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The aim of the study was to compare the efficacy of anesthesia in infants with NEC presacral during anesthesia with different preparations.
We were treated 19 infants with NEC from 1B to 3A stages, during the double-blind controlled prospective randomized study and the period from 2012 to 2014. Boys were 12, girls – 7. Body weigh was 1996+0.2 gramms. The group 1 of 10 infants was assigned the complex treatment technique, developed by us, presacral anesthesia 0.5% sol. ropivacaine of 0.1ml/kg. The group 2 was 9 infants, was assigned with the traditional methods of complex intensive care the blockade of procaine solution 0.25% the rate of 0.5ml per administration. Determined by the concentration of substance P, cardiac output and peripheral vascular resistance at diagnosis, after 2,4,8 and 16 hours after initiation of treatment. Assessed the extent and severity of pain on a scale CHEOPS. The control group consisted of 20 healthy newborns without evidence of NEC.
After 16 hours from the start of treatment, despite the additional analgesic therapy was undertaken in a group 2, level of pain on a scale CHEOPS was significantly higher than in the same period of observation in the group 1. It was 9.5±0.2 and 6.0±0.5 points, respectively, with p=0.001. The concentration of substance P in serum of blood of newborns with NEC corresponded to the severity of pain and was significantly higher in the group 2 compared to the group 1 to 16 hour of therapy.
Presacral analgesia with ropivacaine is more efficiently and reduces the number of surgical interventions in newborns with NEC probably by reducing circulatory disorders of internal organs and systems.
1. Aarnoudse-Moens C. S., Weisglas-Kuperus N., van Goudoever J. B., Oosterlaan J. Meta-analysis of neurobehavioral outcomes in very preterm and / or very low birth weight children. Pediatrics 2009;124:717-728. doi:10.1542/peds.2008-2816
2. Anand K. J. Pain panacea for opiophobia in infants? JAMA 2013;309:183-184. doi:10.1001/jama.2012.208359
3. Brummelte S., Chau C. M. Y., Cepeda I. L., Degenhardt A., Weinberg J., Synnes A. R., Grunau R. E. Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress. Psychoneuroendocrinology 2015;51:151-163. doi:10.1016/j.psyneuen.2014.09.018
4. De Graaf J., van Lingen R. A., Valkenburg A. J., Weisglas-Kuperus N., Groot Jebbink L., Wijnberg-Williams B. et al. Does neonatal morphine use affect neuropsychological outcomes at 8 to 9 years of age? Pain 2013;154:449-458. doi:10.1016/j.jpeds.2013.02.039
5. McElroy S. J., Underwood M. A., Sherman M. P. Paneth Cells and Necrotizing Enterocolitis: A Novel Hypothesis for Disease Pathogenesis. Neonatology 2013;103:10-20. doi:10.1159/000342340
6. Minaev S. V., Isaeva A. V., Tovkan E. A., Gudiev Ch. G., Timofeev S. I., Kachanov A. V., Romaneeva N. M. The prognostic value of bactericidal / permeabilityincreasing protein in infants with congenital pathology of the gastro-intestinal tract. Medicinskii Vestnik Severnogo Kavkaza. – Medical News of North Caucasus. 2014;9 (2):116-119. doi:10.14300/mnnc.2014.090327. Neu J., Walker W. A. Necrotizing Enterocolitis. New England Journal of Medicine 2011;364 (3):255-264.doi:10.1056/NEJMra1005408
8. Reynolds R. M. Glucocorticoid excess and the developmental origins of disease: two decades of testing the hypothesis in 2012 Curt Richter Award Winner. Psychoneuroendocrinology 2013;38:1-11.
9. Sato Y., Fukasawa T., Hayakawa M., Yatsuya H., Hatakeyama M., Ogawa A., Kuno K. A new method of blood sampling reduces pain for newborn infants: A prospective, randomized controlled clinical trial. Early Human Development 2007;83(6):389-394. doi:10.1016/j.earlhumdev.2006.08.004
10. Tanner S. M., Berryhill T. F., Ellenburg J. L., Jilling T., Cleveland D. S., Lorenz R. G., Martin C. A. Pathogenesis of Necrotizing Enterocolitis. The American Journal of Pathology 2014;185(1):4-16. doi:10.1016/j.ajpath.2014.08.028
11. Van den Anker J. N. Treating pain in newborn infants: navigating between Scylla and Charybdis. J Pediatr 2013;163(3):618-619. doi:10.1016/j. jpeds.2013.04.004
12. Zouikr I., Tadros M. A., Barouei J., Beagley K. W., Clifton V. L., Callister, R. J., Hodgson D. M. Altered nociceptive, endocrine, and dorsal horn neuron responses in rats following a neonatal immune challenge. Psychoneuroendocrinology 2013;41:1-12. doi:10.1016/j.psyneuen.2013.11.016
Keywords: necrotizing enterocolitis, treatment, anesthesia, pain, scale CHEOPS, newborns