Clinical and laboratory manifestations of congenital infectious and inflammatory diseases in extremely low and very low birth weight infants


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Objective. To study the clinical and laboratory manifestations of congenital infections in extremely low and very low birth weight (ELBW and VLBW) infants. Subject and methods. A prospective study included 129 ELBW and VLBW neonatal infants, 51 of whom were found to have congenital infection, 52 babies formed a group at high risk for congenital infection; the latter was excluded in 26 newborn infants. Clinical blood tests were carried out on day 1 of life and repeated on 3 of life; biochemical blood and hemostasiogram tests were done on day 3 of life; acid-base balance (ABB) and capillary blood lactate levels were estimated every 6-8 hours; C-reactive protein (CRP) and procalcitonin (PCT) were measured on day 3 of life; neurosonography, abdominal ultrasonography, echocardiography, and chest X-ray study were performed on day 1 of life. According to the babies’ status, neurosonography, echocardiography, and chest X-ray study were repeated on day 3 of life. Results. The characteristic manifestation of congenital infectious and inflammatory diseases in ELBW and VLBW infants in the first 72 hours of life is multiple organ dysfunction with the development of mainly respiratory and hemodynamic disorders and renal failure, which was accompanied by significant metabolic disturbances (hyperglycemia and persistent ABB disorders). Inflammatory changes in clinical blood tests have no sufficient sensitivity and specificity in verifying the diagnosis of congenital infection in ELBW and VLBW infants in the first 72 hours of life. The exception is the neutrophil index measured in the first 24 hours of life, which has moderate specificity, but low sensitivity. Conclusion. The isolated increase of one of the biochemical markers for systemic inflammation (CRP or PCT) in the absence of other clinical and laboratory signs may not be used as a significant sign of the diagnosis of congenital infection in ELBW and VLBW babies at least in the first 72 hours of life.

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作者简介

Olga Milaya

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: o_milaya@oparina4.ru
postgraduate of neonatal intensive care unit of the obstetric department

Oleg Ionov

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: o_ionov@oparina4.ru
Ph.D., Head of the intensive care department of neonatology and pediatrics

Anna Degtyareva

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: a_degtyareva@oparina4.ru
MD, Head of the Scientific Advisory Pediatrics Division of Neonatology and Pediatrics

Anna Levadnaya

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: a_levadnaya@oparina4.ru
PhD, researcher at the Department of Clinical Pharmacology

Dmtitry Degtyarev

Academician V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation

Email: d_degtiarev@oparina4.ru
MD, PhD, DM, professor, Deputy Director for Science

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