X-ray study in infants of the first year of life who had congenital heart diseases: traditions, specific features, new capacities

The paper analyzes the experience with ultrafast computed tomography (CT) used for 4 years to examine 178 babies with complicated congenital heart diseases (CHD), admitted to A.N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, for surgical treatment. It shows the comparative capacities of X-ray study, CT, and catheterized angiography in the diagnosis of CHD and concomitant lung diseases in patients of the first year of life in terms of the physiological and anatomic features of the course of disease. A complex of noninvasive radiation studies is shown to be of high informative value in evaluating the actual anatomy of complicated cardiac and pulmonary anomalies and in detecting the predictors of respiratory complications. The introduction of CT into the traditional algorithm of preoperative examination of patients with CHD has resulted in a considerable reduction in intracardiac diagnostic studies in neonates and infants of the first year of life.     

Cardiac vessels of human fetuses and newborn infants

The anatomy of the cardiac arteries has been studied in 78 and that of the veins--in 74 total preparations of human fetal hearts 3--10-lunar month-old and in newborns. The cardiac vessels are injected with contrast masses, erythrocytes are stained with benzidine, histotopograms are made. In the fetuses all branches of the 1st-3d order of the coronary arteries and cardiac veins have been formed. Topography and main dimentions of large cardiac vessels are defined. During the prenatal period ramification zones of the coronary arteries do not change. In different age groups of the fetuses and newborns right coronary type of the cardiac blood supply predominates considerably (58-60%), in 27-32%--equal, and in 8-13%--left coronary type is observed. A great variability of the venous cardiac bed, vast intervenous anastomoses and a special importance of the cardiac middle vein in blood outflow are noted.     

Plasma levels of DSIP in infants in the first year of life and SIDS risk.

In searching for abnormalities related to the sudden infant death syndrome (SIDS), delta sleep-inducing peptide (DSIP), a regulatory peptide with sleep promoting actions, was investigated in the first year of life in four groups of children: (1) preterm infants (n = 28), (2) infants with a high mean apnea duration evaluated polysomnographically (n = 26), (3) healthy full-term infants (n = 37) and (4) siblings of SIDS-victims (n = 26). DSIP was radioimmunoassayed in plasma. Half of the infants were also investigated polygraphically during sleep. The ratio between quiet sleep and active sleep was determined. There was no age dependence of the plasma level of DSIP in the first year of life but there was an increase in the ratio of quiet/active sleep depending of maturity. The level of DSIP in healthy full-term infants was significantly higher (P less than 0.05) (median: 1885 pmol/l, interquartile range: 757 pmol/l) than in preterms (1595; 385) and in infants with a high mean apnea duration (1542; 373). There was no significant difference in DSIP concentrations between healthy full-term infants and SIDS-siblings (1605; 271).     

Morbidity in Canadian Indian and non-Indian children in the first year of life.

A cohort study of health status was undertaken to determine the patterns of morbidity in the first year of life for Indian and non-Indian infants living in southern Ontario. The annual incidence of office-reported health problems was 8.0 episodes for the 99 Indians and 4.5 for the 316 non-Indians studied. The risk of illness of most diagnostic categories was more than 1.5 times greater and the rate of hospital admission 4 times greater for the Indian infants. There was no difference between the two cohorts in the rates of visits to hospital emergency departments. The main cause of illness in both cohorts was respiratory tract infection; lower respiratory tract infections, particularly pneumonia, were a major health problem among the Indian infants. Only 36% of the Indian infants compared with 68% of the non-Indian infants attended five or more well-baby examinations. Part of the difference in morbidity between the Indian and non-Indian infants may be attributed to environmental factors, health care behaviour and geographic constraints.     

Formation of intestinal microflora in children during the first year of their life

In 525 young children the state of intestinal microbiocenosis was studied every month of the first year their life. The study revealed that the process of the microflora formation lasted throughout the first year of their life and was characterized by dysbiotic disturbances. During this period the aggravation of dysbiotic changes in the intestine of these children on months 3, 6-7 and 11-12 was of particular importance. The formation of stable dysbacteriosis led to a decrease in the immunological status of the child, which was manifested by the increased content of such microorganisms as hemolytic cocci, Proteus and a decrease in the quantitative level of bifidobacteria in the total intestinal microbiocenosis by the end of the first year of child's life.     

A neurophysiologic study of sleep in children during the first year of life]

Polygraphic investigation of day sleep has been carried out in thirty suckling infants (aged from 25 days to 12 months). EEG, OCG, SGR, respiration ECG, muscular activity, and in some infants, also rheographic parameters (REG and RG of the shin) have shown that already at an early nursing age, states of drowsiness, falling asleep, light and medium depth and deep slow sleep set in, as well as the so-called rapid sleep which occurs only after slow sleep. The denotation of the slow sleep stages is based on the classification by Loomis et al., though their electroenecepholographic expression in the infant is in many ways peculiar and undergoes certain dynamics during the first year of life. Peculiarities of the central area EEG have been exhibited in all the age groups, and it has been assumed that the central parts of the cortex of a suckling infant are a kind of "window" into the subcortical parts. While EEG, displaying new forms of activity at certain stages of sleep undergo distinct age changes, vegetative sleep manifestations display only some age depending quantitative differences. Thus, at the nursing age the mechanisms of electroencephalographic and vegetative sleep manifestations are of different degree of maturity: they possess a considerable autonomy, although they function in concord.     

Brain CT diagnosis in infants of the first year of life who have congenital heart diseases

Computed tomography (CT) was used to study the brain in 73 infants of the first year of life who had different congenital heart diseases (CHD). CT was performed on a HiSpeed CT/i spiral computer tomograph (the firm "CE") and a C-150 XP electronic radiation tomograph (the firm "Imatron"). The capacities of the technique in the diagnosis of brain lesion were explored in CHD infants of the first year of life. The studies indicated that the commonest abnormalities in CHD infants of this age were hydrocephalus frequently concurrent with congenital malformations, as well as diffuse and focal changes in the brain.