Method for prediction of thymomegalia in three-month-old mature newborns sufferedprenatal influenza b complicated by placentitis

FIELD: medicine.

SUBSTANCE: after thymomegalia has been excluded, tissue specimens of three-day-old mature newborns are studied to evaluate areas of inflammation changes in points in the placental umbilical cord (A), in the foetal placenta (B), in the maternal placenta (C), in extraplacental membranes (D); then thymomegalia is predicted by a discriminant equation: DE=-0.350×A-1.176×B-1.690×C-1.203×D, wherein DE is a discriminator function with a threshold equal to - 15.00. If DE is equal to or more than the threshold, the absence of thymomegalia is predicted; if D is less than the threshold, thymomegalia is predicted, whereas the score is taken at: (A) - 1 point - no inflammation, 2 points - amnionitis, 3 points - leukocytic infiltration in the Wharton's jelly, 4 points - phlebitis, 5 points - arteriitis, 6 points - a combination of two or more areas of inflammation: in blood vessels or in vessels and in the Wharton's jelly, (B) - 1 point - no inflammation, 2 points - chorioamnionitis, 3 points - villusitis, 4 points - vasculitis, 5 points - intervillesitis, 6 points - a combination of two or more areas of inflammation, (C) - 1 point - no inflammation, 2 points - villusitis, 3 points - vasculitis, 4 points - intervillesitis, 5 points - deciduitis, 6 points - a combination of two or more areas of inflammation, (D) - 1 point - no inflammation, 2 points - amnionitis, 3 points - chorioamnionitis, 4 points - deciduitis, 5 points - choriodeciduitis, 6 points - a combination of two or more areas of inflammation.

EFFECT: enabling the prediction of thymomegalia in the three-month-old mature newborns suffered prenatal influenza B complicated by placentitis.

2 ex

 

The invention relates to medicine, namely to Perinatology and Pediatrics.

It is known that in women with acute respiratory viral infections in pregnancy complicated by placental insufficiency [2, 3, 4], it is noted in utero stimulation of the immune system, leading to the development of thymomegalia their offspring [5]. However, the size and weight of the thymus, antenatal contact with respiratory viruses, does not always change in children at birth and can grow only during the first months of life in the process of their adaptation to various antigens [6] and prolonged stimulation of the adrenal cortex [1]. It is established that the increase in the number of foci of inflammation in the placenta increases the risk of infectious diseases in neonates [7], and in the placenta (deciduate) increases the risk of hyperplasia of the thymus gland in fetuses [8].

The known method of qualitative morphological assessment of inflammation in the placenta [8] does not allow to predict the timomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta.

The objective of the proposed method is the ability to predict thymomegalia within three months of age in full-term neonates with intrauterine influenza, complicated by placenta.

The objective of dostigao�Xia, the prediction of thymomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta, is carried out by determining the number of foci of inflammatory changes in the umbilical cord (in points) (A), the number of foci of inflammatory changes in the fetal part of the placenta (in points) (B), the number of foci of inflammatory changes in the maternal part of the placenta (in points) (C), the number of foci of inflammatory changes in unpleasantry shells (in points) (E), and then carry out a forecast of thymomegalia using discriminant equation:

D=-0,350×A-1,176×In-1,690×C-1,203×D, where

D - discriminant function with boundary value is 15.00.

When D is equal to or greater than the boundary values, predict the absence of thymomegalia, when D is less than the boundary values predict timomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta.

The method is as follows.

1. In full-term neonates with intrauterine influenza diagnosed by serologic analysis of response inhibition of haemagglutination) serum in pairs "mother-child", as well as by immunofluorescence studies of brushstrokes-prints of the nasal mucosa or secretions of the genome of the pathogen with the help of� polymerase chain reaction [5], performed ultrasound of the thymus at 3 days of life to avoid thymomegalia.

