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1997

ТОМ XXXVII, 2/1997 година, VOLUME XXXVII, 2/1997 year

СЪДЪРЖАНИЕ

ОБЗОРИ И ЛЕКЦИИ

Божинова, В., Л. Белопитова

"Съвременни тенденции в диагностиката, Клиниката и лечението на епилепсията в детска възраст (по материали на Втори Европейски конгрес по епилептология, Хага, 1-5 септември 1996 г.)

Йорданова М.

SD34 природа, структура, биологични особености и клинично приложение

Стефанов, Г.

Инхалация на азотен окис - нова, ефективна терапевтична тактика при лечението на персистираща белодробна хипертония при новородените

КЛИНИЧНИ И ПРОФИЛАКТИЧНИ НАБЛЮДЕНИЯ

Масларска, Р., Л. Спасов, Р. Клясова, Сн. Томова

Терапевтично поведение при недоносени новородени с персистиращ артериален канали респираторен дистрес синдром

Георгиева, Р.

Проследяване ефекта от приложението на екзогенен сърфактант при новородени деца с хиалинно-мембранна болест

Праматарова, Т., Т. Дачева, А. Михайлова

Анемия на недоносените и етиологично лечение с еритропоетин

Георгиева, Р., Ю. Тулевска, Д. Дянкова

Трансфонтанелна ехография при доносени новородени деца с перинатална асфиксия и хипоксично-исхемична енцефалопатия

Бешанска, Б., Х. Аврамова, С. Ранкова, С. Желязова

Хернии у недоносените деца

Слънчева, Б., Л. Вакрилова, Н. Яръкова, Ст. Дачева

Хранене на недоносени деца с ниско тегло под 1500 г. и възраст под 32 гестационна седмица

Дойчева, Е., Л. Вакрилова, 3. Емилова

Динамика и структура на неонаталната смъртност при новородени с ниско тегло за периода 1991 -1995 година в ДУБ „Майчин дом" - София

Георгива, Р., Д. Дянкова, Б. Драгижева, Р, Масларска, Ю, Тулевска

Приложение на флуконазол при кандида албиканс инфекции в неонаталния период

Тодорв, Ив.

Рискови фактори при острия рецидивиращ среден отит в детската възраст

Рангелова, Г.

Епистаксис в детската възраст

ТЕРАПЕВТИЧНИ ПРОБЛЕМИ

Ковачева, Ю.

Клнично приложение на адаптираното ниско лактозно мляко Nutrilon Low Lactose

Белопитова, Л., Р. Йотова, В. Божинова

Предимства на ретардните форми на карбамазепин при лечение на епилепсията в детската възраст

ЗА ПРАКТИКАТА

Маринова, Й

Фризолак Н - съдържа бета-каротин нова формула, единствена на нашия пазар

ХРОНИКА

Иванов, Ив.

Новости в неврорентгенологията от педиатрична гледна точка (впечатления от Европейския конгрес по рентгенология (2-7 март 1997, Виена)

IN MEMORIAM

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CONTENTS

REVIEWS AND LECTURES

Bozhinova, V., L. Belopitova

Modern Trends in Diagnostics, Clinics and Therapy of Epilepsia in Childhood

Yordanova, M.

SD34, its Nature, Structure, Biological Peculiarities and Clinical Application

Stefanova, G.

Inhalation of Nitrogen Oxide - New Effective. Therapeutic Tactics in the Teatment of Persisting Pulmonary Hypertonia in the Neonate

CLINICAL AND THERAPEUTIC OBSERVATIONS

Maslarska, R., L. Spasov, R. Klyasova, S. Tomova

Therapeutic Conduct in Preterm Neonates with Ductus Arteriosus Persistent and Respiratory Distress Syndrome (RDS)

Georgieva, R.

Follow up of the Effect of Applied Exogenic Surfactant in Neonates with Hyalin-Membrane Disease

Pramatarova, T., T. Dacheva, A. Mihailova

Anaemia in Preterm Neonates and Aetiological Treatment with Erythropoietin

Georgieva, R., J. Toulevska, D. Dyankova

Echography through the Fontanel in Mature Neonates with Perinatal Asphyxia and Hypoxic-lshaemic Encephalopathy

Beshinska, B., H. Avramova, S. Rankova, S. Zhelyazova

Herniae in Premature Infants

Sluncheva, V., L. Vakrilova, N. Yarukova, St. Dacheva

Enteral Feeding of Infants with Very Low Weight at Birth

Doicheva, E., L. Vakrilova, Z. Emilova

Dynamics and Structure of Neonatal Mortality in Low Birth-Weight Infants for the Period 1991-1995

Georgieva, R., D. Dyankova, B. Dragizheva R. Maslarska, J. Toulevska

Application of Fluconasol in Candida Albicans Infections in the Neonatal Period

Todorv, Iv.

