Sarapuk I. Neonatal integrated neuro-developmental care for preterm infants: prerequisites, components, their pathogenetic mechanisms, early and long-term outcomes

Українська версія

Thesis for the degree of Doctor of Science (DSc)

State registration number

0523U100134

Thesis Registration Form

0523U100134.pdf

Applicant for

Specialization

  • 14.01.10 - Педіатрія

06-09-2023

Specialized Academic Board

Д 58.601.02

Ternopil National Medical University named after I. Gorbachevsky of the Ministry of Health of Ukraine

Essay

The dissertation is devoted to the issue of optimizing the provision of medical care to preterm infants by creating an integrated neuro-developmental care model to improve early (stabilization of vital functions, prevention of the infectious and somatic pathology associated with premature birth) and long-term outcomes (survival, morbidity, disability, physical, motor, communication and cognitive development, duration of breast-feeding) of these newborns. The new pathogenetic-based mechanisms of modern approaches to the preterm infants care using the neonatal integrated model of neuro-developmental care with the skin-to-skin contact as its main component was obtaintd. This model of care has been proven to improve the early and long-term outcomes of preterm infants. For the first time, a comparative analysis of the characteristics of preterm newborns’ care in a regional perinatal center and European neonatology clinics (Poland, France) was carried out, the advantages and effectiveness of complex neuro-developmental care and its elements for these category of infants were shown. The effectiveness of early, regular and prolonged SSC in reducing the risk of late-onset sepsis, BPD, digestive system disorders, and supporting breastfeeding in extremely and very preterm infants has been proven. The clinical and paraclinical determinants of pain and stress in preterm infants, their relationship with gestational age and child’s health status severity were studied. It was shown that this cohort of newborns experienced stress and was exposed to the pain syndrome in the intensive care unit, which was confirmed by high EDIN scale scores and hormonal imbalance. The influence of the fundamental component of the neuro-developmental care – skin-to-skin contact – on the stress and pain indicators in preterm infants has been confirmed. This intervention has been found to reliably reduce stress by decreasing the cortisol levels while simultaneously increasing oxytocin and melatonin levels, as well as reducing neonatal pain by decreasing dopamine levels and increasing β-endorphin and serotonin levels. For the first time in Ukraine, the peculiarities of parental stress of preterm children treated in the intensive care unit were investigated; the factors contributing to its increase were identified. The effectiveness of parental stress management with the skin-to-skin contact has been proven.

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Research papers

1. Casper C, Sarapuk I, Pavlyshyn H. Regular and prolonged skin-to-skin contact improves short-term outcomes for very preterm infants: A dose-dependent intervention. Arch Pediatr. 2018;25(8):469-475. doi: 10.1016/j.arcped.2018.09.008. (SCOPUS, Q3)

2. Павлишин ГА, Кліщ ОВ, Сарапук ІМ. Оцінка оксидативного стресу в передчасно народжених дітей у ранньому неонатальному періоді. Проблеми клінічної педіатрії. 2019;4(46):6-13. doi: 10.24144/1998-6475.2019.46.6-13.

3. Павлишин ГА, Кліщ ОВ, Сарапук ІМ, Козак КВ. Ранні неонатальні наслідки у передчасно народжених немовлят менше 32 тижнів гестації. Проблеми клінічної педіатрії. 2020;1-2(47-48):13-25. doi: 10.24144/1998-6475.2020.47-48.13-25.

4. Сарапук ІМ, Павлишин ГА, Боршевска-Корнацка М-К, Кліщ ОВ. Проблеми виходжування передчасно народжених немовлят та можливості їх вирішення Актуальні питання педіатрії, акушерства та гінекології. 2020;1:23-30. doi: 10.11603/24116-4944.2020.1.11479.

5. Павлишин ГА, Кліщ ОВ, Сарапук ІМ. Клітинний енергодефіцит у передчасно народжених в ранньому неонатальному періоді. Неонатологія, хірургія та перинатальна медицина. 2020;1(35):22-27. doi: 10.24061/2413-4260.X.1.35.2020.3

6. Klishch ОV, Pavlyshyn HА, Коzak КV, Sarapuk ІМ. Predictors of adverse outcomes in preterm infants in the early neonatal period. Journal of Education, Health and Sport. 2020;10(10):364-373. doi.org/10.12775/JEHS.2020.10.10.035

7. Pavlyshyn H, Sarapuk I, Kozak K, Klishch O. Diagnostic value of markers of oxidative stress and metabolic disorders in preterm infants in the early neonatal period. Paediatr Croat. Paediatr Croat. 2021;65:7-12. doi: 10.13112/PC.2021.2. (SCOPUS, Q4)

