Saratov JOURNAL of Medical and Scientific Research

Nechaev V.N.

Saratov State Medical University n.a. V. I. Razumovsky, Department of Hospital Pediatrics and Neonatology, Assistant Professor, Candidate of Medical Science

Twin-to-twin transfusion syndrome: A clinical case

Year: 2019, volume 15 Issue: №2 Pages: 236-240
Heading: Pediatrics Article type: Case report
Authors: Nechaev V.N., Chernenkov Yu.V.
Organization: Saratov State Medical University
Summary:

At the heart of the development of twin-to-twin transfusion syndrome (TTTS) is the presence of pathological anastomoses in the placental vascular network. The article presents a clinical case of TTTS development in monochorionic twins with placental vessel abnormality with a diagnostic search and a plan of further management.

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Congenital megakaryoblastic leukemia: A clinical case

Year: 2019, volume 15 Issue: №1 Pages: 34-40
Heading: Pediatrics Article type: Case report
Authors: Nechaev V.N., Chernenkov Yu.V., Mishina O.A., Fedorova Yu.A., Averyanov A.P.
Organization: Clinical Perinatal Center of the Saratov Region, Saratov State Medical University
Summary:

Leukemia in children (leukemia) is a systemic hemoblastosis, accompanied by a violation of bone marrow hemato- poiesis and replacement of normal blood cells with immature blast cells of the leukocyte series. Acute megakaryoblastic leukemia-one of the rarest forms of acute leukemia (1-3% of all leukaemias), which is characterized by the presence in the blood and bone marrow, along with undifferentiated blasts also megakaryoblasts, ugly megakaryocytes and platelet clusters. The work presents a clinical case of congenital acute megakaryoblastic leukemia in the child S., combined with the mosaic form of Down syndrome and a congenital heart defect.

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Perinatal lesions of the central nervous system in newborns according to the data of Clinical perinatal center of the Saratov region

Year: 2018, volume 14 Issue: №4 Pages: 639-645
Heading: Pediatrics Article type: Original article
Authors: Nechaev V.N., Chernenkov Yu.V., Averianov А.Р., Utts I.A.
Organization: Saratov State Medical University
Summary:

The purpose was to analyze the risk factors for the development of perinatal lesions of the central nervous system and to identify cause-effect relationships. Material and Methods. The retrospective analysis of primary documentation: history of childbirth and history of development of newborns is carried out. The work is based on the results of a comprehensive clinical and neurological examination, neurosonographic data and individual laboratory parameters. Results. In 2017 in the clinical perinatal center of the Saratov region 3301 births were conducted, of which the first delivery was performed in 69,4%, repeated in 30,6% and cesarean section in 41,2% of women. Hypoxic-ischemic disorders were observed in 928 newborns (27,7%). Children with low Apgar score had a combined genesis of chronic intrauterine hypoxia and acute asphyxia in childbirth in 3.8% of cases. Intraventricular hemorrhages (IHD) were diagnosed in 4,3% of cases, birth injuries in 3,6%. Congenital malformations of the central nervous system (CNS) were detected in 31 children (24,4%). Conclusion. The pathological course of pregnancy, problematic natural childbirth and emergency cesarean section are the most frequent risk

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Organization and work of the department of catamnesis of Clinical Perinatal Center of the Saratov region

Year: 2018, volume 14 Issue: №2 Pages: 226-223
Heading: Pediatrics Article type: Original article
Authors: Chernenkov Yu.V., Nechaev V.N.
Organization: Saratov State Medical University
Summary:

