This article explores systemic inflammatory response syndrome (SIRS), thromboinflammation, and septic shock in fetuses and neonates, offering a comprehensive examination of their pathophysiology, diagnostic criteria, and clinical implications. It identifies SIRS as an exaggerated response to external stress, disrupting the balance between inflammation and adaptive mechanisms, driven by cytokines such as TNF-α and IL-1. The fetal inflammatory response syndrome (FIRS), a subset of SIRS, is noted for its role in adverse neonatal outcomes, including organ damage, inflammation, and long-term developmental disorders. The article discusses the extensive effects of FIRS on critical systems, including the blood, lungs, central nervous system, and kidneys. It highlights the challenges in diagnosing and managing septic shock in neonates, focusing on the relationship between inflammation and the hemostatic system. Additionally, the paper points out recent advancements, such as the convergent model of coagulation and emerging biomarkers like microRNAs for early detection. Despite this progress, gaps remain in understanding the molecular mechanisms underlying these conditions and in developing effective therapeutic strategies. This highlights the necessity for targeted research to mitigate the morbidity and mortality associated with septic shock in neonates.

The article presents the main directions of development of modern neonatology and pediatrics of early age. Along with the unconditional achievements in the field of nursing newborns, important issues are raised for further improving the organization and ensuring adequate and effective follow-up of children after discharge from the hospital, which is primarily aimed at improving outcomes. Early respiratory therapy, open resuscitation and priority of breastfeeding, treatment and prevention of bronchopulmonary dysplasia, prevention of respiratory syncytial viral infection, as well as the organization of postneonatal habilitation of premature babies, audits to improve the quality of medical care for newborns and children are the main ones, but far from all directions that are indicated by the team of authors in this publication. At the same time, attention is focused on the most pressing issues of drug and technical support, personnel shortage, safety and effectiveness of the use of modern technologies in neonatal practice, which we all have to solve in the future. The purpose of the publication is to draw attention to the pressing problems of everyone on whom the development strategies of domestic neonatology and pediatrics depend. The authors invite everyone to express their opinions and suggestions by sending their letters collectively or individually to the editorial office.

Multiple organ dysfunction syndrome (MODS), or multiple organ system failure (MOSF), or multiple organ failure (MOF) in children in the early neonatal period is usually developing against the background of severe birth asphyxia and/or hypoxemia due to various causes (e.g., against the background of critical congenital heart disease) or an infectious process, being one of the main and most frequent reasons for the poor outcome. The level of Interleukin-6 (IL-6) is considered the earliest biomarker for the presence of an infectious process in newborns. The relationship between the level of IL-6 in the blood of premature newborns and the severity of MOF has not been studied enough as yet. The purpose of this research was to study the relationship between the level of IL-6 in the blood and the severity of MOF in premature newborns with a birth weight (BW) of less than 1500 grams in the early neonatal period. Materials and methods used: a single-center retrospective cohort study was conducted in May 26 - September 26, 2022 on the basis of L.A. Vorokhobov Moscow City Clinical Hospital No. 67 of the Moscow Department of Healthcare (located in Moscow, Russia). All of the patients had been followed-up since birth until the discharge from the hospital. Authors have included premature infants with birth weight of less than 1500 grams, gestational age (GA) of less than 32 weeks, with MOF, who were determined by the level of IL-6 in blood serum by high-precision immunochemiluminescent analysis in the first 24 hours and 72 hours of life. Children with severe congenital developmental anomalies, chromosomal and/or genetic syndromes were excluded. Results: a total of 86 preterm infants were included. The patients were divided into 2 groups: G1 of 49 with IL-6<30 pg/ml, and G2 of 37 with IL-6≥30 pg/ml. The groups were identical in terms of gender, BW, GA, height, and the APGAR score. In G2 the premature rupture of amniotic fluid was more common - 6 (12.0%) vs. 15 (41.0%), p=0.005; there were fewer children on non-invasive mechanical ventilation - 15 (31.0%) vs. 3 (8.0%), p=0.015; NEOMOD MOF severity score was higher - 2.0 [1.0; 3.0], (n=47) vs. 3.0 [2.0; 6.0], (n=37), p=0.001; modified inotropic index by the 3rd day of life significantly prevailed - 3.0 [2.0; 5.0], (n=13) vs. 25.5 [19.0; 77.5], (n=12); p=0.001. The average level of IL-6 in G2 was significantly higher on the first day of life and amounted to 121.0 [71.6; 188.0] pg/ml vs. 13.95 [8.79; 17.52] pg/ml in G1; p<0.001. Conclusion: the level of IL-6 of more than 30 pg/ml in the blood of premature newborns with BW of less than 1500 grams in the first 24 hours of life can be considered as an indicator for the MOF severity.

