FUNCTIONAL STATE OF THE HEPATOBILIARY SYSTEM IN NEWBORNS OF GESTATIONAL AGE LESS THAN 32 WEEKS IN PATHOLOGICAL CONDITIONS OF THE NEONATAL PERIOD

In recent years, Ukraine has seen an increase in the incidence of premature births andbirths of children with severe forms of perinatal pathology. The presence of morphologicaland functional immaturity at birth is a signifi cant cause of metabolic disorders in the body,causing dysfunctional changes in major organ systems, including the hepatobiliary system.The aim – to study the peculiarities of the functional state of the hepatobiliary system andthe main pathophysiological mechanisms of its dysfunction, taking into account a set ofgenerally accepted methods for the study of biochemical blood parameters in children ofgestational age at birth less than 32 weeks.Materials and methods of the study. A comprehensive clinical and laboratory evaluation wasperformed on 54 preterm infants with a gestational age of less than 32 weeks; the comparisongroup consisted of 50 conditionally healthy infants born at 34-36/6 weeks. Inclusion criteriawere: gestational age at birth less than 32 weeks, presence of clinical signs of perinatalpathology; exclusion criteria were: gestational age at birth greater than 32 weeks, congenitalmalformations diagnosed antenatally and postnatally. The list of biochemical studies of newbornserum: total protein, bilirubin and its fractions; glucose, urea, cholesterol, triglycerides; lactatedehydrogenase, alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase,γ-glutamyltransferase (ALT, AST, LDH, ALP and GGT) activity. Biochemical studies wereperformed using a semi-automatic biochemical analyzer Microlab 300 (Vital Scientifi c N. V.,the Netherlands) and reagents from ELITech Clinical System (France) at the biochemicallaboratories of obstetric institutions. Informed consent was obtained from the parents ofnewborns with an explanation of the main purpose, objectives and methods of the study.Statistical processing of the study results was performed on a PC using the Statistica softwarepackage (StatSoft Inc., StatSoft Inc., Version 13.0, USA) and Microsoft Excel (2010), MicrosoftOffi ce (2010). The study was performed as part of the research work of the Department ofPaediatrics, Neonatology and Perinatal Medicine of Bukovinian State Medical University.Results. Somatic, obstetric and gynecological anamnesis and clinical features of adaptation ofchildren with gestational age less than 32 weeks were studied. On the basis of a set of clinicaland laboratory parameters, the characteristics of the functional state of the hepatobiliary systemin the complex of multiple organ failure syndrome under hypoxia in perinatal pathology weredetermined, the main pathophysiological mechanisms of the development of disorders werestudied. On the basis of the obtained data, the clinical signs of hepatobiliary system dysfunctionare summarized, and a list of necessary laboratory tests based on biochemical analysis of bloodserum is proposed. It is noted that the main pathophysiological mechanisms of hepatobiliarysystem disorders in premature infants are the syndrome of cytolysis, cholestasis, and mesenchymalinfl ammatory reaction, which is confi rmed by the results of the study, which requires appropriatecorrection of therapeutic interventions in the presence of multiple organ failure syndrome.Conclusions. 1. Dysfunction of hepatobiliary system in the complex of multiple organ failuresyndrome in premature infants with gestational age less than 32 weeks should be diagnosedin time for timely correction of homeostatic disorders in conditions of hypoxia and deepmorphological and functional immaturity of the organism. 2. Clinical manifestations ofhepatobiliary dysfunction in preterm infants include: enlarged liver or hepatoliver syndrome,fl atulence, edema, jaundice, acholic stools, hemorrhagic manifestations, including bleedingfrom the gastrointestinal tract. 3. Laboratory criteria indicating a violation of the functionalstate of the hepatobiliary system in the complex of multiple organ failure syndrome withhypoxic damage in premature infants are: decreased levels of total protein, glucose andtriglycerides; increased levels of bilirubin, urea creatinine and cholesterol; increasedenzymatic activity of ALT, AST, LDH, ALP and GGT. 4. Diagnosis of disorders of thefunctional state of the hepatobiliary system should consider the results of a comprehensiveclinical and laboratory examination with the determination of the main pathophysiologicalmechanisms of disorders to ensure appropriate correction of treatment measures.