch Dis Child. 2013;98:127–132. doi: 10.1136/archdischild-2011-300659
  48. Guner YS, Chokshi N, Petrosyan M, et al. Necrotizing enterocolitis — bench to bedside: novel and emerging strategies. Semin Pediatr Surg. 2008;17(4):255–265. doi: 10.1053/j.sempedsurg.2008.07.004
  49. Yoneyama F, Okamura T, Takigiku K, Yasukouchi S. Novel urinary biomarkers for acute kidney injury and prediction of clinical outcomes after pediatric cardiac surgery. Pediatr Cardiol. 2020;41(4):695–702. doi: 10.1007/s00246-019-02280-3

Copyright (c) 2022 Bezhenar V.F., Ivanova L.A., Ivanov D.O., Krasnogorskaya O.L.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies