RU2012341C1 - Method of treating neonates suffering from sepsis - Google Patents

Abstract

FIELD: medicine, particularly, pediatrics. SUBSTANCE: neonate's venous blood sample was taken to determine concentration of immunoglobulins of classes G and M and T lymphocytes. When absolute number of T lymphocytes was found below 2.8 ths/ml and ratio of contents of G immunoglobulin to M one was equal to 12.6 and above, about 5 mg of thymogen preparation were administered intranasally into each nostril during five days. If ratio of contents of immunoglobulin G to M one was equal to 8.5 and below, about 1 mg of myelopid preparation was administered intramuscularly at rate of three injections on alternate days. Disclosed method allows determining expediency of prescribing immunocorrecting therapy. EFFECT: treatment period reduced by 5 to 10 days and lethality diminished. 4 tbl

Description

 The invention relates to medicine, namely to pediatrics.

 Despite the significant progress in pharmacology and the annual appearance in the clinic of a large number of powerful antibacterial chemotherapeutic agents, sepsis continues to be an urgent problem of pediatrics, taking 3-4th place in the structure of the incidence of newborns (A.D. Ostrovsky, A.S. Vorobyov, 1985). The introduction of highly effective antibacterial agents, immunotherapy drugs, detoxification therapy into clinical practice has reduced mortality in generalized forms of purulent infection in children in the first weeks of life, but it still remains high, ranging from 11.2 to 35% (R. E. Berman, V. K. Wogan, 1987; S. Ya. Doletsky et al., 1987). An increase in the specific gravity of pathogens resistant to antibiotics does not rarely delay the treatment of acute neonatal sepsis up to 8–9 weeks (G.V. Yatsyk et al., 1987).

 In recent years, the attention of researchers has been attracted to the development and implementation of active immunocorrection in septic conditions (R. N. Stepanenko et al., 1990; S. A. Samsygina et al., 1990). Long-term studies (N. B. Andreeva, V. Ye. Wolf, 1982-1991) established that neonatal sepsis causes prolonged dys- (hypo-) immunoglobulinemia, T deficiency.

 The traditional treatment of acute neonatal sepsis in newborns includes antibacterial, detoxification and passive immunotherapy (A.D. Ostrovsky, A.S. Vorobiev, 1985). However, passive immunotherapy in cases of the torpid course of acute neonatal sepsis is not very effective.

 The prototype of the claimed technical solution is a method of treating sepsis in newborns, including massive antibacterial, detoxification therapy and the introduction of hyperimmune antistaphylococcal gamma globulin and antistaphylococcal plasma.

The disadvantages of this method include:
- treatment duration in excess of six weeks;
- the possibility of death;
- the occurrence of adverse reactions to the introduction of antistaphylococcal gamma globulin and plasma in 2-5.8% of cases (Yu. E. Malakhovsky et al., 1981).

 These shortcomings are eliminated in the claimed technical solution.

 The aim of the invention is to reduce treatment time, reduce mortality.

 The goal is achieved in that in a newborn with acute neonatal sepsis in the venous blood, the content of T-lymphocytes and immunoglobulins of classes G and M is determined and, when the absolute number of T lymphocytes is reduced below 2.8 thousand / μl with the ratio of the concentration of IgG to Ig M 12, 6 and above - prescribe the drug thymogen, if the ratio of the concentration of Ig G to Ig M 8.5 and below prescribe the drug myelopid.

 The emergence of new drugs - immunocorrectors and their use in the clinic for the correction of immune disorders (V. I. Shalnev et al., 1988) reveals new possibilities for the treatment of sepsis in newborns. A new myelopid preparation was used, developed by the Institute of Immunology of the Ministry of Health of the USSR and approved for clinical use by the USSR Pharmacological Committee on 02/14/91, meeting protocol No. 2. The drug belongs to the myelopeptide group (bone marrow is the point of application) and enhances antibody production. Another drug, thymogen (the point of application of which is the thymus) stimulates the reactions of cellular and humoral immunity, as well as non-specific resistance.

