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DOI: 10.32743/UniMed.2025.119.2.19183 FEATURES OF ASPIRATION PNEUMONIA IN NEWBORNS
Galym Aigerim
Deputy Director of Pediatrics at Keruen- Medicus, Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty https://orcid. org/0000-0001-5806-2747
Aman Berkinbay
resident 2nd year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty https://orcid.org/0000-0002-3973-7283 E-mail: [email protected]
Nazerke Bakir
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty E-mail: [email protected]
Aruzhan Omarbay
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty E-mail: [email protected]
Dana Mynzhanova
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty E-mail: mynzhanovad@mail. ru
Balzhan Yelubek
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty E-mail: [email protected]
Ayazhan Kairat
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty E-mail: ayazhan. [email protected]
Библиографическое описание: FEATURES OF ASPIRATION PNEUMONIA IN NEWBORNS // Universum: медицина и фармакология : электрон. научн. журн. Galym A. [и др.]. 2025. 2(119). URL:
https://7universum.com/ru/med/archive/item/19183
Zhasulan Maulen
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty Е-mail: _ jasulanmaulen22@,gmail. com
Zamira Almazkyzy
intern 7th year,
Kazakh National Medical University named after S.D. Asfendiyarov NCJSC,
Kazakhstan, Almaty, Е-mail: [email protected]
ОСОБЕННОСТИ АСПИРАЦИОННОЙ ПНЕВМОНИИ У НОВОРОЖДЕННЫХ
Талым АйгерМ Талымцызы
зам. директора по педиатрии в Керуен- Medicus, НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Беркинбай Аман Бакытжанович
резидент 2 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Бакир Назерке Ажибеккызы
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Омарбай Аружан Уалиханкызы
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Мынжанова Дана Болаткызы
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Елубек Балжан Талгаткызы
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Кайрат Аяжан Кайраткызы
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Маулен Жасулан Талгатулы
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
Алмазцызы Замира
интерн 7 курса,
НАО Казахский Национальный медицинский университет им. С.Д. Асфендиярова,
Республика Казахстан, г. Алматы
A UNÎVERSÛM:
№2(119)_февраль, 2025 г.
ABSTRACT
Aspiration pneumonia (AP) in newborns remains one of the most challenging and unresolved issues in the fields of obstetrics and neonatology. This is attributed to the complexity of its diagnosis and the multifactorial nature of its causes. Given the relevance of this condition, mastering algorithms for identifying, preventing, treating, and diagnosing risk factors is critical, as it allows for a reduction in treatment duration and infant mortality rates. In our study, the etiological factors of aspiration included meconium aspiration (42.1%) and amniotic fluid aspiration (31.6%). The prevalence of preterm birth among newborns with AP was significantly higher (47% versus 28%). Moreover, Gram-positive bacteria were identified in 63.2% of cases among infants with AP.
АННОТАЦИЯ
Аспирационная пневмония (далее - АП) у новорожденных - одна из сложных нерешённых проблем в области акушерства и неонатологии. Это связано с трудностями диагностики и многофакторностью причин. В связи с актуальностью заболевания, овладение алгоритмами выявления, профилактики, лечения и диагностики факторов риска позволяет сократить время лечения младенцев и снизить уровень смертности. В нашем исследовании этиологическими факторами аспирации выступали: аспирация мекония - 42,1%, аспирация околоплодных вод -31,6%. Частота преждевременных родов среди новорождённых с АП значительно выше (47% против 28%). У младенцев с АП в 63,2% случаев были выявлены грамположительные бактерии.
Keywords: newborns, pneumonia, lungs, complications, aspiration.
Ключевые слова: новорожденные, пневмония, легкие, осложнения, аспирация.
Introduction
One of the pressing issues in modern neonatology is aspiration pneumonia (AP) in newborns, which is frequently encountered in clinical practice [1, 2]. According to Clearly and Wiswell, the severity of AP can be classified as mild (FiO2 < 0.40 for less than 48 hours), moderate (FiO2 > 0.40 for more than 48 hours), or severe (requiring mechanical ventilation for more than 48 hours and/or pulmonary hypertension) [2].
According to various authors, the average incidence of AP is 2-3% of all newborns [3, 4], while meconium obstruction of amniotic fluid occurs in 9-15% of laboring women [2-5].
