PERINATOLOGIYA AND PEDIATRIYA.2019.1(77):63-68; doi 10.15574/PP.2019.77.63

Plekhanova T. M., Stepanenko T. I.
SI «Dnipropetrovsk Medical Academy of the Ministry of health of Ukraine», Dnipro

Introduction. The con sequence of perinatal asphyxia maybe not only damage to the nervous system, but also somatic dysfunctions from the vital organs — the lungs, heart, kidneys, intestines, with the possible development of multipleorgans failure. Systemic therapeutic hypothermia (STH) in the post-resuscitation period has a neuroprotective effect, reduces the frequency of deaths and neurological deficit. Scientific and practical interest is the effect of STH on the restoration of the functions of the somatic organs in newborns.

Purpose — to study the results of the recovery of somatic dysfunctions in newborns with asphyxia after systemic therapeutic hypothermia.

Patients and methods. Retrospective analysis of the results of treatment of 56 full-term newborns with asphyxia who received STH in the post-intensive period. The hemodynamics, kidney function, parameters and duration of artificial ventilation of lungs, the formation of enteral nutrition were studied.

Results. All children were born with severe asphyxia and after initial resuscitation had early manifestations of hypoxic ischemic encephalopathy, such as: depression syndrome of 37.5%, convulsions of 48.2%, and the brain coma in 14.3% of children. All children had indications for the STH, which was started in the first 6 hours after birth. At the beginning of the STH, the following somatic dysfunctions, such as: respiratory disturbances in 34 (66.1%), hemodynamic disorders in 23 (48.2%), acute kidney damage in 14 (25.0%), multiple organ failure in 12 (21.4%) children were recorded. After the STH, the respiratory function and hemodynamic disorders (at the first 12–48 hours after the termination of the STH) were restored most rapidly, and the renal function was restored more lasting (within 48–72 hours after the child warmed up). Disorders from the gastrointestinal tract were more resistant. Almost half of the children had complete enteral nutrition within 10 days, and one third of children had completed full enteral nutrition within two weeks after the STH was stopped.

Conclusions. Restoration of the functions of vital organs and systems in newborns in the post-asphyxia after the STH occurs gradually and not simultaneously. Most children have long-term gastrointestinal dysfunction with motor-evacuation disorders and nutritional intolerance. Children with multiple organ dysfunction syndrome and cerebral coma syndrome have more prolonged somatic dysfunctions.

Key words: newborn, asphyxia, systemic therapeutic hypothermia, somatic dysfunction.

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Article received: Nov 14, 2018. Accepted for publication: Feb 22, 2019.