Information technologies in clinical and pharmaceutical management of newborn patients with rotavirus infection: retrospective analysis

Анотація

Aim. A retrospective analysis of the effectiveness of pharmacotherapy of newborn patients with rotavirus infection using the developed information technology Materials and Methods. We proposed to evaluate therapy outcome based on survival analysis approach. Since cohort of patients has two available states: alive or dead, we proposed to use two states: hospitalized and discharged from hospital. Therefore, therapy effectiveness was associated with durations os stay in hospotal. For a certain cohort such effectiveness could be displayed as probablity curve of stay in hospital, so a lower curve reflexes higher intervention effectiveness. This could be graphically described as transmission of patients in a cohort between two states: hospitalized and discharged patients.Results. This approach was based on the developed computer program "Clinical and Pharmaceutical Management of Viral Infections" and tested with the use of 85 medical records for newborn babies from 5 to 60 days of life born in the period from 2001 to 2002 and came from maternity hospitals to the 1st and 2nd outbreaks of newborns and the intensive care unit of the NHSL "OKHMATDIT" mainly in a difficult condition: with clinical manifestations of gastrointestinal disorders, hypoxic or hypoxic-hemorrhagic lesions of the central nervous system, hyperbaric ilirubinemia, respiratory distress syndrome, etc. Analysis of medical records showed that all hospitalized patients were examined for RVI by the presence of rotavirus antigens in the clinical material (feces) by the indirect hemagglutination reaction method, the most accessible and widespread at that time in the laboratory. The principle of the method was that pretreated formalin or tannin erythrocytes (more often human or sheep), on the surface of which the specific antibodies are sorted, in the presence of a homologous antigen form aggregates, manifested by the phenomenon of agglutination. Among the patients studied proved positive 60 persons (70.6%), 32 of whom received basic pathogenetic therapy.The analysis showed that the onset of positive therapy outcomes for patients with RVI was longer, and therefore, it is more likely to remain in the hospital for the first 1 to 20 days of the disease. In a detailed analysis, both in all patients and only in patients with RVI, it was noted that the severity of the leading symptoms at the end of therapy was significantly reduced. However, the use of complex therapy with α2b-interferon was characterized by faster reverse development of clinical manifestations of the disease than in patients who did not receive interferon.In comparison, it was also investigated the use of smectites - antidiarrheal agents of natural or synthetic origin with sorption properties. The obtained results gave a confident ability to indicate their effectiveness, which was determined by a significant decrease in the probability curve of hospitalization days, both in the analysis of data of all patients and only in patients with RVI.Conclusion. The retrospective analysis using the developed IT showed that rectal application of recombinant α2b-interferon and smectites in the complex therapy of RVI in newborns can increase the clinical efficacy of therapy, namely, positively affect clinical manifestations of the disease through more rapid elimination of a number of symptoms. The results of the study prove that ICT based on pharmacoeconomic modeling can become an effective tool for clinical and pharmaceutical management of patients in a hospital, and is a reliable source for assessing the recovery rate, which is necessary to support decision-making by the doctor in choosing the optimal patient pharmacotherapy in real time.