 The method is as follows, in a newborn with acute neonatal sepsis, on the second or third day from receipt, take 3 ml of venous blood, in the serum of which determine the concentration of immunoglobulins of classes G and M, as well as the number of T lymphocytes.

 Determination of T lymphocytes is carried out by the widely used method of spontaneous rosette formation with sheep erythrocytes (E-ROCK) according to the method of R.V. Petrov et al. (1976). Determination of serum immunoglobulins of classes G and M is carried out by the method of simple radial immunodiffusion in a gel according to Mancini (1965). Reactions are placed on glass plates (9 x 12 cm) using domestic commercial antisera against the main classes of human immunoglobulins.

 With a combination of a decrease in the absolute number of T lymphocytes below 2.8 thousand / μl with a value of the ratio of the concentration of immunoglobulin G to M of 12.6 and higher, thymogen is prescribed at a dose of 5 μg intranasally in each nostril for 5 days in the evening.

 With a decrease in the absolute number of T lymphocytes below 2.8 thousand / μl in combination with a value of the ratio of the concentration of immunoglobulin G to M equal to 8.5 or less, the drug myelopid was administered at a dose of 1 mg intramuscularly for a course of three injections, every other day in the evening.

 The terms of treatment by the present method were 32-35 days for septicemia, 31-34 days for septicemia, mortality decreased.

PRI me R 1. Patient T. 12 days (case history N 3574) was admitted 6.06.90, in the Department of neonatal pathology N 1 RNIIAP with a preliminary diagnosis of acute neonatal sepsis, septicopyemia. The general condition was severe, lethargy, adynamia, and refusal of the chest were noted. On the skin of the abdomen, chest, abundant medium-sized vesicles filled with a turbid liquid, which is regarded as pyoderma. The results of the bacteriological examination of June 8, 1990 - Staphylococcus aureus was sown in the blood and the same in the smears of the separated elements of the rash. The results of the immunological examination dated June 7, 1990: leukocytes 8.9˙10 ⁹ / l, lymphocytes 50%, T lymphocytes 66% - 2.9 thousand / μl, IgG - 700 mg%, IgM - 51 mg%, ratio G to M 12.5.

On admission, kefzol was prescribed for 100 thousand three times intramuscularly, detoxification therapy (10% glucose solution with components, albumin, native plasma at the rate of 8 ml per kg of body weight). On June 9, 1990, the child’s condition worsened: there was a short-term rise in temperature to 39 ^о , swelling and pulsation of the large fontanel, hypertonicity of the flexor muscles, and the addition of new elements of pyoderma. A medical diagnostic lumbar puncture was made, in which the cerebrospinal fluid flowed out under high pressure, cloudy. 50 thousand of kefzol are entered endolumbally. Laboratory analysis of cerebrospinal fluid revealed: 1.9% protein, 3000 cells in 1 ml due to 82% of neutrophils, 12% of lymphocytes, 6% of monocytes. The final diagnosis was clarified: acute neonatal sepsis, septicopyemia (pyoderma, purulent meningoencephalitis). Kefzol was canceled, claforan was prescribed 100 thousand intramuscularly three times a day, and chloramphenicol 70 thousand twice a day intramuscularly, as well as antistaphylococcal gamma globulin 3 ml (1 dose) intramuscularly N 5, intravenously antistaphylococcal plasma 8 ml per one kg of body weight N 4. The cerebrospinal fluid was completely sanitized on 06/23/90 (control puncture). The child was in hospital for 41 days and was discharged with clinical recovery.

