CC BY
16
ENGLISH-AIDED INTEGRATION IN THE ADVANCED NEONATAL PRACTICE
A.V. Kubishkina1, Postgraduate Student I.I. Logvinova1, Doctor of Sciences in Medicine, Professor A.V. Medvedeva1, Associate Professor E.A. Bukhantseva2, neonatologist M.V. Fedorova2, neonatologist 1Voronezh N.N. Burdenko State Medical University Voronezh State Clinical Hospital of Emergency Care №10 (Russia, Voronezh)
DOI: 10.24411/2500-1000-2020-10806
Abstract. The paper deals with the concept of in utero programming and development of "mature" diseases among fetuses. Modern methods of evaluating the physical development of a newborn is a way to evaluate the metabolic state of a fetus. The objective of the work is to compare methods of evaluating the physical development of premature newborns and to determine the best available method for estimating weight and height indicators of premature newborns.
The authors demonstrate significant differences in existing methods of evaluating the physical development of premature newborns. They also provide results of their own research that confirm existing differences, indicating English as a medium of research. The authors give recommendations for evaluating the physical development of premature newborns that match modern global tendencies in neonatology.
Keywords: in utero programming, physical development, premature newborns, late preterm infants, metabolic state, English.
Evaluating a newborn's physical development is one of the key objectives of a neonatologist. An adequate evaluation of weight and height measurements allows understanding the metabolic state of a fetus and developing a program suitable for a newborn's nutrition [1].
Over a quarter of century ago an English scientist David Barker suggested an "in utero programming" concept. As a result of any prenatal dysfunction a fetus experiences hy-poxia, and a phenotype is formed, which is programmed to build-up a fat tissue and develop insulin resistance. D. Barker and his colleague C. Hales described this phenomenon as "thrifty phenotype" [1]. A fetus tries to compensate prenatal deficiency of nutrients by means of redistributing nutrients in favor of brain and "stealing" them from other organs, primarily from skeletal muscle. This way a fetus prepares itself for a "successful" existence in unfavorable conditions. However, if an organism is exposed to conditions of sufficient or excessive nutrition, its developed compensatory mechanisms turn out to be harmful, this is how a conflict between prena-
tal and postnatal growth rate is developing [2,
3].
Excess consumption of protein at an earlier age is considered nowadays to be the major cause of metabolic disorders, diabetes, obesity and arterial hypertension starting to develop among children. On the other hand, children with intrauterine growth retardation have elevated plastic needs, primarily to ensure normal neural development. Consequently, the issue of evaluating a newborn's physical development is of particular importance, especially in cases of premature newborns. Thus far there are two methods used to evaluate a premature newborn's physical development: Fenton growth chart and INTER-GROWTH21 standards of growth [4, 5].
The purpose of the study is to compare the results of physical development evaluation using Fenton growth charts and INTER-GROWTH21 standards of growth.
Materials and methods. A retrospective evaluating of physical development of 315 newborns has been performed using Fenton growth charts and INTERGROWTH standards of growth. Gestational age of newborns
was 34-36 weeks. English is used as a linguistic medium of the research.
Statistical processing of obtained data was carried out using standard software. On assessing of quantitative indicators, average value and standard deviation were calculated (m±SD).
Results. The weight of a newborn at 34 weeks of gestational age was measured as 2071,9±393,6 g, at 35 weeks of gestational age - 2353,3±319,2 g, at 36 weeks of gestational age - 2496,6±363,4 g. Body length at 34 weeks of gestational age was measured as 44,9±2,8cm, at 35 weeks of gestational age -46,3±1,8 cm, at 36 weeks of gestational age -48,5±2,2cm. Head circumference at 34 weeks of gestational age was measured as 30,8±1,46 cm, at 35 weeks of gestational age -31,6±1,58cm, at 36 weeks of gestational age - 32,2±1,48cm.
