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Here, we review the latest available studies on using surfactant lavage in newborns with severe manifestations of meconium aspiration syndrome (MAS), illustrated by a representative clinical case. Meconium-stained amniotic fluid may be found in 8-20 % of all births, with the incidence reaching 23-52 % after a full 42 weeks of gestation. From 2 to 9 % of newborns with meconium-stained amniotic fluid subsequently develop MAS clinical signs. About a third of newborns with MAS require tracheal intubation and mechanical ventilation. MAS-related mortality rate due to severe injuries of the lung parenchyma and the development of pulmonary hypertension, can exceed 20 %. Other complications, including air leak syndrome (ALS), occur in 10-30 % of children with MAS. Surfactant lavage may be one of the clinical tools that avoids extracorporeal membrane oxygenation (ECMO) in severe MAS cases. This clinical observation is also of interest because a mature, even post-term newborn with MAS subsequently developed a typical bronchopulmonary dysplasia (BPD), which required proper treatment.

Compared to children of other ages, neonates especially seriously ill and premature subjects comprise a high thrombotic risk group. A decline in the incidence of neonatal thrombosis may be accounted for by improved treatment of severe conditions in newborns and increased survival of premature infants. Neonatal and adult hemostasis exhibit distinct physiological features: difference in concentration, synthesis rate of blood coagulation factors, metabolic rate, thrombin and plasmin levels. At the same time, neonatal threshold values for natural blood coagulation inhibitors (protein C, protein S, antithrombin, heparin cofactor II) and vitamin K-dependent coagulation factors (FII, FVII, FIX, FX) are quite low, whereas that of FVIII and von Willebrand factor exceeds those found in adults. Thus, newborns have lower plasma fibrinolytic activity. The main risk factors for developing thrombotic complications are as follows: central venous catheters, altered body fluid volume, liver disease, as well as sepsis and inflammatory processes particularly COVID-19. The significance of congenital and acquired maternal and neonatal thrombophilia may pose an additional risk factor for thrombotic complications. Low-molecular weight heparins are the first-choice drugs in treatment and prevention of neonatal thrombosis.

Introduction. We proposed a hypothesis that prognosis in preterm infants may be affected by concentration of the administered surfactant preparation able to determine its viscosity and, therefore, even distribution throughout the lungs.Aim: to assess an effect of poractant alfa (PA) administered at low (40 mg/mL) vs. standard (80 mg/mL) concentration without changing recommended dosage (200 mg/kg) on outcomes of preterm infants at gestational age (GA) under 32 weeks receiving various respiratory support.Materials and Methods. A prospective randomized controlled multicenter study was conducted. A total of 325 infants under 32 weeks of GA in five perinatal centers were randomized. The inclusion criteria were met by 264 patients: required respiratory therapy, had indications for surfactant administration at birth/within the first 30 minutes of life, and informed parental consent. Patients were excluded if they had no indications for surfactant preparations at the age of the first 30 minutes of life, had chromosomal and genetic abnormalities, congenital malformations, early neonatal sepsis, or gross deviations from the study protocol. Two groups were formed and compared: Low concentration (LC) group – PA concentration was 40 mg/mL (n = 111) and Standard concentration (SC) group (control) – PA concentration was 80 mg/mL (n = 153). Additionally, we compared two subgroups with surfactant preparation administered by minimally invasive methods in spontaneously breathing infants (using LISA – a less invasive method of introducing surfactant through a thin catheter or endotracheal tube): subgroup LC – PA concentration was 40 mg/mL (n = 27) and subgroup SC (control) – PA concentration was 80 mg/mL (n = 34).Results. It was found that development of pulmonary hemorrhages in LC and SC groups was significantly less common in infants who received PA at concentration of 40 mg/mL vs. 80 mg/mL: 3.6 (4/111) % vs. 13.1 (20/153) % (p = 0.008). While comparing subgroups with minimally invasive PA administration (LISA or endotracheal tube), we found that treatment with 40 mg/mL significantly decreased total respiratory therapy duration– 142 [70.0; 219.0] hours vs. 250 [141.0; 690.0] hours (p = 0.008), incidents of bronchopulmonary dysplasia – 4.0 (1/27) % vs. 29.0 (10/34) % (p = 0.009), length of stay in neonatal intensive care unit and hospital – 8.0 [7.5; 13.0] days vs. 14.0 [8.0; 33.75] days (p = 0.014) and 38.0 [26.5; 48.5] days vs. 50.5 [36.25; 62.5] days (p = 0.014), respectively.Conclusion. PA administered at concentration of 40 mg/mL without changing the recommended dose did not aggravate nursing of preterm infants at GA under 32 weeks. Minimally invasive PA administration at concentration of 40 mg/mL, lowered risk of bronchopulmonary dysplasia, and when used in infants on mechanical lung ventilation, it lowered a risk of pulmonary hemorrhage. All the discussed findings require to be further assessed in large prospective, multicenter, randomized studies in large patient cohort.

