In the dissertation an actual task of periatrics has been solved –improvement of medical supervision for children of first year of life born pretermally with perinatal pathology by development of algorithm for catamnestic follow-up basing on evaluation of predictors of perinatal pathology formation and estimation of their prognostic value. The randomized controlled research included three stages of children born with perinatal pathology evaluation: 1) retrospective estimation of macro-epidemiological parameters (morbidity, mortality) in the city of Kharkiv in 2008-2013 aiming on reveal of practically significant aspects of health state (n=86026); 2) retrospective analysis of neonates health state in Kharkiv City Perinatal Center in 2008–2013 with goal of stratification principle working-out (n=1908); 3) prospective catamnestic follow-up of children with estimation of prognostic information capacity of predictors for the condition of children aged under 1 year, born pretermally with pathology of central nervous system, broncho-pulmonary dysplasy, disturbances of vision and hearing in Kharkiv City Perinatal Center (n=108).
Predictors were determined and the pathogenetic estimation of their prognostic value for the development of the central nervous system, bronchopulmonary dysplasy, vision and hearing impairment was made: gestational age, birth weight, maternal age, Apgar score for 10 min, obstetric-gynecologic anamnesis, duration of stay in the neonatal intensive care unit, the timing of respiratory support, the presence of intraventricular bleeding, hypoglycemia, etc. The definition of the diagnostic coefficient and the informative significance of the factors determining the course of perinatal affection of central nervous system, bronchopulmonary dysplasia, disturbances of vision and audition in children were performed, the algorithm of catamnestic follow-up of children from the neonatal period to 1-year-old was created. In preterm neonates born in maternity hospitals of Kharkiv in 2008–2013 the structure of morbidity (general value – 194,5 ‰) and mortality (general value — 1,6 ‰) are characterized by development of congenital anomalies (26,5 ‰), antenatal hypoxia and asphyxia in delivery (30,7 ‰), respiratory pathology (18,7 ‰), intracerebral bleeding not caused by birth trauma (2,2 ‰), this forces to focus on appropriate nosologic forms with evaluation of their prognostic potential. In Main factors determining the perinatal affection of central nervous system, bronchopulmonary dysplasy, disturbances of audition and vision in preterm neonates and up to 40 weeks of age are body weight at birth (influence power 38 %, р<0,001), hestation duration (37 %, р<0,001), mother’s age >30 years (30 %, р<0,001), obstetric-gynecological anamnesis (29 %, р<0,001), duration of a nonates intensive care unit stay (9 %, р<0,01), duration of respiratory support (8 %, р<0,01), Apgar score at 10th minute (8 %, р<0,05), intraventricular hemorrhages (3 %, р<0,05), hypoglycemia (2 %, р<0,05) etc. Predictors of health state of pretermally born children with perinatal pathology are: mother’s age, obstetric-gynecological anamnesis (р<0,001); gectation term, body weight of children at birth, duration of child stay in reanimation or a Department of neonatal pathology, terms of respiratory support (р<0,01); Apgar score, character of intraventricular hemorrhages, intrauterine development delay, hypoglycemia (р<0,05), the rest has a character of tendency (р<0,10). The algorithm of catamnestic follow-up of children with perinatal affection of central nervous system, bronchopulmonary dysplasia, disturbances of vision and audition in children borm pretermally is characterized by sensitivity at level of 87 %, specificity of 51 %, positive prognostic value of 68 %, negative prognostic value of 84 %, this allowes to recommend it for practical application.
