ANALYSIS OF ANAMNESTIC DATA AND CLINICAL AND LABORATORY CRITERIA FOR FOOD INTOLERANCE IN PRETERM INFANTS TAKING INTO ACCOUNT THE SEVERITY OF PERINATAL PATHOLOGY
Authors: Godovanets O. 
Published: December 2024

Every year, up to 10% of the total number of children in the world are born before term. Preterm birth is considered to be one of the main factors in the increase of neonatal morbidity and mortality. The morphological and functional immaturity of the body at premature birth is one of the factors in the development of severe metabolic disorders. The negative effect of intrauterine hypoxia causes a violation of the functional state of organ systems, causes the development of multiple organ failure after birth For the timely detection of these disorders, justification of the necessary preventive and therapeutic measures, the issues of improving diagnostic measures in children in the neonatal period, in order to prevent the development of gastrointestinal pathology in the future are discussed.
The aim of the study. To analyze the anamnestic data and clinical and laboratory criteria for disorders of the functional state of the gastrointestinal system in premature infants, considering the severity of the course of perinatal pathology.
Materials and methods of the study. The main group of the study consisted of 149 premature infants of gestational age 32-33/6 weeks: subgroup A - newborns with severe forms of perinatal pathology (67 children), subgroup B - children with clinical signs of moderate perinatal pathology (82 children). The comparison group consisted of 50 conditionally healthy children with gestational age of 34-36/6 weeks. Inclusion criteria: gestational age at birth 32-33/6 weeks, manifestations of digestive system dysfunction with the consent of the child's parents. The complex of laboratory methods included the study of the level of albumin, α-1-antitrypsin, fecal elastase-1, PMN-elastase and calprotectin in coprofiltrate. The studies were conducted in accordance with the provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (1997), the Declaration of Helsinki of the World Medical Association for the Ethical Principles of Scientific Medical Research Involving Human Subjects (1964-2008), the Order of the Ministry of Health of Ukraine No.690 dated 23.09.2009 (as amended by the Order of the Ministry of Health of Ukraine No.523 dated 12.07.2012). Approval of the Bioethics Committee of the Bukovinian State Medical University (Protocol No. 2 dated 9.02.2015). Statistical processing of the study results was performed using the software "STATISTICA" (StatSoft Inc., USA, version 10). Comparison of quantitative indicators with normal distribution was performed using Student's t-test (p<0.05; p<0.001). Qualitative differences between the comparison groups were evaluated using MedCalc software (Statistical Software Package for Biomedical Research, 2023, Version 16.1). The study was performed as part of the research work of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University (Chernivtsi, Ukraine).
Results of the study. The risk of developing food tolerance disorders in IPV depends on a complex of factors, namely, a burdened maternal history of gastroenterological diseases and the implementation of adverse factors during pregnancy and childbirth. Assessment of the newborn's somatic status should be comprehensive, with special attention to clinical and paraclinical criteria for gastrointestinal dysfunction. The clinical signs of combined gastrointestinal disorders are: increase in liver size beyond the physiological norm (100.0%) or hepatolithiasis (52.24%), jaundice (86.57%), edema (80.6%), endotoxemia syndrome (71.64%), intestinal flatulence (73.13%) and hemorrhagic manifestations (56.27%), including bleeding from the gastrointestinal tract (43.68%). The laboratory criteria confirming the presence of severe forms of food intolerance are an increase in the level of calprotectin > 390.15 µg/g, albumin > 37.25 µg/g, α-1-antitrypsin > 452.67 µg/g with a decrease in the level of PMN elastase < 95.49 ng/g in the newborn coprofiltrate.
Conclusions. The significant risk of disorders of the functional state of the digestive system in conditions of perinatal hypoxia in critical conditions of the newborn period in premature infants requires special attention of practitioners to clarify the characteristics of the somatic history, the course of pregnancy and childbirth of the mother, as well as the nature of postnatal adaptation of the newborn. Such an approach will allow to identify newborns with increased risk of developing gastrointestinal disorders in the acute period of neonatal diseases, as well as long-term consequences, with due regard to the peculiarities of the formation of long-term adaptation processes.