Risk Factors in Acute Recurrent Otitis Media in Childhood

Rangelova, G.

Epistaxis in Childhood

THERAPEUTIC PROBLEMS

Kovacheva, J.

Clinical Application of Adapted Low Lactose Milk - Nutrilon Low Lactose

Belopitova, L., R. Yotova, V. Bozhinova

Advantages of Prolonged Acting Forms of Carbamazepin in the Treatment of Epilepsia in Childhood

FOR THE PRACTICE

Marinova, I.

Frisolac N - New Formula with Caroline

CHRONICLE

Ivanov, Iv. New Achievements in Neuroradiology from the Paediatric Point of View. Impressions from the European Congress of Radiology. Vienna, 2. - 7. March 1997

IN MEMORIAM

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SUMMARIES

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Therapeutic Conduct in Preterm Neonates with Ductus Arteriosus Persistens and Resiratory Distress Syndrome (RDS)

R. Maslarska, L Spasov, R. Klyasova, S. Tomova

Dynamics in clinical and ultrasound patterns in preterm neonates with RDS and haemodynamically significant duc-tus arteriosus persistent (DAP) as well the efect of administered indomethacin for its closure are being followed up. The study includes 10 children with RDS and haemodynamically significant DAP, observed during the period 1995-1996 with gestational age 29-34 weeks (mean 31,5 weeks) and body mass at birth between 950 and 2139 g (mean 1645 g). Clinical data for DAP have been established between the 2nd and 8th (mean of 5,5 days) after birth. In all chidlren clinical and echocardiographic data for significant RL shunt are appearing between the 5th to 12th day (mean 10,7 days) after birh. Treatment includes conventional therapy - restriction of liquids, furantril and medicinal closure of the open arterial channel by means of venous administration of indomethacin on the day of echocardiographic disclosure of significant RL shunt. Closure of DAP set in: in two children of the 4th hour after the first application, in 1 patient - after the second application in 6 children -after the third administration. In 2 children the therapeutic course has in been repeated due to persistent significant shunt. In these patients closure has been achieved after the fourth and fifth application. In four chilren a haemodynamic insignificant shunt through DAP is persisting. Not a single child revealed a reopening of DAP at dismissal.

Authors' experience with the administration of indomethacin for the closure of haemodynamically significant DAP in preterm neonates with RDS supports this noninvasive alternative to surgery.

Key words: prsistent arterial channel, respiratory distreass, medicinal therapy, indomethacin, prematures

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Follow up of the effect of Applied Exogenic Surfactant in Neonates with Hyalin-Membrane Disease

R. Georgieva

Present study covers 6 preterm neonates with hyalin-membrane disease, treated with endotracheal application of exogenic surfactant. Following data have been analysed - oxygen concentration of the gas mixture, peak inspira-tory pressure, alveolar-arterial gradient, quotients of partial oxygen pressure to oxygen concentration in the delivered gas mixture and oxygen index all of them have been checked at 6 hours' intervals till the 48 hour after insuflation of the surfactant. In two children with a high oxygen index (severe respiratory distress syndrome) at the beginning, the change in the above mentioned indices is slower and of a lower degree this has been used as an indication for the application of a second dose of exogenic surfactant. In the remaining cases dynamics proved faster and a shorter period of instrumental ventilation. Methodology may be used for the assessment of the effectiveness of exogenic surfactant in neonates with hyalin-membrane disease as well in neonates with hyalin-membrane disease as well in order individualize the therapeutic scheme. Key words: sirfactant, hyalin-memrane disease

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Anaemia in Preterm Neonates and Aetiological Treatment with Erythropoietin

T. Pramatarova, T. Dacheva, A. Mihailova

This study is aimed at the role of erythropoietin in the treatment of hyporegenerative anaemia in infants with low birth weight, Treatment with Eprex (Cilag, Switzerland) covers 10 infants with anaemia due to loss of blood, infection haemolysis. Infants with congenital abnormalities and exchange transfusion have been excluded from the study. Haematological indexes (Hb, Ht, Ere., Retc., Leuc., acid-base state, general status were followed up during the period of treatment and after it. Initial levels of erythropoietin were radioimmunologically determined. They were considerably lower than those in adults. Increased number of reticulocytes, rsulting from treatment and to less extent of Hb, Ere. and Ht. Significant changes in leucocytes, electrolytes, acid-base state and blood pressure have not been disclosed before and during treatment. Reduced numbr of correcting haemotransfusions has been established during the treatment compared to the preceding period.