When using INTERGROWTH21 standards of growth to evaluate physical development 50% of the children had the body weight appropriate for the gestational age. 19% had a low birth weight, 8% had a very low birth weight, 9% had a high birth weight and 14% had a very high birth weight. The body length appropriate for the gestational age was determined among 51% of children. 2% had a low birth length, 17% had a very low birth length, 20% had a high birth length and 10% had a very high birth length. The head circumference appropriate for the gesta-tional age was determined among 57% of children. 19% of children had a low head birth circumference, 10% had a very low head birth circumference, 11% had a high head birth circumference and 3% had a very high head birth circumference.
When using Fenton preterm growth charts to evaluate physical development 63% of the
children had the body weight appropriate for the gestational age. 24% had a low birth weight, 6% had a very low birth weight, 6% had a high birth weight and 1% had a very high birth weight. The body length appropriate for the gestational age was determined among 69% of children. 6% had a low birth length, 16% had a very low birth length and 9% had a high birth length. The head circumference appropriate for the gestational age was determined among 61% of children. 22% of children had a low birth head circumference, 2% had a very low birth head circumference, 13% had a high birth head circumference and 2% had a very high birth head circumference.
Conclusions. As we can see in the data provided above there are significant differences in the results of evaluating anthropo-metric indicators using these methods. Which is understandable, given that unlike Fenton growth charts, that have been developed based on retrospective analysis, INTER-GROWTH21 standards of growth are based on prospective studies, in which the technique of evaluating anthropometric indicators is completely standardized and evaluating a newborn's growth rate is a continuation of studying fetal growth [4]. Taking into account the differences in standards of growth provided in various methods, it is necessary to adopt common standards for evaluating physical development. In our opinion, INTER-GROWTH21 standards of growth is more optimal/beneficial, because the research as a result of which they have been developed, has higher quality design. We would also like to indicate the effectiveness of English as a linguistic support of the research giving a shortcut to the advanced neonatal study and practice.
Reference
1. Carpinello OJ, DeCherney AH, Hill MJ. Developmental Origins of Health and Disease: The History of the Barker Hypothesis and Assisted Reproductive Technology. Semin Reprod Med. 2018. №36 (3-04): 177-182.
2. Boyle E.M, Johnson S., Manktelow B., et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed 2015. №100: F. 479-485.
3. Boyle EM, Poulsen G, Field DJ, et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ 2012. №344: e896.
4. Villar J, Cheikh Ismail L, Victora CG, et al. International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. Lancet. 2014. №384 (9946): 857-868.
5. World Health Organization, and UNICEF. Countdown to 2015 Decade Report (20002010): tacking stock of maternal, newborn and child survival. Washington, DC: WHO/UNICEF, 2010.
АНГЛИЙСКИЙ ЯЗЫК ДЛЯ ИНТЕГРАЦИИ В ПЕРЕДОВУЮ НЕОНАТАЛЬНУЮ
ПРАКТИКУ
А.В. Кубышкина1, аспирант И.И. Логвинова1, д-р мед. наук, профессор А.В. Медведева1, канд. филол. наук, доцент Е.А. Буханцова , врач-неонатолог М.В. Федорова2, врач-неонатолог
воронежский государственный медицинский университет им. Н.Н. Бурденко 2БУЗ ВО ВГКБСМП № 10 (Россия, г. Воронеж)
Аннотация. В статье рассмотрены вопросы концепции внутриутробного программирования и формирования болезней «взрослого» у плода. Приводятся современные методы оценки физического развития новорождённого, как способа оценки метаболического статуса плода. Цель работы сравнить методы оценки физического развития недоношенных новорожденных и определить оптимальный метод оценки массо-ростовых показателей недоношенных детей. Авторы демонстрируют значимые различия в существующих методах оценки физического развития недоношенных новорожденных, приводят результаты собственных наблюдений, подтверждающие существующие различия. Английский язык используется как лингвистический посредник в проведении исследования. В заключении авторы дают рекомендации по оценки физического развития недоношенных новорожденных.
Ключевые слова: внутриутробное программирование, физическое развитие, недоношенные новорожденные, поздние недоношенные, метаболический статус, английский язык.
