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52 ПРАКТИЧЕСКАЯ МЕДИЦИНА Том 18, № 3. 2020
The Influence of Hemogram Indices’ Correction
on Physical Development Parameters in Follow-Up
History Among Children With Very Low Body Weight
and Extremely Low Body Weight at Birth
Contact:
Korotaeva N.V. — PhD (medicine), Assistant Lecturer of the Department of Hospital and Polyclinic Pediatrics, neonatologist of Highest
qualification
Address: 10 Studencheskaya Str., 394036, Voronezh, Russian Federation, tel. (473) 237-27-46, e-mail: korotaeva.nv@mail.ru
Objective. To evaluate the effect of hemoglobin level correction on the dynamics of physical development in five-year follow-up
among children with very low (VLBW) and extremely low body weight (ELBW) at birth.
Material and methods. A prospective study included 312 premature infants with very low and extremely low body weight at birth,
which were divided into two groups. The first group included newborns with birth body weight of less than 1000 grams, and newborns
with birth body weight from 1000 to 1500 grams made up the second group. The level of hemoglobin and indicators of physical
development were checked in all children participating in the study in the following periods: on the 1st day of life and aged 1-14
weeks of life. In the follow-up history, in the periods: 3, 6, 9, and 12 months, and from 2 to 5 years of life, except for the estimation
of hemoglobin level and dynamics of physical development, the registration of a concomitant diseases spectrum was carried out. All
children participating in the study received iron supplements to prevent premature and late anemia of premature infants in accordance
with the requirements of the Federal Clinical Recommendations.
Results. Analysis of physical development indicators at the time of birth among children of the first group showed that 82% of
newborns were born small by gestational age (SGA). In the second group, the proportion of small children to gestational age was 90%.
When analyzing the risk factors for early anemia of prematurity (EAP) development, it was revealed that mother’s anemia, threat of
pregnancy termination and infection due pregnancy are the factors coming from mother’s side, and from the child’s side – infections
and decrease in T3, T4 levels. A study of the hemoglobin level showed that a decrease in its level was observed as early as 4 weeks
after birth in each group, regardless of the preventive measures for early anemia in premature infants. However, the frequency of blood
transfusions was lower among children who underwent EAP prophylaxis in accordance with clinical recommendations, than among
children who were not prescribed preventive doses of iron medication. When assessing the dynamics of physical development in both
groups, catch-up growth was recorded, which made it possible to compare the parameters of physical development of 70% of children
to the parameters of their peers.
Conclusion. In the course of study it was found that the introduction and adherence to protocols for the prevention of early anemia
in premature infants (EAP) can reduce the frequency of transfusions of donor blood components in prematurely born children. The
prophylactic admission of iron medication helps to ensure the rate of catch-up growth in the five-year history of premature children with
VLBW and ELBW at birth.
Key words: newborns, low body weight, premature anemia, physical development, correction.
(For citation: Korotaeva N.V., Ippolitova L.I., Nastausheva T.L., Kogutnitskaya M.I., Pershina E.S., Zhilkina A.I. Influence of
hemoglobin level correction on physical development in follow-up history of children born with very low and extremely low body
weight. Practical Medicine. 2020. Vol. 18, № 3, P. 51-55)
Анемия является распространенным заболеванием,
которым, по оценке Всемирной организации
здравоохранения, страдают 24,5% населения всего
земного шара, что составляет около 1,6 миллиарда
людей, к которым относятся и новорожденные
дети [1]. Наиболее встречающимся вариантом анемии,
с которым сталкиваются реаниматологи и неонатологи
отделений интенсивной терапии и выхаживания,
является ранняя анемия недоношенных
(РАН), частота которой составляет от 17 до 91% у
детей с гестационным возрастом менее 30 недель и
массой тела менее 1500 грамм в 4-6 недель фактического
возраста(ФВ) [2]. После выписки из стационаров
(в 3-4 месяца ФВ) дети, рожденные раньше
срока, становятся угрожаемыми уже по развитию
поздней анемии недоношенных, в основе которой
лежит дефицит железа. Данный элемент оказывает
очень важное влияние на неврологическое развитие
ребенка, т. к. является важным фактором
в миелинизации нейронов, метаболизме, нейротрансмиссии
и нейрогенезе, что влияет на поведение,
память, обучение и сенсорные системы ребенка
[3, 5]. Введение новых подходов к проведению
профилактических мероприятий по РАН еще на
этапе стационаров позволило существенно снизить
частоту гемотрансфузий в отделениях интенсивной
терапии и выхаживании новорожденных, но до конца
остается не ясна тенденция уровня гемоглобина
у недоношенных детей не только во время нахождения
в специализированных стационарах, но и в
катамнестическом наблюдении.
Цель исследования ― оценить влияние коррекции
уровня гемоглобина на динамику физического
развития при пятилетнем катамнестическом
наблюдении у детей с очень низкой массой тела
(ОНМТ) и экстремально низкой массой тела (ЭНМТ)
при рождении.
Материал и методы. Проведен анализ результатов
наблюдения 312 недоношенных детей, находящихся
на стационарном лечении с 2015 по