PRI me R 2. Patient E., 18 days (medical history N 1095). Received 10.08.90 g in the Department of neonatal pathology N 1 RNIIAP diagnosed with acute neonatal sepsis. The mother of the child is a chronic carrier of Staphylococcus aureus. The condition of the child was very serious at admission. We noted lethargy, adynamia, shortness of breath of a mixed nature up to 80 in 1 'with the participation of auxiliary muscles. During bacteriological examination from 08/11/90, Staphylococcus aureus was sown from the blood, and epidermal staphylococcus was smeared in throat smears. The parameters of the immune status from 08/12/90, leukocytes 13.1˙10 ⁹ / L lymphocytes 39%, T lymphocytes 57% - 2.9 thousand / μl, IgG - 450 mg%, IgM - 50.6 mg%, ratio G to M - 8.9. Upon admission, the child was prescribed 300 thousand carbenicillin three times a day intramuscularly and gentamicin 7 mg twice a day intramuscularly, detoxification therapy (intravenous administration of a solution of 10% glucose, albumin, native plasma 5-8 ml per 1 kg of body weight). 06.16.90, the child's condition remained extremely serious, acrocyanosis, shortness of breath 74 in 1 ', small bubbling rales on both sides appeared in the lungs. X-ray revealed bilateral focal-confluent pneumonia. The final diagnosis is acute neonatal sepsis, septicemia (focal-confluent pneumonia). The antibiotics were replaced by claforan 120 thousand three times intramuscularly and brulamycin 8 mg two times intramuscularly. A course of anti-staphylococcal gamma globulin 1 dose was administered intramuscularly for a course of 5 injections and anti-staphylococcal plasma was administered intravenously at a dose of 5 ml per 1 kg of body weight N 3. There were no other foci of the septic process in dynamics. The child was in hospital for 48 days and was discharged with clinical recovery.

PRI me R 3. Patient A., 16 days (medical history N 5277). Received 10.10.90, in the Department of neonatal pathology N 1 RNIIAP in serious condition with a diagnosis of acute neonatal sepsis. The general condition of the child is serious: lethargy, adynamia, breast failure, purulent discharge from the umbilical wound, swelling and redness of the skin over the right hip joint, painful and limited active and passive movements in the right hip joint. During bacteriological examination from 10/11/90, a cytrobacter is sown in blood, epidermal staphylococcus is sown in smears from a detached umbilical wound. The results of the immunological study from 12.10.90 are as follows: white blood cells 9.6˙10 ⁹ / l, lymphocytes 31% E, T lymphocytes 45 - 1.3 thousand / μl, IgG - 420 mg%, IgM - 33 mg%, ratio G to M - 12.7. Upon admission, therapy was prescribed - 250,000 ampiox three times a day IM and gentamicin 6 mg twice IM, detoxification therapy (intravenous administration of 10% glucose solution with components, albumin, native plasma 5 ml per 1 kg body weight). On October 16, 1990, an X-ray of the right hip joint was made, where the phenomena of osteoporosis and periostitis were detected in the proximal diaphysis of the right femur. The final diagnosis has been clarified: acute neonatal sepsis, septicopyemia (purulent omphalitis, osteomyelitis of the proximal diaphysis of the right femur). On 10.16.90, thymogen was prescribed, 5 μg intranasally in each nostril for 5 days in the evening. A day after the end of the course of thymogen, the general condition of the child improved, the symptoms of general intoxication decreased, the redness and swelling of the skin over the right hip joint disappeared, but the movements were not in full. The child was in hospital for 33 days and was discharged with clinical recovery.

PRI me R 4. Patient W., 12 days (medical history N 52/34). He was admitted to the Department of Neonatal Pathology No. 1 (ARF No. 1) of RNIIAP on December 5, 1990, in an extremely serious condition with symptoms of general intoxication in the form of lethargy, gray discoloration of the skin, frequent regurgitation, and also with soft tissue abscess in the left axillary cavity, moderately severe hepatolienal syndrome. Diagnosis at admission: acute neonatal sepsis, septicemia. During bacteriological examination dated 6.12.90, Klebsiella was sown in the blood, epidermal staphylococcus from the pharynx. The parameters of the immunological examination dated December 7, 90, were leukocytes 10˙10 ⁹ / l, lymphocytes 45%, T lymphocytes 60% - 2.7 thousand / μl, IgG - 525 mg%, IgM - 39 mg, ratio G to M - 13.5. Upon admission, complex therapy was started, including claforane of 150 thousand three times / m, detoxification therapy (intravenous administration of a 10% glucose solution with components, albumin). December 9, 1990, thymogen was prescribed, 5 μg intranasally in each nostril for 5 days in the evening. No new foci of infection have been identified in dynamics. December 15, 1990, after the end of the thymogen course, the phenomena of general intoxication significantly decreased, the grayish shade of the skin disappeared. 12/17/90, there was a fluctuation in the area of the abscess, and with its active opening 4 ml of thick pus were obtained, in the crops of which epidermal staphylococcus was sown. The child was in hospital for 32 days and was discharged with clinical recovery.

