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EVALUATION OF THE RESULTS OF EXAMINATION OF
NEWBORNS WITH INTRAUTERINE INFECTION
Usmanova Munira Fayzullayevna
Аssistant of the Department of №1 Pediatrics and neonatology
Samarkand State Medical University
Tolibjonova Nozanin Xusenovna
Student of the 622
th
group of the Faculty of Pediatric
Samarkand State Medical University
Аnnotation. Intrauterine infections are caused mainly by bacterial and viral
pathogens that have penetrated to the fetus from the mother before or during
childbirth. Intrauterine infection (IUI) has numerous manifestations, such as
conjunctivitis,
rhinitis,
pyoderma,
pneumonia,
hepatitis,
otitis,
meningoencephalitis, up to the development of sepsis. However, intrauterine
infection does not always lead to generalized IUI, in some cases infected children
do not have any clinical symptoms of the disease. The aim of the study was to study
the most common variants of IUI in newborns and to determine their relationship
with infectious urogenital and extragenital diseases of the mother. The analysis of
the birth histories and the development histories of newborns, including the
somatic and obstetric-gynecological anamnesis of the pregnant woman, the course
of pregnancy and childbirth, the results of clinical and laboratory studies, as well
as the assessment of the child's condition after childbirth, was carried out.
Key words: intrauterine infections, newborns, extragenital diseases.
Relevance.
Intrauterine infections (IUI) are characterized by polyetiology, the
absence of specific signs and a wide variety of clinical manifestations, which
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complicates their antenatal diagnosis and, as a consequence, preventive measures
and treatment of the realized infection [1,11,14].
Intrauterine infection (IUI) is one of the most important medical and social
problems in modern perinatology. VUI develops in 27,4 – 36,6% of children born
alive, and infectious pathology occupies one of the leading places in the structure
of newborn mortality, causing from 11 to 45% of child deaths [2,12,15].
Intrauterine infections are characterized by polyetiology, the absence of specific
signs and a wide variety of clinical manifestations, which complicates their
antenatal diagnosis and, as a consequence, preventive measures and treatment of
the realized infection. At the moment, it is not known why, with intrauterine
infection of the fetus, the pulmonary system is one of the most vulnerable places
[3,10,13]. In the world, 1.79 cases of intrauterine pneumonia (IUP) are recorded
per 1,000 newborns. This disease is still a serious threat to the life of a child
[4,5,17]. At the same time, according to A. R. Zaripova, pneumonia associated with
the provision of medical care amounts to 1.02 cases per 1000 newborns. According
to E. G. Sulima (2006), the VUP of bacterial nature in newborns is a clinical
manifestation of septicemia, and the bronchopulmonary system is the gateway to
infection.
Currently, there is an increase in the incidence of intrauterine pneumonia in
full-term newborns [6,7]. This severe disease of the newborn, which has a
significant impact on the further physical development of the child, can contribute
to the formation of chronic bronchopulmonary disease, allergic processes, and a
decrease in immunological reactivity, therefore, the study of the clinical features
of the VUP remains an urgent problem of modern pediatrics [8,9,16].
The purpose of the study. To identify the results of tests of newborns with
intrauterine infection and to determine their relationship with urogenital and
extragenital diseases of the mother.
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Material and methods of research.
In order to identify cases of intrauterine
infection of newborns, an analysis of birth histories and newborn development
histories was performed, including the somatic and obstetric-gynecological history
of the pregnant woman, the course of pregnancy and childbirth, the results of
clinical and laboratory studies, as well as an assessment of the child's condition
after childbirth (Apgar scale, weight and height, neurological status, the course of
the early neonatal period), laboratory and instrumental examination of a newborn
(general blood test, biochemical blood test, umbilical cord blood culture,
determination of CRP, procalcitonin test, chest X-ray). To achieve this goal, VI
groups of patients were formed:
Group I included 102 women of high infectious risk, whose children had no
signs of an infectious process at birth. The II included 34 women whose children
had signs of the implementation of VUI at birth.
