V.F.Snegirev Archives of Obstetrics and GynecologyV.F.Snegirev Archives of Obstetrics and GynecologyАрхив акушерства и гинекологии им. В.Ф. Снегирева2313-87262687-1386Eco-Vector11103110.17816/2313-8726-2022-9-3-163-171Original study articlesОригинальные исследованияOriginal study articlesResearch ArticleNewborns in the early neonatal period in a group of mothers at high obstetric and perinatal riskНоворождённые в раннем неонатальном периоде в группе матерей высокого акушерского и перинатального рискаhttps://orcid.org/0000-0001-7882-8922SamchukPetr M.СамчукПетр Михайлович
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

samchuk_p_m@staff.sechenov.ruhttps://orcid.org/0000-0003-1773-7474TsaroevaInna K.ЦароеваИнна Хасановна
Russian Federation

postgraduate student

аспирант

tsaroevainna@mail.ruhttps://orcid.org/0000-0003-3338-1113IshchenkoAnatoliy I.ИщенкоАнатолий Иванович
Russian Federation

MD, Dr. Sci. (Med.), Professor

д.м.н., профессор

7205502@mail.ruhttps://orcid.org/0000-0002-3711-2423AzoevaEvelina L.АзоеваЭвелина Лазаревна
Russian Federation

postgraduate student, gynecologist

аспирант, врач акушер-гинеколог

ewelina.azoeva@yandex.ruI.M. Sechenov First Moscow State Medical University (Sechenov University)Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет)Moscow State Clinical Hospital named after V.V. VeresaevГородская клиническая больница им. В.В. Вересаева23092022931631712309202223092022Copyright ©; 2022, Samchuk P.M., Tsaroeva I.K., Ishchenko A.I., Azoeva E.L.Copyright ©; 2022, Самчук П.М., Цароева И.Х., Ищенко А.И., Азоева Э.Л.Copyright ©; 2022,2022Samchuk P.M., Tsaroeva I.K., Ishchenko A.I., Azoeva E.L.Самчук П.М., Цароева И.Х., Ищенко А.И., Азоева Э.Л.https://creativecommons.org/licenses/by-nc-nd/4.0/https://archivog.com/2313-8726/article/view/111031

AIM: We aimed at assessing the status of newborns in the early neonatal period in a group of mothers at high prenatal risk for preeclampsia (PE), fetal growth restriction (FGR), preterm birth (PTB), and fetal chromosomal abnormalities (FCA).

MATERIALS AND METHODS: We prospectively analyzed the status of 435 singletons. Mothers in the first-trimester underwent prenatal screening with risk assessment. Group 1 (study group, n=231) included high-risk subgroups for FCA (subgroup 1A, n=67), maternal PE (subgroup 1B, n=66), FGR (subgroup 1C, n=46), and PTB (subgroup 1D, n=52). We excluded risk combinations. Group 2 (controls) included 204 children of low-risk women.

RESULTS: Group 1 had a higher incidence of mild-to-moderate asphyxia compared with group 2 (p <0.05) and was more frequent in 1B, 1C, and 1D subgroups. Moreover, the frequency of severe asphyxia was similar between the groups (p >0.05). Intrauterine growth restriction (IUGR) and developmental delay were more frequent in group 1 than in group 2 (p <0.05). Moreover, group 1 children required monitoring and treatment more frequently that in group 2 (p <0.05). The frequency of infectious complications in group 1 and 1A, 1B, and 1C subgroups was equally higher than that of group 2 (p <0.05), while respiratory distress syndrome predominated in group 1 (subgroup 1D) and was not observed in group 2. The discharge rate was 95.7% in group 1 and 84.0% in group 2 (p <0.05). On days 3 to 5, 16% and 3.4% of children in groups 1 and 2, respectively, were transferred to the second stage of aftercare (p <0.05).

CONCLUSIONS: In the early neonatal period, children born to high-risk mothers, as opposed to those born to low-risk mothers, were significantly more likely to have asphyxia, IUGR, infectious complications, and indications for continued treatment in the second stage of nursing.

Цель исследования ― оценить состояние новорождённых в раннем неонатальном периоде в группе матерей высокого пренатального риска по развитию преэклампсии (ПЭ), задержки роста плода (ЗРП), преждевременных родов (ПР) и хромосомных аномалий у плода (ХА).