PRI me R 5. Child D., 24 days (medical history N 2154). Received October 2, 1990, at the acute respiratory arrest patient N 1 RNIIAP in extremely serious condition - sluggish, dynamic with a "marble" skin pattern, purulent discharge from the umbilical wound, profuse pustular rash on the skin of the back and abdomen, pulsation of a large fontanel. During bacteriological examination from 3.10.90, Pseudomonas aeruginosa and epidermal staphylococcus were sown in blood from a detached umbilical wound and rash elements. The results of the immunological examination dated 4.10.90, - leukocytes 11.3˙10 ⁹ / l, lymphocytes 34%, T lymphocytes 50% - 1.9 thousand / μl, IgG - 847 mg%, IgM - 67 mg%, ratio G to M - 12.6. Upon admission, therapy was prescribed - claforan 150 thousand three times a day IM, gentamicin 8 mg IM twice a day, detoxification therapy (intravenous administration of a 10% glucose solution with components, albumin). The condition of the child worsened, neurological symptoms increased in the form of hypertonicity of flexor muscles, tremor of the extremities, bulging of a large fontanel. 10.10.90, a medical diagnostic puncture was made, cerebrospinal fluid flowed out under high pressure, cloudy. Endolumbally introduced 30 thousand claforan. Laboratory study of cerebrospinal fluid showed: 1.1% protein, 2580 cells in 1 ml of cerebrospinal fluid due to 91% of neutrophils. Diagnosed with acute neonatal sepsis, septicopyemia (purulent omphalitis, pyoderma, purulent meningoencephalitis). On 10.10.90, thymogen was prescribed, 5 μg intranasally in each nostril for 5 days in the evening. October 13, 1990, the child’s condition improved, symptoms of general intoxication decreased, the “marble” skin color disappeared, there was no sprinkling of new elements of pyoderma and purulent discharge from the umbilical wound. Liquor was completely sanitized on 10.24.90 (the results of the control lumbar puncture). The child was in hospital for 34 days and was discharged with clinical recovery.

PRI me R 6. Child S., 13 days (medical history N 5134). He entered the ARF N 1 RNIIAP 1.01.91, in serious condition with symptoms of general intoxication, hepatolienal syndrome, purulent discharge from a wide umbilical wound. Diagnosis at admission: acute neonatal sepsis, septicemia (purulent omphalitis). When bacteriological examination from 2.01.91, E. coli was sown in the blood, group B streptococcus was isolated from a detached umbilical wound. The results of an immunological examination from 2.01.91 revealed: leukocytes 15.4˙10 ⁹ / l, lymphocytes 26% T lymphocytes 48% - 10 ⁹ thousand / μl, IgG - 320 mg%, IgM - 25 mg%, ratio G to M - 12.8. Upon admission, therapy was started - kefzol 120 thousand three times IM, detoxification therapy (intravenous administration of a 10% glucose solution, with components, native plasma at a dose of 8 ml per 1 kg of body weight). 5.01.91, thymogen was prescribed 5 μg intranasally in each nostril for 5 days in the evening. 12.01.91, the symptoms of general intoxication decreased, the general condition of the child improved, there was an appetite, the phenomena of purulent omphalitis stopped. The child was in hospital for 31 days and was discharged with clinical recovery.

