Bondarenko T. Pediatric consequences of neonatal hypoxic ischemic encephalopathy and possible ways of their medical and social correction

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

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  • 228 - Педіатрія


Specialized Academic Board

ДФ 05.600.061

Vinnytsia National Pirogov Memorial Medical University


According to the results of examination of 214 children the influence of gender on the course of neonatal hypoxic ischemic encephalopathy was first established: newborn males with HIE were found to have apnea, convulsions and pronounced proteinuria significantly more frequently than the females (p < 0.1). Some additional data concerning risk factors for the development of hypoxic ischemic encephalopathy in full-term newborns were presented, such as the influence of mother's health, complications of pregnancy and childbirth. Besides, new data were obtained suggesting the negative role of blood group A(II) and rhesus-negative factor, as well as the protective effect of blood group O(I). The negative role of insufficient obstetric activity, in particular low frequency of planned and emergency cesarean section, vacuum extraction, was confirmed. The relationship between the level of pro-inflammatory cytokines in the first 3 days of life of full-term neonates with HIE and adverse consequences of brain damage at the age of 12 months was first established. IL-6 was 3 times higher than in children with HIE with no adverse long-term consequences. The level of TNF was 30% higher in this group. The results obtained correlate with Apgar score at birth, duration of mechanical ventilation and oxygen therapy. Blood serum IL-6 content in early neonatal period proved to be sensitive (73.3%) and specific (72.2%) marker in predicting adverse long-term consequences of HIE. The development of disability due to HIE was first shown to be influenced by gender and age characteristics. Thus, among disabled children, boys predominated (69.57%). The number of children with established disability increased with age from 9.52% at 12 months to 15.65% at 3 years and remained unchanged at 6 years of age. It was first found that among pathological conditions of children with the consequences of HIE, anemia predominated at the age of 3, being found in every fourth girl and every fifth boy with a history of severe HIE, ophthalmologic diseases - in 23.5% of boys in this group, and bronchial asthma - in 9.52% of children. It was first established that mortality rate in children who experienced neonatal HIE was 2.72% in the first 6 years of life. New data have been obtained regarding the management of consequences of neonatal HIE: early rehabilitation in neonatal period and wide use of outpatient rehabilitation as well as inpatient rehabilitation in neurological departments and children's rehabilitation centers, seem to be reasonable measures.


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