Decrease of Prenatally Significant Infection
Decrease of Children's Morbidity and Mortality Rate from Perinatally Significant Infections
Tech Area / Field
- MED-DID/Diagnostics & Devices/Medicine
3 Approved without Funding
State Institution, Republican Scientific-Clinical Centre of Pediatrics and Children's Surgery, Tajikistan, Dushanbe
Project summaryPerinatal fetus infection at the present is one of the most important problems of obstetrics and perinatology. Its frequency ranges from 6 to 53 %, reaching 70 % among premature infants. In the structure of perinatal mortality relative density of a prenatal infection rates from 2 to 65,6 %. Such contradictory indicators could be explained by difficulties in diagnostics of the given pathology which is often disappears behind such diagnoses, as intrauterine hypoxia, intrauterine asphyxia, and patrimonial trauma.
The increase of a role of perinatal infection in the structure of the reasons of perinatal morbidity and mortality rates has been registered for the last years. The structure of infectious morbidity of pregnant women, fetus and the newborn has changed; the role of pathogenic agents of sexually transmitted diseases has sharply increased. The problem of diagnostics of the given pathology still remains extremely important and difficult. Despite a considerable number of scientific researches devoted to a problem of perinatal fetus infection, the ways of fetus infection are not sufficiently studied, clinical picture of infection of mother and child, ultrasonic criteria of infectious placenta affection, methods and criteria of antinatal diagnostics of the given pathology, terms and instructions for conducting specific therapy, terms and ways of labor are not developed.
According to a number of researches, infectious diseases are revealed in 50 - 60 % of full term hospitalised and in 70 % of prematurely born children. On results of autopsy of newborns in 67,5 % of died children the infectious pathology was principle cause of death which accompanied or complicated a clinical course of the basic disease.
In Tajikistan the birth rate indicator in 1998 made 31,3, that has decreased up to 28 ‰ during the last ten years has decreased to 28 ‰. If for the beginning of 21st century the country population made 6188,3 million, in 2007 it has increased up to 7139,8 million. Meanwhile the share of children in age structure of the population in 2007 has increased in comparison with 2000 for 18 %.
According to an official statistics, infant death rate indicators in 1998 made 23,4 for 1000 of live births, in 2007 14,2, that exceeds indicators of the most developed countries for 4-5 times. In the structure of the reasons of infantile and children's death rate the leading place is occupied by an infectious pathology. Relative density of lethal outcomes from infectious diseases in postneonatal period has made 58,8 %.
The researches conducted in countries of CAR and K have revealed, that 62,1 % of all deaths were in early neonatal period at the age of 0- 1 year. The analysis of deaths in newborns in early neonatal period has shown, that the congenital pneumonia (43,7 %), intrauterine infection (65,9 %) were principal causes of lethal outcomes. From general number of deaths at the age 0- 5 years of age in late neonatal period have died 8,1 % of children.
Practically identical results has been revealed in Republic of Tajikistan. The greatest share of death cases in newborns during the first 168 hours of life was registered in 1998 in the city of Dushanbe (9.8 ‰), in 2007 - 12,4 ‰ and a slightly lower in Sogd area (5,8 and 9,3 ‰) accordingly where intrauterine infection was found to found to be principal cause of death. Hence, the results received testify that from year to year the sharpness of a problem of an infectious pathology of fetus, the newborn and the first year child remains rather actual not only for Tajikistan, but for other countries of Central Asian region as well.
Even with an established fact of death causes of the first year children where over 2/3 comes to the share of prenatal infections, for today in Tajikistan there is no special сountry strategy on prevention, diagnostics and treatment of perinatally significant infections. It is country approach that can influence substantially to decrease morbidity and mortality indicators of children in perinatal period from infections specific to the given ontogenesis period.
There is no total screening for perinatally significant infections in any country of the world. As a result the cases when healthy children were born from an infected mothers are not being registered. The distortion of infection indicators, morbidity, risk of vertical transfer of agents is promoted also by lack of microbiological monitoring of all fetuses at interrupted pregnancy, obligatory microbiological study of tissues of stillborn children, placentae in all cases of the premature, complicated labors, as well as labors resulted in birth of the diseased, weak or hypotrophic child.
At fetus infection shortly before the childbirth manifistations of a pre-natal infection depend on disease stage. If for the delivery moment the disease is in its initial phase, the infection manifests during the first 3 days after birth. If childbirth comes to a final stage of illness, the syndrome of disadaptation in early neonatal period is more often observed and further synchronisation and persisting latent infection can be demonstrated.
There are five basic ways of caustive agent penetration:
- ascending (through birth canal),
- descending (from inflammatory- changed adnixae of a uterus, appendix)
Among the diseases of the pregnant woman resulting in fetus and newborn infection, the greatest attention deserve urogenital infections (colpitis, cervicitis, chronic salpingo-oophoritis, cystitis, asymptomatic bacteriouria, chronic and gestational pyelonephritis) and chronic nonspecific lung diseases. Presence of chronic infection focuses in woman organism and its aggravation during pregnancy could be referred to a risk factor.
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