PRI me R 7. Patient B., 18 days (medical history N 212/6189). Received 5.04.91 g in the ARF N 1 RNIIAP in extremely serious condition with symptoms of general intoxication in the form of lethargy, adynamia, "marbling" of the skin, as well as purulent discharge from the umbilical wound, multiple abscesses (size no more than 1.5 x 2 cm) on the skin of the lower extremities, purulent discharge from the conjunctiva of both eyes. During the bacteriological examination of April 6, 91, Klebsiella was seeded in the blood, Staphylococcus aureus was separated from the umbilical ring, and there were no seeding from the eye conjunctiva. The immunological parameters as of April 6, 2011 were as follows: white blood cells 5.5 510 ⁹ / l, lymphocytes 38%, T lymphocytes 67% - 1.4 thousand / μl, IgG - 515 mg%, IgM - 94 mg%, ratio G to M - 5.5. The diagnosis was made of acute neonatal sepsis, septicopyemia (purulent omphalitis, purulent bilateral conjunctivitis, multiple abscesses on the skin of the lower extremities). Upon admission, complex therapy has been started - cefamizine 100 thousand IM three times a day, detoxification therapy (intravenous administration of a 10% glucose solution with components, albumin). 8.01.91, the complex therapy included the drug myelopid 1 mg intramuscularly at night for a course of three injections every other day. 04.16.91, the general condition of the child improved, the "marble" color of the skin, purulent discharge from the umbilical wound and conjunctiva of the eyes disappeared, the appearance of new abscesses was not noted in the dynamics, while the old abscesses began to gradually dissolve. The child was in the hospital for 34 days and was discharged with clinical recovery.

PRI me R 8. Patient H., 13 days (medical history N 787). He entered 2.03.91 g in the ARF N 1 RNIIAP in a very serious condition with symptoms of general intoxication: lethargy, adynamia, grayness of the skin in combination with muscle hypotension, hyporeflexia, single abscess elements in the folds of the skin. When bacteriological examination of 03.03.91, there was no seeding of microorganisms in the blood and smears. The results of the immunological examination from 03.03.91 are as follows: leukocytes 7.4˙10 ⁹ / l, lymphocytes 39%, T lymphocytes 49%, 1.4 thousand / μl, IgG 710 mg%, IgM 85 mg%, the ratio of G to M is 8.4. Upon admission, complex therapy was prescribed - ceporin, 150 thousand IM three times a day, detoxification therapy (iv administration of a 10% glucose solution with components, native plasma 8 mg per 1 kg of body weight, albumin). The child's condition worsened, 03.03.91, lethargy and adynamia gave way to anxiety, at times a sharp cry against the background of muscle hypotension and hyporeflexia, ^a short-term rise in temperature to 38.9 ° C, rashing of new elements of an abscess rash. A diagnostic lumbar puncture was made - the cerebrospinal fluid is xantochromic, turbid, flowed out under high pressure. An analysis of cerebrospinal fluid revealed 2.4% of the protein, 1500 cells in 1 ml of cerebrospinal fluid due to 65% of neutrophils, 30% of lymphocytes, 5% of monocytes. Diagnosed with acute neonatal sepsis, septicopyemia (pyoderma, purulent meningoencephalitis).

 The second antibiotic was prescribed - chloramphenicol 80 thousand IM twice a day. 03.03.91, prescribed myelopid at 1 mg / m for a course of three injections every other day at night. 03/13/91, the general condition of the child improved, appetite appeared, the grayish tint of the skin disappeared, there were no new rashes of pustular elements. Liquor was completely sanitized on 03/21/91 (the results of control puncture). The child was in hospital for 35 days and was discharged with clinical recovery.

PRI me R 9. Patient Yu., 19 days (medical history N 32/829). Received in ARF N 1 RNIIAP on 5.03.91 in serious condition with symptoms of general intoxication in the form of lethargy, adynamia, fever up to 38.9 ^about , muscle hypotension, purulent discharge from a wide, edematous umbilical wound. On March 6, 2011, during bacteriological examination, Staphylococcus aureus was sown in blood, and no sowing was performed in smears from a separated umbilical wound. 03.03.91, the results of an immunological study are as follows - leukocytes 11.9˙10 ⁹ / l, lymphocytes 35%, T lymphocytes 64% - 2.7 thousand / μl, IgG - 1150 mg%, IGM - 152 mg%, ratio G to M - 7.6. Diagnosed with acute neonatal sepsis, septicemia (purulent omphalitis). Upon admission, complex therapy has been started - claforan 100 thousand IM three times a day, detoxification therapy (iv administration of a 10% glucose solution with components, albumin, native plasma 8 ml per 1 kg of body weight). From 9.03.91, myelopid was prescribed at 1 mg IM per course of three injections every other day in the evening. 03.16.91, the symptoms of general intoxication decreased, the “marble” skin color disappeared, there was no purulent discharge from the umbilical wound, the temperature reaction began to be subfebrile in nature, which persisted for the next 15 days of illness. The child was in hospital for 33 days and was discharged with clinical recovery.