8. Pavlyshyn H, Sarapuk I, Casper C, Makieieva N. Kangaroo mother care can improve the short-term outcomes of very preterm infants. J Neonatal Perinatal Med. 2021;14(1):21-28. doi: 10.3233/NPM-200455. (SCOPUS, Q3)

9. Pavlyshyn H, Bokiniec R, Borszewska-Kornacka MK, Sarapuk I, Horishna I. Neonatal outcomes of preterm infants depending on the care approaches. Archives of the Balkan Medical Union. 2021;56(1):43-50. doi: 10.31688/ABMU.2021.56.1.05. (SCOPUS, Q4)

10. Pavlyshyn H, Sarapuk I, Horishna I, Slyva V, Skubenko N. Skin-to-skin contact to support preterm infants and reduce NICU-related stress. Int J Dev Neurosci. 2022 Nov;82(7):639-645. doi: 10.1002/jdn.10216. Epub 2022 Jul 22. (SCOPUS, Q3)

Sarapuk I, Pavlyshyn H. Assessment and Correction of Stress in Preterm Infants and Their Mothers. Turk Arch Pediatr (Turk Pediatri Arsivi). 2022 Mar;57(2):146-150. doi: 10.5152/TurkArchPediatr.2022.21158. (SCOPUS, Q3)

12. Павлишин ГА, Сарапук ІМ, Сатурська УВ, Скубенко НВ, Зайцева ТЮ. Оцінка материнського стресу у відділенні інтенсивної терапії новонароджених. Неонатологія, хірургія та перинатальна медицина. 2022;12(1):14-20. doi: https://doi.org/10.24061/2413-4260.XII.1.43.2022.3 (SCOPUS, Q4)

13. Pavlyshyn H, Sarapuk I, Saturska U. Maternal Stress Experience in the Neonatal Intensive Care Unit after Preterm Delivery. Am J Perinatol. 2022 Aug 27. doi: 10.1055/s-0042-1747942. Online ahead of print. (SCOPUS, Q1)

Pavlyshyn H, Sarapuk I, Kozak K. Peculiarities of melatonin levels in preterm infants. Wien Klin Wochenschr. 2022 Nov 24. doi: 10.1007/s00508-022-02109-9. Online ahead of print. (SCOPUS, Q3)

15. Павлишин ГА, Сарапук ІМ. Розвитковий статус передчасно народжених немовлят залежно від типу догляду. Актуальні питання педіатрії, акушерства та гінекології. 2022;2:5-11. doi: 10.11603/24116-4944.2022.2.13427

Павлишин ГА, Сарапук ІМ, Сатурська УВ. Материнський стрес у ВІТН під час пандемії COVID-19. Неонатологія, хірургія та перинатальна медицина. 2022;3(45):42-47. doi: 10.24061/2413-4260.XIІ.3.45.2022.6 (SCOPUS Q4)

17. van Veenendaal NR, Labrie NHM, Mader S, van Kempen AAMV, van der Schoor SRD, van Gou-doever JB….Sarapuk I. CROWN Study Group. An international study on implementation andfacilitators and barriers for parent-infant closeness in neona-tal units. Pediatr Investig. 2022;00:1-10. doi: 10.1002/ped4.12339. (SCOPUS, Q3)

18. Pavlyshyn H, Sarapuk I, Tscherning C, Slyva V. Developmental care advantages in preterm infants management. Journal of Neonatal Nursing. 2023;29(1):117-122. doi: 10.1016/j.jnn.2022.03.008. (SCOPUS, Q3)

19. Pavlyshyn H, Sarapuk I, Kozak K. The relationship of melatonin concentration in preterm infants and adverse outcomes in the late neonatal period. Biochem Med (Zagreb). 2023;33(1):010706. doi: 10.11613/BM.2023.010706 (SCOPUS, Q3)

20. Pavlyshyn H, Sarapuk I. Skin-to-skin contact – an effective intervention on pain and stress reduction in preterm infants. Front Pediatr. 2023;11:1148946. doi: 10.3389/fped.2023.1148946. (SCOPUS, Q1)

21. Pavlyshyn H.A., Sarapuk I.M., Kozak K.V., Zaitseva T.Yu.. Peculiarities of chronic pain and pain-related stress markers in preterm infants. Neonatology, surgery and perinatal medicine. 2023; 1(47):4-11. doi: 10.24061/2413-4260.Xiіi.1.47.2023.1 (SCOPUS, Q4)

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