CC BY
0CHARACTERISTICS OF RESPIRATORY DISORDERS IN NEWBORNS WITH SEPSIS BORN TO MOTHERS WHO CONTRACTED COVID-19 DURING PREGNANCY
Khodjimetova Sh.Kh.
Tashkent pediatric medical institute https://doi org/10.5281/zenodo. 12739043
Abstract. This article is devoted to the study of clinical and diagnostic conditions of hypoxic-ischemic brain damage in premature newborns.
It was established that the clinical manifestations of respiratory organ damage in newborns with sepsis could be attributed to COVID-19 infection contracted during pregnancy. All newborns with sepsis required respiratory support, but the duration of its application was significantly higher in the group of newborns born to mothers who had COVID-19 during pregnancy (p<0.001). The needfor respiratory support also depended on the gestational age.
Keywords: neonatal sepsis; COVID-19; Silverman scale; respiratory distress syndrome; apnea; CPAP.
Relevance. The incidence of purulent-septic infections among newborns shows no signs of decreasing [2,3,4,6,8]. In recent years, these conditions have been characterized by atypical and mildly manifesting clinical forms, which significantly complicates their diagnosis [10,11,12].
The peculiarities of the immune system in newborns lead to the generalization of the infectious process, the formation of a systemic inflammatory response, and damage to various organs. In preterm infants, neonatal sepsis is associated with a high percentage of mortality due to insufficient immune activity and the immaturity of the barrier functions of the skin and mucous membranes.
Currently, COVID-19 is considered an acute respiratory viral infection primarily affecting the lower respiratory tract. The disease can range from mild ARVI to severe pneumonia, ARDS, and sepsis. The tropism of coronaviruses to the respiratory system is explained by the presence of several potential receptors for the virus in human lungs [1,5,7,9].
Objective. To conduct a comparative characterization of respiratory disorders in newborns with sepsis born to mothers who had COVID-19 during pregnancy.
Materials and methods. Sixty-four newborns were examined and divided into two groups: Group I (main group) included newborns with sepsis born to mothers who had COVID-19 during pregnancy (n=34, 53.1%). Group II (comparison group) included newborns with neonatal sepsis (n=30, 46.9%).
Analysis included obstetric history, Apgar score assessment, Silverman scale assessment, and clinical, laboratory, and instrumental studies.
Results and discussion. The study showed (Diagram 1) that the number of newborns born to mothers with a gestational age of 28-32 weeks was slightly higher (59.9%) compared to those with a gestational age of 38-42 weeks (14.0%) and 26-27 weeks (10.9%). Only two newborns (3.1%) were born at a gestational age of 36-37 weeks.
Most newborns with neonatal sepsis born to mothers who had COVID-19 during pregnancy were born at a gestational age of 28-30 weeks (35.2%). Among newborns with neonatal sepsis, the majority were born at a gestational age of 31-32 weeks (40.0%).
Diagram 1.
Characteristics of Newborns with Sepsis Based on Gestational Age
Table -1.
Comparative Apgar Score Assessment at Birth.
Indicators (M ± m) Groups (M ± m)
I n=34 II n=30
Apgar score at 1st minute (points) 4.1±0.35 4.5±0.33**
Apgar score at 5th minute (points) 5.5±0.38 5.3±0.32*
Note: Significance of differences between groups: *P<0,05; **P<0,01
Comparative assessment of the mean at Apgar scale scores at 1 and 5 minutes at birth between the groups (Table 1) showed significantly lower scores in infants born to mothers who
had covid 19 during pregnancy (P<0.01).
Table - 2.
Frequency of Asphyxia in Newborns in the Study Groups.
Apgar Scores Group I n= 34 Group II n =30 Total. n=64
Abs. % Abs. % Abs. %
Asphyxia of moderate severity (OSA 4-6) 11 32.3 10 33.3 21 32.8
Severe asphyxia (OSA 0-3) 8 23.5** 4 13.3 12 18.7
Note: *-significance of differences, data between groups I and II ** - P<0,01
Most newborns with sepsis (23.5%) born to mothers who had COVID-19 during pregnancy were born in severe asphyxia, with an Apgar score of 0-3 points. Among the newborns, the number of children born with an Apgar score of 4-6 points with moderate asphyxia was observed in equal numbers in both groups (32.3%, 33.3%) respectively (Table 2).