AP is occasionally observed in 23-52% of pregnancies exceeding 42 weeks, with a mortality rate of 5-12% [5]. Additionally, from 1995 to 2015, massive aspiration syndrome ranked 5th to 7th among the causes of early neonatal mortality (1.8-3.44%) [6-8]. The mortality rate associated with meconium aspiration syndrome reaches 24-28%, and if mechanical ventilation is required, mortality rises to 36-53% [1, 9].
According to several authors [2-5], aspiration is rare before 37 weeks of gestation, but meconium aspiration occurs in 30% of newborns when the gesta-tional age exceeds 40 weeks. This is most common in newborns with a birth weight exceeding 3500 g and less common in preterm infants weighing less than 2000 g, due to the reduced sensitivity of preterm intestines to hypoxic conditions and procedures such as extubation and bronchoscopy [2-5]. Meconium aspiration caused by fetal asphyxia leads to mesenteric vessel spasm, increased intestinal motility, relaxation of the anal sphincter, and the release of meconium [5, 7, 9].
The most common pathogens of aspiration pneumonia worldwide are bacteria of the Enterobacteriaceae family, Pseudomonas aeruginosa, and Staphylococcus aureus [3, 11]. Gram-positive bacteria cause 12.6% of pneumonia cases, while gram-negative bacteria account for 67.5%, with respiratory viruses making up the remainder [3, 11].
The primary pathogenesis of the disease is as follows: fetal respiratory movements promote the aspiration of me-conium into the trachea, from where it enters the airways, leading to obstruction of the bronchi and bronchioles. This results in the formation of subsegmental atelectasis with impaired aeration of adjacent areas. Increased respiratory workload and uneven ventilation of lung tissue lead to alveolar rupture. Spasm of pulmonary vessels and impaired microcirculation contribute to the development of pulmonary hypertension and extrapulmonary shunts [3, 5].
Symptoms of meconium aspiration may develop immediately after birth, but they more often manifest within 12-24 hours as respiratory failure with characteristic radiological signs [3, 5, 14]. Aspiration of amniotic fluid can sometimes lead to asymptomatic aspiration pneumonia in newborns [3, 5, 14]. Pulmonary changes in such cases may develop gradually and imperceptibly without pronounced clinical symptoms [10]. On radiographs, these changes appear as interstitial pneumonia, pulmonary fibrosis, or, in some cases, bronchiectasis [5, 10].
The diagnosis of aspiration pneumonia is based on a combination of clinical data and radiological findings, such as persistent or progressive infiltration, consolidation, cavitation, or pneumatocele in infants under one year of age [14, 15].
In recent years, there has been a trend toward reduced mortality among children with AP [3, 5]. This reduction is attributed to the introduction of new methods for monitoring fetal status during labor, an increased frequency of cesarean sections for various indications, early postnatal diagnosis of aspiration, and the use of modern respiratory support techniques [3, 4, 11].
Objective of the study: To study the clinical and diagnostic features of aspiration pneumonia in newborns and to evaluate the effectiveness of the therapy provided.
Materials and methods: A retrospective analysis was conducted at the "Newborns" department of the "№5 Perinatal Center" in Almaty from January 1, 2019, to August 31, 2024. A total of n=124 cases were ana-
№ 2 (119)
UNIVERSUM:
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lyzed, among which n=19 newborns (15.32%) were con- rays), and laboratory tests (complete blood count, bio-
firmed to have aspiration pneumonia. The diagnosis was chemical parameters) (Figure 1).
based on clinical data, instrumental results (chest X-
□ Aspiration Pneumonia □ No Pneumonia
Figure 1. Classification of patients included in the study (%)
Inclusion criteria: newborns with a confirmed diagnosis based on clinical and laboratory diagnostics.
Exclusion criteria: children older than 28 days, not classified as newborns; lung diseases unrelated to aspiration (e.g., viral infections); refusal of treatment, and cases of death.
All children included in the study were classified according to the Gundobin classification. Data on laboratory and instrumental examination results, disease severity, functional classes, complications, and treatment outcomes were analyzed.
To verify the analyzed data, statistical methods were used, including the calculation of mean values (M±m) and assessment of the significance of differences between arithmetic means using Student's t-test (t). Differences at the level of p<0.05 were considered statistically
In the study, the average values of height and weight of newborns, as well as the corresponding deviations, were determined (Table 1). Newborns with aspiration pneumonia showed a difference in weight of 0.5 ± 1.8 and in height of 1.6 ± 0.67 compared to the group without pneumonia (p<0.05). Thus, the difference between
significant. Statistical processing of data was performed using the Microsoft Office Excel application.