2. In full-term neonates with intrauterine influenza, histological preparations of placental side of the umbilical cord hematoxylin-the Böhmer - eosin, determine the number of foci of inflammatory changes in points (1 point - no inflammation; 2 points - amnionic; 3 points - leukocytic infiltration in Vartanova jelly; 4 points - phlebitis; 5 points - arteritis; 6 points - combination of 2 or more foci of inflammation in blood vessels or in the vessels and in Vartanova jelly) (A).

3. On histological preparations of the Central portion of fruit part of the placenta hematoxylin-the Böhmer-eosin, count the number of inflammatory foci in points (1 point - no inflammation; 2 points - chorioamnionitis; 3 points - villosa; 4 points - vasculitis; 5 points - intervilles; 6 points - combination of 2 or more foci of inflammation) (B).

4. On histological preparations of the Central portion of the maternal part of the placenta hematoxylin-the Böhmer-eosin, set the number of inflammatory foci in points (1 point - no inflammation; 2 points - villosa; 3 points - vasculitis; 4 points - intervilles; 5 points - decidua; 6 points - combination of 2 or more foci of inflammation) (C).

5. On histological preparations unpleasantry� membranes (the fracture), hematoxylin-the Böhmer-eosin, count the number of inflammatory foci in points (1 point - no inflammation; 2 points - amnionic, 3 points - chorioamnionitis; 4 points - decidua; 5 points - choriodecidua; 6 points - combination of 2 or more foci of inflammation in unpleasantry shells) (E).

6. Using discriminant equations that determine the magnitude of discriminant functions:

D=-0,350×A-1,176×In-1,690×C-1,203×D, where

D - discriminant function with boundary value is 15.00.

7. Compare the value of the discriminant function from its boundary value is 15.00.

8. Predict the development of thymomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta: when D is equal to or greater than the boundary values, predict the absence of thymomegalia, when D is less than the boundary values predict timomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta. The probability of a correct prediction was 89.1%.

To illustrate the effectiveness of the proposed method of predicting thymomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta, the following clinical examples.

Example 1

Newborn C. mother's first pregnancy, p�regular was observed in the antenatal clinic with 7 weeks. At 16 weeks of gestation showed signs of flu confirmed in the study of paired sera by reaction of hemagglutination-inhibition (antibody titer of 1:4-1:16). Flu proceeded with the clinic rhinopharyngitis, fever up to 38°, headache, cough, runny nose and weakness. At 28 weeks, was diagnosed placental insufficiency, about which the mother was treated in the obstetric hospital. Blood group A (II), RH - positive. First birth at term. Amniotic fluid light.

Clinical diagnosis of the mother: a Birth in the first term, quick. Complicated current of pregnancy (flu). Chronic placental insufficiency. Amniotomy.

The boy was born with the weight of 3350 g, length 53 cm, head circumference - 35 cm chest - 34 see blood Group b (III) RH - positive. In the blood from the vein of the umbilical cord of the child's total hemoglobin - 215 g/l, leucocytes - 28×109/l, eosinophils - 1%, stab neutrophils - 6%, segment reflexology point pressure-nuclear neutrophils - 70%, lymphocytes - 20%, and monocytes - 3%. The concentration of antibodies to influenza virus B in serum pairs "mother - newborn" - 1:32-1:128.

A newborn's condition at birth was close to satisfactory. Was observed cyanosis of nasolabial triangle, decreased activity, muscle tone and tendon reflexes. Physiological reflexes were expressed as odd�O. Heart tones are clear, rhythmic to 144 beats per 1 minute. Respiratory rate - 46 in 1 minute. The breath in the lungs puerile. The external genitals are developed correctly by male type. Peeing in the delivery room. When the pathological examination of the placenta in the umbilical cord was noted foci of leukocytic infiltration of the amnion (2 points), in the fetal part of the placenta showed morphological signs of chorioamnionitis (2 points), in the maternal part of the placenta - vasculitis (3 points), in unpleasantry shells - amnionitis (2 points). With ultrasound the baby was not observed increase of the thymus at 3 days after birth compared with its size and weight in healthy full-term newborns [5].