Материалы и методы. Проведён проспективный анализ состояния новорождённых от 435 одноплодных родов. Матерям в I триместре выполнен пренатальный скрининг с оценкой риска. В 1-ю, основную группу (n=231) включили подгруппы с высоким риском по развитию ХА у плода ― подгруппа 1А (n=67), ПЭ у матерей ― подгруппа 1В (n=66), ЗРП ― подгруппа 1С (n=46), ПР ― подгруппа 1D (n=52). Исключены сочетания рисков. Вторая, контрольная группа включала 204 ребёнка от женщин с низким риском.

Результаты. В 1-й группе отмечена более высокая частота рождения детей в состоянии асфиксии лёгкой и средней степени, чем во 2-й группе (р <0,05), и чаще в подгруппах 1В, 1С и 1D. Частота тяжёлой асфиксии не имела отличий между группами (р >0,05). Задержка внутриутробного роста и развития (ЗВУР) в 1-й группе встречалась чаще, чем во 2-й (р <0,05). Наблюдение и лечение потребовалось детям 1-й группы чаще, чем детям 2-й группы (р <0,05). Частота инфекционных осложнений у детей в 1-й группе и в подгруппах 1А, 1В и 1С оказалась выше, чем во 2-й группе (р <0,05). Респираторный дистресс-синдром преобладал в 1-й группе в подгруппе 1D, во 2-й группе он не отмечен. Выписаны 84,0% детей 1-й группы и 95,7% детей 2-й группы (р <0,05). На 3–5-е сутки 16% детей 1-й группы переведены на 2-й этап долечивания, во 2-й группе ― 3,4% (р <0,05).

Заключение. У детей, рождённых от матерей с высоким риском, в отличие от рождённых от матерей с низким риском, в раннем неонатальном периоде достоверно чаще отмечены асфиксия, ЗВУР, инфекционные осложнения и показания к продолжению лечения на втором этапе выхаживания.