Results and discussion. Initially, the study analyzed the catamnestic and clinical data of the newborns. Accordingly, the average parity of pregnancies in mothers (n=124) was 3.17±1.13, and the mean gestational age was 37.54±5.63 weeks (p<0.05). The majority of newborns (41.93%) were born after the first pregnancy, and the proportion of those born at 37-41 weeks gestation was 78.32% (Figures 2a, 2b) (p<0.05).
The etiological factors of aspiration were identified as follows: meconium aspiration — 42.1% (n=8), aspiration of amniotic fluid — 31.6% (n=6), and aspiration of breast milk — 26.3% (n=5).
the groups was statistically insignificant (p = 0.12 and p = 0.03), meaning that in this study, height and weight were not significant changing factors for aspiration pneumonia in newborns.
41,93%
6,45%
15,32%
78,32%
1 (first pregnancy)
2-3 (second and third pregnancies)
4 or more pregnancies
28-32 weeks gestation 33-36 weeks gestation 37-41 weeks gestation
Figure 2a and 2b. Catamnestic data of newborns (%)
Table 1.
Statistical data of the subjects (x)
№ Indicators Group I (n=105) Group II (n=19) P
1 Height of newborns at birth (cm) 49,8 ± 2,2 48,2 ± 1,17 0,12
2 Birth weight of newborns (kg) 3,4 ± 0,4 2,9 ± 0,5 0,03
Aspiration pneumonia is one of the most severe and dangerous infections in neonates and infants. The main risk factors include the following: prematurity and low birth weight, children with impaired respiratory function (such as respiratory distress syndrome), susceptibility to aspiration, dysfunction of the cough reflex, the use of sedative or neurotropic medications, congenital abnormalities, intubation, mechanical ventilation, and others [5, 7].
The highest incidence of aspiration pneumonia has been observed among low-birth-weight infants (less than 2500 g), accounting for 52.63%, as well as among children with infectious complications (sepsis, urinary tract infections). Prematurity (less than 37 weeks of gestation) is a significant risk factor, which is supported by the high percentage of aspiration pneumonia cases
among preterm infants — n=9 (47%). Additionally, n=4 (21%) of the newborns had mothers who suffered from infectious complications (sepsis, urinary tract infections) (Table 2).
The frequency of prematurity among newborns with aspiration pneumonia is significantly higher (47% versus 28%, p = 0.02), indicating increased risks for this group of children. At the same time, the difference in the frequency of infections between the groups is statistically insignificant (p = 0.11), suggesting that this factor may not have such a strong impact on the development of aspiration pneumonia in this study, and further research is required for a more precise evaluation of this factor.
47,00%
28,00%
72,00%
53,00%
Preterm infants Full-term infants
■ Group I (n=105) □ Group II (n=19)
Figure 3. Catamnestic data of neonates (%)
Table 2.
№
Indicators
Statistical data of the researchers (%)
Group I (n=105) Group II (n=19)
1 Preterm infants (less than 37 weeks) Infectious complications (sepsis, urinary
2
tract infections)
47% (9/19) 21% (4/19)
28% (29/105) 10% (11/105)
P
0,02 0,11
Based on the laboratory test results in neonates, we identified the following findings: Group II showed a significantly higher level of leukocytosis (14.2 ± 3.6) compared to Group I (10.3 ± 2.7). r (Pearson) = 0.41, which confirms the correlation between the presence of pneumonia and the leukocyte count in the blood (Table 3).
In Group II, the average level of C-reactive protein (CRP) was 18.5 ± 4.8 mg/L, which was significantly higher than in the group without pneumonia (10.2 ± 3.4
mg/L), r = 0.45 — a moderate positive correlation, indicating a relationship between elevated CRP levels and the presence of aspiration pneumonia.
PaO2/FiO2 in Group II was 125 ± 20, significantly lower compared to neonates without pneumonia, where this parameter was 170 ± 22. PaO2/FiO2 is used to assess the severity of respiratory failure, r = -0.48 — a moderate negative correlation, indicating that a decline in PaO2/FiO2 correlates with worsening condition and
increases the likelihood of pneumonia. Thus, the laboratory results confirm the presence of marked inflammatory changes in neonates with aspiration pneumonia,
as evidenced by significantly elevated leukocyte counts and CRP levels, indicating a severe infectious process (Table 3).