Clinical diagnosis of the newborn: Intrauterine infection (flu - influenza titers of antibodies in the system "mother - newborn" 1:16-1:64).

The above indicators were then entered into a discriminant equation:

D=-0,350×2-1,176×2-1,690×3-1,203×2=-10,53, where D is the discriminant function with boundary value is 15.00.

Predicted lack of development of thymomegalia 3 months of life in term newborns with intrauterine influenza and In the placenta.

When holding the child sonographic studies have not been diagnosed timomegalia within three months of age.

Prima� 2

Newborn P. was Born from the first pregnancy. At 20 weeks the mother suffered from influenza In (antibody titer of 1:16-1:64) with a temperature rise up to 37,5°, with a headache, cough, runny nose and weakness. At 29 weeks was diagnosed placental insufficiency, for which she was treated in the hospital. Blood group B (III), RH - positive. In female consultations were observed regularly from 7 weeks of pregnancy. Birth vaginally. Amniotic fluid light. Clinical diagnosis of the mother: a Birth in the first period. Premature discharge of amniotic fluid. Chronic placental insufficiency.

The boy was born weighing 3460 g, length 53 cm, head circumference - 34 cm and chest - 33 cm blood type A (II), RH - positive. In the venous blood from the umbilical cord of the child at birth, total hemoglobin was 210 g/l, white blood cell count of 14.2×109/l, eosinophils - 2%, stab neutrophils - 4%, segmented neutrophils 72%, lymphocytes - 20%, and monocytes - 2%. The concentration of antibodies to influenza virus In the sera of pairs "mother - newborn" was 1:16-1:64.

A newborn's condition is satisfactory. The skin of the face, extremities and trunk was clean. Was observed cyanosis of nasolabial triangle, as well as reduced muscle tone and tendon reflexes. Determined all physiological reflexes. Tones with�rdca - clear, rhythmical to 142 beats per 1 minute. Respiratory rate 48 in 1 minute. The breath in the lungs puerile. External genitalia were well developed correctly by male type.

When pathological examination of the placenta in the umbilical cord of the child was determined leukocytes in Vartanova jelly (3 points), in the fetal part of the placenta was diagnosed with intervilles (5 points) in the maternal part of the placenta - villosa (2 points), in unpleasantry shells - a combination of deciduata and chorioamnionitis (6 points). Sonographically not detected an increase organometric indicators of the thymus at 3 days after birth compared with its parameters in healthy term newborns.

Clinical diagnosis of the newborn: Intrauterine infection (influenza b, influenza titers of antibodies in the system "mother - newborn" 1:64-1:256).

The above symptoms were entered into the discriminant equation:

D=-0,350×3-1,176×5-1,690×2-1,203×6=-17,53, where D is the discriminant function with boundary value is 15.00.

Dynamic observation of the child in a children's polyclinic at 3 months had been diagnosed with timomegalia.

The method was tested in the survey 44 full-term newborns with antenatal influenza and placenta.

A correct prediction was confirmed at 89.1% of cases.

The technical result of the use of�izlagaemogo method of prediction is a method for predicting thymomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta, will allow for timely therapeutic measures aimed at desensitization, detoxification and improving children's immune resistance of the organism to respiratory viral infections in early neonatal age. Thus, the role of timely identify pathological foci of inflammation in born the placenta and their numerical score, allowing the use of discriminant analysis to establish the probability of development in the three month old thymomegalia that in pediatric practice is usually associated with adrenal insufficiency [1], with impaired pituitary-adrenal relationships and dysfunction of T-cell immunity [5] and with decreased resistance to viral infections [6].

Sources of information

1. Grigorenko A. A. Morphological and histochemical changes of the endocrine glands in sepsis in children: author. dis. Cand. honey. of Sciences, Novosibirsk, 1981. - 19 p.