asphyxiaintrauterine growthintrauterine growth restrictionnewbornsprenatal screeningrisk levelасфиксиявнутриутробное развитиезадержка внутриутробного ростановорождённыепренатальный скринингстепень рискаZamanskaya TA, Evseeva ZP, Evseev AV. Biochemical screening in the first trimester in predicting pregnancy complications. Russian Bulletin of Obstetrician-Gynecologist. 2009;3:14–18. (In Russ).Заманская Т.А., Евсеева З.П., Евсеев А.В. Биохимический скрининг в I триместре при прогнозировании осложнений беременности // Российский вестник акушера-гинеколога. 2009. № 3. С. 14–18.Cuckle H, Platt LD, Thornburg LL, et al. Nuchal Translucency Quality Review (NTQR) program: first one and half million results. Ultrasound Obstet Gynecol. 2015;45(2):199–204. doi: 10.1002/uog.13390Cuckle H., Platt L.D., Thornburg L.L., et al. Nuchal Translucency Quality Review (NTQR) program: first one and half million results // Ultrasound Obstet Gynecol. 2015. Vol. 45, N 2. P. 199–204. doi: 10.1002/uog.13390Breathnach FM, Malone FD, Lambert-Messerlian G. First- and second-trimester screening: detection of aneuploidies other than Down syndrome. Obstet Gynecol. 2007;110(3):651–657. doi: 10.1097/01.AOG.0000278570.76392.a6Breathnach F.M., Malone F.D., Lambert-Messerlian G. First- and second-trimester screening: detection of aneuploidies other than Down syndrome // Obstet Gynecol. 2007. Vol. 110, N 3. P. 651–657. doi: 10.1097/01.AOG.0000278570.76392.a6Coco C, Jeanty P. Isolated fetal pyelectasis and chromosomal abnormalities. Am J Obstet Gynecol. 2005;193(3 Pt 1):732–738. doi: 10.1016/j.ajog.2005.02.074Coco C., Jeanty Ph. Isolated fetal pyelectasis and chromosomal abnormalities // Am J Obstet Gynecol. 2005. Vol. 193, No. 3 Pt 1. P. 732–738. doi: 10.1016/j.ajog.2005.02.074Smith-Bindman R, Chu P, Goldberg JD. Second trimester prenatal ultrasound for the detection of pregnancies at increased risk of Down syndrome. Prenat Diagn. 2007;27(6):535–544. doi: 10.1002/pd.172527:535Smith-Bindman R., Chu P., Goldberg J.D. Second trimester prenatal ultrasound for the detection of pregnancies at increased risk of Down syndrome // Prenat Diagn. 2007. Vol. 27, N 6. P. 535–544. doi: 10.1002/pd.1725Order of the Ministry of Health of the Russian Federation No. 1130n dated October 20, 2020 «Ob utverzhdenii Poryadka oka zaniya meditsinskoi pomoshchi po profilyu akusherstvo i gine kologiya». Available from: 1130n.pdf. (In Russ).Приказ Министерства здравоохранения РФ от 20 октября 2020 г. № 1130н «Об утверждении Порядка оказания медицинской помощи по профилю «акушерство и гинекология». Режим доступа: 1130n.pdf. Дата обращения: 04.07.2022.Palomaki GE, Lambert-Messerlian GM, Canick JA. A summary analysis of Down syndrome markers in the late first trimester. Adv Clin Chem. 2007;43:177–210.Palomaki G.E., Lambert-Messerlian G.M., Canick J.A. A summary analysis of Down syndrome markers in the late first trimester // Adv Clin Chem. 2007. Vol. 43. P. 177–210.Cnossen JS, Morris RK, ter Riet G, et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis. CMAJ. 2008;178(6):701–711. doi: 10.1503/cmaj.070430Cnossen J.S., Morris R.K., ter Riet G., et al. Use of uterine artery Doppler ultrasonography to predict pre-eclampsia and intrauterine growth restriction: a systematic review and bivariable meta-analysis // CMAJ. 2008. Vol. 178, N 6. P. 701–711. doi: 10.1503/cmaj.070430Palomaki GE, Eklund EE, Neveux LM, Lambert Messerlian GM. Evaluating first trimester maternal serum screening combinations for Down syndrome suitable for use with reflexive secondary screening via sequencing of cell free DNA: high detection with low rates of invasive procedures. Prenat Diagn. 2015;35(8):789–796. doi: 10.1002/pd.4609Palomaki G.E., Eklund E.E., Neveux L.M., Lambert Messerlian G.M. Evaluating first trimester maternal serum screening combinations for Down syndrome suitable for use with reflexive secondary screening via sequencing of cell free DNA: high detection with low rates of invasive procedures // Prenat Diagn. 2015. Vol. 35, N 8. P. 789–796. doi: 10.1002/pd.4609Than NG, Romero R, Hillermann R, et al. Prediction of pre eclam psia ― a workshop report. Placenta. 