№
Indicators
1 leukocytosis (*103/^L)
2 C-reactive protein (mg/L)
3 PaO2/FiO2 (mm/Hg)
Laboratory test results (x)
Group I (n=105) Group II (n=19)
r (Pearson)
10,3 ± 2,7 10,2 ± 3,4 170 ± 22
14,2 ± 3,6 18,5 ± 4,8 125 ± 20
Table 3.
p
0,41 p < 0,01
0,45 p < 0,01
-0,48 p < 0,01
In the group of newborns with aspiration pneumonia (n=19), 63.2% tested positive for gram-positive bacteria. The most common pathogens were Streptococcus pneumoniae and Staphylococcus aureus, which are considered to play a primary role in the development of pneumonia (Table 4). Additionally, in Group II, Escherichia coli and Klebsiella were found in 31.6%, while these bacteria were identified in only 1.9% of newborns in Group I. No viral infections were detected in either group. Based on the data, aspiration pneumonia in newborns is primarily caused by gram-
positive and gram-negative bacteria, with Streptococcus pneumoniae and Staphylococcus aureus being the most frequent (Figure 4). Fungal flora (e.g., Candida albicans) was also observed to a lesser extent. Viral infections did not play a significant role in the development of aspiration pneumonia in newborns in this study. The statistical significance of the differences between the pneumonia and non-pneumonia groups is low, i.e., p < 0.01.
Table 4.
Results of bacteriological indicators (%)
№ Indicators Group I (n=105) Group II (n=19) r (Pearson) p
1 «Gram-positive» bacteria. 3 (2,9%) 12 (63,2%) 0,72 p < 0,01
2 «Gram-negative» bacteria 2 (1,9%) 6 (31,6%) 0,68 p < 0,01
3 Fungi 0 (0%) 1 (5,3%) 0,32 p < 0,05
4 Viruses 0 (0%) 0 (0%) 0 1
31,60%
0%
26,30%
1,90%
_15,80%
0,90%
10,50% 0,90%
0%
5,30%
Streptococcus Streptococcus Escherichia coli Klebsiella Candida albicans pneumoniae pneumoniae pneumoniae
□ Group I (n=105) □ Group II (n=19)
Figure 4. Results of bacteriological indicators (%)
According to the results of chest X-rays, in newborns with aspiration pneumonia (Group II), chest radiography was performed in 94.7% of cases, which is significantly higher compared to the group without pneumonia (42.9%). The correlation coefficient r (Pearson) = 0.56 indicates a moderate positive correlation, confirming a strong association with the frequency
of chest X-ray use for diagnosis. Saturation levels: in Group II, the mean value was 88 ± 3%, which was lower compared to Group I (92 ± 4%) (r = -0.36). This was due to impaired gas exchange and the need for intensive respiratory monitoring, resulting in an increased demand for oxygen therapy (Table 5).
№
Indicators
Results of instrumental studies (x)
Group I (n=105) Group II (n=19)
r (Pearson)
Table 5.
P
1 Chest X-ray (n, %)
2 Saturation (x, %)
45 (42,9%) 92 ± 4
18 (94,7%) 88 ± 3
0,56 -0,36
p < 0,01 p < 0,05
In the main clinical presentation of aspiration pneumonia in newborns of Group II (n=19), tachypnea was observed in 88.9%, chest retraction in 77.8%, cyanosis (skin discoloration) in 55.6%, and hypoxia - a decrease in oxygen saturation to 100%, which confirms the presence of respiratory failure. Elevated body temperature
was noted in 63.2%, and neurological symptoms (such as seizures or apnea) were found in 31.6% of the newborns, which may be associated with hypoxia and metabolic disturbances (Figure 5).
88,90% n I ,80% 1 /o 55,60% 1 00% 00% 63, ,20% 31,60% 1 1
Tachypnea Chest retraction Cyanosis Hypoxia Elevated body Neurological temperature symptoms (seizures, apnea)
Figure 5. Main clinical manifestations in newborns diagnosed with aspiration pneumonia (%)
Regarding the types of treatments administered to the newborns, antibacterial therapy was used in all cases regardless of the presence of aspiration pneumonia, with a correlation coefficient of r = 0.00 and p = 1.00. Standard use of antibiotics was observed in all cases. In the aspiration pneumonia group (52.6%), hormonal therapy was used significantly more often than in the group without pneumonia (4.8%) (correlation coefficient r = 0.58 and p < 0.01). Physiotherapy for sputum clearance was prescribed in 63.2% of cases
in Group II, compared to only 8.6% in the group without pneumonia (r = 0.50, p < 0.01). In this same group, 100% of the children received oxygen therapy, while only 26.7% in the pneumonia-free group did, and symptomatic therapy was administered in 78.9% of cases (r = 0.35, p < 0.05). Treatment of aspiration pneumonia requires more intensive and specialized therapy, including hormones, physiotherapy, and oxygen therapy (Table 6).
