RU2542083C1 - Diagnostic technique for respiratory distress syndrome in mature newborn infants in first minutes of life - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: biological fluid aspirate is taken from the anterior nasal cavity by placing a 7-8 mm stopper on a soft catheter by means of a mm-ruler. Air 1 ml is taken into a syringe; the catheter is inserted into the anterior nasal cavity at 7-8 mm, and the biological fluid is taken. The catheter is removed, and the biological fluid with the air is ejected from the syringe into test tube No.1. The catheter is washed with 0.85% sodium chloride 5 ml. That is followed by placing a 20 mm stopper on the soft catheter, and the air 1 ml is taken into the syringe, and the catheter is inserted into the deep nasal pharynx at 20 mm. The biological fluid is taken; the catheter is removed, and the biological fluid with the air is ejected into test tube No.2. The concentration of average-molecular peptides (AMP) is measured in test tubes No.1, No.2. If the AMP difference in test tubes No.1 and No.2 makes 0.009±0.001 absorbance units, the mature newborn infant is considered to be healthy. If the AMP difference in test tubes No.1 and No.2 makes 0.018±0.001 absorbance units, respiratory distress syndrome is diagnosed in the newborn infant.

EFFECT: technique provides the most effective diagnosing of the given pathology in the mature newborn infants, including in the meconium-contaminated amniotic fluid aspiration.

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Description

The invention relates to medicine, namely to perinatology and neonatology.

An important role in the diagnosis of perinatal pathology in full-term newborns in the first minutes of life is given to assessing the severity of biochemical changes in the aspirate of biological fluid from the nose and nasopharyngeal space [2, 3, 4]. In the antenatal period of development, the biological fluid located in the initial part of the nasal cavity is more often in contact with the amniotic fluid washing it, while in the deeply located part of the nasopharyngeal space, a significant part of the under-oxidized metabolic products and secretions secreted by bronchial glandulocytes and cellular elements of the respiratory lung are accumulated. intrauterine fetus [2]. One of the integral indicators of the well-being of newborns in the first minutes of life is a change in the biological fluid aspirate, for example, the level of medium-molecular peptides [4, 7]. Intrauterine hypoxia of the fetus is often accompanied by centralization of blood flow [1], which leads to the ingress of meconium from the intestine into the amniotic fluid, the aspiration of which makes it difficult to objectively evaluate the content of, for example, medium molecular peptides in different parts of the airways and the need to compare the concentration of medium molecular peptides in the aspirate from the initial department and from the deep located department of the nasopharyngeal space.

A known method of obtaining an aspirate of biological fluid [7] using a device for aspiration of biological fluid from the nasal cavity and nasopharyngeal space in newborns [5].

The disadvantage of this method is the inability to separately obtain aspirated biological fluid from the initial section of the nasal cavity and from the deep located nasopharyngeal space.

The objective of the proposed method is to provide separate receiving aspirate of biological fluid from the initial section of the nasal cavity and from the deep located nasopharyngeal space in term newborns.

The essence of the method for separately obtaining aspirated biological fluid from the initial section of the nasal cavity and from the deeply located section of the nasopharyngeal space in term newborns is as follows:

1. A device for aspiration of biological fluid from the initial section of the nasal cavity and the deeply located section of the nasopharyngeal space in term newborns is attached to a 5 ml sterile syringe [5].

2. Using a millimeter ruler, a 7-8 mm stopper is placed on the soft catheter of the device for aspiration of biological fluid from the initial section of the nasal cavity and the deeply located section of the nasopharyngeal space in term newborns and 1 ml of air is drawn into the syringe.

3. The working section of the device is carefully administered to the full-term newborn immediately after birth in the right or left half of the nose to a depth of 7-8 mm, which corresponds to the initial third of the nasal cavity, since the bottom of the nasal cavity in full-term newborns is from 20 to 24 mm [8] .

4. During the introduction through the soft catheter of the device, the aspirate of the biological fluid contained in the initial part of the nasal cavity is slowly injected with a syringe until the 7-8 mm limiter contacts the nose wings of the full-term newborn.

5. The soft catheter of the device is removed from the initial part of the nasal cavity and squeezed out with the air in the syringe, the contents of the soft catheter into tube No. 1, the soft catheter is washed with a 0.85% sodium chloride solution in an amount of 5 ml.