PRI me R 10. Child B., 15 days (medical history N 246/7184). Received May 6, 2011 at the arrest center N 1 RNIIAP in serious condition with purulent discharge from the umbilical ring, purulent discharge from the conjunctiva of both eyes, a rise in temperature to 38.5 ^about . 05/05/91, there was redness and swelling of the skin in the middle of the left humerus, and later on pain with passive movements. During bacteriological examination dated 8.05.91, Pseudomonas aeruginosa was seeded in the blood, epidermal staphylococcus in smears from a detached umbilical wound. The results of the immunological examination dated May 8, 2011 - leukocytes 10.5 × ^{10 9} / l, lymphocytes 34%, T lymphocytes 72% - 2.6 thousand / μl, IgG - 1100 mg%, IgM - 129 mg%, ratio G to M - 8.5. Diagnosed with acute neonatal sepsis, septicopyemia (purulent conjunctivitis, purulent omphalitis, osteomyelitis of the left humerus). Upon admission, therapy was started - kefzol 150 thousand i.m. three times a day, detoxification therapy (iv administration of 10% glucose solution, native plasma 8 ml per 1 kg of body weight). From 10.05.91, myelopid was prescribed at 1 mg IM per course of three injections every other day in the evening. 05.17.91, the general condition improved, purulent discharge from the umbilical wound and from the conjunctiva of the eyes was not noted, the temperature decreased to normal numbers, the swelling of tissues in the metaphysis of the left humerus decreased significantly. 05/21/91, during an X-ray examination, periostitis was found in the metaphysis of the left humerus. The child was in the hospital for 35 days and was discharged with clinical recovery.

 In the process of work, three groups of sick full-term newborns with acute neonatal sepsis were identified, who were admitted to ARF N 1 RNIIAP at the age of 12-20 days.

 The first group of patients included 27 newborns, of which 13 sepsis proceeded in the form of septicemia, 14 - septicopyemia. In 18 patients the etiofactor was Staphylococcus aureus golden, in 9 - epidermal staphylococcus. All children in this group underwent complex therapy, including at least three courses of antibiotics, detoxification agents (10% glucose solution with components, albumin, native plasma 5-10 ml per 1 kg of body weight), as well as passive immunotherapy (administration of antistaphylococcal gamma -globulin 1 dose intramuscularly 5 injections in the first 3-5 days from receipt and intravenous administration of antistaphylococcal plasma in a single dose of 5-8 ml per 1 kg of body weight N 3-5).

 Despite the therapy, four patients with acute neonatal sepsis, septicopyemia died by 3-4 weeks of illness.

 The foci of the septic process in children were: purulent meningoencephalitis (6), tubular bone osteomyelitis (4), purulent omphalitis (20), purulent conjunctivitis (16), pyoderma (10), pneumonia (4), soft tissue abscesses (2). In the table. 1 shows the investigated immunological parameters in the group of children who underwent traditional therapy of neonatal sepsis.

 The parameters of the immune status of children who were subsequently prescribed treatment according to the prototype are given in table. 1.

 Thus, from the table. 1 shows that in all patients of this group the absolute number of T lymphocytes exceeded the figure of 2.8 thousand / μl, and the ratio of the concentration of immunoglobulins G to M varied from 8.6 to 12.5.

