CLINICAL CHARACTERISTICS AND POSSIBILITIES OF LABORATORY DIAGNOSTICS OF GASTROINTESTINAL DISEASES IN PERINATAL PATHOLOGY OF PREMATURE INFANTS

Abstract

The neonatal period is crucial for the development of postnatal adaptation and the formation of health and quality of life. Premature birth of a child in conditions of hypoxia and morphological and functional immaturity implies a high risk of adaptation disorders in the postnatal period, causing the formation of functional and chronic diseases in the later years of life. The course of the neonatal period can be characterized both by transient states due to the formation of physiological adaptation and the development of dysfunction of organ systems, in particular the digestive system, which is a consequence of pathological labor stress in the implementation of adverse factors during pregnancy and childbirth in the mother. Timely detection and correction of early manifestations of gastrointestinal dysfunction in perinatal pathology will improve approaches to the provision of medical care to newborns, especially premature infants, should be aimed at both stabilizing the child’s condition and preventing the development of its long-term consequences.Aim of the study. To study the peculiarities of clinical and laboratory indicators of intestinal dysfunction in perinatal pathology in premature infants.Materials and methods. A comprehensive clinical and laboratory examination of premature infants of gestational age 34-36 weeks who had signs of disorders of the functional state of the gastrointestinal system in perinatal pathology in the early neonatal period was carried out. Group I consisted of 55 children with clinical signs of severe perinatal pathology; group II (control) consisted of 50 conditionally healthy children of the same gestational age. Exclusion criteria were newborns with diagnosed congenital malformations.The list of laboratory indicators of the functional state of the intestine included: the level of α1-antitrypsin (A1AT), secretory IgA (sIgA), fecal elastase 1 (FE-1), PMN elastase and albumin in the coprofi ltrate of newborns in the fi rst week of life. Methods of indicators determination: using enzyme- linked immunosorbent assay (ELISA) on the basis of Ukrainian- German laboratory «BUKINTERMED» (Chernivtsi, Ukraine). The scientifi c research was conducted in accordance with the provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Research Involving Human Subjects (1964-2008), the Order of the Ministry of Health of Ukraine No. 690 of September 23, 2009 (as amended by the Order of the Ministry of Health of Ukraine No. 523 of July 12, 2012). Protocol of the researchstudy of the Biomedical Ethics Committee of BSMU dated 12.09.2015. Informed written consent was obtained from the parents of the patients before the study with an explanation of the purpose, objectives and methods of laboratory research.Statistical processing of the results was performed using STATISTICA software (StatSoft Inc., USA, version 10). Comparison of quantitative indicators with normal distribution was performed using Student’s t-test, the probability of diff erences was considered statistically signifi cant at p<0.05.The study was conducted within the framework of the scientifi c theme of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University: Research work «Improvement of directions of prognostication, diagnosis and treatment of perinatal pathology in newborns and young children, optimization of schemes of catamenial observation and rehabilitation» (0115U002768, term of execution 01.2015-12.2019); Research work «Chronobiological and adaptive aspects and features of vegetative regulation in pathological conditions in children of diff erent age groups» (0122U002245, term of execution 01.2020-12.2024).Research results and discussion. In premature infants with clinical forms of perinatal pathology, a signifi cant incidence of autonomic dysfunction syndrome was noted, which was accompanied by disorders of the functional state of the gastrointestinal system. Clinical signs of dysfunction were: absence or decrease of sucking refl ex, regurgitation, stasis, intestinal paresis, delayed passage of meconium, fl atulence, hepatomegaly. Of the total number, 43.6 % of newborns had signs of multiple organ failure. Laboratory studies of coprofi ltrate showed an increase in the level of A1AT, sIgA, PMN-elastase, albumin with a decrease in the level of FE-1, which are interdependent criteria that confi rm the presence and in some way explain the pathophysiological mechanisms of digestive system dysfunction. In particular, a decrease in tolerance to enteral nutrition in newborns occurs against the background of insuffi cient activity of pancreatic proteolytic enzymes, activation of a local allergic reaction and increased permeability of the intestinal mucosa, which, against the background of local infl ammation, entails the risk of increased translocation of microorganisms and toxins into the bloodstream, resulting in deepening of endotoxemia in severe forms of perinatal pathology.Conclusions.1. Severe diseases of the perinatal period in premature infants with clinical signs of multiorgan dysfunction require timely diagnosis of disorders of the functional state of the digestive tract.2. Non-invasive laboratory markers using coprofi ltrate (A1AT, FE-1, sIgA, PMN-elastase, albumin), together with clinical signs, provide an opportunity to clarify gastrointestinal dysfunction, considering its pathophysiological mechanisms, which is aimed at appropriate correction of treatment measures.