6. On a soft catheter of a device for aspirating biological fluid from the nasal cavity and nasopharyngeal space in newborns [5], using a millimeter ruler, set a limiter of 20 mm and draw 1 ml of air into the syringe.

7. The working section of the device is carefully introduced into the newborn in the same half of the nasal cavity to a depth of 20 mm into the deeply located section of the nasopharyngeal space, where biological fluid is drawn into the soft catheter with a syringe.

8. The soft catheter is removed from the deep located nasopharyngeal space and squeezed out the contents of the soft catheter into tube No. 2 with the air in the syringe.

9. Centrifuge the aspirate of biological fluid from the initial section of the nasal cavity (test tube No. 1) and the aspirate from the deeply located part of the nasopharyngeal space (test tube No. 2) at 1500 rpm for 10 minutes.

10. Determine, for example, the value of the average molecular peptides in units of optical density (unit opt. Raft.) In the supernatant of the aspirate of the biological fluid located in tubes No. 1 and No. 2.

To assess the capabilities of the proposed method, first using a spectrophotometer, for example, SF-16 or HITACHI-557 (Japan) at a wavelength of 280 nm (E ₂₈₀ ) [6], the concentration of medium-molecular peptides in the supernatant of the aspirated biological fluid from the initial part of the nasal cavity was determined (tube No. 1), and then from the deeply located nasopharyngeal space (tube No. 2) immediately after birth in 20 full-term newborns with moderate respiratory distress syndrome without meconium aspiration (first main group ppa) (Table 1), in 20 full-term newborns with respiratory distress syndrome on the background of meconial aspiration (second main group) and in 32 healthy full-term newborns with a normal course of the early neonatal period from mothers with a physiologically ongoing pregnancy (control group) (table .2).

Table 1 shows that in healthy full-term newborns in the first minutes of life, minimal differences in the concentration of medium-molecular peptides were detected in the supernatant of the aspirate of biological fluid taken from the initial section of the nasal cavity and from the deeply located section of the nasopharyngeal space (0.009 ± 0.001 opt. Raft. ) (p> 0.05).

In newborns of the first main group, compared with the control, there was a tendency to an increase in the difference in the concentration of medium-molecular peptides in the supernatant of the aspirate of the biological fluid obtained from the initial part of the nasal cavity and from the deeply located nasopharyngeal space up to 0.011 ± 0.007 units. opt. raft., however, the revealed differences did not reach the degree of statistical reliability (p> 0.05).

Table 1 The concentration of medium molecular peptides (SMP) (unit opt. Raft) in the supernatant of the aspirate of biological fluid (ab) from the initial part of the nasal cavity (nopn) and from the deep located nasopharyngeal space (grong) when they are separately received immediately after birth in healthy full-term neonates and newborns with moderate respiratory distress syndrome without meconium aspiration (M ± m) Control Group (n = 32) The first main group (n = 20) SMP to abz from nopn SMP in abzh from grongp Differences between SMP in abzh from nopn and from grongp SMP to abz from nopn SMP in abzh from grongp Differences between SMP in abzh from nopn and from grongp 0.325 ± 0.006 0.334 ± 0.006 0.009 ± 0.001 0.620 ± 0.003 0.631 ± 0.003 0.011 ± 0.007 p - - - - p> 0.05 Note: p is the significance level of the differences between the differences in the rates of aspirate from the initial section of the nose and the deeply located section of the nasopharyngeal space in newborns compared with the control group; n = number of cases.

In the second main group, compared with the first main group, the differences in the concentration of medium-molecular peptides in the supernatant of the aspirate of the biological fluid in the initial section and in the deeply located section of the nasopharyngeal space significantly increased to 0.018 ± 0.001 units. opt. raft. (p <0.001) (Table 2).

table 2 The concentration of medium molecular peptides (SMP) (unit opt. Raft) in the supernatant of the aspirate of biological fluid (ab) from the initial part of the nasal cavity (nopn) and from the deep located nasopharyngeal space (grong) when they are separately received immediately after birth in healthy full-term neonates and newborns with moderate respiratory distress syndrome and meconium aspiration (M ± m) Control Group (n = 32) The second main group (n = 20) SMP to abz from nopn SMP in abzh from grongp Differences between SMP in abzh from nopn and from grongp SMP to abz from nopn SMP in abzh from grongp Differences between SMP in abzh from nopn and from grongp 0.325 ± 0.006 0.334 ± 0.006 0.009 ± 0.001 0.636 ± 0.002 0.654 ± 0.002 0.018 ± 0.001 p - - - - p <0.001 Note: p is the significance level of the differences between the differences in the rates of aspirate from the initial section of the nose and the deeply located section of the nasopharyngeal space in newborns compared with the control group; n = number of cases.

