Intensive care of newborns: improvement of approaches to the correction of renal disorders under perinatal pathology
Background. Considering an important role of the urinary system in ensuring the stability of homeostasis in the whole organism and high incidence of renal dysfunction in term newborns with pathological course of postnatal adaptation, the management of patients of neonatal intensive care units requires a systematic approach and is directed to the protection of vital functions including prevention of severe renal injuries and their long-term effects. Therefore, the objective of the study is to improve intensive therapy of neonates with severe forms of perinatal pathology against the background of functional disorders of the urinary system. Materials and methods. A comprehensive clinical and paraclinical examination of 100 term newborns with severe perinatal pathology was conducted. The main group included 60 babies who underwent improved treatment. Forty children (comparison group) received standard therapy. In addition to traditional measures to stabilize homeostasis, neonates from the main group were administered a drug from methylxanthine group with theophylline as an active agent for the prevention of adenosine-induced renal vasoconstriction and Cytoflavin, a drug with combined anti-hypoxic and anti-oxidant action. Results. As compared to the traditional therapy, administration of the advanced treatment enabled to improve considerably the functioning of the urinary system in case of severe perinatal pathology, and, particularly, to decrease the incidence of acute kidney injury. The benefits of this study were increased hourly diuresis, decreased creatinine level in the blood serum, increased glomerular filtration rate, improved main Doppler indices of the renal blood flow and stabilized body weight balance. Moreover, stimulation of the antioxidant effect was confirmed by a significant decrease of malone aldehyde in erythrocytes and protein oxidative modification in the blood plasma, increased activity of glucose-6-phosphate dehydrogenase in erythrocytes, glutathione reductase and glutathione-S-transferase in the blood plasma. Conclusions. The results of the study showed the reasonability of the suggested treatment which is evidenced by normalization of the renal functions under perinatal hypoxia and reduced severity of the pathology in newborns during the early neonatal period.
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