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UDC 616.12-008-073.96-053.35
IMPLEMENTATION OF CARDIOINTERVALOGRAPHY FOR ESTIMATION OF THE NEWBORN STATE SEVERITY
Altai State Medical University, Barnaul, Russia O.M. Malyuga, O.V. Nevskaya
There were examined 15 full-term and 14 preterm newborns in the intensive care unit, whose state was estimated as severe and extremely severe. The control group consisted of 30 newborns with uncomplicated course of the early adaptation. The results of the study showed that the parameters of cardiointervalography recording and their dynamics in the diseased newborns compared with healthy newborns indicate the failure of adaptation and mismatch of regulatory systems. In our opinion, the implementation of cardiointervalography in newborns allows to objectively estimate the severity of newborns' condition and allows to monitor the dynamics of their state. Key words: cardiointervalography, newborns, severity of condition, prematurity.
Perinatal morbidity and mortality are the main qualitative indicators of the assessment of obstetric and neonatological services. The leading factors in increasing perinatal morbidity and mortality are premature birth, presence of gestosis in the mother during pregnancy, hypoxia [1, 2]. This determines the importance of methods of objective control, allowing a minimum time to judge the state of the newborn, especially its severity, and evaluate the effectiveness of the therapy.
The indicator of the state of adaptation reactions of the body is the cardiovascular system. Cardiointervalography (CIG) is a simple and accessible method for recording sinus heart rhythm followed by a computerized mathematical analysis of its structure that allows you to objectively assess the state of stress in the body's regulatory systems, regardless of the etiologic factor of the disease and which can be used to assess the severity of the newborn's condition, which is especially important for assessment of the state of premature infants [3, 4, 5].
The purpose of our study was to reveal the information value and significance of the method of cardiointervalography for assessing the severity of the condition of full-term and premature newborns.
Materials and methods
There were examined 15 full-term and 14 premature babies in the intensive care unit, whose condition was assessed as severe and extremely severe. The control group consisted of 30 newborns with uncomplicated course of the early adaptation period. To record the cardiointervalogram, the automated complex PULSE was connected to the cardiac monitor. The following indices were calculated: voltage index (VI, cu), mode (Mo, sec), mode amplitude (AMO,%) and variation range (dX, sec). Mathematical processing of the research results was carried out according to the standard methods of variation statistics, the reliability of the differences between the mean values of the parameters
was determined using the criterion of significance t (Fisher-Student). Statistical processing of the received material was carried out using the licensed program "Statistica" 6.0.
Results and discussion
The parameters of CIG and their dynamics in ill newborns compared with healthy newborns indicate a disruption in adaptation and mismatch of regulatory systems. This was manifested by a progressive decrease in the variation range, an increase in the amplitude of the mode and the stress index in newborns with a severe condition, with perinatal CNS lesion and somatic pathology, whereas in healthy newborns, on the contrary, an increase in the parameters of the variation range, a decrease in the amplitude of the mode and the voltage index (p<0.05) (Tables 1 and 2) were registered. As can be seen from Table 2, there were no significant differences in the parameters of CIG between term and preterm neonates in the severe condition. However, preterm infants underwent the influence of humoral regulation (mode), while sympathetic (mode amplitude) and simultaneously parasympa-thetic influences (variation range) are slightly higher in comparison with full-term children in severe condition.
In general, the degree of voltage in adaptation processes is higher in premature infants.
Thus, indices of CIG indicate the immaturity and mismatch of regulatory mechanisms in premature infants compared with full-term children. The parameters of CIG in newborns in severe condition are determined by the severity of the condition of the newborn, regardless of the nature of the pathology and gestational age.
Here is a clinical example of the use of CIG to monitor the condition of a premature newborn.
