EVALUATION OF CLINICAL AND LABORATORY MARKERS OF NUTRITIONAL DEFICIENCY IN NEWBORNS WITH A GESTATIONAL AGE OF 34-36/6 WEEKS IN SEVERE FORMS OF PERINATAL PATHOLOGY

Clinical and laboratory indicators of impaired nutritional tolerance in preterm infants are a pressing issue in neonatology that requires scientific research. In-depth diagnosis and correction of nutritional deficiency in perinatal pathology will improve approaches to providing care to newborns during their adaptation to extrauterine life and prevent the development of functional and chronic pathology in later years of life. Aim –to study the risk factors and clinical- laboratory signs of nutritional deficiency in newborns with a gestational age of 34-36/6 weeks in severe forms of perinatal pathology. Materials and methods. An analysis of risk factors and clinical- laboratory indicators of nutritional deficiency in perinatal pathology was conducted in 41 preterm infants with a gestational age of 34 to 36/6 weeks (Group I) compared to a control group of 50 newborns of the same gestational age (Group II). The inclusion criteria for Group I were: severe forms of perinatal pathology, including signs of nutritional deficiency, and parental informed consent for the child’s participation in the study. Exclusion criteria were: congenital malformations and lack of parental informed consent for the child’s participation in the study. Nosological diagnoses were established in accordance with ICD-10 recommendations. Analysis of blood biochemical parameters and co-profiltrate was performed using generally accepted and specialized research methods. The study utilized the resources of the German- Ukrainian Laboratory «BUKINTERMED» with the support of the Cottbus Public Laboratory of Medicine, Microbiology, and Infectious Epidemiology, Cottbus, Germany. The research was conducted in compliance with the main provisions of GCP (1996), the Convention of the Council of Europe on Human Rights and Biomedicine (1997), the Helsinki Declaration of the World Medical Association on Ethical Principles for Medical Research Involving Human Subjects (1964-2008), and Order No. 690 of the Ministry of Health of Ukraine dated 23.09.2009 (as amended by Order No. 523 of the Ministry of Health of Ukraine dated 12.07.2012). Approval was obtained from the Bioethics Commission of Bukovinian State Medical University (Protocol No. 2 dated 09.02.2015). Statistical analysis of the data was performed using the «Statistica» software (StatSoft Inc., Version 13.0, USA). Statistical values were determined taking into account the standard deviation (S), standard error (m), and arithmetic mean (M), using the Shapiro- Wilk test (normal distribution for sample sizes greater than 30, p<0.05) and the Kolmogorov- Smirnov test. Quantitative indicators in samples with normal distribution were assessed using the Student’s t-test, and statistical significance of the results was determined at p<0.0001. Results. The conducted studies have showen that digestive dysfunction in preterm infants has a complex nature and is caused by combined dysfunction of the hepatobiliary system, pancreas, and intestine. The basis of the pathophysiological mechanisms is hypoxic inflammation against the background of morpho- functional immaturity of the body, accompanied by imperfect regulatory systems. Clinical manifestations of nutritional deficiency in newborns include: residual volume greater than 50%, regurgitation and vomiting, hepatomegaly and hepatolienal syndrome, flatulence, presence of blood residues in co-profiltrate, acholic stools, jaundice, edema, and signs of endotoxicosis. Laboratory indicators directly or indirectly confirming the presence of nutritional deficiency include: from the hepatobiliary system – increased activity of ALT, AST, and LDH (cytolysis syndrome), activity of GGT and ALP, levels of cholesterol and bilirubin (cholestasis syndrome), decreased levels of total protein and increased levels of cholesterol (cholestasis syndrome and hepatocellular insufficiency syndrome); from the pancreas – decreased levels of amylase, lipase, trypsin, and leucine aminopeptidase (exocrine insufficiency); from the intestine – increased levels of calprotectin, albumin, α-1-antitrypsin, and fecal elastase-1; decreased levels of PMN-elastase (inflammation and increased permeability of the intestinal mucosa). Conclusions. 1. Nutritional deficiency in preterm infants with perinatal pathology is caused by combined dysfunction of the hepatobiliary system, pancreas, and intestine, requiring comprehensive examination from birth. 2. Impaired functional state of the gastrointestinal system in preterm infants is a manifestation of general body dysfunction under conditions of hypoxia and morpho- functional immaturity during adaptation to extrauterine existence. 3. Evaluation of clinical and paraclinical signs of nutritional deficiency in newborns should be comprehensive, analyzing both conventional biochemical blood parameters and specialized indicators that have shown significance, including at the level of preclinical manifestations of pathology.