2008;29 Suppl. A:S83–85. doi: 10.1016/j.placenta.2007.10.008Than N.G., Romero R., Hillermann R., et al. Prediction of preeclampsia ― a workshop report // Placenta. 2008. Vol. 29, Suppl. A. P. S83–S85. doi: 10.1016/j.placenta.2007.10.008Grill S, Rusterholz C, Zanetti-Dällenbach R, et al. Potential markers of preeclampsia ― a review. Reprod Biol Endocrinol. 2009;7(70):1–14. doi: 10.1186/1477-7827-7-70Grill S., Rusterholz C., Zanetti-Dällenbach R., et al. Potential markers of preeclampsia ― a review // Reprod Biol Endocrinol. 2009. Vol. 7, N 70. P. 1–14. doi: 10.1186/1477-7827-7-70Dagklis T, Plasencia W, Maiz N. Choroid plexus cyst, intracardiac echogenic focus, hyperechogenic bowel and hydronephrosis in screening for trisomy 21 at 11 + 0 to 13 + 6 weeks. Ultrasound Obstet Gynecol. 2008;31(2):132–135. doi: 10.1002/uog.5224Dagklis T., Plasencia W., Maiz N., Duarte l., Nicolaides K.H. Choroid plexus cyst, intracardiac echogenic focus, hyperechogenic bowel and hydronephrosis in screening for trisomy 21 at 11 + 0 to 13 + 6 weeks // Ultrasound Obstet Gynecol. 2008. Vol. 31, N 2. P. 132–135. doi: 10.1002/uog.5224Hedley PL, Placing S, Wøjdemann K, Carlsen AL, Shalmi AC. Free leptin index and PAPP-A: a first trimester maternal serum screening test for pre-eclampsia. Prenat Diagn. 2010;30(2):103–109. doi: 10.1002/pd.2337Hedley P.L., Placing S., Wøjdemann K., Carlsen A.L., Shalmi A.C. Free leptin index and PAPP-A: a first trimester maternal serum screening test for pre-eclampsia // Prenat Diagn. 2010. Vol. 30, N 2. P. 103–109. doi: 10.1002/pd.2337Lain SJ, Algert CS, Tasevski V, Morris JM. Record linkage to obtain birth outcomes for the evaluation of screening biomarkers in pregnancy: a feasibility study. BMC Med Res Methodol. 2009;9:48. doi: 10.1186/1471-2288-9-48Lain S.J., Algert C.S., Tasevski V., Morris J.M., Roberts C.L. Record linkage to obtain birth outcomes for the evaluation of screening biomarkers in pregnancy: a feasibility study // BMC Med Res Methodol. 2009. Vol. 9. P. 48. doi: 10.1186/1471-2288-9-48Volodin NN, ed. Neonatologiya. Natsional’noe rukovodstvo. Moscow: GEOTAR-Media; 2009. 848 p. (In Russ).Неонатология. Национальное руководство / под ред. Н.Н. Володина. Москва : ГЭОТАР-Медиа, 2009. 848 с.Belousova TV, Andrushina IV. Intrauterine growth retardation and its impact on children’s health in after-life. The possibility of nutrition support. Current Pediatrics. 2015;14(1):23–30. (In Russ). doi: 10.15690/vsp.v14i1.1259Белоусова Т.В., Андрюшина И.В. Задержка внутриутробного развития и её влияние на состояние здоровья детей в последую щие периоды жизни. Возможности нутритивной коррекции // Вопросы современной педиатрии. 2015. Т. 14, № 1. С. 23–30. doi: 10.15690/vsp.v14i1.1259American College of Obstetricians and Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013;121(5):1122–1133. doi: 10.1097/01.AOG.0000429658.85846.f9American College of Obstetricians and Gynecologists. ACOG Practice bulletin No. 134: fetal growth restriction // Obstet. Gynecol. 2013. Vol. 121, N 5. P. 1122–1133. doi: 10.1097/01.AOG.0000429658.85846.f9Baer RJ, Rogers EE, Partridge JC, et al. Population-based risks of mortality and preterm morbidity by gestational age and birth weight. J Perinatol. 2016;36(11):1008–1013. doi: 10.1038/jp.2016.118Baer R.J., Rogers E.E., Partridge J.C., et al. Population-based risks of mortality and preterm morbidity by gestational age and birth weight // J Perinatol. 2016. Vol. 36, N 11. P. 1008–1013. doi: 10.1038/jp.2016.118Iliodromiti S, Mackay DF, Smith GC, et al. Customised and noncustomised birth weight centiles and prediction of stillbirth and infant mortality and morbidity: a cohort study of 979,912 term singleton pregnancies in Scotland. PLoS Med. 2017;14(1):e1002228. doi: 10.1371/journal.pmed.1002228Iliodromiti S., Mackay D.F., Smith G.C., et al. Customised and noncustomised birth weight centiles and prediction of stillbirth and infant mortality and morbidity: a cohort study of 979,912 term singleton pregnancies in Scotland // PLoS Med. 2017. Vol. 14, N 1. P. e1002228. doi: 10.1371/journal.pmed.1002228Beune IM, Bloomfield FH, Ganzevoort W, et al. Consensus based definition of growth restriction in the newborn. J Pediatr. 