GENDER ASPECTS FOR THE MANAGEMENT OF PERSISTENT PULMONARY HYPERTENSION IN PREMATURE INFANTS

Nowadays, premature birth continues to cause negative long-term consequences for subsequent morbidity and mortality of infants. Underdevelopment of pulmonary vessels on the background of insufficiency of the antioxidant system and diseases of the early neonatal period lead to the development of persistent pulmonary hypertension. Since pulmonary hypertension is a multifaceted pathology that requires a systematic approach to diagnosis and treatment, we considered the gender aspects of the management of persistent pulmonary hypertension in premature infants. The aim of the study: To improve the effectiveness of management of premature infants with persistent pulmonary hypertension with asphyxia and respiratory distress syndrome based on the development of an algorithm for a differentiated approach to the diagnosis and treatment of pulmonary hypertension, taking into account the levels of oxidative stress as determined by the urinary 8-hydroxy-2-deoxyguanosine and gender differences. Material and methods of the study. The study included 100 premature infants born at a gestational age of 26/1–34/6 weeks: group I consisted of 50 children with respiratory distress syndrome, group II - 50 children with respiratory distress syndrome associated with perinatal asphyxia. Group I included 26 boys and 24 girls, group II included 25 boys and 25 girls. All newborns were assessed for the presence and severity of persistent pulmonary hypertension using echocardiography on the first and 3rd-5th days of life, and 44 infants were quantified for the urinary 8-hydroxy-2-deoxyguanosine (ng/ml) by enzyme-linked immunosorbent assay on the first and 3rd-5th days of life. The study was carried out in compliance with the requirements of bioethics within the framework of the planned scientific research work of the Department of Pediatrics №3 and Neonatology of Kharkiv National Medical University (state registration number 0122U000025). Results. Gender differences in pulmonary hypertension were established in premature infants with respiratory distress syndrome: mean pulmonary artery pressure levels were significantly lower in girls in both groups, despite the aggravating effect of perinatal asphyxia. It was determined that in both groups of newborns by the 3rd-5th day of life, the number of cases of mild persistent pulmonary hypertension exceeded that in girls, which was observed due to a higher proportion of cases of moderate and severe persistent pulmonary hypertension in boys. According to the results of the analysis of cases of complications of the neonatal period, there were a greater number of episodes of bronchopulmonary dysplasia, intraventricular hemorrhages of grade II-IV, retinopathy of prematurity of stages I-III, hearing impairment (test not passed), anemia of prematurity, hypoxic-ischemic encephalopathy stages II-III in premature boys of both groups. A correlation was found between the content of urinary 8-hydroxy-2-deoxyguanosine as a biomarker of oxidative stress in premature infants and mean pulmonary artery pressure on the first and 3rd-5th day of life. Levels of urinary 8-hydroxy-2-deoxyguanosine on the 3rd-5th day of life were significantly higher in boys of both groups. The created algorithm of a differentiated approach to the management of persistent pulmonary hypertension includes the calculated diagnostic coefficient of the male sex (I=1.04) as a predictor of the development of severe pulmonary hypertension by the 3rd-5th day of life. Conclusions. 1. On the first day of life moderate and severe persistent pulmonary hypertension occurs in premature boys 3 times more often than in girls in the early neonatal period, and on the 3rd-5th day of life - 4 times more often. 2. Perinatal asphyxia complicates the course of persistent pulmonary hypertension in infants with respiratory distress syndrome to a greater extent in prematurely born boys, which is associated with the peculiarities of compensation for the effects of oxidative stress at birth. 3. In the developed algorithm of a differentiated approach to the management of persistent pulmonary hypertension, it should be taken into account that the diagnostic coefficient in male newborns is I=1.04, and is a predictor of the development of severe persistent pulmonary hypertension by the 3rd-5th day of life.