Key words: prematures, anaemia, erythropoietin

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Echography through the Fontanel in Mature Neonates with Perinatal Asphyxia and Hypoxic-lshaemic Encephalopathy

R. Georgieva, J. Toulevska, D. Dyankova

The investigation covers 40 neonates born in term with perinatal asphyxia and hypoxic-ishaemic encephalopathy of different gravity. Results of echography through the fon-tanel and Doppler's echography during the first 72 hours after delivery are being analysed. Diffuse increased echogenicity of brain parenchyma and a lowered index of resistance (< 0,5) have been disclosed in cases with severe ishaemic encephalopathy. Positive correlative dependence is being present between echographic pattern and index of resistance < 0,5.

Incresed focal echogenicity is being observed in all degrees of hypoxic-ishaemic encephalopathy thus having synonymous clinical significance. In the groups with slight and moderate hypoxic-ishaemic encephalopathy the realtive part of cases with normal echographic pattern is prevailing. This is being observed in 13,3% of the children with severe hypoxic-ishaemic encephalopathy. Therefore interpretation of this index must be carried out as well that of the results of Doppler's sonography has to be carried out in combination with clinical neurological investigation.

Follow up (clinical and echographic) disclosed positive dependence between structural brain changes diagnosed by means of echography during the neonatal period and up to the 6th month of life as well the gravity of neurological complicaitons.

Key words: echography through the fontanel, hypoxic-ishaemic encephalopathy, neonates

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Herniae in premature Infants

B. Beshinska, H. Avramova, S. Rankova, S. Zhelyazova

Present investigation is being aimed at the origin, type and prevalence of herniae in preterm neonates with low birth weight. The study covers 338 premature infants with diagnosed herniae these representing 15% of a total of 2252 for the period May 1984 - October 1996. Results disclose a prevalence of umbilical hernia (69%) being two times higher among girls. Following is inguinal hernia (21%) with a prvalence of the bilateral-one, the combined reaching 10%. Inguinal hernia is nearly three times prevailing among boys. Clinical manifestation is observed at the end of the second month, i.e. the 57th day. Accompanying diseases especially respiratory distress provoke the appearance of herniae. A relative low percentage of children with hernia disclose incarceration (13,9% only 8 of them being operated. Present study reveals that herniae are an actual problem for surgery in childhood. Their early detection and diagnosis during the neonatal period as well surgery in due time depends on the activity of the treating physician.

Keywords: hernia, umbilical, inguinal, prematurity, incarceration

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Enteral Feeding of Infants with Ver Low Weight at Birth

V. Sluncheva, L. Vakrilova, N. Yarukova, St. Dacheva

Present prospective study includes 22 premature neonates with very low birth weight (VLBW) admitted at the intensive care unit, University Maternal Hospital Maichin Dom, Sofia 1996. Criteria for entry: birth weight below 1500 g, ges-tational age up to 32 weeks total or prevailing entral feeding. Exclusion criteria: major inborn malformations, severe problems or unstable condition. Neonates have been divided in two groups: a basic one -13 neonates fed with Nenatal and 9 neonates fed with breast milk as controls. Babies in both groups are followed up for - body weight and daily weight gain, head measures, lenght, laboratory data - haemoglobin, haematocrit, total protein, blood sugar, Na, K, Ca, P, creatinin, urea, acid-base status. It has been disclosed that babies in the basic group have a better body weight curve on the same nutritional regimen as controls. They reveal a medium daily gain in body weight of 15,1 g/kg while gain in weight is slower in the controls, i.e. 11,6 g/kg. laboratory data in the basic group remain mostly within reference values. Complications related to enteral feeding are insignificant in both groups.

Key words: very low birthweight infant, enteral feeding

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Application of Fluconasol in Candida Albicans Infections in the Newborn Period

R. Georgieva, D. Dyankova, B. Dragizheva

The investigation covers 11 neonates with sure and supposed generalysed Candida albicans infection. Treatment with Fluconasol intravenously (6 mg/kg b.w. for 24 hours) or orally (5 mg/kg b.w. for 24 hours). Mycological results proved negative in 100% of treated cases. In all children parameters e.g. blood picture, C. reactive protein proved negative. In 81% considerable improvement of the clinical status has been observed. No side effects have been present during the application of the medicine. Present data disclose a possibility to use fluconasol as an alternative antimycotic drug during the neonatal period.

Key words: neonatal Candida albicans infection, Fluconasol

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Risk Factors in Acute Recurrent Otitis Media in Childhood

Iv. Todorov

Author discuss prevailing risk factors for the appearance and development of acute recurrent otitis media in childhood. Resistance of the pathogens is the most important factor related to microorganisms. Other factors connected to the macroorganism e.g. sex, rearing in kindergartens, breastfeeding, allergy, passive smoking, adenoids and socio-economic status. The widespread and often incorrect administration of antibiotics is also of some importance for the appearance of recurrent otitis media in children.

