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medical news of north caucasus
2023. Vol. 18. Iss. 2
not only the nervous system is depleted, symptoms of general somatic diseases are increasingly manifested with age. The research results revealed the characteristic
медицинский вестник северного кавказа
2023. Т. 18. № 2
signs of PBS in older dentists with extensive experience in the specialty, their psycho-emotional exhaustion, and physical and nervous overwork.
Disclosures: The authors declare no conflict of interest.
References
1. Boyko V. V. Documents accompanying patients from entry to exit. Sovremennaya stomatologiya. - Modern stomatology. 2020;3:33-39.
2. Petrov P. I., Mingazov G. G. Emotional burnout syndrome among dentists. Kazan Medical Journal. 2012;93(4):657-660.
3. Zaitseva O. A., Ovcharenko Z. V. Occupational burnout among medical workers. Young Scientist. 2021;37(379):139-146.
4. Tokmakova S. I., Lunitsyna Yu. V., Porseva Yu. D., Protopopova T. A. Studying the manifestations of emotional burnout syndrome in doctors. Actual problems of stomatology. 2014;1:34-37.
5. Sharp M., Burkart K. M., Adelman M. H., Ashton R. W., Biddison L. D. [et al.] A National Survey of Burnout and
Depression Among Fellows Training in Pulmonary and Critical Care Medicine: A Special Report by the Association of Pulmonary and Critical Care Medicine Program Directors. Chest. 2021;159(2):733-742. https://doi.org/10.1016/j.chest.2020.08.2117
6. Nikolaev N. A., Martynov A. I., Skirdenko Yu. P., Anisi-mov V. N., Vasilieva I. A. [et al.] Management of adherence-based treatment. Consensus document - clinical guidelines. English version. Medical News of North Caucasus. 2021;16(2):125-134.
https://doi.org/10.14300/mnnc.2021.16029
7. Reverchuk I. V. Psychodynamic and behavioral mechanisms for the formation of biosocial and intrapsychic conflict. Bulletin of Udmurt University. Series History and Philology. 2015;1(25):22-30.
About authors:
Bobryshev Aleksey Nikolaevich, DEcSc, Professor, Vice-Rector for Research and Innovation; tel.: +79054147791; e-mail: bobrishevaleksey@yandex.ru
Sarkisov Armen Akopovich, CMSc, Professor, Head of the Department of Pediatric Dentistry; tel.: +79086102448; e-mail: a.sarkisov@rambler.ru
Reverchuk Igor Vasilyevich, DMSc, Professor, Head of the Department of Psychiatry and Neurosciences; tel.: +79622647030; e-mail: igor7272igor@gmail.com
Tarasova Svetlana Ivanovna, DPedSc, Professor, Head of the Department of Pedagogy, Psychology and Sociology; tel.: +79624009864; e-mail: tr.sv5lg@mail.ru
Zelensky Vladimir Alexandrovich, DMSc, Professor, Head of the Department of General Practice Dentistry and Pediatric Dentistry; tel.: +79624460793; e-mail: moon175@yandex.ru
© Group of authors, 2023 UDC 616-08-039.75
DOI - https://doi.org/10.14300/mnnc.2023.18045 ISSN - 2073-8137
EVALUATION OF SHORT-TERM OUTCOMES
IN PRETERM INFANTS WITH NECROTIZING ENTEROCOLITIS
Gerasimenko I. N. \ Obedin A. N. \ Timofeev S. I. 2, Grigorova A. N. 3, Isaeva A. V. \ Mashchenko D. N. 3, Iachnaia O. I. \ Lytkina A. A. 1
1 Stavropol State Medical University, Russian Federation
2 Far Eastern State Medical University, Khabarovsk, Russian Federation
3 Kuban State Medical University, Krasnodar, Russian Federation
ОЦЕНКА НЕПОСРЕДСТВЕННЫХ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ У НЕДОНОШЕННЫХ ДЕТЕЙ С НЕКРОТИЗИРУЮЩИМ ЭНТЕРОКОЛИТОМ
И. Н. Герасименко 1, А. Н. Обедин 1, С. И. Тимофеев 2, А. Н. Григорова 3, А. В. Исаева 1, Д. Н. Мащенко 3, О. И. Ячная 1, А. А. Лыткина 1
1 Ставропольский государственный медицинский университет, Российская Федерация
2 Дальневосточный государственный медицинский университет, Хабаровск, Российская Федерация
3 Кубанский государственный медицинский университет, Краснодар, Российская Федерация
The work assessed the impact of the principles of open resuscitation on the results of the treatment of premature infants with NEC. The type of organization of the ICU (open or limited access) did not affect the daily and 7-day mortality. The previous severity of the NEC condition and the nature of the surgical intervention were of primary importance. Significant
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differences were noted in terms of the duration of administration of systemic analgesics (2.3+1.1 and 6.8+1.2 days, p<0.05) and the timing of the start of enteral nutrition (3.7+1.5 and 6.7+2.2 days, p<0.05). With unrestricted access of mothers of newborns with NEC to ICU, the microbial spectrum in cultures from different loci was significantly richer. However, further research is needed to explore this approach in preterm infants with NEC.