Assessment of the condition of the newborns revealed an extremely severe condition during the first three days among children with sepsis born to mothers who had COVID-19 during pregnancy (23.5%) compared to the newborns in Group 2. Comparative assessment of the mean Apgar scores at 1 and 5 minutes at birth between the groups (Table 3) showed significantly lower scores in newborns born to mothers who had COVID-19 during pregnancy (p<0.01), with the majority of those in severe condition being newborns with sepsis (43.7%).
Table - 3.
General Condition of Observed Newborns at Birth
General Condition Group I n=34 Group II n=30 Total n=64
Abs. % Abs. % Abs. %
Extremely severe 8 23.5±7.2 6 20±7.3 14 21.8±6.8
Severe 14 41.1±8.4 14 46.6±6.3 28 43.7±7.6
Moderately severe 12 35.2±5.8 10 33.3±8.8 22 34.3±8.8
The Silverman score of 1-3 points on the first day of life was statistically significantly higher (p<0.05) in newborns of the main group compared to the comparison group. Additionally, there was a statistically significantly higher need for mechanical ventilation during the first three days of life, indicating a greater degree of respiratory failure (p<0.01) (Table 4).
Table - 4
Assessment of the degree of respiratory disorders in the examined children using the
Silverman score
Degree of Respiratory Distress (points) Group I n=34 Group II n=30 Total (n=64)
Abs % Abs % Abs %
1-3 15 44.1±9.2* 10 33.3±7.8 25 31.2±5.7
4-5 11 32.3±8.0 17 56.7±8.6* 28 32.8±6.4
>6 8 23.5±7.2* 3 10.0±5.4 11 32.3±4.6
Note: *-significance of differences, data between groups I and II P<0,05;
The respiratory organs were often affected in newborns with sepsis (Table 5). Most newborns in both groups had weakened breathing. Symptoms such as dyspnea and apnea were present in almost one-third of the children and were more pronounced in newborns born to mothers who had COVID-19 during pregnancy (P>0,05; P<0,01).
Clinical symptoms such as oral cyanosis and acrocyanosis were prevalent in most children and significantly exceeded the indicators in the comparison group (P<0,05). Signs of respiratory failure, such as intercostal and sternal retractions, were more frequent in the majority of newborns in both groups.
A predominant number of children with respiratory system disorders among the examined newborns with sepsis required CPAP (70.3%). The overall duration of respiratory therapy was high in both groups, with no statistically significant differences between the groups. Pneumopathies (41% and 39%, respectively) and pneumonias, often intrauterine, were frequently observed, depending on whether the mother had COVID-19 during pregnancy.
In the 3rd trimester (43% and 33%, respectively), pneumonia in newborns of the main group was characterized by episodes of apnea and cyanosis, and oxygen dependence for several days.
The conducted study on the spectrum of clinical manifestations of respiratory organ damage in newborns with sepsis may indicate that the new coronavirus infection COVID-19 contracted during pregnancy plays a significant role. All examined newborns with sepsis required respiratory support, but the duration of its application was significantly higher in the group of newborns born to mothers who had COVID-19 during pregnancy (p<0.01). The need for respiratory support also depended on the gestational age. The data obtained allow us to conclude that the initial health condition of the mother can be a cause of a high level of pathology in newborns.
Table 5.
Comparative Characteristics of Respiratory Disorders in Observed Newborns
Clinical Signs Group I n=34 n-34 Group II n=34 n -30 Total n -64
Abs % Abs % Abs %
Dyspnea: Severe 19 56.0±8.5* 13 43.3±9.0 22 34.3±5.9
Apnea episodes 20 59.0±8.4** 8 26.7±8.0 28 43.7±6.1
Oral cyanosis 30 88.0±5.5** 17 56.7±9.0 47 73.4±5.5
Acrocyanosis 20 59.0±8.4 19 63.3±8.7 39 61.0±6.0
Cough 26 76.0±7.3 26 86.7±6.1 52 81.2±4.8
Sternal retraction 25 73.5±7.5 22 73.3±8.0 57 89±3.9
Intercostal retractions 27 79.4±6.9 26 86.7±6.1 53 82.8±4.7
Weakened breathing 28 82.3±5.4 26 86.7±6.1 56 87.5±4.1
Harsh breathing 6 17.6±5.9 4 13.3±6.4 10 15.6±6.1
Type of breathing:
Spontaneous 12 35.3±8.8* 7 23.3±8.0 19 29.7±8.3
CPAP 22 64.7±6.5 23 76.7±7.8 45 70.3±5.0
Mechanical ventilation 4 11.7±3.8** 1 3.3±3.2 5 7.8±3.3
Note: Significance of differences between groups: *Р < 0,05; **Р < 0,01.
