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For the basis of studying of efficiency detoxication methods at HDN clinical and
laboratory indicators were used. Clinical indicators included an assessment of
dynamics of neurologic symptoms for the 1st, 3rd, 5th days of children life with HDN.
Control pulse frequency, arterial pressure, electrocardiogram, respiration, Sat0 2 and
body temperatures of the newborn by means of the Siemens cardiomonitor.
Laboratory diagnostics included:
definition of IB [9] as basic HDN marker;
free hemoglobin (FH) [10] as indicator of stability of cellular membranes of
erythrocytes, FH defined before operations PA and BET.
To all newborn children CBV was calculated. CPV was carried out on a formula:
CPV = CBV CBV Hematocrit/100 [7, 8].
The comparative analysis of need of the transfer of children of the 1 st, 2nd and 3rd
groups to the newborns pathology department and average day numbers of newborns
in chamber of intensive therapy is carried out.
For calculation of value of average data and their mistakes were used methods of
descriptive statistics. For a correctness of application of these or those methods of the
statistical analysis previously for all selections of quantitative and quality indicators
tests for a distribution normality were carried out. In case of confirmation of a
normality
Distributions of selection for check reliability of a zero hypothesis parametrical
methods (Student's t-criterion), otherwise nonparametric methods were used (MannWhitney's criterion, Kolmogorova-Smirnov). Usually distributed data are submitted
as "medianquantile.
Deviations", unusually distributed data "medianquartile (a probable
deviation)" and categorical data raw data and as frequencies.
Reliability level for all analyses it was established as p<0.05. (KolmogorovaSmirnov).
Initial IB
175.95.1
290,112,9
173,533,5
1st day
2nd day
3rd day
4th day
315.935.
350.113.4*
164,512,5*
1
290,112, 224,410,1*, ** 125,116,9*,*
9
*
5th day
85,510,5*
56,54,5*
66,215,3*,*
*
42,35,2*,*
*
309,533,
390,310,2
305,415,6
195,315,7
116,55,5
5
Note. * p <0,05 in comparison with 3 gr., ** p <0,05 in comparison with 1 gr..
At the same time, at children of the 2nd group, where to their mothers in
treatment a Rhesus factor sensitization at pregnancy the course of membrane PA was
applied, were more stable indicators of IB by the end of 2 days and it is reliable below
(p<0,05), than at children of the 1 st and 3rd groups. This group of children also had the
minimum hourly gain of IB and BET wasn't required to them.
The analysis of the conducted research showed essential decrease in IB (p <0,05)
in the 1st group and, especially, in the 2nd group of children to which mothers courses
PA, in comparison with control 3rd group were conducted that is presented in tab. 2.
Tabl. 2.
The FH dynamics before and after operations PA and BET
Groups
1
3
1st operation
Before
After
2.30.2
1.30.1*
2.50.2
3.50.3
2nd operation
Before
After
1.10.1
0.50.3*
2.20.3
3.60.3
Newborn children of the 1st and 2nd groups didn't need transfer to department of
pathology of newborns.
(+). This pregnancy proceeded with an isosensitization on a Rh-factor with the advent
of antibodies titre by 20th week of pregnancy in November, 2009 to 1:124, haemolytic
IgG1 and IgG3 were noted. In November-December, 2009 in the pathology of
pregnancy department the pregnant woman spent 5 sessions of a membrane plasma
exchange with an interval at first 2 times in week, then once a week with decrease in
antibodies titres till 1:8 (in December the titre already was 1:4). For a session of a
membrane plasma exchange 600800 ml of an autoplasma was removed.
In January and February, 2010 at the pregnant woman increase of antibodies
titres 1:124 with identification of IGg1and IgG3 was noted again. Sessions of a
membrane plasma exchange in January and February with dynamics of decrease in a
antibodies titres to 1:8 were carried out. Dynamic research ultrasonography of fetus
pathology wasn't revealed.
Childbirth took place without complications the boy with the body weight of
3100 g, an assessment across Apgar 1min 7 points, 5 min. 8 points. Laboratory:
IB from an umbilical blood it is no more than 24 mol/l also to the end of the first
days of 120 mol/l. For the 5th day the child was discharged from maternity hospital
home together with mother in a satisfactory condition (!!!) with indirect bilirubin of
64 mol/l. Signs of essential HDFN at a fetus during pregnancy and at the newborn
in this case it wasnt noted. After the birth it wasn't required to the newborn child of
neither BET, nor a membrane plasma exchange in view of preventive carrying out a
plasma exchange during pregnancy.
Conclusion
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