Method for evaluating viability in neonatals with extremely low body weight according to thymic state

FIELD: medicine, pathological anatomy.

SUBSTANCE: the present innovation deals with detecting viability in neonatals of 22-27-wk-long gestation, at their body weight up to 1 kg based upon evaluation of thymic morphological maturity. Moreover, in 10 visual fields in medullary substance in thymic lobules one should calculate the content of Hassal's bodies and reticuloepithelial cells. If the content of reticuloepithelial cells is above 10 and Hassal's bodies - above 2 one should consider a neonatal to be a viable one, at the content of reticuloepithelial cells being below 9 and Hassal's bodies - below 2 - as nonviable one. This method enables to detect quantitative criteria in evaluating the viability in neonatals at extremely low body weight by thymic state for the first time, helps to increase accuracy and simplify pathologoanatomical diagnostics of viability and objectively evaluate tactics and purposefulness of resuscitation procedures.

EFFECT: higher accuracy and efficiency of evaluation.

3 ex, 1 tbl

 

The invention relates to medicine, namely to pathological anatomy, and can be used to determine the viability of the newborn 22-27 weeks of gestation with a body weight up to kg on the basis of the evaluation of morphological maturity of the thymus gland.

With the transition of the Russian health care on the new who-recommended evaluation criteria, and a live - and stillbirths (order of the RF Ministry of health N318 from 04.1992 g) increased number of newborns with extremely low birth weight (extremely low body weight), and despite the introduction of new technologies of care these children indicators of postnatal death in this category newborns continue to remain high and do not have a stable trend of reduction [8, 9].

The relevance of the proposed method is determined by a high mortality of newborns with extremely low body weight, which is closely linked with their low viability, often developing as the result of intrauterine infection, leading to structural and functional immaturity of the thymus gland [3].

When the currently existing methods of assessing the maturity of the thymus, including morphological, you cannot install its morphological and functional maturity.

There is a method of assessing the maturity of the organs of the immune system by their ergonometrically parameters and histological review film [4].

The disadvantages of the method:

1. In 35-1% of cases with intrauterine infection and complicated pregnancy, these indicators do not change.

2. This method does not allow you to diagnose early changes in the organs of the immune system.

3. Unknown accuracy of the method.

There is a method of assessing the development of the thymus gland in ontogenesis on the relative amount of cortical and medullary substance of slices on the dynamics of changes in the number of lymphocytes and Taurus of Kassala[2, 6, 7].

The disadvantages of the method:

1. These parameters are used to characterize the formation of the organs of the immune system in ontogenesis.

2. Not considered their dynamics in terms of pathology.

3. There are no quantitative values for newborns with extremely low body weight.

4. There is no information about the accuracy of the method.

The closest technical solution to the claimed method is a method of estimating the hidden pathology of the thymus gland in infants and young children by defining the specific area of the parenchyma, stroma, and the average number of lymphocytes per 1,000 μm2the cortex of the thymus gland. As a criterion hidden pathology of the thymus gland is offered the morning is the average standard deviation of determined parameters [1].

The disadvantages of the method:

1. Not used to assess the viability of newborns.

2. Not used in newborns with extremely low body weight.

3. Requires complex morphometric manipulation and with ateisticheskoi processing.

4. Clinical manifestations of pathology of the thymus manifested before the possibility of using this method.

5. Do not specify the accuracy of the method.

These drawbacks are proposed to be eliminated in the inventive method.

The technical solution of the method consists in assessing the viability of newborns with extremely low body weight, by definition, the average number of Taurus Kassala and reticuloendothelial cells in 10 fields of view of the brain lobes of the thymus. When the number reticuloendothelial cells more than 10, Taurus, Kassala more than 2 condition of the thymus gland is rated as Mature and decisive in 88% of cases the viability of the newborn. When the number reticuloendothelial cells of the brain slices less than 9 and Taurus, Kassala less than 2 condition of the thymus gland is assessed as immature as newborn as impractical.

The method is as follows.

Standard 30 minutes after the death of the newborn (early opening) material from the thymus gland is taken for histological study. Pieces of thymus 1,0×1.0 cm are fixed in a 12% solution of neutral formalin for 72 hours. In the future by standard paraffin wiring material, and blocks on paraffin microtome to prepare a slice thickness of 4-5 microns, which are stained by the hematoxylin Erlichs dobriskey eosin.