Keywords: preterm infants, necrotizing enterocolitis, open visitation, outcomes
В работе проведена оценка влияния принципов открытой реанимации на результаты лечения недоношенных детей с некротизирующим энтероколитом (НЭК). Тип организации реанимационного отделения (открытый или ограниченный доступ) не оказывал влияния на досуточную и 7-суточную летальность. Основное значение имела предшествующая тяжесть состояния НЭК и характер хирургического вмешательства. Значимые различия были отмечены в длительности назначения системных анальгетиков (2,3+1,1 и 6,8+1,2 суток, р<0,05) и сроков начала проведения энтерального питания (3,7+1,5 и 6,7+2,2 суток, р<0,05). При неограниченном доступе матерей к новорожденным детям с НЭК в реанимационном отделении микробный спектр при высевах из различных локусов был существенно богаче. Вместе с тем требуются дополнительные исследования по дальнейшему изучению данного подхода среди недоношенных новорожденных с НЭК.
Ключевые слова: недоношенные дети, некротизирующий энтероколит, открытая реанимация, результаты
For citation: Gerasimenko I. N., Obedin A. N., Timofeev S. I., Grigorova A. N., Isaeva A. V., Mashchenko D. N., Iach-naia O. I., Lytkina A. A. EVALUATION OF SHORT-TERM OUTCOMES IN PRETERM INFANTS WITH NECROTIZING ENTEROCOLITIS. Medical News of North Caucasus. 2023;18(2):193-195. DOI - https://doi.org/10.14300/mnnc.2023.18045
Для цитирования: Герасименко И. Н., Обедин А. Н., Тимофеев С. И., Григорова А. Н., Исаева А. В., Мащен-ко Д. Н., Ячная О. И., Лыткина А. А. ОЦЕНКА НЕПОСРЕДСТВЕННЫХ РЕЗУЛЬТАТОВ ЛЕЧЕНИЯ У НЕДОНОШЕННЫХ ДЕТЕЙ С НЕКРОТИЗИРУЮЩИМ ЭНТЕРОКОЛИТОМ. Медицинский вестник Северного Кавказа. 2023;18(2):193-195. DOI - https://doi.org/10.14300/mnnc.2023.18045
GIT - gastrointestinal tract NEC - necrotizing enterocolitis
ICU - intensive care unit
Necrotizing enterocolitis (NEC) remains the most common cause of disability and death in children. To date, the incidence of NEC is about 6.3 % (2.5:1000) of newborns of the total number of children admitted to neonatal intensive care units (ICU) [1-3]. The principle of open resuscitation is to organize the child's stay with parents in the ICU and the professional activities of the department's staff, which provides for a family-oriented approach to the treatment and care of patients [3]. As you know, free access to the ICU has many advantages: psychological comfort of family members, commitment to ongoing treatment, best contact with medical personnel, and reduction of complaints from relatives [4, 5]. However, the impact of such a system on NEC for premature infants in ICU has not been sufficiently studied.
The work aimed to evaluate compliance with the principles of open resuscitation on the results of treatment of premature infants with NEC.
Material and Methods. Between 2017 and 2022, under our supervision, there were 41 premature infants with NEC stage IIB-IIIB. There were 24 (58.5 %) boys, girls - 17 (41.5 %). Gestational age ranged from 25 to 38 weeks (mean 29 weeks). Body weight went from 456 to 1476 grams (average weight - 975 grams). We formed two groups: group I - 18 (43.9 %) newborns, who in the postoperative period in the ICU adhered to the principles of open resuscitation [4]; group II - 23 (53.1 %) children who received conventional treatment.
Surgical treatment of children with NEC was carried out in several stages: the first stage was laparotomy, revision of the abdominal cavity, and estoma; the second stage was a reconstructive surgery with anastomosis (on average, at 23.2±1.6 days). The reconstructive stage was accompanied by creating an enteroanasto-
mosis in 17 (41.4 %) patients and a T-shaped anastomosis - in 24 (58.6 %). At the same time, the anastomosis site was additionally treated with its own platelet-rich plasma.
In the study groups, the duration of extubation and the possibility of withdrawal of analgesic therapy, the beginning of intestinal nutrition, as well as microflora diversity determined by standard microbiological screening were assessed. Statistical processing was performed using Statistica 10.0 (StatSoft Inc., USA) software package. Statistical processing was carried out using Fisher's exact test. The criterion for statistically significant differences between the groups was the value of the Fisher criterion less than 0.05.
