DIAGNOSTIC VALUE OF PANCREATIC DYSFUCNTION MARKERS IN CRITICALLY ILL FULL-TERM NEONATES

The data of modern scientific literature and the results of clinical studies indicate that stress-induced disorders of the digestive system in newborns are associated with immaturity of digestion and absorption processes, as well as gastrointestinal motility. Hypoxic damage to the body is accompanied not only by intestinal dysfunction, but also leads to the involvement of other digestive organs, such as the hepatobiliary system and pancreas, in the pathological process. The aim of this study was to evaluate the diagnostic value of serum markers of pancreatic dysfunction in critically ill term neonates. Materials and methods of the study. In the course of the study, 66 full-term newborns were subjected to a comprehensive clinical and paraclinical examination, of which 35 patients with manifestations of severe perinatal pathology formed the main study group (group I), and 31 healthy children formed the control group (group II). The activity of amylase, lipase, trypsin, leucine aminopeptidase and insulin levels were determined in the umbilical cord blood of the newborns in the German-Ukrainian laboratory "Bukintermed" (Chernivtsi, Ukraine, Cottbus, Germany). The study was conducted in accordance with the rules of ethical principles of scientific medical research on human subjects approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EEC Directive 609 (24.11.1986), Order of the Ministry of Health of Ukraine No. 690 from 23.09.2009 and confirmed by the conclusion of the Commission for Biomedical Ethics of the Bukovinian State Medical University. For statistical analysis of the results, we used the licensed programs Statistica (StatSoft Inc., Version 7) and MedCalc Software Ltd (Version 22.021). The study was conducted within the framework of the complex research of the Department of Pediatrics, Neonatology and Perinatal Medicine of the Bukovinian State Medical University on "Improvement of prognosis, diagnostics and treatment of perinatal pathology in newborns and infants, optimization of schemes of catamenial observation and rehabilitation" (state registration number 0115U002768, term 01. 01.01.2015 - 31.12.2019) and "Chronobiological and adaptive aspects and features of vegetative regulation in pathological conditions in children of different age groups" (state registration number 0122U002245, term of execution 01.01.2022 - 31.12.2026). Results of the study. The results obtained showed a statistically significant higher activity of amylase, lipase and trypsin, as well as insulin levels in the cord blood of term infants with severe perinatal pathology compared to healthy children. Thus, the activity of amylase in children of the main group was 0.39 ± 0.03 μmol/l*s, in children of the control group - 0.14 ± 0.01 μmol/l*s, p < 0.0001; lipase activity - 0.35 ± 0.01 and 0. 32 ± 0.01, respectively, p = 0.01; trypsin activity - 574.7 ± 23.1 and 400.8 ± 19.4 μg/l, respectively, p = 0.0001; insulin level - 12.85 ± 1.33 and 2.74 ± 0.2 μU/mL, respectively, p < 0.0001. Leucine aminopeptidase activity was not significantly different between the study groups. The most significant diagnostic tests for the detection of pancreatic dysfunction in term infants with severe perinatal pathology are increased insulin levels at a threshold > 4.7 μU/mL (AUROC 0.9 (CI 0.802; 0.96), p < 0.0001, SN 82.86%, SP 96.77%); increased amylase activity at a threshold > 24 μmol/l*s (AUROC 0.895 (CI 0.702; 0.957), p < 0.0001, SN 74.29%, SP 96.77%). 24 μmol/l*s (AUROC 0.895 (CI 00.795; 0.957), p < 0.0001, SN 74.29 %, SP 96.77 %); increased trypsin activity at a threshold of > 486 μg/l (AUROC 0.762 (CI 0.641; 0. 858), p < 0.0001, SN 62.86%, SP 83.87%); increased lipase activity at a threshold of > 0.35 μmol/L*s (AUROC 0.676 (CI 0.549; 0.786), p = 0.0084, SN 45.71%, SP 87.1%). Conclusion. In umbilical cord blood of term infants with severe perinatal pathology, statistically significant higher activities of amylase, lipase and trypsin as well as insulin levels were found compared to healthy infants. This may indicate stress-induced overactivation of pancreatic functions due to pathological hypoxic damage initiated during fetal development.