DIGESTIVE DISORDERS IN PRETERM INFANTS WITH PERINATAL PATHOLOGY: RISK FACTORS, SENSITIVITY AND SPECIFICITY OF LABORATORY PARAMETERS
Authors: Dronyk T. 
Published: November 2024

According to the WHO, 9 to 16 % of babies are born preterm each year. One of the leading causes of neonatal morbidity and mortality, preterm birth is associated with short- and long-term consequences for physical and neuropsychological development, as well as early onset of chronic diseases. Developmental immaturity aff ects organ systems and causes damage during the perinatal and neonatal periods. Intestinal infl ammation, which represents increased activity of intestinal neutrophils and protein loss, is accompanied by high levels of intestinal infl ammatory markers and is an important factor in childhood stunting. The immaturity of the intestine and the associated increased risk of morbidity and food intolerance in premature infants make the choice of appropriate enteral nutrition extremely important. Aim of the study. To analyze the risk factors for disorders of the functional state of the intestine in perinatal pathology, as well as the results of clinical and laboratory studies in premature infants, to determine the sensitivity and specifi city of indicators in order to use them in practical medicine.Materials and methods of the study. A comprehensive clinical and paraclinical examination of 91 premature infants with clinical manifestations of moderate and severe perinatal pathology with signs of disturbances of the functional state of the digestive system (group I, gestational age 29 (0/7) – 36 (6/7) weeks) and 57 conditionally healthy newborns (group II, gestational age 35 (0/7) – 36 (6/7) weeks) was performed. The total number of children studied was 148. Inclusion criteria: neonates with gestational age of 25-36 (6/7) weeks, body weight between 500 and 2500 g, informed parental consent to participate in the clinical trial. Exclusion criteria: gestational age < 25 weeks and ≥ 37 weeks, body weight < 500 g and ≥ 2500 g, congenital malformations and septic conditions, lack of informed parental consent to participate in the clinical trial.The study of the coprofi ltrate in children of the observation groups, in particular, the determination of the levels of α-1-antitrypsin, PMN-elastase, albumin, fecal calprotectin and fecal elastase-1 was performed by the enzyme- linked immunosorbent assay (ELISA) in the German- Ukrainian laboratory «BUKINMED» (Chernivtsi, Ukraine) using reagents of Immundiagnostic AG (Germany). The study was conducted in accordance with the basic provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (April 4, 1997), the World Medical Association’s Declaration of Helsinki for the Ethical Principles of Scientifi c Medical 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). The study was approved by the Biomedical Ethics Committee of the Bukovinian State Medical University (Protocol No. 2 dated February 9, 2015). Statistical processing of the obtained data was performed using the software package «STATISTICA» (StatSoft Inc., USA, version 10), MedCalc software (version 16.1), with calculation of the odds ratio of the coeffi cient of excess (Chi-squared), odds ratio (OR), 95 % confi dence interval (CI), statistically signifi cant diff erences between the study groups were considered at a value of p<0.005. Receiver operating characteristic (ROC) curves, area under ROC (AUROC), sensitivity (SN), and specifi city (SP) were analyzed using MedCalc software (version 16.1).The dissertation was carried out within the framework of researches of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University on the topic: «Improvement of the areas of prognosis, diagnosis and treatment of perinatal pathology in newborns and infants, optimization of the schemes of catamnestic observation and rehabilitation» (State registration number 0115U002768, term of execution 2015-2019) and «Chronobiological and adaptive aspects and features of vegetative regulation in pathological conditions in children of diff erent age groups» (State registration number 0122U002245, term of execution 2020-2024).Results of the study. The burdened background of extragenital and obstetric and gynecological maternal pathology has a signifi cant impact on the risk of severe perinatal pathology in premature infants. A number of factors aff ect the functional state of the intestine, which in connection with the development of perinatal pathology leads to food intolerance. Increased permeability of the intestinal mucosa and violation of its integrity due to local infl ammation cause the translocation of pathogenic and opportunistic microfl ora into the bloodstream. The presence of a local infl ammatory process and exocrine insuffi ciency of the pancreas provokes a disruption of parietal absorption processes. The use of specifi c, sensitive and minimally invasive indicators will allow timely prediction of intestinal dysfunction and development of food intolerance in newborns with perinatal pathology.Conclusions.1. The causes of digestive system disorders in preterm infants under hypoxia is the combined adverse eff ect of extragenital and obstetric- gynaecological pathology in the mother, which leads to the development of perinatal pathology.2. Determination of the criteria for food intolerance in preterm infants with disorders of the functional state of the digestive system will increase the eff ectiveness of diagnostic measures in the postnatal period.