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21DOI: 10.24411/2181-0443/2021-10006 ЛУЧЕВАЯ ДИАГНОСТИКА СИНДРОМА ДЫХАТЕЛЬНЫХ РАССТРОЙСТВ У НОВОРОЖДЕННЫХ
Мардиева Гульшод Маматмурадовна Ашуров Жахонгир Низом угли Турдуматов Жамшед Анварович
Самаркандский государственный медицинский институт Самарканд, Узбекистан
Выделен вариант рентгенологической верификации изменений по степеням в зависимости от тяжести рентгенологических проявлений и выраженности признаков, встречающихся при воспалительном процессе на фоне незрелости легочной ткани у новорожденных. Результаты рентгенологических исследований при пневмонии у новорожденных детей позволяют сделать вывод о необходимости проведения их в неонатологическом периоде, способствуют отработке тактики лечения, предотвращающего развитие необратимых изменений в легких, хронической дыхательной недостаточности, бронхообструктивного синдрома и бронхолегочной дисплазии у детей более старшего возраста.
Ключевые слова: рентгенография, новорожденные, недоношенные, СДР, пневмония.
RADIATION DIAGNOSTICS OF RESPIRATORY DISORDER SYNDROME IN NEWBORNS
Highlight radiological verification of changes in powers depending on the severity of radiographic manifestations and severity of symptoms occurring in the inflammatory process on the background of the immaturity of the lung tissue in pneumonia of newborns. The results of X-ray studies for pneumonia in newborns make it possible to conclude that it is necessary to conduct them in the neonatological period, contribute to the development of treatment tactics that prevent the development of irreversible changes in the lungs, chronic respiratory failure, broncho-obstructive syndrome and bronchopulmonary dysplasia in older children.
Key words: rentgenography, newborns, premature babies, RDS, pneumonia.
ЯНГИ ТУГИЛГАН ЧАЦАЛОЦЛАРДА НАФАС БУЗИЛИШИ СИНДРОМИНИНГ НУР
ДИАГНОСТИКАСИ
Зотилжам ташхисли ча;алок;ларда гестация муддатига боглик; х,олда етуклик белгисини рентгенологик белгилари комплекс урганилди ва нафас бузилиш синдроми белгилари билан туГилган болаларни диагностик белгилари кузатув давомида аницланди. Ча;алок;ларда упка тукимасини етилмаганлиги фонида яллиГланиш жараёнига богли; рентгенологик узгаришлар верификацияси вариантлари ажратилган. Янги туГилган ча;алок;ларда пневмония рентгенологик тадкицотлар натижалари неонатал даврда утказиш кераклиги, упкада кайтарилмас узгаришлар, сурункали нафас олиш етишмовчилигининг, катта ёшдаги болаларда бронхо-обструктив синдром ва бронхопульмонал дисплазия ривожланишига тус;инлик киладиган даволаш тактикасини ишлаб чи;ишга ёрдам беради..
Калит сузлар: рентгенография, янги туГилган ча;алок;лар, муддатдан олдин туГилган ча;алок;лар, нафас бузилиш синдроми, пневмония.
Pneumonia is a fairly common form of respiratory damage in children in all age groups. Respiratory diseases are widespread among the child population and have a large share in the morbidity structure, especially in newborns.
An alarming trend in modern neonatology is the almost universal increase in the birth rate of children with respiratory
disorders, the most common causes of which are SDR and pneumonia of newborns. It should be noted that in recent years, respiratory disorders of newborns have attracted great attention of researchers, because often their outcome is chronic respiratory failure, broncho-obstructive syndrome, bronchopulmonary dysplasia in older children.In recent years, respiratory disorders in
newborns have attracted a lot of attention from researchers because often their outcome is chronic respiratory failure, broncho-obstructive syndrome, bronchopulmonary dysplasia in older children [1,3,4]. The timeliness of assessing the state of the respiratory system in newborns and especially premature infants, as well as the presence of signs of morphological immaturity in the syndrome of respiratory disorders (RDS), requires widespread use of well-known examination methods, in particular, it concerns timely X-ray examination. X-ray examination of newborns with modern advanced X-ray technology remains the leading and most accessible method for diagnosing respiratory diseases in newborns [2].
The aim of the study was to determine the radiological criteria for the severity of SDR in pneumonia of the newborn.
Materials and research methods. Clinical and X-ray examination of 100 newborns was carried out, including 50 full-term newborns and 50 premature newborns with prematurity of I and II degrees. X-ray examination was carried out on a KX050F - "Toshiba" apparatus, made in Japan. During chest x-ray in children, the following technical conditions were adhered to: voltage of 50-55 kV, current of 100-150 mA, holding time 0.03-0.04 seconds.
Results and discussion. Newborn children born with RDS require special attention from the first days of illness and professionally competent medical tactics. Clarification by the radiologist of the severity of the RDS of the newborn with pneumonia allows the most accurate and objective assessment of the severity of the sick child. X-ray examination of premature infants with pneumonia showed the prevalence of manifestations of signs characteristic of RDS. In all observations in the groups of premature infants, a decrease in pneumatization of the pulmonary fields was characterized by varying degrees of severity, including darkening like ground glass and "white lungs". In full-term, a moderate decrease in airiness was noted only in 20% of cases.
On radiographs, in addition to signs of impaired ventilation, shadows from miliary spotting of the reticulogranular pattern with a gradual general uniform veiling to large or conglomerate lobular shadows and general
diffuse hypopneumatosis or apnematosis of all lobes were observed. Areas of darkening in the lungs of premature infants were expressed by bilateral diffuse mesh-focal infiltration and compensatory multifocal emphysema. In full-term newborns, along with diffuse focal changes, grouping of focal shadows was most often observed, manifested by areas of limited darkening of the mosaic structure (due to air and swollen groups of lobules that are not involved in the inflammatory process) with their predominant localization in individual segments, which are somewhat delayed in its development.