Table 6.
Indicators by Main Treatment Methods (x)
№ Indicators Group I (n=105) Group II (n=19) r (Pearson) P
1 Antibacterial therapy 105 (100%) 19 (100%) 0,00 p = 1.00
2 Hormonal therapy 5 (4,8%) 10 (52,6%) 0,58 p < 0,01
3 Physiotherapy 9 (8,6%) 12 (63,2%) 0,50 p < 0,01
4 Oxygen therapy 28 (26,7%) 19 (100%) 0,74 p < 0,01
5 Symptomatic therapy 42 (40,0%) 15 (78,9%) 0,35 p < 0,05
The group without pneumonia (Group I) demonstrated almost complete recovery (99.0%), while in the group with aspiration pneumonia, this figure was 84.2% (Table 7). The statistically significant difference (p < 0.05) confirms the impact of aspiration pneumonia treatment on the outcomes. Regarding complications, 1.0% were registered in Group I, while 2 (10.5%) newborns
in Group II experienced complications (r = 0.40, p < 0.05). In Group II, only one newborn (n=1) had a fatal outcome related to multi-organ failure and sepsis (5.3%). Hospitalization for newborns with aspiration pneumonia was significantly longer compared to those without pneumonia (5.2 ± 1.1 days), with an average of 15.6 ± 3.5 days (r = 0.65, p < 0.01).
№
Indicators
Research results (x)
Group I (n=105) Group II (n=19) r (Pearson)
Table 7.
p
1 Complete recovery 104 (99,0%) 16 (84,2%) -0,35 p < 0,05
2 Complications 1 (1,0%) 2 (10,5%) 0,40 p < 0,05
3 "Mortality rate 0 (0%) 1 (5,3%) 0,25 p < 0,05
4 "Average length of hospitalization (days, x) 5,2 ± 1,1 15,6 ± 3,5 0,65 p < 0,01
Conclusion. Therefore, aspiration pneumonia in newborns is a severe pathological condition characterized by a high frequency of complications and a significant increase in hospitalization duration. The disease is associated with severe hypoxia, lung infiltration, and changes in laboratory indicators. The main treatment methods include antibiotic therapy, oxygen therapy, and physiotherapy. Children with aspiration pneumonia have a higher risk of complications and mortality, along with a significant increase in hospitalization duration.
Early diagnosis and comprehensive treatment help improve the prognosis and reduce complications.
Main recommendations:
1. Strengthening the monitoring of newborns with risk factors for aspiration pneumonia.
2. Improving instrumental and laboratory methods for early diagnosis.
3. Developing standardized treatment and rehabilitation protocols to reduce hospitalization duration.
References:
1. Hooven TA, Polin RA. Pneumonia. Semin Fetal Neonatal Med. 2017 Aug;22(4):206-213. doi: 10.1016/j.siny.2017.03.002. Epub 2017 Mar 24. PMID: 28343909; PMCID: PMC7270051.
2. Klompas M, Branson R, Cawcutt K, Crist M, Eichenwald EC, Greene LR, Lee G, Maragakis LL, Powell K, Priebe GP, Speck K, Yokoe DS, Berenholtz SM. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol. 2022 Jun;43(6):687-713. doi: 10.1017/ice.2022.88. Epub 2022 May 20. PMID: 35589091; PMCID: PMC10903147.
3. Korang SK, Nava C, Mohana SP, Nygaard U, Jakobsen JC. Antibiotics for hospital-acquired pneumonia in neonates and children. Cochrane Database Syst Rev. 2021 Nov 2;11(11):CD013864. doi: 10.1002/14651858.CD013864.pub2. PMID: 34727368; PMCID: PMC8562877.