Objective: to examine the catamnesis of infants born with very low and extremely low birth weight, as well as undergoing critical conditions in the early neonatal period. To assess the health status of children observed, recommendations for further rehabilitation and prognosis. Material and Methods. At the department of catamnesis 4373 children were observed (total 21343 admissions), 62% of them were preterm infants. Children with extremely low body weight and very low body weight (157 patients, 20.3%) were evaluated for physical development, somatic and psychoneuro-logical status. Results. Analyzing the structure of morbidity observed in children hematologic violations are revealed in the form of anemia of prematurity moderate and severe degree in 15 patients (11.4%), slowing growth and development 25 (19.4%), respiratory disorders (19 children, 14.5%). In the assessment of physical development, growth disharmony revealed in 20.9%, weight disharmony in 29.4% of patients. Neuro-psychological development corresponded to the postconceptual age at 49.2% of children. Breastfeeding saved in 44.6%, mixed and in vitro were transferred in 55.4%. In a group of children follow-up observations identified numerous pathological conditions and high morbidity, requiring subsequent mandatory correction. Many of the children belong to the Group of infectious diseases patients (28.4%), with lots of somatic pathology (78.1%). A direct impact of the dynamics of body weight during the first months after birth was revealed in figures physical development of a child and the incidence in the future. The most vulnerable preterm infants from multiple pregnancies, small for gestational body weight deficiency which recovers slowly and have them marked lower psychomotor development. Conclusion. Improving rehabilitation technology, previously early steps, the integrated use of various methods and means, phases taking into accountthe stage of the disease process and individual approach to a child significantly improve the efficiency and effectiveness of rehabilitation therapy.

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Health status of newborns after vacuum extraction

Year: 2017, volume 13 Issue: №3 Pages: 498-501
Heading: Pediatrics Article type: Original article
Authors: Chernenkov Yu.V., Nechaev V.N., Kuchekov F.A.
Organization: Saratov State Medical University
Summary:

Objective: to study the outcome of labor and neonatal status after obstetric operations of vacuum extraction method KIWI. Material and Methods. The research and treatment of 58 newborns after the operation method KIWI were carried out. Conducted survey and evaluation of neurological status of newborn, analysis of medical documents (medical card of the pregnant, findings of ultrasound screening of the fetus, birth history and development of the newborn) were performed. Results. Indications for obstetrics KIWI included: narrow pelvis (17.2%), uterine inertia and discoordination (25.9%), fetal distress — 33 (56.9%). The KIWI application was a complete opening of the uterine mouth, the absence of membranes, a living fetus, clinical according to the size of the fetal head and pelvis of mother. The results of the assessment of children by Apgar scale: 1-3 points from 1.7%; 3-6 points of 25.9%; 7 or more points 72.4% of children. Cerebral ischemia 1 degree was diagnosed in 63.8%; of the 2 degree of 34.5%, grade 3 in 1.7% of children. The average stay of children in the Department of physiology was 6.5 days, the 2nd stage is 11.6 days. Generic tumor from the apparatus KIWI was observed in 36.2%, cephalohematoma in 31,0%; no serious complications have to 32.7% of children. All patients were discharged from hospital. Examination of 29 children at the Department of Catamnesis showed that 13.7% of them noted a neurological deficit in the form of small brain dysfunctions. Conclusion. The introduction of new models of vacuum extraction, enhance the delivery through natural patrimonial ways. No significant impact on the course of the neonatal period, which allows us to recommend the method for more widespread use. However, the vacuum extraction of the fetus may be effective and safe only if indications, conditions and technique are strictly followed.

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Analysis of status of preterm infants with bronchopulmonary dysplasia

Year: 2017, volume 13 Issue: №2 Pages: 251-255
Heading: Pediatrics Article type: Original article
Authors: Chernenkov Yu.V., Nechaev V.N., Nesterova D.l.
Organization: Saratov State Medical University
Summary:

