TREATMENT OF A NEWBORN WITH CHYLOTHORAX, CHYLOPERICARDIUM AND CHYLOPERITONEUM

Аннотация

One of the most severe diseases in newborns, necrotic enterocolitis, is analyzed from a modern standpoint. The causes and risk factors for the development of the disease are considered. The features of the pathogenesis and microbiological status of newborns are shown. The clinical picture of necrotic enterocolitis is covered in detail, the clinical stages of the disease, on which its classification is based, are analyzed. Kеywоrds: necrotic enterocolitis, intestinal necrosis, intestinal diseases in newborns. INTRОDUСTIОN Necrotizing enterocolitis (NEC) is one of the most severe diseases in newborns, in which the target organ is the intestine. The first report on this disease was published in 1964, and the first work reflecting the experience of surgical treatment of enterocolitis appeared in print in 1967. MАTЕRIАLS АND MЕTHОDS According to foreign authors, NEC occurs with a frequency of 2.4 per 1000 newborns, which is 2.1% of all children admitted to neonatal intensive care units; according to domestic authors, it occurs with a frequency of 4%. From a clinical point of view, NEC is characterized by a wide range of disease course options: from mild cases to severe forms complicated by intestinal necrosis, perforation, peritonitis, and sepsis [1]. RЕSULTS АND DISСUSSIОN As a rule, the disease develops in the first two weeks of life, but in 16% of patients it occurs immediately after birth. In practice, pediatric surgeons often encounter enterocolitis already at the peritonitis stage, when the prognosis for the life of patients worsens and the mortality rate reaches 70%, and with extensive intestinal necrosis - 100%. Until recently, it was believed that NEC is the fate of "surviving premature babies", but today this process is often diagnosed in full-term children. Risk factors that can predispose to the development of this disease include hypoxia, asphyxia, apnea, lung pathology, 142 THEORETICAL ASPECTS IN THE FORMATION OF PEDAGOGICAL SCIENCES International scientific-online conference hypovolemic shock, complicated labor, anhydrous period lasting more than 6 hours, congenital heart defects, intrauterine infection, prematurity, perinatal CNS damage, "aggressive" enteral nutrition, and features of the intestinal blood supply in newborns. Despite the polyetiological nature of the development of NEC, the main cause of the disease is intrauterine chronic fetal hypoxia. Other associated risk factors have a synergistic effect in the pathogenesis of the disease [2]. Pathogenesis. The initial stage in the development of NEC is damage to the mucous layer of the intestinal wall, which can be complicated by ulceration, perforation, peritonitis. The pathological process is localized in the small and / or large intestine in the form of "scattered" foci of necrosis. Taking into account the leading factor of pathogenesis, three variants of the course of NEC are distinguished: hemodynamic, mixed, infectious and inflammatory. The hemodynamic variant of the course is characterized by the presence of intestinal ischemia as a consequence of perinatal damage to the central nervous system, centralization of blood circulation. Inflammation indicators are slightly elevated in the blood test. In the morphological picture, circulatory disorders are noted in the form of plethora of the vessels of the submucosal layer, stasis of erythrocytes, extensive foci of hemorrhage, ischemic necrosis of the mucous membrane. Microbiology. The leading place in the microbiological status of newborns is occupied by s. epidermidis, P. aeruginosa, E. coli, E. faecalis, representatives of the genus Enterobacter. In most cases, s. epidermidis are cultured from the umbilical wound, and the growth of the latter is also noted in cultures from the intubation tube and oral cavity. Representatives of the genus Enterobacter give abundant growth in cultures from the abdominal cavity, which is taken into account when sanitizing the surgical area. In cases of no growth of microorganisms from peritoneal effusion in purulent peritonitis, the presence of anaerobes (C. perfringens, C. difficile) can be assumed. Thus, with C. perfringens, the disease occurs in a fulminant form with pronounced pneumatosis of the intestinal wall, perforation and often ends in death [3]. Differential diagnostics. NEC should be differentiated from birth spinal injury, cerebrovisceral syndrome, in which: 1) intestinal paresis, regurgitation and vomiting develop earlier - on the 1st-3rd day of life, in NEC the clinical picture unfolds on the 2nd week of life; 2) neurological symptoms prevail in the status; 3) radiography shows only isolated paretic levels and distention of intestinal loops; 4) neurological treatment significantly improves the condition. 143 THEORETICAL ASPECTS IN THE FORMATION OF PEDAGOGICAL SCIENCES International scientific-online conference Treatment. The choice of treatment tactics for NEC depends on the severity of the child's condition and the stage of the process. Cons