SOVREMENNAYA PEDIATRIYA.2018.1(89):103-109; doi 10.15574/SP.2018.89.103

Shunko Ye., Sirenko O., Starenka S.
Shupyk National Medical Academy of Postgraduate Education, Kyiv, Ukraine
National Children's Specialized Hospital «OHMATDET», Kyiv, Ukraine

Objective: to determine the features of the early neonatal period, the clinical and metabolic adaptation of the late preterm infants (LPIs) in conditions of high perinatal risk.
Material and methods. The study included 97 LPIs, who were born by the mothers with high perinatal risk. All children were divided into three groups: the first group included 29 children with gestational age (GA) 34 (0/7 — 6/7) weeks, the second one — 34 children with GA 35 (0/7 — 6/7) weeks and the third group comprised 34 children with GA 36 (0/7 — 6/7) weeks. The anthropometric data, gender, the state of children at birth, the need for resuscitation, the course of neonatal period were studied.
Results. In the initial and resuscitative measures, 52 (53.6%) children were needed in the labour ward / operating room. Among the children who were underwent intubation in the labour ward, children of 36 GW prevailed (7 children — 20.6%). The 51minute Apgar score of less than 7 points was much more common in children with GA 36 weeks. The condition of 31 (32%) children worsened during the first day of life. Respiratory disorders were detected in 79 (81.4%) children. Respiratory support was required in 49 (50.5%) cases. Oxygen therapy was given to 27 (27.8%) children, among them 34 and 35 GW prevailed. In respiratory support in the nCPAP regime, 8 (8.2%) children were needed, among them mainly LPIs with GA 36 weeks (6 children — 17.6%). Artificial ventilation was required by 30 (30.9%) children. The duration of respiratory support was the greatest among children 34 weeks of gestation. Apnea of prematurity was more frequent among children 34–35 weeks of gestation. The ultrasound signs of morphofunctional immaturity of the brain were determined in 60 (61.9%) children. In connection with the predisposition to hypothermia, the majority of LPIs (92.8%) were rewarming in an incubator or in a bed under the source of radiant heat. The duration of additional heating was inversely proportional to the gestational age of the children. Hypoglycemia was developed in 45 (46.4%) children. Hyperbilirubinemia of prematurity was observed in the majority (89.7%) of LPIs. Among children with GA of 34–35 weeks the jaundice was developed more often than in children of 36 GW. The duration of inpatient treatment was the highest among children with GA 34 weeks and made up 32 (26–39) days.
Conclusions. Late preterm infants who were born in conditions of high perinatal risk need to be monitored by medical personnel and thoroughly clinico-laboratory monitoring in the period of early adaptation. The risk of development of postnatal adaptation violations is conditioned by both morphofunctional dismaturity and unfavorable conditions of the intrauterine development of child.
Key words: late preterm infants, postnatal adaptation, respiratory distress syndrome, hypoglycemia, hyperbilirubinemia.

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