Antiphospholipid syndrome in neonates and children is a rare, but in some cases life-threatening condition with arterial and/or venous thrombosis and/or non-thrombotic neurological, skin, ophthalmological and other manifestations. This review highlights the available information about the features of pediatric APS, including the rare catastrophic form, the differences between pediatric and adult APS, and the role of genetic thrombophilia in APS manifestation. The clinical manifestations and treatment options for APS in children may differ from those in adults, and prescribing therapy can be challenging due to the unique clinical and morphological characteristics of the pediatric patient. Pediatric APS may be a predictor of the development of certain autoimmune diseases and classic manifestations of APS in adulthood, therefore, a revision of the existing criteria for the diagnosis and treatment of APS in children is necessary.

Introduction. Early-onset neonatal sepsis (EONS) remains the leading cause of serious mobility and mortality worldwide. At the present time, the impact of the COVID-19 pandemic on the incidence of other infections is of particular interest. Aim: to conduct a comparative analysis of the features of the course of EONS in newborns before the COVID-19 pandemic (2018) and during the COVID-19 pandemic (2021). Materials and Мethods. A retrospective cohort single-center continuous study included 73 newborns born and hospitalized in the Regional Kaluga Perinatal Center (PC) based on Kaluga Regional Clinical Hospital. The data for the period of stay in the PC from January to October 2018 and the same period in 2021 were analyzed and compared. Newborns were divided into two groups: group 1 (n = 26) – in 2018, and group 2 (n = 47) – in 2021. The following parameters of EONS severity were selected: the need for the use of norepinephrine, surfactant and fresh-frozen plasma (FFP). Results. The incidence of EONS in 2021 (n = 47) was significantly higher than in 2018 (n = 26): odds ratio (OR) = 3.27; 95 % confidence interval (CI) = 1.57–6.40; p = 0,001. Gestational age and Apgar score at the 1st and 5th minutes were significantly higher in group 1 than in group 2: 36.2 [33.3; 38.0] weeks vs. 33.3 [28.5; 36.1] weeks (p = 0.016); 7.0 [5.0; 7.0] vs. 5.0 [3.0; 7.0] (p = 0.019) and 9.0 [6.8; 8.0] vs. 6.0 [5.0; 8.0] (p = 0.012), respectively. Newborns with EONS in 2021 compared with 2018 showed a significant increase in norepinephrine administration of (42/47 vs. 16/26 newborns, respectively; OR = 5.25; 95 % CI = 1.58–17.44; p = 0.007), FFP transfusions (47/47 vs. 19/26 newborns, respectively; OR = 36.54; 95 % CI = 2.05–649.84; p < 0.001) and surfactant therapy (32/47 vs. 7/26 newborns, respectively; OR = 5.79; 95 % CI = 2.04–16.45; p = 0.001). Mortality among patients with EONS in 2021 compared to 2018 was significantly higher: 13/47 (21.3 %) vs. 2/26 (7.7 %) newborns, respectively (OR = 9.56; 95 % CI = 1.22–74.96; p = 0.014). Conclusion. Among the newborns of the Kaluga region there is a significant rise in the incidence and mortality of EONS on the background of the COVID-19 pandemic. In 2021 there is a significant increase in the need for surfactant administration, use of vasopressors, and transfusion of FFP in infants with EONS.

OBJECTIVE To analyze the relationship between high and low NEOMOD scores, medical records, clinical characteristics and outcomes in preterm infants with gestational age <32 weeks and birth weight <1500 grams in early neonatal period. MATERIAL AND METHODS A retrospective observational cohort single-center study included 78 premature newborns between 2022 and 2023. All ones were divided into two groups: group 1 — low NEOMOD scores (2—4, n=58); group 2 — high NEOMOD scores (≥5, n=20). Inclusion criteria: birth in one perinatal center and immediate admission to ICU, birth weight <1500 grams, gestational age <32 weeks, multiple organ failure within 6 hours of life with NEOMOD score ≥2, dynamic assessment of scores until relief of multiple organ failure or death. RESULTS Higher NEOMOD scores were significantly more common in patients with low birth weight (980.0 vs 810.0, p=0.019), lower gestational age (28.0 weeks vs 25.0 weeks, p=0.008) and lower Apgar score at the 1st/5th minutes, respectively (5/6 vs 2.5/5.0, p=0.005/p=0.025). A full course of prenatal steroids avoids severe manifestations of multiple organ failure (46.6% vs 0.0%, p<0.001), and premature rupture of membranes increases the risk of multiple organ failure (17.2% vs 45.0%, p=0.018). CONCLUSION The modified NEOMOD score of multiple organ failure in infants with birth weight <1500 grams in early neonatal period increases with lower birth weight, height and gestational age, as well as in premature rupture of membranes. A full course of prenatal steroids has a protective effect against multiple organ failure. Polyuria in premature infants should be regarded as one of the manifestations of multiple organ failure.