Introduction. Early-onset neonatal sepsis (EONS) remains the leading cause of serious mobility and mortality worldwide. At the present time, the impact of the COVID-19 pandemic on the incidence of other infections is of particular interest. Aim: to conduct a comparative analysis of the features of the course of EONS in newborns before the COVID-19 pandemic (2018) and during the COVID-19 pandemic (2021). Materials and Мethods. A retrospective cohort single-center continuous study included 73 newborns born and hospitalized in the Regional Kaluga Perinatal Center (PC) based on Kaluga Regional Clinical Hospital. The data for the period of stay in the PC from January to October 2018 and the same period in 2021 were analyzed and compared. Newborns were divided into two groups: group 1 (n = 26) – in 2018, and group 2 (n = 47) – in 2021. The following parameters of EONS severity were selected: the need for the use of norepinephrine, surfactant and fresh-frozen plasma (FFP). Results. The incidence of EONS in 2021 (n = 47) was significantly higher than in 2018 (n = 26): odds ratio (OR) = 3.27; 95 % confidence interval (CI) = 1.57–6.40; p = 0,001. Gestational age and Apgar score at the 1st and 5th minutes were significantly higher in group 1 than in group 2: 36.2 [33.3; 38.0] weeks vs. 33.3 [28.5; 36.1] weeks (p = 0.016); 7.0 [5.0; 7.0] vs. 5.0 [3.0; 7.0] (p = 0.019) and 9.0 [6.8; 8.0] vs. 6.0 [5.0; 8.0] (p = 0.012), respectively. Newborns with EONS in 2021 compared with 2018 showed a significant increase in norepinephrine administration of (42/47 vs. 16/26 newborns, respectively; OR = 5.25; 95 % CI = 1.58–17.44; p = 0.007), FFP transfusions (47/47 vs. 19/26 newborns, respectively; OR = 36.54; 95 % CI = 2.05–649.84; p < 0.001) and surfactant therapy (32/47 vs. 7/26 newborns, respectively; OR = 5.79; 95 % CI = 2.04–16.45; p = 0.001). Mortality among patients with EONS in 2021 compared to 2018 was significantly higher: 13/47 (21.3 %) vs. 2/26 (7.7 %) newborns, respectively (OR = 9.56; 95 % CI = 1.22–74.96; p = 0.014). Conclusion. Among the newborns of the Kaluga region there is a significant rise in the incidence and mortality of EONS on the background of the COVID-19 pandemic. In 2021 there is a significant increase in the need for surfactant administration, use of vasopressors, and transfusion of FFP in infants with EONS.

Neonatal sepsis still remains a serious problem of modern health care, being one of the main causes of neonatal and infant mortality, as well as disability in surviving children. Due to the high risk of adverse outcomes, the problem of early neonatal sepsis (ENS), especially in preterm infants, attracts special attention. At the same time, if in the previous decades the main causative agents of ENS were Escherichia coli and Streptococcus group B, then in recent years it has been noted that while maintaining the leading value in the etiological structure of Escherichia coli, the frequency of detection of Haemophilus influenzae began to increase. The article contains a review of modern publications on the role of Haemophilus influenzae in the formation of perinatal losses, as well as the significance of this pathogen in the development of neonatal sepsis. The article also presents a clinical case report of ENS caused by Haemophilus influenzae. Particular attention is paid to the issues of timely diagnosis of ENS, which is possible only with a comprehensive analysis of the results of clinical and laboratory-instrumental examination.

Early-onset neonatal sepsis (EОNS) is one of the most severe diseases of the neonatal period and is often coupled to extremely unfavorable outcomes. In many ways, the severity of the condition and the results of newborn nursing depend on the etiology of the bacterial process. The major EОNS pathogens are traditionally considered to be Streptococcus group B and E. coli, much less common are other Gram-negative bacteria including casuistic cases caused by caused by Proteus mirabilis (P. mirabilis). The article provides a review on the P. mirabilis role in developing neonatal sepsis with pathogen-specific disease course and outcomes. In addition, we describe a clinical case of P. mirabilis-caused EОNS not only primarily characterized by the rarity of its causative agent, but also that it proceeded with a more favorable brain damage in contrast to similar cases described worldwide and because the neonatal EОNS developed in one of triplets, with two other babies being asymptomatic despite that P. mirabilis was also detected.