The following is offered on histological sections in 10 fields of view using a 100-point grid (Thu, 1990) at 300-fold increase to count the number reticuloendothelial cells in the medulla slices of calf thymus and Kassala 10 fields of view. When the number reticuloendothelial cells more than 10, Taurus, Kassala more than 2 condition of the thymus gland is rated as Mature and diagnosed the viability of newborn 22-27 weeks of gestation, and when the number reticuloendothelial cells less than 9 and Taurus, Kassala less than 2 - state of the thymus gland is regarded as immature and leading to the failing of a newborn.

Previously reticuloendothelial cells were used in characterizing the stages of development of the thymus gland [7, 8], Taurus, Kassala - the endocrine function of the thymus gland[3, 6, 8].

To assess the viability of newborns with extremely low body weight status thymus reticuloendothelial cells and calf, Kassala used for the first time.

The novelty of the proposed method is that first proposed quantitative criteria for evaluating the viability of newborns with extremely low body weight, by definition, the average number of Taurus Kassala and reticuloendothelial cells in 10 fields of view of the brain lobes of the thymus gland.

Differentiate the performance communications features of the method.

The proposed quantitative criteria for evaluating the viability of newborns with extremely low body weight status of the thymus gland, when the number reticuloendothelial cells more than 10 and the Taurus Kassala more than 2 condition of the thymus gland is rated as Mature and newborn baby is considered viable, and when the number reticuloendothelial cells less than 9, Taurus, Kassala less than 2 - thymus, immature, and that the baby is not viable.

The essence of the proposed method is illustrated by the following examples.

Example 1. Pregnant With., 21 years old was admitted to the hospital with complaints of cramping abdominal pain. After 2 hours in the spontaneous termination of pregnancy live boy was born weighing 610,0 g, length 31 cm, mesorectum factor - 19,6. In the postpartum period in women with bacteriological study found E. coli 0-111 with hemolytic properties. This pathogen was isolated from placenta, lung, ileum and sieve intestines of a newborn who died in the early neonatal period due to growing signs of respiratory distress and intoxication. Autopsy diagnosed with bilateral congenital pneumonia and ulcero-necrotic enterocolitis. In the placenta revealed exudative-proliferative chorioamnionitis, basal decidua.

Ergonometrics the settings of the thymus gland: weight (2.35 g), volume (2.5 cm3) and the linear parameters (3,2×2,1×0.4 cm) corresponded to 25 weeks of gestation. According to the generally accepted method for the assessment of maturity, based on ergonometrically parameters and review the histological picture, the state of the thymus rated as Mature.

According to the proposed method after the death of a newborn on histological sections of the thymus gland found that the average number reticuloendothelial cells in 10 fields of view of the brain slices was - 6, and the Taurus Kassala - 2, suggesting structural immaturity of the thymus and confirms the non-viability of the fetus. Despite intensive treatment, causal antibiotic therapy, newborn with extremely low body weight died in the early neonatal period due to growing signs of respiratory distress and intoxication.

Conclusion: the use of the proposed method proved unviable newborn and inappropriate conducted treatment and rehabilitation activities.

Example 2. Pregnant H., 32 years turned on consultative reception in the perinatal center with complaints of cramping abdominal pain and leakage of amniotic fluid. On the basis of objective data: determine the circumference of the abdomen, the height of the fundus of the uterus and data ultrasound diagnosis: pregnancy 26 weeks. Prosaude the premature birth.

Despite therapy, occurred preterm birth. The child was born weighing 895,0 g, body length 37 cm, weight growth factor - 24,2. Anthropometric parameters were consistent with gestational age. By the end of the first day of life marked deterioration of the newborn, increased neurological symptoms. Was diagnosed with bilateral hemorrhage into the lateral ventricles of the brain. Along with neurological symptoms appeared respiratory and cardio-vascular disorders of Central origin, which was the leading links teratogenesis.

According to the proposed method, after the death of a newborn on histological sections of the thymus gland was determined by the average number reticuloendothelial cells of the brain substance and the Taurus Hassale. Linear, volume and weight parameters fork gland consistent with gestational age. The average number of Taurus Kassala was 4, reticuloendothelial cells 14 that the claimed method meets the viability of the newborn and the condition of the thymus gland is rated as Mature.

Conclusion: the method allowed us to assess the condition of the newborn as viable on the basis of histological maturity of the thymus on the organ and tissue levels. However, a newborn with extremely low body weight died in the early neonatal the period after the merger intercurrently pathology - bilateral hemorrhage into the lateral ventricles of the brain.

