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25. Kameneva, E.A. Protokol vedeniya boljnihkh s tyazheloyj sochetannoyj cherepno-mozgovoyj travmoyj / E.A. Kameneva, E.V. Grigorjev, G.A. Li, S.A. Merlushkin [Eh/r]. - R/d: http://www.gkb3.ru/document.php?id=659
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Статья поступила в редакцию 10.11.12
УДК 613.952
Jaxalykova K.K., Kozhakhanova A.Y. BODY MASS OF NEWBORN AS THE INDICATOR OF ANTENATAL DEVELOPMENT OF THE FETUS. On the basis of analysis of mothers age structure (420), their health and social condition and other anamnestic data there were revealed the main reasons leading to born of newborns with low body mass from women of childbearing age, which in most cases (97,4) are linked with high level of perinatal risk.
Key words: women-mothers, low body mass, childbearing age, newborns, anamnestic analysis.
К.К. Джаксалыкова, д-р мед. наук, проф., г. Семей, E-mail: dkk06@mail.ru;
А.Е. Кожаханова, магистрант, г. Семей, E-mail: akbotaismailova@mail.ru
МАССА ТЕЛА НОВОРОЖДЕННОГО - ИНДИКАТОР АНТЕНАТАЛЬНОГО РАЗВИТИЯ ПЛОДА
В статье рассматривается одна из актуальных проблем современной неонатологии - выхаживание новорожденных с малой массой тела (ММТ). Переход Республики Казахстан с 2008 года на использование в практической работе разработанных и рекомендованных ВОЗ критериев живо- и мертворожденности, привел к регистрации новорожденных с ММТ от 500 до 999 грамм. Внедрение современных перинатальных технологий, широкое использование методов интенсивной терапии в лечении детей с малой массой тела способствуют увеличению их выживаемости.
Ключевые слова: женщины-матери, малая масса тела, детородный возраст, новорожденные, анамнестический анализ.
Rehabilitation and care of premature newborns is one of the main actual problems of modern neonatology. Transmission of Kazakhstan from the beginning of 2008 on usage in practical work of working outs and alive - and stillbirth criteria recommended by WHO lead to increasing number of registered newborns with body mass from 500 to 999 gr. [1].
The implementation of modern perinatological technologies and the wide usage of intensive therapy methods in treatment of children with low body mass contribute to increase of survival [2].
Health condition of children with low body mass and prognosis of their development influence have many reasons which not only unfavorably influence the postnatal adaptation but also lead to decreasing quality of life in subsequent years [3].
Due to worsening of demographic situation and decrease of birthrate care of deep preterm newborns is prior direction of modern neonatology [4].
Because of extreme level of morphological - functional immaturity children birth with extremely low body mass (ELBM) composes the main risk group by critical condition development in newborn period [5].
Appearance in first hour after birth cerebral disturbances (hypoperfusion, ischemia, interventricular hemorrhages) mostly define course of early neonatal period and became one of the main reasons of child disability [6].
Modern prophylaxis of cerebral complications, development of high technology help impossible without analysis and revealing of risk factors of severe outcomes in preterm infants [7].
Thus the aim of the given article is to study risk factors of children born with low body mass.
We analyzed somatic and obstetric-gynecological anamnesis, medical and social factors and also some course peculiarities of pregnancy and labor of 420 women born children with low body mass (LBM). Depending on mass at birth there were pointed out into 3 groups: 1 group - children with low body mass (LBM) weight from 2500 - 1500 gr., 2 group - children with very low body mass (VLBM) weight from 1500 - 1000 gr., 3 group - children with extremely low body mass (ELBM) weight 1000 gr. and less. Control group composed
30 mothers whose pregnancy finished by birth of healthy mature children.
96,6% of newborns' mothers of the control group were in optimal childbearing age (20-29 years). Specific gravity with optimal childbearing age among women bearing children with LBM was lower (70,2%), as for the mothers at the age of 30-34 years the indicators were sixfold higher (21,7%) than in control group (3,4%), and juvenile (17-19 years) composed 8,1 %. In control group there were no juvenile mothers.
Among women bearing children with VLBM there were 11,4 % of juveniles, 31,8 %, - at the age of 30-34 years and 4,5 % at the age of 35 years and more. At optimal childbearing age the indicators comprised 52,3 %, that is 1,3 times less than in control group.