Group III included 43 patients with a low infectious risk, whose children had
no signs of infection. The study included newborns diagnosed with VUI and their
mothers.Group IV includes 100 newborns diagnosed with intrauterine infection.
Group V consisted of newborns with intrauterine pneumonia, group VI - newborns
without intrauterine pneumonia.
Results and their discussion. In the course of the work, the health status of 179
pregnant women was analyzed, extragenital pathology was revealed, the most
common diseases are urinary tract pathology - 49 (36%) women, chronic
pyelonephritis - 41 (30%). Most women have a burdened obstetric and
gynecological history: medical abortions - 64 (47%), miscarriages - 37 (27%),
chronic salpingoophoritis with repeated exacerbation - 57 (42%), colpitis - 83
(61%), bacterial vaginosis - 41 (30%), benign cervical changes- 34 (25%). The first
half of pregnancy was complicated by toxicosis in 56 (41%) women, anemia – in
22 (16%), the threat of termination of pregnancy in 56 (41%), infectious diseases
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– in 30 (22%), ARVI – in 26 (19%), candidiasis – in 64 (47%), bacterial vaginosis
- in 41 (30%), benign cervical changes-34 (25%).
The most frequent complications of the second half of pregnancy: the threat
of termination of pregnancy - 94 (69%), anemia - 71 (52%), CFPN (chronic
fetoplacental insufficiency) - 71 (52%), exacerbation of pyelonephritis-53 (39%),
colpitis - 60 (44%), polyhydramnios - 34 (25%). Prenatal outpouring of amniotic
fluid was observed in 41 (30%) pregnant women, the duration of the anhydrous
period was more than 12 hours in 30 (22%) women, pathology of amniotic fluid in
41 (30%). In 108 (80%) newborns, the Apgar score at the 1st minute of life is less
than 7 points, 6 points in 38% (52 newborns), 5 points in 22% (30 newborns), 4
points in 8% (11 newborns), 3 points in 8 % (11 newborns), 52 (38%) children had
signs of prematurity. In 100 newborns of group IV, congenital pneumonia was the
most common — 96 (96%) of newborns. In 11 (11%) — congenital rhinitis, in 5
(5%) — congenital vesiculosis. 71 (74%) newborns with congenital pneumonia
had no respiratory failure, 15 (16%) had grade 1 DN, 7 (7.2%) had grade 2 DN and
6 (6,2%) had grade 3 DN. The analysis of concomitant pathology showed that there
are significant differences in the groups of newborns for perinatal hypoxic-
ischemic damage of the central nervous system (CNS) (p = 0.001 according to
Pearson's -2).
In group V of newborns with intrauterine pneumonia, hypoxic-ischemic CNS
lesion of the II degree was diagnosed in 92,0%, and perinatal hypoxic-ischemic
CNS lesion of the III degree was diagnosed in 6,0% of cases. In group VI, perinatal
hypoxic-ischemic CNS lesion of the II degree was diagnosed in 40,0%, and
perinatal hypoxic-ischemic CNS lesion of the III degree was diagnosed in 2,0% of
newborns.
Conclusions.
Summing up, we conclude that the risk factors for the
development of infection in newborns are the presence of infectious and
inflammatory pathology in the mother's anamnesis (colpitis, vaginitis, chronic
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pyelonephritis, etc. pathologies), the threat of termination of pregnancy, as well as
polyhydramnios is a prognostically unfavorable criterion for the implementation of
IUI in infection. As for the prenatal outpouring of amniotic fluid and a long
anhydrous period, they also contribute to an increase in the risk of ascending
infection by microorganisms of the birth canal, which in turn leads to an increased
risk of infection in the newborn. The most common pathology in children in the
intensive care unit was congenital pneumonia — 96%, in every third case occurring
with respiratory failure. A frequent combination of VUP with perinatal hypoxic-
ischemic CNS lesion was revealed.
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