Shadows of various intensities were simultaneously visualized on the X-ray diffraction patterns, which indicates their occurrence at different times and unequal depth of occurrence. Diffusely widespread multiple small focal blackouts very often tended to merge and were combined with multifocal swellings. In the group of patients with prematurity up to 60% of cases, along with low-intensity focal shadows, small-focal shadows of somewhat high density were visualized, very characteristic of atelectasized lobules, which proved the development of pneumonia against the background of pneumopathy.
The symptom of increased vascular pattern, characteristic of the inflammatory process, did not manifest itself in the groups of premature babies we examined. Analysis of the X-ray picture of the pulmonary pattern revealed that a certain number of premature infants, due to their immaturity, were characterized by a depletion of the vascular pattern (36%). There was an enrichment of the nodose-reticular mesh type, caused by widened interlobular septa and manifested by gentle polygonal shadows of varying length and detected in most cases (60%). The symptom of "air bronchogram" was also more often detected in the group of immature newborns. Assessing the condition of the roots of the lungs, sometimes (20%) it was not possible to identify their pattern due to the increased shadow of the mediastinal organs, as well as because of the additional shadow in the root zone due to the involvement of interstitial tissue in the process, which was interpreted as an expansion of the root zone (72%).
When X-ray analysis of combinations of various forms of pulmonological pathology, it is
and the the
necessary to bear in mind that each component, interacting with others, changes its pathological and pathophysiological appearance, which ultimately contributes to the formation of the corresponding severity of X-ray signs of RDS in newborns, depending on the signs of immaturity.
Based on our own observations analyzing the available information in literature, as well as generalizing classifications we studied about the X-ray manifestations of the RDS stages, we identified the following version of the X-ray verification of changes in degrees depending on the severity of the X-ray manifestations and the severity of signs that occur during the inflammatory process against the background of immaturity of the lung tissue. I degree of severity: moderate decrease in pneumatization, miliary spotting, limited low-intensity shadows, nodose-reticular mesh (vague), "air bronchogram" is distinguishable. II degree of severity: decreased pneumatization, rough, randomly scattered areas of the seals of the lung tissue, nodose-reticular mesh, "air bronchograms". III degree of severity: a
("frosted glass"), smoothing of the pulmonary-diaphragmatic and pulmonary-cardiac border (symptom of "silhouette"), "air bronchograms". IV degree of severity: "white lungs".
The results of X-ray studies for pneumonia in newborns make it possible to conclude that it is necessary to conduct them in the neonatological period, contribute to the development of treatment tactics that prevent the development of irreversible changes in the lungs, chronic respiratory failure, broncho-obstructive syndrome and bronchopulmonary dysplasia in older children.
Findings. The X-ray method for assessing the severity of RDS in pneumonia of newborns, especially premature infants, and with intrauterine growth retardation syndrome is convenient for its non-invasiveness, minimal radiation exposure to the subject, a wide range of indicators and rich information of morphological data, which contributes to the timely correction of complex treatment, especially at the risk of RDS, saving the use of drugs, reducing the development of post-hypoxic complications of the adaptation period.
pronounced decrease in pneumatization
References:
1. Abdullaeva M.N., Mardieva G.M. The value of morphological and biochemical immaturity of the lungs in newborns in the genesis of respiratory disorders // "Medical Journal of Uzbekistan" - 2011. - №3. S. 77-86
2. Bakradze M.D., Gadliya D.D., Rogova O.A. On the problems of diagnosis and treatment of pneumonia in children. // Pediatric Pharmacology. - 2015 - 12 (3) - pp. 354 - 359.
3. Baranova L.S., Kulichenko T.V., Malakhova A.E. Pneumococcal pneumonia in children: lessons from everyday practice // Questions of modern pediatrics, - 2012, - v.11, - №4, - P.65-72.
4. Geppe N.A., Malakhov A.B., Volkov I.K. et al. On the further development of a scientific and practical program for community-acquired pneumonia in children // Rus. honey. zhurn. - 2014. - T. 22, - No. 3. - S. 188-193.
5. Ibragimova Zh.R. Community-acquired pneumonia in preschool children caused by atypical pathogens. Optimization of diagnostics and therapy. / Author's abstract. dis. Cand. honey. sciences. Kazan. - 2014. - S. 22.
6. Pikuza O.I., Samorodnova E.A. Modern features of community-acquired pneumonia in young children. // Practical medicine. - 2013. - 6 (75) - pp. 35-41.
7. Trufanov G.E., Fokin V.A., Ivanov D.O. Features of the application of methods of radiation diagnostics in pediatric practice. // Bulletin of modern clinical medicine. - 2013 - volume 6, issue 6. - S.48-54.
8. Tsarkova S.A., Abdullaev A.N., Surovtseva D.A. X-ray negative pneumonia in young children is a real phenomenon or a diagnostic error. // Russian Pediatric Journal. - 2020; - No. 1 (2) - P.31-37.
9. Volianyuk E.V., Safina A.I. Congenital pneumonia in premature infants: features of etiology, diagnosis and treatment. // Practical medicine - 2011 - 5 - (53) - P.55-59.
10. Yusupov Sh.A., Mardieva G.M., Bakhritdinov B.R. Features of X-ray semiotics in pneumonia in young children // Scientific and practical journal "Actual nutrition of pediatric obstetrics and gynecology". Ternopil (Ukraine). - 2017. - No. 2 (20). - S. 21-24.