REFERENCES
1. WHO. Oxygen Therapy for Children: A Manual for Health Workers. 2016. 66 pages.
2. Temporary Guidelines COVID-19 in Children. Version 1 (03.04.2020). Ministry of Health of the Russian Federation.
3. Doctor.ru. Health Status of Newborns of Mothers with SARS-CoV-2 Infection at Different Gestation Periods.
4. Congenital Pneumonia as a Cause of Perinatal Mortality in the Russian Federation / A.I. Shchegolev, U.N. Tumanova, M.P. Shuvalova, O.G. Frolova // Neonatology: News, Opinions, Training. - 2016. - No. 2. - P. 61-66.
5. Mukhin V.E. Neonatal Sepsis: Problems of Laboratory Diagnosis / V.E. Mukhin, L.L. Pankratyeva, N.N. Volodin // Pediatrics. - 2018. - Vol. 97, No. 1. - P. 141-146.
6. National Guidelines for COVID-19, Ministry of Health of the Republic of Uzbekistan (26.03.2020).
7. Samssygina G.A. Neonatal Sepsis: Monograph / G.A. Samssygina. - Moscow: Pediatrician, 2014. - 173 pages.
8. Ходжиметова Ш. Х. и др. РЕСПИРАТОРНЫЕ НАРУШЕНИЯ У НОВОРОЖДЕННЫХ ДЕТЕЙ С СЕПСИСОМ, РОДИВШИХСЯ ОТ МАТЕРЕЙ, ПЕРЕНЕСШИХ COVID 19 ВО ВРЕМЯ БЕРЕМЕННОСТИ //Re-health journal. - 2024. - №. 1 (21). - С. 104-110.
9. Ходжамова Н. К., Рахманкулова З. Ж., Камалов З. С. Особенности гемодинамических изменений у недоношенных новорожденных с задержкой внутриутробного развития, родившихся в асфиксии //Журнал теоретической и клинической медицины. - 2015. -№. 3. - С. 97-99.
10. Рахманкулова З. Ж. и др. Приоритетные факторы риска развития маловесных детей с перинатальной гипоксией //Молодой ученый. - 2017. - №. 3. - С. 261-265.
11. Рахманкулова З. Ж., Абдукодирова М. К., Сулейманова Л. И. Характеристика частоты встречаемости клинических признаков поражения органов дыхания у новорожденных детей с цитомегаловирусной инфекцией //Children's Medicine of the North-West. - 2020. - Т. 8. - №. 1. - С. 410-410.
12. Рахманкулова З. Ж. и др. Сравнительная характеристика факторов риска у доношенных и недоношенных новорожденных детей с задержкой внутриутробного развития //Молодой ученый. - 2018. - №. 5. - С. 67-70.
13. Мохира, Т. (2015). ЖАНРА РАССКАЗА С ТОЧКИ ЗРЕНИЯ ИССЛЕДОВАТЕЛЕЙ И ЕГО ПРИМЕНЕНИЕ В ДЕТСКОЙ ЛИТЕРАТУРЕ. Вестник Таджикского национального университета. Серия филологических наук, (4-5), 201-206.
14. Нигматова, Г. М., & Кочиева, А. М. (2023). Влияние гистерэктомии в репродуктивном возрасте на качество жизни женщин (Doctoral dissertation, Современные подходы к стандартизации оказания медицинской помощи в акушерско-гинекологической практике).
15. Zufarova, S., & Turakulova, S. (2024). WAYS TO CORRECT MENSTRUAL DYSFUNCTION IN WOMEN WITH OBESITY. Science and innovation, 3(D5), 527-531.
