DIFFERENTIAL-DIAGNOSTIC CRITERIA OF THE DEGREE OF SEVERITY OF PANCREATIC FUNCTIONAL STATE DISORDERS IN FULL-TERM NEWBORNS WITH PERINATAL PATHOLOGY

Objective – to determine diff erential- diagnostic criteria of pancreatic functional statedisorders in full-term newborns depending on degree of severity of perinatal pathology.Material and methods. Two hundred fi ve full-term newborns were examinedcomprehensively. І group included 82 infants with the signs of severe perinatal pathology,ІІ group included 73 infants with manifestations of maladaptation syndromes of moderateseverity, ІІІ group included 50 healthy neonates.Inclusion criteria: gestation age more than 37 weeks; clinical- paraclinical manifestationsof multiple organ dysfunction syndrome and maladaptation syndromes at birth and/orduring the early neonatal period; parental consent on participation of their child in theresearch. Exclusion criteria: gestation age less than 37 weeks; congenital malformations;low body weight (size) at birth; signs of infectious processes.Biochemical markers of pancreatic dysfunction (activity of amylase, lipase and trypsin,insulin level) were determined in the blood of infants on the 1-3rd days of their life, fecalelastase-1 level in meconium was determined on the 1-3rd days of their life. Laboratoryexaminations were carried out on the base of the clinical laboratory of the MunicipalNon- Profi t Institution «Municipal Clinical Maternity Home № 2» of Chernivtsi MunicipalGovernment, German- Ukrainian laboratory «Bukintermed» (Chernivtsi).The study was carried out in compliance with the Rules of Ethical Principles of ConductingScientifi c Medical Research with Human Participation.The licensed programs Statistica (StatSoft Inc., Version 7) and MedCalc Software Ltd(Version 22.021) were applied to calculate statistical results.Results. The total frequency of pathological symptoms from the gastrointestinal tractwas found to be statistically signifi cantly higher in full-term infants with the signs ofsevere perinatal pathology as compared to infants with the signs of moderate perinatalpathology (86.6 and 35.6 %, respectively, р < 0.0001).The most signifi cant diagnostic tests to fi nd disorders of the pancreatic functional state in infantswith the signs of maladaptation syndromes of moderate severity are amylase activity in the blood(threshold value > 0.21 μmol/L*s; AUROC 0.857 (95 % CІ 0.745; 0.933, р < 0.001); sensitivity74.19 %; specifi city 90.32 %) and insulin level in the blood (threshold value ≤ 0.87 μU/ml;AUROC 0.999 (95 % CІ 0.939; 1.0, р < 0.0001); sensitivity 100.0 %; specifi city 96.77 %).The most signifi cant diagnostic tests to diagnose pancreatic dysfunction in neonates withsevere perinatal pathology are those to determine amylase activity in the blood (thresholdvalue > 0.52 μmol/L*s; AUROC 0.64 (95 % CІ 0.512; 0.754, р = 0.0401); sensitivity 25.71 %;specifi city 100.0 %); lipase activity in the blood (threshold value < 0.31 μmol/L*s; AUROC0.706 (95 % CІ 0.581; 0.812, р = 0,0012); sensitivity 71.43 %; specifi city 64.52 %); trypsinactivity in the blood (threshold value > 476 μg/L; AUROC 0.767 (95 % CІ 0.647; 0.862,р < 0.0001); sensitivity 62.86 %; specifi city 100.0 %); insulin level in the blood (thresholdvalue > 0.87 μU/ml; AUROC 0.971 (95 % CІ 0.897; 0.997, р < 0.0001); sensitivity 94.29 %;specifi city 100.0 %); fecal elastase-1 level in meconium (threshold value > 208 μU/ml;AUROC 0.694 (95 % CІ 0.568; 0.802, р = 0.0038); sensitivity 51.43 %; specifi city 93.55 %).Conclusions. Formation of perinatal pathology manifestations in full-term neonates inthe early neonatal period is associated with dysfunctions of a multicomponent digestivesystem. In order to timely diagnose disorders of the pancreatic functional state in infantsdepending on the degree of severity of perinatal pathology the threshold values ofbiochemical markers in the blood (activity of amylase, lipase and trypsin, insulin level)and in meconium (fecal elastase-1 level) can be used.