Considering the statistical significance of the difference in the concentration of medium-molecular peptides in the supernatant of aspirates of biological fluid obtained from the initial part of the nasal cavity and from the deeply located nasopharyngeal space in full-term newborns in the second main group compared with the control, we propose using this indicator for a more objective assessment of the clinical condition with moderate respiratory distress syndrome, caused primarily by endotoxemia p during meconial aspiration (Table 3).

Table 3 Comparison of differences in the concentration of medium molecular peptides (SMP) (unit opt. Raft) in the supernatant of the aspirate of biological fluid (ab) from the initial section of the nasal cavity (nopn) and from the deeply located section of the nasopharyngeal space (gronp) with their separate collection immediately after birth in healthy full-term newborns and newborns with moderate respiratory distress syndrome without aspiration and meconium aspiration (M ± m) Control Group (n = 32) The first main group (n = 20) The second main group (n = 20) 0.009 ± 0.001 0.011 ± 0.007 0.018 ± 0.001 p p> 0.05 p <0.001 Note: p is the significance level of the differences between the differences in the contents of the initial part of the nose and the deeply located part of the nasopharyngeal space in newborns compared with the control group; n = number of cases.

To illustrate the effectiveness of the proposed method for the separate production of aspirated biological fluid from the initial section of the nasal cavity and from the deeply located section of the nasopharyngeal space in term newborns, we present the following clinical examples.

Example 1

Newborn Z. Born from the first pregnancy. The mother did not experience complications during the first, second, and third trimesters of pregnancy. Blood type 0 (I), rhesus positive. The antenatal clinic was observed regularly from 7 weeks of gestation. The birth is first, with a period of 38 weeks of gestation, through the natural birth canal. Amniotic fluid light.

Clinical diagnosis of the mother: Birth first, with a period of 38 weeks of pregnancy. Episiotomy Episioraphy.

A girl was born with a mass of 3400 g, a length of 53 cm, a head circumference of 35 cm and a chest of 34 cm. In the delivery room, the Apgar score is 9/10 points. Blood type 0 (I), rhesus positive. The condition of the child was satisfactory. The child responded adequately to the examination. Activity and muscle tone are normal. Tendon and physiological reflexes are clear. Breathing and heart activity are normal. At birth, the concentration of medium molecular peptides in the supernatant of the aspirate biological fluid from the initial part of the nasal cavity was 0.322 units. opt. raft., from a deeply located division of the nasopharyngeal space - 0.330 units. opt. raft. The differences between them were 0.008 units. opt. raft.

After 4 hours, the condition of the newborn is satisfactory. The skin was pink. The scream is loud. Normal activity and muscle tone remained. Tendon and physiological reflexes were distinct. Heart sounds are clear, rhythmic up to 134 beats in 1 minute. Respiratory rate up to 44 in 1 minute. Pueril breath.

Newborn diagnosis: Full-term healthy newborn.

Example 2

Newborn P. Born from the first pregnancy. The mother during the first trimester up to 9 weeks showed signs of mild early gestosis. Blood type A (II), Rhesus positive. The antenatal clinic was observed regularly from 6 weeks of gestation. At 28 weeks - mild anemia, as well as chronic compensated placental insufficiency. The birth is first, with a period of 38 weeks of gestation, through the natural birth canal. Amniotic fluid light.

Clinical diagnosis of the mother: Birth first, with a period of 38 weeks of pregnancy. Chronic intrauterine hypoxia of the fetus. Chronic compensated placental insufficiency. Episiotomy Episioraphy.

A girl was born with a mass of 3380 g, a length of 52 cm, a head circumference of 33 cm and a breast of 32 cm. In the maternity room, an Apgar score of 5/7 points. Blood type A (II), Rhesus positive. The condition of the child is satisfactory. Activity and muscle tone are normal. Tendon and physiological reflexes are clear. Breathing and heart activity are normal. The concentration of medium molecular peptides in the supernatant of the biological fluid of the aspirate from the initial part of the nasal cavity was 0.620 units. opt. raft., from a deeply located part of the nasopharyngeal space - 0.631 units. opt. raft. The differences between them were 0.011 units. opt. raft.