Key words: otitis media, recurrent, risk factors in childhood

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Dynamics and structure of neonatal mortality in low birth-weight infants

Doicheva, L. Vakrilova, Z Emilova, State Maternity Hospital Maichin Dom, Sofia

This is a retrospective study, carried out in State Maternity Hospital Maichin Dom, Sofia for a five years period, which includes all neonates, born with signs of life and post-natally deceased, with a birth-weight below 2500g - 271 infants in total. They are devided in groups according the grade of prematurity and the neonatal mortality is dynamically followed in each of the groups. The early neonatal mortality shows a tendency in decreasing in the studied period, while the late mortality does not show such tendency.

An analysis of the causes for the mortality is made according the grade of prematurity.

It is established, that the major causes for death in newborns with birth-weight below 1500g are those related with the morphologic immaturity -IVH and RDS, followed by intrapartal asphyxia and materno-foetal infections. In more mature infants (I and II gade of prematurity), there is a prevailure of the incompatible with life anomalies, followed by pneumoniae, intrapartal asphyxia and intrapartal injuries. A conclusion is to be made that reserves for decreasing the neonatal mortality in children with birth-weight below 2500g are to be looked for in attempts for decreasing the prematurity rate, in early diagnosis of the severe anomalies, in atraumatic delivery and in improvement of the methods of control, diagnostics and treatment of high-risk neonates.

Key words: low birth-weight newborn, neonatal mortality.

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Epistaxis in Childhood

Grazhina Rangelova

Epistaxis in children in coming from the anterior nasal septum - locus Kiesselbachi. Causes may be local or general. Most serious bleeding is being observed in haematological disease and in nasopharyngeal angiofibroma in growing patients. In most cases with epistaxis control is being achieved by compressing the wings of the nose towards the nasal septum by setting a cotton tampon with or without haemostatic means. Abundant bleeding requires anterior tamponade and if this is not sufficient - posterior tamponade in combination with the anterior-one. Recurrent epistaxis is being properly treated by cauterization. Epistaxis in nasopharyngeal angiofi-broma is being treated by means of its removal by surgery. Serious blood loss is an indication for blood transfusion. Key words: epistaxis, causes, diagnosis, haemostasis

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Advantages of Prolonged Acting Forms of Carbamazepin in the Treatment of Epilepsy in Childhood

L. Belopitova, R. Yotova, V. Bozhinova

The investigation is aimed at the therapeutic effect of a carbamazepin preparation with prolonged action (Neurotop retard in 30 children between 4 and 14 years of age. Epileptic syndrome is being present during 1 to 7 years. Seizures are daily in 15 children (50%). Manifested therapeutic resistance has been observed in 10 cases (33,3%). Focal epileptic seizures were present in 21 children (70%), 11 of whom revealed comon partial and 10 with compelx partial attacks the remaining 9 (30%) are with a polymorph epileptic syndrome.

Indications for Neurotop retard are carefully considered in accordance with the general principles, valid for the administration of carbamazepin. The medicine is being administered as monotherapy in 12 patients. In the remaining 18 children it is combined with other anticonvulsants, in 14 of them it replaced preliminary applied other preparations of carbamazepin. Plasma level of Neurotop retard has been investigated on the 6th day following a quick increase of the daily dose in patients with initial treatment with Neurotop retard, as well on the 15th day after its start when the children have been on another preceding therapy. Early achievement of plasma concentration of the medicine within therapeutic limits has been observed.

Clinical effect is good in 28 children (93,3%), in 14 (46,7%) seizures subside, in another 14 (46,7%) a reduction by 50% is present. This result corresponds with improvement in EEG with a considerable decrease in EEG abnormalities, Very good tolerance of Neurotop retard has been realized in epileptic children.

Our results support the idea for a broader application of retard forms of carabamazepin in paediatric neurological practice relating to their considerable effectiveness, good tolerance and possibility for an administration of the medicine 1 -2 times daily.

Key words: epilepsy, carbamazepin therapy, retard forms

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Clinical Application of Adapted Low Lactose Milk- Nutrilon Low Lactose

J. Kovacheva

Nutrilon Low Lactose is a milk of low lactose content. Its composition is identical to that of Nutrilon Premium. It is different for it low lactose content thus occupying an intermediate position between adapted dietary milks. Nutrilon Low Lactose may be used as ,,test" food in order to disclose unfavourable reactions towards cow milk in infants due to allergy or lactose intolerance. Main clinical application of Nutilon Low Lactose are all forms of lactase deficiency prevalent among them being the secondary rising hypolactasia in a series of gastrointestinal diseases leading to injuries of intestinal mucosa.

Key words: low lalctose milk, intolerance towards lactose. Intolerance to cow milk proteins.

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