EMBRYONIC INFECTIONS AS THE MAIN CAUSE OF THE DEATH OF CHILDREN WITH EXTREMELY LOW BIRTH WEIGHT

Abstract

Timeliness: embryonic infections are one of the most important problems in obstetrics and neonatology. Embryonic infection is diagnosed in 50–65% of hospitalized full-term newborns and more than 70% of premature babies. According to the results of pathological researches of newborns this pathology was the main cause of death in more than 40% of deceased children and it also complicated the course of the underlying disease. Purpose of the study: analysis of causes of death of severely premature babies. Materials and methods of research. Methods: a retrospective analysis of 38 case-record and protocols of pathomorphological studies of severely premature children who were in the NICU from 2016 to 2019 was carried out. The gestational age at the time of birth in the study group was composed as follows: up to 24 weeks - 13 newborns; 25-26 weeks - 51 newborns; 30 weeks - 51 newborns. There are 22 boys and 16 girls in the study group. The average age of mothers of newborns in the study group was over 28 years old, every second one was over 30 years old. 19 of them were first-time-mothers. The aggravating factors were classified into somatic (diseases of the cardiovascular system, chronic diseases of the urinary tract, endocrine diseases, pathology of the gastrointestinal tract) and obstetric-gynecological (medical abortion, spontaneous abortion, early fetal death with delay in the uterus, severe nephropathy). Results: the analysis of the postmortem report showed that the main causes of death in severe premature babies are intrauterine sepsis – 16 cases, IVH of III-IV stage caused by DIC amid the congenital infection – 9 cases, severe purulent pneumonia − 7 cases. Сongenital pneumopathies amid the congenital infection – 4 cases. In a few cases the main cause of the death was necrotizing enterocolitis, congenital bronchopulmonary dysplasia, fetal neonatal hepatitis with forming hepatic cirrhosis which was developing in utero amid the congenital infection.

According to virological and bacteriological researches the main pathogens

at birth were: Enterococcus faecium - 4 cases, Staphylococcus epidermidis - 4 cases, Staphylococcus haemolyticus - 3 cases, Klebsiella pneumonia - 3 cases, Candida albicans - 3 cases, Escherichia coli - 3 cases case. The conclusion: there were generalized congenital infections of bacterial and bacterial-fungal etiology and IVH varying severity in all cases of death of babies with extremely low body weight. There were accompanying pathologies like congenital infections, DIC, severe anemia, immaturity, extreme prematurity in all cases. As a rule the main reasons for the extremely early termination of pregnancy were the burdened somatic one (diseases of the cardiovascular system - in 10 women (26%), chronic diseases of the urinary tract - 21%, endocrine diseases - in 7 women (18%), a pathology of gastrointestinal tract (5 women), a childbearing pattern (50% of pregnant women) and complications in the pregnancy: a chronic fetoplacental insufficiency – 21 cases (55%), a miscarriage risk – 20 cases (52%), a delayed fetal development − 8 cases (21%), preeclampsia - 5 cases (13%).