2. Gorik I. N., Voskoboynikov, O. R., Mirlas M. F., Yarovoy A. A., the uterine-placental, placental and fetal blood flow in the third trimester of pregnancy complicated with acute respiratory viral infections, pyelonephritis and OPG-gestoso� // far East medical. log. - 1997. - No. 2. - P. 51-52.

3. Gorik I. N. The pathogenesis of the changes of blood flow in uterine arteries and ultrasound picture of the chorion in influenza A(H3N2) in women in the first trimester of pregnancy // bull. physiology. and patola. breathing. - 2012. - Vol.44. - P. 79-84.

4. Gorik I. N. The change in uterine blood flow and ultrasonic patterns of fetoplacental complex in influenza A(H3N2) in women in the second trimester of pregnancy // bull. physiology. and patola. breathing. - 2012. - Vol.45. - P. 74-78.

5. T. V. Zabolotskikh, Grigorenko A. A., Gorik I. N. The change in ultrasonic and morphological structure of the thymus in newborns with fetal parainfluenza types 1 & 3 // bull. physiology. and patola. breathing. - 2013. - Vol.50. - Pp. 94-98.

6. Netreba N. And. Features of immune responses in young children and the role of maternal immunity in protection against acute respiratory viral infections // Antenatal care in pregnancy and prevention of perinatal pathology / Theses of reports, the Ministry of health of the Ukrainian SSR, Kiev scientific research Institute of Pediatrics, obstetrics and gynecology named after Hero of the Soviet Union, Professor P. M. buyko. Kiev, 1979. Pp. 190-191.

7. A method of predicting risk of development of intrauterine infection in newborns: us Pat. 2168946 of the Russian Federation, IPC A61M 1/00 / M. P. Openheim, V. A. Medik, V. N. Soloviev, P. E. Murmulev, A. R. Nosov; applicant and patentee: closed joint stock company SOMA. - No. 2000112897/14; s�. 24.05.2000; publ. 20.06.2001.

8. Zinserling A.V., Glukhovets N. G. The broadening of the pathoanatomical studies of fetuses and placentas for late spontaneous abortions // Ross. Bulletin of the women. and Pediatrics. - 1994. - Vol. 39, No. 2. - P. 8-10.

A method of predicting thymomegalia within three months of age in full-term neonates with intrauterine influenza complicated by placenta, which consists in the fact that in full-term infants after exclusion of thymomegalia 3 days of life is determined on histological preparations the number of foci of inflammatory changes in scores in the placental side of the umbilical cord (A), in the fetal part of the placenta (B), in the maternal part of the placenta (C), in unpleasantry membranes (E), and then carry out a forecast of thymomegalia using discriminant of the equation:
D=-0,350×A-1,176×In-1,690×C-1,203×D,
where D is the discriminant function with boundary value is 15.00, moreover, if D is equal to or greater than the boundary values, predict the absence of thymomegalia, when D is less than the boundary values predict timomegalia, and the number of points is the rate of: (A) - 1 point - no inflammation, 2 points - amnionic, 3 points - leukocytic infiltration in Vartanova jelly, 4 points - phlebitis, 5 points - arteritis, 6 points is a combination of two or more foci of inflammation in blood vessels or in the vessels and in Vartanova �tune, (In) - 1 point - no inflammation, 2 points - chorioamnionitis, 3 points - villosa, 4 points - vasculitis, 5 points - intervilles, 6 points is a combination of two or more foci of inflammation, (C) - 1 point - no inflammation, 2 points - villosa, 3 points - vasculitis, 4 points - intervilles, 5 points - decidua, 6 points is a combination of two or more foci of inflammation, (E) - 1 point - no inflammation, 2 points - amnionic, 3 points - chorioamnionitis, 4 points - decidua, 5 points of choriodecidua, 6 points is a combination of two or more foci of inflammation.



 

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