2018;196:71–76.e1. doi: 10.1016/j.jpeds.2017.12.059Beune I.M., Bloomfield F.H., Ganzevoort W., et al. Consensus based definition of growth restriction in the newborn // J Pediatr. 2018. Vol. 196. P. 71–76.e1. doi: 10.1016/j.jpeds.2017.12.059Grimberg A, DiVall SA, Polychronakos C, et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency. Horm Res Paediatr. 2016;86(6):361–397. doi: 10.1159/000452150Grimberg A., DiVall S.A., Polychronakos C., et al. Guidelines for growth hormone and insulin-like growth factor-I treatment in children and adolescents: growth hormone deficiency, idiopathic short stature, and primary insulin-like growth factor-I deficiency // Horm Res Paediatr. 2016. Vol. 86, N 6. P. 361–397. doi: 10.1159/000452150Beukers F, Rotteveel J, van Weissenbruch MM, et al. Growth throughout childhood of children born growth restricted. Arch Dis Child. 2017;102(8):735–741. doi: 10.1136/archdischild-2016-312003Beukers F., Rotteveel J., van Weissenbruch M.M., et al. Growth throughout childhood of children born growth restricted // Arch Dis Child. 2017. Vol. 102, N 8. P. 735–741. doi: 10.1136/archdischild-2016-312003Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects. Clin Med Insights Pediatr. 2016;10:67–83. doi: 10.4137/CMPed.S40070Sharma D, Shastri S, Sharma P. Intrauterine growth restriction: antenatal and postnatal aspects // Clin Med Insights Pediatr. 2016. Vol. 10. P. 67–83. doi: 10.4137/CMPed.S40070Order of the Moscow Department of Health of 14.06.2013 No. 600 (ed. of 12.03.2015) «O sovershenstvovanii organizatsii prenatal’noi (dorodovoi) diagnostiki narushenii razvitiya ploda/rebenka». Moscow; 2013. Available from: http://pravo-med.ru/legislation/rz/5298/?ysclid=l5772bj5bg449907749. (In Russ).Приказ Департамента здравоохранения г. Москвы от 14.06.2013 № 600 (ред. от 12.03.2015) «О совершенствовании организации пренатальной (дородовой) диагностики нарушений развития плода/ребёнка». Москва, 2013. Режим доступа: http://pravo-med.ru/legislation/rz/5298/?ysclid=l5772bj5bg449907749. Дата обращения: 04.07.2022.Protopopova NV, Samchuk PM, Kravchuk NV. Clinical protocols [Klinicheskie protokoly]. Irkutsk, 2006. Available from: https://studfile.net/preview/6233996/. (in Russ).Протопопова Н.В., Самчук П.М., Кравчук Н.В. Клинические протоколы. Иркутск, 2006. Режим доступа: https://studfile.net/preview/6233996/. Дата обращения: 04.07.2022.Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Health Service Executive. Сlinical Practice Guideline. Fetal growth restriction — recognition, diagnosis and ma nagement. Available from: https://www.hse.ie/eng/services/pub li cations/clinical-strategy-and-programmes/fetal-growth-restriction.pdfInstitute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland and Health Service Executive. Сlinical Practice Guideline. Fetal growth restriction — recognition, diagnosis and management. Режим доступа: https://www.hse.ie/eng/services/publications/clinical-strategy-and-programmes/fetal-growth-restriction.pdf. Дата обращения: 05.07.2022.Blue NR, Beddow ME, Savabi M, et al. A comparison of methods for the diagnosis of fetal growth restriction between the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynecologists. Obstet Gynecol. 2018;131(5):835–841. doi: 10.1097/AOG.0000000000002564Blue N.R., Beddow M.E., Savabi M., et al. A comparison of methods for the diagnosis of fetal growth restriction between the Royal College of Obstetricians and Gynaecologists and the American College of Obstetricians and Gynecologists // Obstet Gynecol. 2018. Vol. 131, N 5. P. 835–841. doi: 10.1097/AOG.0000000000002564Kanasaki K, Kalluri R. The biology of preeclampsia. Kidney Int. 2009;76(8):831–837 doi: 10.1038/ki.2009.284Kanasaki K., Kalluri R. The biology of preeclampsia // Kidney Int. 2009. Vol. 76, N 8. P. 831–837. doi: 10.1038/ki.2009.284Orlov VI, Krymshokalova ZS, Maklyuk AM, et al. Rannie markery gestoza beremennykh i zaderzhki rosta ploda. Vestnik Rossiiskogo universiteta druzhby narodov. 2009;(7):21–25. (In Russ).Орлов В.И., Крымшокалова З.С., Маклюк А.М., и др. Ранние маркеры гестоза беременных и задержки роста плода // Вестник РУДН. 2009. № 7. С. 21–25.