The highest percentage of juvenile mothers (15,4%) and those older than 34 years (15,4 %) was found with women who bore children with ELBM. There were 51,2 % of women at the age of 20-29, that is by 1,4 times less than in control group, as for age from 30 to 34 years - 17,8%.
So, among women bearing children with LBM, specific gravity with optimal childbearing age decreases parallel to decreasing of low body mass and the number of juvenile and older mothers increases.
The average age of mothers of examined newborns was: 24,6 ±1,6 years in control group, 26,9±3,2 years in 1 group, 27,2±4,3 years in 2 group, 27,5±5,4 years in 3 group, that is also shows about influencing of childbearing age of mother with LBM.
Analysis of social conditions of mother of examined newborns shows that among the women of control group 60,0 %, are employees, 26,7 % - workers, 10,0 % - housewives and students - 3,3 %.
It is necessary to pay attention to the fact that among women giving birth to children with LBM the specific gravity of housewives is obviously high (16,2 % - in 1, 29,5 % - in 2, and 30,8 % - in 3 group against 10,0 % in control group), and students (35,0 % against 3,3 % in control group), its number increases parallel to growing of LBM, so the number of workers and employees is decreasing. Three of the employees at harmful manufacture in group I (housepainter,
stewardess, typewriter), others are cleaners, yard-keepers, bricklayers and etc. All these jobs are connected with dusting of air and hard physical work.
Half of 22,7% of the employees of group II % were connected with harmful manufacturing (typewriter, cook, worker of silicate glue production and worker of meat factory) and hard physical work. In group III all 33,3% of employees were linked with harmful manufacturing (disinfector, X-ray worker, builder, worker of meat factory, housepainter, bus conductor and etc).
Due to the detailed studying of housewives contingent it became clear that most of them work with re-sale of goods which are bought and sold in far and near abroad or have to be at home due to the lack of work. All of them and also students ate irregularly during the period of pregnancy. At revealing of the influence of women's body mass at given pregnancy and its growth on development of LBM we did not notice evidence dependency, although there is the tendency to its decreasing within the limits of diminishing of body mass. So, body mass of women in control group in average composed 68,6±1,2 kg, in 1 group - 67,2±2,8 kg, in 2 group - 67,4±3,1 kg, in 3 group -64,0±3,1 kg, and height accordingly 160,4±1,1 cm, 159,0±1,6 cm, 159,3±1,3 cm and 156,9±2,5 cm.
It is necessary to notice that among all examined women bearing children with LBM the significant percent of smokers between employees and workers accordingly (12,5 and 15 % dramatically). Among housekeepers working in sale together with hard physical tension is also usage of alcohol (9,1 %). The last one revealed among workers and employees (14,1 %) of main groups.
In control group there prevailed first pregnancy which composed 56,6 % and 60.0 % accordingly. Among women giving birth to children with LBM, the number of first pregnancy (37,8 % in 1 group, 45,5 % in 2 group, and 51,3 % in 3 group) and more women with 4 and more pregnancy (29,8 % in 1, 27,1 % in 2, and 12,8 % in 3 group against 13,3 % in control group).
At detailed analysis of anamnestic data we revealed that among women bearing children with VLBM the significant number of first pregnancy at the age of 30 years and higher (13,6 and 15,4 % accordingly), and also juvenile (114 and 15,4 % accordingly).
Bibliography
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Moreover, number of medical abortions in anamnesis were in reverse dependency from body mass: in 1 group - 32,4 %, in 2- 27,3 %, in 3 - 25,6 %, that is explained by a big number of first born of elder age in women group born children with VLBM and ELBM.
Gynecological diseases in type of chronic and acute adnexitis, colpitis before pregnancy diagnosed in 1/3 women in each group, and dysfunction of ovaries - in 17,3 % (in 1- 5,4 %, in 2 - 6,8 %, in 3 - 5,1 %).
Number of miscarriage abortions, stillbirth, barrenness in anamnesis was significant in all women group born children with LBM.
Extragenital pathology revealed in 86,7 % women in 1 group, 95,6 % in 2 group, and 90,5 % in 3 group. It is necessary to notice that in most cases takes place binding of several unfavorable factors accompanied by born children with LBM.