4. Ludovichetti FS, Zuccon A, Positello P, Zerman N, Gracco A, Stellini E, Mazzoleni S. Preventive oral hygiene and ventilator-associated pneumonia in paediatric intensive care unit. Eur J Paediatr Dent. 2022 Dec;23(4):298-302. doi: 10.23804/ejpd.2022.23.04.09. PMID: 36511909.
5. Pokryvkova M, Zarubova P, Wiedermannova H, Burckova H, Mrazek J, Pavlicek J. Neonatal pneumonia caused by Trichomonas vaginalis. Epidemiol Mikrobiol Imunol. 2020 Spring;69(2):96-99. English. PMID: 32819109.
6. De Luca D. Neonatal ventilator-associated pneumonia: more questions than answers. Minerva Anestesiol. 2018 Jul;84(7):777-779. doi: 10.23736/S0375-9393.18.12991-9. Epub 2018 May 15. PMID: 29774737.
7. Bondarev DJ, Ryan RM, Mukherjee D. The spectrum of pneumonia among intubated neonates in the neonatal intensive care unit. J Perinatol. 2024 Sep;44(9):1235-1243. doi: 10.1038/s41372-024-01973-9. Epub 2024 May 2. PMID: 38698211; PMCID: PMC11379627.
8. Kumar CS, Subramanian S, Murki S, Rao JV, Bai M, Penagaram S, Singh H, Bondili NP, Madireddy A, Lingaldinna S, Bhat S, Namala B. Predictors of Mortality in Neonatal Pneumonia: An INCLEN Childhood Pneumonia Study. Indian Pediatr. 2021 Nov 15;58(11):1040-1045. PMID: 34837364.
9. Nair NS, Lewis LE, Dhyani VS, Murthy S, Godinho M, Lakiang T, Venkatesh BT. Factors Associated With Neonatal Pneumonia and its Mortality in India: A Systematic Review and Meta-Analysis. Indian Pediatr. 2021 Nov 15;58(11):1059-1061. doi: 10.1007/s13312-021-2374-4. PMID: 34837367; PMCID: PMC8639407.
10. Neonatal death from amniotic fluid aspiration pneumonia caused by simple complete transposition of the great artery : A case report]. Fa Yi Xue Za Zhi. 2023 Feb 25;39(1):91-93. Chinese. doi: 10.12116/j.issn.1004-5619.2022.420305. PMID: 37038862.
№ 2 (119)
Л 1
Ä
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МЕДИЦИНА И ФАРМАКОЛОГИЯ
февраль, 2025 г.
11. The course of pregnancy and the peculiarities of childbirth with high-grade myopia // Universum: медицина и фармакология : электрон. научн. журн. Slamhan B. Berkinbay A, 2023. 6(99). URL: https://7univer-sum.com/ru/med/archive/item/15630
12. Shehzad I, Raju M, Manzar S, Dubrocq G, Sagar M, Vora N. Variations and National Perspectives on Evaluation and Management of Ventilator-Associated Pneumonia in Neonatal Intensive Care Units: An In-Depth Survey Analysis. Cureus. 2024 Jul 19;16(7):e64944. doi: 10.7759/cureus.64944. PMID: 39156390; PMCID: PMC11330674.
13. O., T., Ibekenov., A.B., Berkinbay., M., Abdilla. (2023). Modern methods of diagnosis and treatment of acute pancreatitis. literature review. Vestnik hirurgii Kazahstana, 54-61. DOI: doi.org/10.35805/BSK2023II009;
14. Ericson JE, McGuire J, Michaels MG, Schwarz A, Frenck R, Deville JG, Agarwal S, Bressler AM, Gao J, Spears T, Benjamin DK Jr, Smith PB, Bradley JS; Best Pharmaceuticals for Children Act—Pediatric Trials Network Steering Committee and the Clinical Trials Transformation Initiative. Hospital-acquired Pneumonia and Ventilator-associated Pneumonia in Children: A Prospective Natural History and Case-Control Study. Pediatr Infect Dis J. 2020 Aug;39(8):658-664. doi: 10.1097/INF.0000000000002642. PMID: 32150005; PMCID: PMC8293907.
15. Jariwala PS, Kalaniti K, Wonko N, Daspal S, Mugarab Samedi V. The Value of Different Radiological Modalities in Assessment of Spontaneous Pneumomediastinum: Case Review and Diagnostic Perspective. AJP Rep. 2019 Jan;9(1):e72-e75. doi: 10.1055/s-0039-1683862. Epub 2019 Mar 7. PMID: 30854247; PMCID: PMC6406024.