 The second group of children was 25 full-term newborns with acute neonatal sepsis, which in 15 children proceeded in the form of septicemia, in 10 in the form of septicopyemia. The etiofactor in the development of the disease in 5 patients was Klebsiella, in 10 children - Staphylococcus aureus, in 6 children - Pseudomonas aeruginosa, in 4 - transistor bacteremia (once epidermal staphylococcus, Escherichia coli, Klebsiella were isolated). All children of this group underwent antibacterial (at least 2-3 courses of antibiotics), detoxification therapy (intravenous administration of 10% glucose solution with components, albumin, native plasma at the rate of 5-10 ml per 1 kg of body weight), as well as taking into account the results of an immunological examination (Table 2), from the end of the first week of inpatient treatment, a thymogen preparation was administered intranasally, 5 μg into each nostril in the evening for 5 days.

 The parameters of the immune status of children who were subsequently prescribed the drug thymogen are given in table. 2.

 From the table. 2 it follows that in children of the second group the absolute number of T lymphocytes was lower than 2.8 thousand / μl, and the value of the ratio of the concentrations of immunoglobulins G and M exceeded 12.6.

 The difference between the studied parameters, compared with similar indicators of children of the first group, reflects a decrease in immunoglobulin production, in particular IgM against the background of T deficiency, which indicates a predominant violation of the regulatory functions of the T link. The latter substantiates the pathogenetic feasibility of prescribing the drug thymogen, which acts mainly on the T system of immunity.

 The third group of patients was 29 full-term newborns with acute neonatal sepsis, of which 10 had septicemia and 19 had septicopyemia. The foci of the process were: purulent meningoencephalitis (10), tubular bone osteomyelitis (7), pneumonia (2), pyoderma (6), purulent omphalitis (16), purulent conjunctivitis (11), soft tissue abscesses (3). In six children, Staphylococcus aureus was the etiofactor of the development of the process, five had Pseudomonas aeruginosa, two had a cytobacter, eight had Klebsiella, and eight had no etiofactor. All children of the third group received massive antibacterial (at least 2-3 courses of antibiotics) detoxification therapy (intravenous administration of 10% glucose solution with components, albumin, native plasma at the rate of 5-8 ml per 1 kg of body weight), as well as taking into account immunological parameters, from the end of the first week of treatment, the drug included myelopid 1 mg, intramuscularly for a course of three injections, every other day in the evening.

 The parameters of the immune status of children who were subsequently prescribed the drug myelopid are given in table. 3.

 As can be seen from the results given in table. 3, in patients of the third group, as well as in patients of the second group, there is a decrease in the absolute number of T lymphocytes below 2.8 thousand / μl, however, in combination with indicators of the ratio of IgG and IgM concentrations below 8.5, due to a more pronounced IgM- response. In this regard, to enhance the production of specific antibodies, it is advisable to prescribe the myelopid preparation, mainly modulating the humoral response.

 As a result of the inclusion of immunomodulatory drugs — thymogen and separately myelopid in the newborn sepsis therapy — the clinical recovery of sick children was significantly reduced (Table 4), and in no case was there a fatal outcome, while in the first group of children it had place in four patients with septicopyemia (out of 14).

 A comparative analysis of the reduction of treatment time by the present method and prototype in bed days is given in table. 4.

 The results were subjected to statistical processing with the determination of arithmetic mean values (M), average errors (m) using the constant formula, significance of the difference between the indicators (E. V. Moncheviciute-Ohringen, 1964).

The advantages of the proposed method:
The inventive method allows to reduce the treatment time from 43-49 days by a known method (up to 33-35 days); The claimed method reduces mortality; The method allows to individualize adequate tactics of patient management with the choice of a specific immunocorrective drug / thymogen or myelopid /.

 These drugs can be widely used in pediatric hospitals in the treatment of sepsis in newborns based on the assessment of the clinical picture and parameters of the immune status.

Claims (1)

 METHOD FOR TREATING SEPSIS IN NEWBORN CHILDREN, including antibacterial, detoxification and passive immunotherapy, characterized in that the indicators of immunity are determined and when the absolute number of T-lymphocytes is reduced below 2.8 thousand / μl with the ratio of the concentration of immunoglobulin G to immunoglobulin M 12.6 and above, thymogen is administered, and when the ratio of the concentrations of immunoglobulin G to immunoglobulin M is 8.5 and lower, myelopid is administered.

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