Likewise, pregnancy of all women were complicated by presence of extragenital diseases in each women with long lasting gestosis (toxicosis). Miscarriage abortions of pregnancy were revealed in each 2-3 women, anemia in 60-70 %.
Thus, the detailed analysis of age structure in women, health and social condition and etc. shows that LBM formed due to presence of complex of unfavorable factors which can be divided as factors of risk born children with LBM:
1. Social and biological (women age 17-19 years and 30 and higher); professional harm, hard physical work, alcohol abuse, smoking)
2. Presence of extragenital diseases (kidneys, cardio and vascular system, chronic diseases of respiratory system, digestive and endocrine system).
3. Complicated obstetric-gynecological anamnesis (disorder of menstrual function, gynecological diseases, abortions, miscarriage abortions).
4. Linked toxicosis of II half of pregnancy (anemia, aggravation of pyelonephritis and etc).
To sum it up, the birth of children with LBM in most cases (97,4 %) is linked to the high level of perinatal risk and linkage of influences of unfavorable factors.
Volodin, N.N., Actual problems of neonatology / N.N. Volodin // Geotar - Med. 2004.
Kulakov, V.I. Problems and perspectives of rehabilitation newborns with extremely low body mass on modern stage / V.I. Kulakov, A.G. Antonov., E.N. Baibarina. - M., 2007.
Lebedeva, O.V. Risk factors and peculiarities of development perinatal injuries of brain in newborns with extremely low body mass / O.V. Lebedeva, V.V. Belopasov // International neurologic journal. - 2010. № 7 (37).
Dementieva, G.M. Care of deep preterm infants: modern state of problem / G.M. Dementieva, I.I. Ryumina, M.I. Frolova // Pediatrics. - 2003. - № 3.
Glukhovets, N.I. The main reasons of newborn death with extremely low body mass / N.I. Glukhovets, N.A. Belousova, G.G. Popov // Russian massanger of perinatology and pediatrics - 2004. - № 5.
Volodin, N.N. Perinatal neurologic problems and the way of its decision / N.N. Volodin // Neurology and psychiatry - 2009. - № 10. Baranov A.A., Albitskiy V.Y., Volgina S.Y., Immature newborns in childhood (medical and social investigation) / A.A. Baranov, V.Y. Albitskiy, S.Y. Volgina. - M., 2001.
Статья поступила в редакцию 10.12.12
УДК 616.8-001
Firsov S.A. INDICATORS APOPTOSIS IN VICTIMS WITH COMBINED CRANIAL AND SKELETAL INJURIES ASSOCIATED WITH CHRONIC ALCOHOL INTOXICATION. Have shown that in patients with concomitant cranial and skeletal trauma associated with chronic alcohol intoxication, enhanced apoptosis, which necessitates use of immunomodulators and neuroprotective agents in therapy.
Key words: combined cranial and skeletal injuries, apoptosis, neuroprotective, injury while alcohol intoxicated.
С.А. Фирсов, канд. мед. наук, ННИИТО, г. Новосибирск, E-mail: mba@ngs.ru
ПОКАЗАТЕЛИ АПОПТОЗА У ПОСТРАДАВШИХ С СОЧЕТАННОЙ ЧЕРЕПНО-МОЗГОВОЙ И СКЕЛЕТНОЙ ТРАВМОЙ, АССОЦИИРОВАННОЙ С ХРОНИЧЕСКОЙ АЛКОГОЛЬНОЙ ИНТОКСИКАЦИЕЙ
Показано, что у пострадавших с сочетанной черепно-мозговой и скелетной травмой, ассоциированной с хронической алкогольной интоксикацией, усилены процессы апоптоза, что обусловливает необходимость назначения нейропротекторов и иммуномодуляторов в процессе терапии.
Ключевые слова: сочетанная черепно-мозговая и скелетная травмы, апоптоз, нейропротекторы, травмы в состоянии алкогольного опьянения.
У большинства пострадавших, получивших сочетанную че- гольного опьянения, выявляется целый спектр нейрометаболи-репно-мозговую и скелетную травму (СЧМСТ) в состоянии алко- ческих нарушений, связанных с состоянием окислительного