Child U. Final Obstetric Diagnosis: Premature delivery at 30-31 weeks. Low placentation. Chronic pyelonephritis, remission. Chronic fe-toplacental insufficiency, compensated. Anemia of mild degree. The birth weight is 1880 grams,
the height is 45 cm, the head circumference is 27 cm, the chest circumference is 25 cm. Diagnosis: Acute severe intranatal asphyxia. Aspiration syndrome. RDS, pneumopathy, atelectasis. Prematurity with a gestation period of 30-31 weeks. Intubed in the delivery room, on a hardware breath from birth. The first 3 days of life are severe, unstable, equivalent to seizures, periods of tachycardia with a change in persistent bradycardia. Periodically, the increase in signs of hypoxia, requiring correction of the parameters of ventilation. Since the end of 4 days of life, the condition is extremely severe due to the symptoms of dynamic intestinal obstruction and increasing intoxication. On the 7th day of life, there is a lethal outcome. Pathological diagnosis: Perinatal dyscirculato-ry-hypoxic CNS lesion, hemorrhage in the lateral, 3rd ventricles of the brain with extensive softening of the white substance of the hemispheres and cerebellum. Two-sided focal serous-purulent pneumonia on the background of partial atelectasis of the lungs. Swelling of the brain. Hypoxic-hem-orrhagic lesions of the stomach, small and large intestines with ileal intestinal microperforation.
Limited serous-fibrinous peritonitis of the right ileal region. Acute congestion and protein paren-chymal degeneration of internal organs. Incidental involution of the thymus of the 3rd degree. Prematurity. Along with the generally accepted monitoring, the CIG was registered. According to the data of cardiointervalography, in the premature child U, on the 4th day there was a sharp increase in VI up to 12000 units, not decreasing during the course of the day, below 6000 conventional units. In this case, the course of the VI curve completely coincided with the Amo dynamics, i.e. the indicator completely depended on the sympathetic channel of regulation due to the suppression of parasym-pathetic regulation. The cardiac rhythm becomes rigid, the variance is 0. Compared to the previous days of life, a significant decrease in the variation range and mode is observed with a significant increase in VI (p <0.05). On the 4th day, simultaneous decrease of all regulatory influences (decrease of Amo, Mo, dX) is noted as a manifestation of exhaustion and disruption of regulation accompanying a sharp deterioration in the clinic.
Table 1
Indices of cardiointervalography in healthy newborns (M+m) in dynamics
CIG indices 1st day of life 3rd day of life
Variation range 0,096+0,006 0,123+0,017
Mode 0,53+ 0,007 0,515+0,006
Amplitude of the mode 30,09+1,83 26,09+ 1,61
Voltage index 581,76+98,94 343,6 ±36,65
Table 2
Indices of cardiointervalography in newborns (M + m) in severe state
CIG indices Variation range Mode
Amplitude of the mode Voltage index
Full-term newborns (n=15) 0,07+0,015 0,51+ 0,04 49,7+8,77 2303,0+807
Pre-term newborns (n=14) 0,074+0,017 0,454+0,023 55,32+ 3,99 2714,6 +519,5
Thus, as can be seen from the above clinical
References
example, the dynamics of the indices of coronary syndrome correlated with the clinical picture and the change in bradycardia with a rigid rhythm at the maximum tension of the regulatory systems indicates depletion and disruption of all regulatory mechanisms and is an unfavorable prognostic sign.
In our opinion, the use of CIG in the neonatal period helps in an objective assessment of the severity of the condition of the newborns, helps monitor the dynamics of their condition and conduct timely correction of therapy. CIG, as an accessible and informative method, can be used in the departments of pathology and resuscitation of newborns.
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Contacts
Corresponding author: Malyuga Olga Mikhailov-na, Doctor of Medical Sciences, Associate Professor of the Department of pediatrics with the course of FVE of the Altai State Medical University, Barnaul.
656038, Barnaul, Lenina Prospekt, 40.
Tel.: (3852) 409193.
E-mail: [email protected]
Nevskaya Olga Vyacheslavovna, Candidate of Medical Sciences, Associate Professor of the Department of pediatrics with the course of FVE of the Altai State Medical University, Barnaul. 656038, Barnaul, Lenina Prospekt, 40. Tel.: (3852) 409193.
