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Objective. To study the possibility of using N-terminal pro-BNP fragment as a screening criterion of hemodynamic significant of the functioning arterial duct in extremely premature newborns. Hemodynamically significant functioning arterial duct (HSFAD) is a reason of the development of various complications in extremely premature newborns. The basic method for HSFAD diagnosis is Echo CG. The limited technical abilities of ultrasound devices can prevent from an early diagnosis and timely treatment of this state. The search of additional markers of hemodynamic significance the functioning arterial duct (FAD) is actual. Materials and methods. A continuous prospective observational study included patients aged 1 to 3 days with FAD, gestation period of 2532 weeks and birth weight from 500 to 1500 g. Hemodynamic significance of FAD was determined according to generally accepted Eco CG criteria. The level of NT-pro-BNP was identified with IFA on the third day of life. Mathematical modelling was used to calculate a threshold value of NT-pro-BNP, corresponding to 6500 pg/ml, at which the probability of hemodynamic significance of the functioning arterial duct exceeds 80 %. Results. The assessment of NT-pro BNP concentration on the third day of life permitted to establish the following reliable differences: in the main group, the median concentration for NT-pro BNP was 15000 [IQR 2 587; 26 500] pg/ml, in the comparison group 1920 [IQR 1379; 3467] pg/ml, р = 0.001. Mean force direct correlation, r = 0.52, between Echo CG results and NT-pro-BNP values was stated. Conclusions. The obtained results make it possible to use NT-pro-BNP as a screening criterion of FAD hemodynamic significance in extremely premature newborns.

Hemodynamically significant patent ductus arteriosus (hsPDA) in premature newborns is associated with a risk of PDA-related morbidities. Classification into risk groups may have a clinical utility in cases of suspected hsPDA to decrease the need for echocardiograms and unnecessary treatment. This prospective observational study included 99 premature newborns with extremely low body weight, who had an echocardiogram performed within the first three days of life. Discriminant analysis was utilized to find the best combination of prognostic factors for evaluation of hsPDA. We used binary logistic regression analysis to predict the relationship between parameters and hsPDA. The cohort’s mean and standard deviation gestational age was 27.6 ± 2.55 weeks, the mean birth weight was 1015 ± 274 g. Forty-six (46.4%) infants had a PDA with a mean diameter of 2.78 mm. Median NT-pro-BNP levels were 17,600 pg/mL for infants with a PDA and 2773 pg/mL in the non-hsPDA group. The combination of prognostic factors of hsPDA in newborns of extremely low body weight on the third day of life was determined: NT-pro-BNP, Apgar score, Silverman–Anderson score (Se = 82%, Sp = 88%). A cut-off value of NT-pro-BNP of more than 8500 pg/mL can predict hsPDA (Se = 84%, Sp = 86%).

Objective of the Review: To analyse the available information on the potential impact from respiratory support on bronchopulmonary dysplasia (BPD) development in extremely premature children with functional ductus arteriosus. Key Points. In recent decade, the problem of premature children has become very acute as a result of introduction of the new live birth criteria. The most common complication of a premature birth is BPD because of the morphofunctional immaturity of an extremely premature child. BPD is diagnosed in approximately 20% of newborns with the gestational age (GA) of less than 30 weeks and body weight of less than 1,500g; and in over 40% of newborns with GA of less than 28 weeks. Children with extremely low body weight (500–999g) and low body weight (1,000–1,499g) at birth have BPD in 35–80%, and 7–30% of cases, respectively. One problem aggravating the condition of premature children is a haemodynamically functional patent ductus arteriosus (PDA), the prevalence of which is in inverse relation to GA. Conclusion. The studies demonstrate the correlation between PDA and BPD development. The impact of artificial pulmonary ventilation on the haemodynamical significance of PDA and BPD development needs further evaluation. Keywords: premature children, bronchopulmonary dysplasia, respiratory support, patent ductus arteriosus.

Objective. To study the facilities of mathematical modelling of the system aorta-shunt-pulmonary artery for assessing the efficiency of shunt functioning. Materials and methods. The risk factors for the development of complications in 35 newborns and infants of the first year of life were analyzed while carrying out the procedure of the modified Blalock-Taussig shunt (MBTShunt). The study lasted from 2016 to 2021. The age median at the time of operation was 10 (Q1Q3: 3,530) days (from 1 to 180), the body mass median 3,0 (Q1Q3: 2,83,54) kg. The shunt size median was 3,5 mm (Q1Q3: 3,53,5), and the median of shunt size per 1 kg of body mass 1,11 (Q1Q3: 1,01,21) mm/kg. The shunt size was increased for 4 out of 35 (11.4%) patients. As a result of cooperation with Perm Polytechnic University, in the frameworks of the program of hydrodynamic modelling evaluation, the data from 4 patients were processed mathematically to assess blood flowing through the MBTShunt. Results. Three (9 %) out of thirty five patients died in 3 (Q1Q3: 2,511,0) (minmax 219) days because of cardiorespiratory decompensation. The only prognostically unfavorable risk factor for death was a large value of shunt size to body mass ratio (p=0.023). It was stated according to mathematical modelling data that the blood flow through the pulmonary arteries in all the analyzed types of shunts was not symmetric. An increase in the diameter of a shunt permits to improve a symmetry of blood flow through the left and right branches of the pulmonary artery. Conclusions. The procedure of MBTShunt remains the procedure of high risk that is associated with a significant sickness rate and death rate in the early postoperative period. Mathematical modelling of the system aorta-shunt-pulmonary artery prior to the operation makes it possible to choose an optimal diameter of shunt and place of its implantation and will become one of the stages to personified surgery of congenital heart diseases in the future.