After 4 hours, the condition of the newborn is moderate. The cry is quiet. Cyanosis of the nasolabial triangle and widespread cyanosis of the skin were observed. A decrease in activity and muscle tone was noted. Tendon and physiological reflexes were fuzzy. Heart sounds are muffled, rhythmic up to 145 beats per 1 minute. Difficulty breathing through the nose and tension of the wings of the nose were observed. The intercostal space was drawn in by inspiration in the lower chest. Respiratory rate increased to 74 in 1 minute. Auscultation in the lungs revealed limited areas of weakened breathing.

Newborn diagnosis: Moderate respiratory distress syndrome.

Example 3

Newborn U. Born from the first pregnancy, which lasted up to 7 weeks against the background of early gestosis with clinical symptoms of nausea and single vomiting. At 27 weeks, the mother suffered from mild anemia and chronic placental insufficiency. Signs of chronic intrauterine hypoxia were noted, was treated in a hospital. Blood type 0 (I), rhesus positive. The antenatal clinic was observed regularly from 8 weeks of pregnancy. The birth is first, with a period of 38 weeks of pregnancy, through the natural birth canal. In the mother's birth, prenatal discharge of amniotic fluid stained with meconium was noted.

Clinical diagnosis of the mother: Birth first, with a period of 38 weeks of pregnancy. Chronic intrauterine hypoxia. Chronic compensated placental insufficiency. Episiotomy Episioraphy.

A boy was born weighing 3450 g, length - 52 cm, head circumference - 35 cm and chest - 34 cm. The assessment of the state of health of the child according to Apgar in the delivery room was 4/7 points. The amniotic fluid stained with meconium was removed from the oral cavity and nasopharynx. Blood type 0 (I), rhesus positive. The condition is closer to satisfactory. Activity is moderately reduced. Muscle tone saved. Tendon and physiological reflexes are distinct. Changes in the respiratory and cardiovascular systems are absent. The concentration of medium molecular peptides in the supernatant of the biological fluid of the aspirate from the initial part of the nasal cavity was 0.637 units. opt. raft., from a deeply located part of the nasopharyngeal space - 0.656 units. opt. raft. The differences between them were 0.019 units. opt. raft.

After 4 hours, the condition of the newborn is serious. Acrocyanosis was noted. The scream is weak. Activity reduced. Muscle tone is reduced, and tendon reflexes are fuzzy. Physiological reflexes are sharply weakened. The swelling and tension of the large fontanel, severe tremor of the upper extremities, horizontal nystagmus and the symptom of “open eyes” were diagnosed. Heart sounds were muffled, rhythmic up to 158 beats in 1 minute. Respiratory rate 75 in 1 minute. Breathing through the nose was difficult. Auscultation was a tendency to weaken breathing, as well as retraction of the intercostal space in the lower chest and in the epigastric region.

The diagnosis of the newborn: Aspiration of meconium. Respiratory distress syndrome of moderate severity.

Thus, a more objective assessment of the condition in a newborn with moderate respiratory distress syndrome against the background of meconium aspiration was achieved by using the difference between the concentration of medium molecular peptides in the initial part of the nasal cavity and the deep located nasopharyngeal space as a diagnostic test.

The effectiveness of evaluating endotoxemia by the difference in the concentration of medium-molecular peptides in the supernatant of the aspirate biological fluid from the initial part of the nasal cavity and from the deeply located nasopharyngeal space in healthy full-term newborns and newborns with moderate respiratory distress syndrome without aspiration and meconium aspiration is presented in table No. four.

From table 4 it can be seen that our proposed method for separate preparation of biological fluid aspirate using as a diagnostic the difference between biological fluid aspirate from the initial part of the nasal cavity and from the deep located nasopharyngeal space at a concentration of medium molecular peptides of two biological fluids in 92.9% of newborns will allow more objectively evaluate the clinical picture of moderate respiratory distress syndrome against the background of meconial aspiration in full-term but orozhdennyh.