Objective: the combination frequency of BPD in premature infants, assessment of the degree of functional lesion of the respiratory tract and the efficiency of respiratory support. Material and Methods. The survey included 36 women and 38 preterm infants (two twins). Results. In 99% of the surveyed women pregnancy was complicated by chronic intrauterine fetal hypoxia, 2.1% — RH-conflict. At 43.2% of cases acute respiratory viral infection during pregnancy was revealed, 15.3% of bad obstetric history, 5% of women who had bad habits (smoking, alcohol intake). In 2015 there were 5 deaths (13.2%). 14 children (36.8%) were transferred to other hospitals for further treatment, the remaining 19 (50%) were discharged from the hospital. One child — full-term, the other— premature. At 87.7% of children with BPD, the diagnosis was RDS, in 4.2% — aspiration of meconium, 8.1% — congenital pneumonia. 15 children (30.5%) received therapy with surfactant once, including 9 newborns (23.7%) received medication twice. All newborns were carried out intensive care, including respiratory support. Mechanical ventilation in 14 children had been conducting for 8.4±2.3 day, in 13 cases for 17.3±3.8 day, in 11 cases for 23.4±4.1 day. Nasal CPAP was conducted in 23 newborns: from 4 to 6.8±1.9 day, 13 — less of 16.8±2.9 per day, 6 children have had more than 23.2±3.8 day. Conclusion. There is necessity for prevention during pregnancy with glucocorticoids, the prolongation of pregnancy; preterm neonates — surfactant therapy; adequate provision of resuscitation care in the delivery room and respiratory support. The reduction of time of mechanical ventilation and the expansion of the indications for non-invasive methods of respiratory therapy reduced the incidence of BPD, the severity of the disease and improve the prognosis.

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Features of newborns with intrauterine growth restriction (according to the data of perinatal center of the Saratov region)

Year: 2017, volume 13 Issue: №1 Pages: 062-067
Heading: Pediatrics Article type:
Authors: Chernenkov Yu.V., Nechaev V.N., Dudukina E.S.
Organization: Saratov State Medical University
Summary:

Objective: to identify risk factors that adversely affect the development of fetus and child small for gestational age; to assess the incidence of the intrauterine development of fetus and newborn; to analyze the health indicators of these children. Material and Methods. Cases of 226 children (6.6%) with diagnosed intrauterine growth restriction of the fetus were examined, including 134 of prematurity (59%). Results. The most common risk factors for the intrauterine development of the fetus were: violation of the utero-placental circulation — 196 cases, the uterine scar — 78 women, urinary tract infection — 94. Extragenital pathology was found in all women, the threat of termination of pregnancy in 109 cases, medical history of abortions in 106 women and 83 anaemia in women. Birth asphyxia was observed in 102 children (45%), prematurity in 71 cases (31.4%). Asphyxia of severe degree accounted 1 (0.5%) premature and 1 (0.45%) full-term baby. Asphyxia of moderate severity (4-6 points) accounted 70 (30.9%) preterm and 31 (13.7%) full-term infants. The most common form of the intrauterine development of the fetus asymmetrical revealed 178 cases (79.1%). Conclusion: Perinatal factors such as medical abortion, urinary tract infection, extragenital pathology are preventable. The predominant form of the intrauterine development of the fetus is asymmetric form, symmetric and dysplastic revealed to a greater degree in premature infants. Children with low weight for gestational age should be adequately provided with the necessary nutrients, fortifiers, vitamins and in the process of rehabilitation — cerebropro-tective therapy.

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A clinical case of hereditary hydrocephalus (Dandy-Walker's syndrome)

Year: 2016, volume 12 Issue: №4 Pages: 571-574
Heading: Pediatrics Article type: Case report
Authors: Chernenkov Yu.V., Nechaev V.N., Lysova Yu.V.
Organization: Saratov State Medical University
Summary:

Congenital malformations are considered as one of the main causes of mortality and disability in early childhood. Congenital anomalies resulting in serious disorders often accompany pathology of the brain. The results of clinical observation and treatment of the patient with significant malformation of the central nervous system, hereditary hydrocephalus (Dandy — Walker's syndrome) have been presented in the work. The issues on early prenatal diagnosis and correction of this malformation in the neonatal period have been stressed.

