Obolonskij О. The reduction in the severity of bronchopulmonary dysplasia in premature neonates by optimizing pharmacological closure of the ductus arteriosus and methods of respiratory support

Thesis deals with the peculiarities of the development and course of the various forms of bronchopulmonary dysplasia in premature infants with respiratory distress syndrome and patent ductus arteriosus, intensive care and respiratory therapy. The necessity of antenatal and intrapartum factors analysis in preterm infants due to risk of BPD formation was established. Timely analysis of BPD predictors allows you to make more precise prognosis of BPD development and start preventive therapy as early as possible. The effect of different timing of the closure of the ductus arteriosus in the development and severity of BPD was studied. It was proven that the pharmacological closure of PDA in the early stages (up to 3 days), significantly decreases the risk of BPD formation. The late closing of PDA, especially in cases of surgical clipping, increases the risk of severe and moderate-severe BPD. For the first time we have used the rectal forms of ibuprofen for pharmacological PDA closure. Its safety and efficiency have been proven. The effect of different amounts of infusion therapy for PDA closing and BPD formation was defined. Taking into account the correlations it was shown that the using of volume intake restriction increases the effectiveness of COX to PDA closure in the early stages and prevents the development of BPD or improves its course. We studied influence of respiratory support and parameters of ventilation for the BPD development and course and proved safety and effectiveness of new methods of non-invasive mechanical ventilation such as SNIPPV and NIPPV, instead of the standard CPAP therapy. Clinical protocol of medical care in preterm infants with respiratory distress syndrome and patent ductus arteriosus was improved.