Table 4 The effectiveness of evaluating endotoxemia by the difference in the concentration of medium-molecular peptides (SMP) in the supernatant of the biological fluid of the aspirate (ab) from the initial section of the nasal cavity (nopn) and from the deep-seated section of the nasopharyngeal space (gronp) with moderate respiratory distress syndrome in full-term newborns with meconium aspiration compared to the prototype [7] Methods of abzh sampling by concentration of SMP Total number of newborns examined The actual number of newborns with effective diagnosis Efficiency (in%) When collecting abzh from nopn and from grongp with the establishment of their differences 42 39 92.9 When taking the aspirate in a known manner (mixed) 40 34 85.0

The technical result of the invention is as follows:

1. Our proposed method for the separate production of aspirated biological fluid from the initial section of the nasal cavity and from the deeply located section of the nasopharyngeal space in full-term newborns compared with the prototype [7] is 7.1% more effective in assessing their clinical condition with moderate respiratory distress syndrome severity on the background of meconium aspiration.

Information sources used

1. Garmasheva N.L., Konstantinova N.N. Introduction to perinatal medicine. - M.: Medicine, 178. - S.109-117.

2. Gorikov I.N. The structure of the mucous membrane of the trachea in human fetuses with late toxicosis of pregnant women: Abstract. dis. ... cand. honey. Sciences., Novosibirsk, 1986.- 19 p.

3. Gorikov I.N. Clinical and metabolic criteria for intrauterine infection of newborns with the influenza A (H3N2) virus // Issues of modern pediatrics. - 2003. - T.2. - Appendix No. 1. - P.88.

4. Gorikov I.N., Nakhamchen L.G., Sorokina T.S. On the pathogenesis of diseases in newborns from mothers with chronic bronchitis // Materials of the 5th Russian Scientific Forum ″ Maternal and Child Health 2003 ’, Moscow, Central House of Artists, May 20-23, 2003, Moscow, 2003. - P.63-64.

5. Gorikov I.N., Lutsenko M.T., Samsonov V.P., Ushakova E.V., Kostromina N.O. A device for aspirating biological fluid from the nasal cavity and nasopharyngeal space in newborns. RF patent for the invention No. 2392974. Published: June 25, 2010. Bull. Number 18.

6. Samsonov V.P., Lutsenko M.T., Novik E.V. Diagnosis of various degrees of endotoxemia in lung abscesses: guidelines of the Ministry of Health of the RSFSR, Institute of Physiology and Respiratory Pathology, Siberian Academy of Medical Sciences. - Blagoveshchensk, 1988 .-- 10 p.

7. A method for the diagnosis of respiratory distress syndrome in newborns: US Pat. RU No. 2342667, IPC G01N 33/68 / I.N. Gorikov, V.P. Kolosov, V.P. Samsonov, L.G. Nahamchen; Applicant and patent holder of GU DNTs FPD SB RAMS. - No. 2007136874/15; capt. 10/04/2007; publ. 12/27/2008, bull. Number 36.

8. Topographic and anatomical features of the newborn / Ed. merit scientist, prof. EAT. Margorina. - Leningrad, Medicine, LO. - 1977. - P.31.

Claims (1)

A method for the diagnosis of respiratory distress syndrome in full-term newborns in the first minutes of life by obtaining aspirated biological fluid from the initial part of the nasal cavity using a device containing a syringe with a PVC soft catheter and a movable stopper, characterized in that they additionally receive aspirate from a deeply located nasopharyngeal space , while first receiving an aspirate of biological fluid from the initial section of the nasal cavity, for which using a millimeter ruler and set the stopper on the soft catheter at 7-8 mm, draw 1 ml of air into the syringe, insert the catheter into the initial section of the nasal cavity to a depth of 7-8 mm and collect the biological fluid, remove the catheter and squeeze the biological fluid from the air in the syringe into tube No. 1, the catheter is washed with 5 ml of a solution of 0.85% sodium chloride; after that, a 20 mm stopper is placed on the soft catheter and 1 ml of air is drawn into the syringe, the catheter is inserted into the deeply located nasopharyngeal space to a depth of 20 mm, biological fluid is collected, the catheter is removed and biological fluid is squeezed out with the air in the syringe into tube No. 2; then measure the concentration of medium molecular peptides (SMP) in tubes No. 1, No. 2, and if the difference in the number of SMPs in tubes No. 1, No. 2 is 0.009 ± 0.001 units of optical density, this is a healthy full-term newborn; if the difference in SMP in test tubes No. 1, No. 2 is 0.018 ± 0.001 units of optical density, a respiratory distress syndrome is diagnosed in the newborn.