Example 3. Pregnant P., 25 years old was admitted to the hospital for abortion for medical reasons (high myopia). Pregnancy is wanted. On the basis of objective data (abdominal circumference, the height of the fundus of the uterus), data, obstetric history and ultrasound examination was diagnosed with pregnancy 23 weeks.

The result of induced abortion extracted fruit weight 740,0 g, length of 33.0 cm weight growth factor - 22.4. These anthropometric parameters were consistent with gestational age. A conclusion was made: the fruit of 23 weeks of gestation.

Ergonometrically parameters of the placenta: weight 205 g, volume - 200 cm3and the area of maternal surface - 175 cm2- corresponded to 23 weeks of pregnancy.

The linear parameters of the thymus gland in length and 2.8 cm; width 2.2 cm and thickness 0.4 cm; weight - 1,77 g, volume - 2.0 cm3matches a given gestational age. There is a General method, based on the determination ergonometrically parameters and review the histological picture, the state of the thymus gland regarded as Mature.

According to the claimed method, the average number reticuloendothelial cells of the brain substance was 7; and Taurus, Kassala - 4.

Conclusion: when data is x the values of the parameters of the thymus gland, defined according to the proposed method, the newborn assessed as non-viable, and the thymus gland immature, because one of the parameters, namely the average number reticuloendothelial cells below the established standards.

According to the claimed method are investigated 25 newborns with extremely low body weight in gestation 22-27 weeks. The data are summarized in table.

Table
Prototype methodThe inventive method
The number of casesNumber of newborns with immature thymus in the method prototypeThe accuracy of the methodThe number of newborns with suspected unviable.Confirmed by the claimed methodThe accuracy of the method
251456%252288%
P<0,01

The advantages of the proposed method:

1. Given the quantitative criteria for evaluating the viability of newborns with extremely low body weight.

2. Simple in execution.

3. Allows you to objectify the cause of death of the newborn with extremely low body weight, to formulate correctly patologia the atomic diagnosis and discharge summary.

4. To evaluate tactics and the appropriateness of resuscitation events.

References

1. Badgers B.C., pipe V.T. Morphological diagnosis of some forms of pathology of the thymus gland in children using morphometrics. // Archives of pathology. - 1997. - Vol. 59. No. 2. - P.48-52.

2. Zaretians O.V. thymus Hyperplasia: classification, questions Pato - and morphogenesis, place in human pathology. // Archives of pathology. - 1991 - T. No. 10. - P.3-12.

3. Ivanovo IE, Chlebowski A.I. Problems of tissue malformations in childhood. // Archives of pathology. - 1988. No. 5. - S-87.

4. Peretyatko, L.P., Kolida L.V., Protsenko E.V. Diagnostic criteria dichronic development agencies neuroendocrine, immune, respiratory and reproductive systems of fetuses and newborns with extremely low birth weight. Ivanovo, 1995. - 15 S.

5. Torbek WE, Yudin N.A. Ultrastructure of the epithelial cells of the thymus offspring by altering the hormonal background in functional system mother-placenta-fetus. // Univ.: Medicine. - Lead. Grew up with. University of friendship of peoples. - 2000 - №2. - P.45-49.

6. Khlystova SS, S. p. Shmelev, Kalinin, A.I., and other Card settlement organs of the immune system of the embryo and fetal human T - and b-lymphocytes and the beginning of the endocrine function of the thymus. // Immunology. - 2002. No. 2. - P80-82.

7. Khlystova SS the formation of the immunogenesis of the human fetus, - M.: Medicine, 1987. - 256 S.

8. Effec of antenatal steroid therapy on mortality and morbidity in very low birth weight infants / L. Doyel, Kitchen W., Ford, G. et all // J. Pediatr. - 1996. - Vol.108. No. 2. - P.287-292.

9. Perinatal mortality review; focus on prevention. / Menard M., Bowes W., Hart, J. et all // Amer. J.Obstet. and Gynecol. - 1991. - Vol.164. No. 1. - P.381.

A method of evaluating the viability of newborns with extremely low birth weight by morphological studies of the thymus gland, characterized in that in 10 fields of view in the medulla of thymus lobules of the gland is counted content of the Taurus Kassala and reticuloendothelial cells, when the number reticuloendothelial cells more than 10 and the Taurus Kassala more than 2 newborn is evaluated as viable when the number reticuloendothelial cells less than 9 and Taurus, Kassala less than 2 - as impractical.



 

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