Diagnostic Significance of Computer Bronchophonography in Respiratory Diseases in Newborns

The dissertation is dedicated to the study of the diagnostic significance of computer bronchophonography as an objective method for assessing the function of external respiration in newborns with various bronchopulmonary pathology. The research was conducted in the Republic of Sakha (Yakutia) and is aimed at solving the urgent problem of early and differential diagnosis of respiratory disorders in newborns, among which are respiratory distress syndrome, pneumonias, bronchopulmonary dysplasia, and bronchoobstructive syndrome. The method of computer bronchophonography is based on the registration of high-frequency respiratory sounds and makes it possible to obtain an integral breathing pattern described from the standpoint of statistical methods.

The work established normative bronchophonogram indices in newborns without respiratory organ pathology and identified patterns of changes in the respiratory pattern in various bronchopulmonary system diseases before and after treatment. The obtained results justify the inclusion of computer bronchophonography in the diagnostic complex of neonatology due to its simplicity, accessibility, informativeness, and high sensitivity. Methodological recommendations for the use of this method in practical healthcare have been developed.

Relevance of the Problem. A troubling trend in modern neonatology is the almost universal increase in the birth of children with respiratory disorders, the most common causes of which are respiratory distress syndrome (RDS) and neonatal pneumonia (38). These groups of diseases occupy a significant place in terms of severity of outcomes and are the cause of 20-23% of perinatal mortality cases (24).

Outcomes of respiratory disorders in newborns may include: chronic respiratory insufficiency, bronchoobstructive syndrome, bronchopulmonary dysplasia (BPD) (18).

Among the approaches to reducing morbidity, improving treatment, and decreasing the degree of disability of patients, important significance attaches to early and differential diagnosis of pathological processes, objective assessment of patient condition, forecasting the course and outcomes of diseases, and, finally, the well-founded choice of preventive and therapeutic measures.

The task of diagnosis consists in determining the nature and degree of deviation from the norm. The essential components necessary for solving diagnostic tasks are the characteristics of the system being diagnosed; the availability of a set of parameters (signs, symptoms) that can be assessed; previous experience accumulated by medicine that can be used in this case; and the physician with their subjective experience.

The continuous increase in the volume of information that must be dealt with necessitates the search for new forms of integral representation of clinical data. This problem became especially acute with the introduction of computer technology. Diagnosis of diseases using computer technology is a developing direction in the improvement of the clinical process. The effect of computer approaches is especially noticeable in recognizing pathological processes when new diagnostic signs are formed, since computer approaches make it possible to provide objective classification of diseases, conditions, symptoms, and symptom complexes.

In clinical medicine, decisions are often made based on heterogeneous information that can be processed in various ways.

A computer-based method for assessing the function of external respiration, based on the registration of specific acoustic phenomena—respiratory sounds—was developed by specialists at the Moscow Energy Institute (Technical University).

The result of registering respiratory sounds leads to the representation of the respiratory cycle in the form of the so-called breathing pattern (60,63).

The breathing pattern is proposed as an integral parameter describing clinical data and also enabling comprehensive forecasting taking into account the individual characteristics of the patient. It contains information both about the intensity of breathing and about the frequency range in which each specific pattern exists.

The pattern, or more precisely the zone of diagnostically reliable signs (25,39), belongs to the class of random stationary ergodic processes; therefore, for its description, it is necessary to employ the mathematical apparatus of statistical methods in the corresponding formulation.

It is known that the adequate application of statistical methods makes it possible not only to describe the results of experiments or observations but also to construct appropriate mathematical models. The latter is very important, as it provides the possibility of obtaining the required quantitative estimates based on scientific prediction and rational decision-making.

In other words, one should expect that breathing patterns will differ from one another, and this difference can be evaluated in quantitative form, for example, by the magnitudes of maximum intensity of respiratory sound.

At present, the method of computer bronchophonography is sufficiently understudied. Computer bronchophonography was first used in clinical practice to obtain breathing patterns in children with various chronic nonspecific lung diseases (Kagan S.Yu., Astakhov N.V., Polukhin V.F., MalyShev B.Ts., Ardashnikova S.N., Berger E.F. Inventor's Certificate No. 904661, 1982 - Method for Recording High-Frequency Respiratory Sounds, B.Ts. MalyShev et al., Russian Federation Patent No. 5062396, Bulletin No. 18, 1995). Bogdanova T.A. (2003) evaluated bronchophonogram indices in children with bronchial asthma. In her work, Makarova S.A. (2004) studied the clinical-functional features of bronchoobstructive syndrome in early-aged children using the method of bronchophonography. Dementyeva G.M. (1996) determined bronchophonogram indices in premature newborns in the early neonatal period.

In connection with the above, the diagnostic significance of this method in newborns with various bronchopulmonary pathology is increasing, which determined the goal and objectives of the study.

Objective of the Research: To study the diagnostic significance of computer bronchophonography as an objective method for investigating the function of external respiration in respiratory diseases in newborns in the Republic of Sakha (Yakutia).

Tasks:

1. To clarify the risk factors for the development of respiratory diseases in newborns in the Republic of Sakha (Yakutia).

2. To determine the normative indices of computer bronchophonography in newborns without respiratory organ pathology.

3. To determine the diagnostic capabilities of computer bronchophonography in newborns with bronchopulmonary diseases.

4. To provide recommendations for practical healthcare on the use of computer bronchophonography for the diagnosis of respiratory diseases in newborns.

Scientific Novelty:

As a result of the work, the causative-significant risk factors for the development of respiratory diseases in newborns have been clarified.

The parameters of bronchophonograms in newborns without respiratory organ pathology have been established by the method of computer bronchophonography, and norms for the acoustic work of breathing index have been proposed.

For the first time, patterns of changes in the respiratory pattern on phonorespirograms in newborns with respiratory diseases before and after treatment have been identified.

It has been established that the method objectively reflects the main trends of pathological changes and can be used for confirming diagnosis and rehabilitation.

The necessity of including computer bronchophonography in the diagnostic complex for respiratory diseases during the neonatal period has been justified, owing to its simplicity, accessibility, informativeness, and high sensitivity.

The practical significance of the research lies in the development of bronchophonogram evaluation norms for examining newborns through an economical, informative, and labor-efficient method, with the aim of further clarifying diagnosis and rehabilitation in medical institutions.

The results of the research are of interest from the standpoint of forecasting the pathological process in newborns with respiratory diseases.

Implementation in Practice.

Based on the research materials, an informational letter for physicians of the Perinatal Center of the National Center of Medicine of Republican Hospital No. 1 has been developed, approved by the clinic director R.D. Filippova.

Methodological recommendations titled 'Indices of Computer Bronchophonography in Newborns of the Republic of Sakha (Yakutia)' have been prepared, which will be used in the training and retraining programs for physicians of the pediatric and therapeutic faculties of the Medical Institute of the Yakut State University named after M.K. Ammosov.

The main provisions of the dissertation were discussed at the XI Scientific-Practical Conference 'Lavrentyevskie Readings' of the Yakut State University (2005) and at the scientific conference of young scientists of the Medical Institute of YSU (2005).