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Congenital malformations in a fetus and a newborn according to the data of Perinatal Center of the Saratov region

Year: 2016, volume 12 Issue: №3 Pages: 393-398
Heading: Pediatrics Article type: Original article
Authors: Chernenkov Yu.V., Nechaev V.N., Katkova E.M.
Organization: Saratov State Medical University
Summary:

The aim: to study the frequency of birth defects in Perinatal Center of the Saratov region from 2014 till 2015, the possibility of prognosing, early diagnosis and optimization of programs for the prevention and correction of congenital malformations, the evaluation of treatment outcomes. Materials and Methods. The study included newborn babies and fetuses with birth defects for the period 2014-2015 according to data received from Perinatal Center. The data on ultrasound examination of pregnant women and about 149 fetuses with malformations in case of early terminated pregnancies were analyzed. Results. In 2014 Perinatal Center of the Saratov region found 77 newborns with congenital malformations, in 2015-72; 24 children (16.1%) required early surgical intervention. The comprehensive assessment of the health status of women and their children, the assessment of placental blood flow and fetal development, the identification of chromosomal and genetic abnormalities were conducted. 5 children of 149 children with congenital malformations died at the stage of the maternity hospital where average mortality accounted for 3.3%. Congenital malformations of central nervous system and sense organs accounted for 13.4%, malformations of the face and neck — 5.4%, malformations of the cardiovascular system — 28.8%, malformations of the respiratory system — 2.7%, malformations of the gastrointestinal tract — 4%, malformations of the musculoskeletal system — 9.4%, malformations of the urinary system — 27.5%, genital malformations — 4%, defects of the skin and its appendages — 1.3%, other malformations — 2.7%. Multiple malformations accounted for 4.7%. During 2014-2015 due to congenital malformations 311 births (4.4%) were interrupted, the main cause was determined as chromosomal abnormalities. Training, diagnosis, management of pregnant women and their delivery is carried out in Perinatal Center of the Saratov region in accordance with the complex program and algorithm methods for the prevention and correction of congenital malformations. Conclusion: This study has shown that there is a growth of small anomalies and reduction of frequency of multiple malformations. Comprehensive preventative program is possible to reduce the number of infants with untreated birth defects (13,5%), increase the percentage of defects detected by ultrasound from 51.7 to 66.7%.

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Indices of retinopathy morbidity among premature children in Saratov region institutions of obstetrics

Year: 2015, volume 11 Issue: №4 Pages: 553-555
Heading: Pediatrics Article type: Original article
Authors: Сhernenkov Yu.V., Nechaev V.N., Tereshenko V.A., Stasova Yu.V.
Organization: Saratov State Medical University
Summary:

Research objective: to study efficiency of diagnostic and preventive actions for decrease in frequency and weight of the retinopathy of the prematurely born (RPB), and also to carry out the analysis of incidence, the accompanying states and dynamic monitoring of prematurely born children with RPB. Material and methods. For 2 years it was surveyed on the retinal chamber "Ret Cam 3" — 531 patients of second stage of nursing Perinatal center of the Saratov region. Results. In 2013 from the examined 239 children, RPB is revealed at 56 (23,4%), 183 children (76,5%) had various changes of vessels of an eye bottom. In 2014 at 292 children the following ophthalmologic pathology was noted: incomplete development of vessels — at 101 (34,5%), an angiopatiya of vessels of a retina — 122 (41,8%), angiospasm — 18 (6,2%), a partial atrophy of disks of optic nerves at 3 (1,0%), an atrophy of eyeballs — 1 (0,3%), RPB is revealed at 47 (16,1 %). It is important to note that all children with the RPB malignant form had body weight at the birth less than 1000 grams and gestational age lower than 28 weeks. Conclusion. For the last year the tendency to decrease in cases of RPB including heavy forms, however spontaneous regress at initial stages of a disease was 12,4% lower, than in 2013 is noted.

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