Results and Discussion. Analyzing the data obtained, it becomes clear that the type of organization of the ICU (open or limited access) did not affect the one daily (1 (5.6 %) and 2 (8.7 %), respectively) and seven daily (1 (5.6 %) %) and 3 (13.0 %), respectively) mortality. The previous severity of the NEC condition and the nature of the surgical intervention were of primary importance.
In contrast to mortality rates, we found significant differences between the models for organizing the work of the ICU and the quality of accompanying therapy. Thus, systemic inflammatory response syndrome developed much less frequently (p<0.05) in newborns of Group 1, than in Group 2 (2 (11.1 %) and 4 (17.4 %), respectively). Similar significant differences were noted between study groups of preterm infants with the open resuscitation and the traditional approach in such important indicators as the duration of use of systemic analgesics (2.3+1.1 and 6.8+1.2 days, p<0.05) and the timing of the start of enteral nutrition (3.7+1.5 and 6.7+2.2 days, p<0.05). However, the most critical indicators for such patients, such as the duration of the arti-
medical news of north caucasus
2023. Vоl. 18. Iss. 2
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2023. Т. 18. № 2
ficial respiration and the length of stay in the ICU, do not differ (p>0.05).
Remarkable data were obtained from the analysis of the microbiological landscape of the patients with the research team. With unfettered access by newborn mothers to ICU, the microbial spectrum in different loci cultures was much more affluent. This is due to the use of various technologies in this method of work organization. The predominance of St. epidermidis is due to the use of tactile contact with impact elements, the kangaroo technique, and finger training.
In the preterm infants from group II, the microbial spectrum was significantly narrower; Kl. pneumonia
and Acinetobacter baumannii predominate as pathogens. The risk of contamination with nosocomial flora was significantly higher in Group 2 compared to Group 1 (OR 2.65:10.3 at p=0.0231 and 1.65:8.7 at p=0.0241, respectively).
Conclusion. The data thus obtained significantly increases our understanding of the importance of open resuscitation for improving the quality of care for premature infants with NEC. Creativity and innovation will enable emergency physicians to facilitate family visits in the ICU. However, further multicentric research is required.
Disclosures: The authors declare no conflict of interest.
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2. Veshkurtseva I. M., Akselrov M. A., Minaev S. V., Suprunets S. N., Emelyanova V. A. [et al.] Effect of microbial landscape on the character of antibacterial therapy in newborns with necrotizing enterocolitis. Medical News of North Caucasus. 2020;15(4):492-495. https://doi.org/10.14300/mnnc.2020.15115
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the high frequency electromagnetic fields. Medical News of North Caucasus. 2019;14(2):308-311. https://doi.org/10.14300/mnnc.2019.14074
4. Mistraletti G., Giannini A., Gristina G., Malacarne P., Mazzon D. [et al.] Why and how to open intensive care units to family visits during the pandemic. Crit. Care. 2021;25(1):191.
https://doi.org/10.1186/s13054-021-03608-3
5. Li W., Tang J., Zhu Z., Tang W. Initial surgical treatment of necrotizing enterocolitis: a meta-analysis of peritoneal drainage versus laparotomy. Eur. J. Pediatr. 2022;181(7):2593-2601.
https://doi.org/10.1007/s00431 -022-04454-3
About authors:
Gerasimenko Igor Nikolaevich, MD, PhD, Associate Professor of the Department of Pediatric Surgery; tel.: +79187704217; e-mail: igor9551@yandex.ru; ORCID: 0000-0003-3003-612X
Obedin Aleksander Nickolaevich, MD, PhD, Associate Professor, Head of the Department of Anesthesiology and Intensive Care; tel.: +79034169771; e-mail: volander@mail.ru; ORCID: 0000-0002-9990-7272
Timofeev Sergey Ivanovich, PhD, Assistant Professor of the Department of Surgery; tel.: +79148537178; e-mail: timofeev_si@mail.ru; ORCID: 0000-0002-5808-0686
Isaeva Alesya Vasilevna, PhD, Associate Professor of the Department of Pediatric Surgery; tel.: +78652357769; e-mail: isaeva_alesya@mail.ru
Grigorova Alina Nikolaevna, PhD, Assistant Professor of the Department of Surgical Diseases of Children; tel.: +79633877244; e-mail: alina.mashchenko@mail.ru; ORCID: 0000-0001-5020-232X
Mashchenko Dmitry Nikolaevich, student;
tel.: +7953108519; e-mail: dima.mashchenko.2005@inbox.ru
Iachnaia Oksana Igorevna, postgraduate student of the Department of Pediatric Surgery; tel.: +79614931377; e-mail: yachnaya_oksana@mail.ru; ORCID: 0000-0003-3408-8074
Lytkina Anastasia Alekseevna, resident of the Department of Pediatric Surgery; tel.: +79187440274; e-mail: Lytkina.stav@gmail.com; ORCID: 0009-0006-6719-987X
