PREDICTING NEURO-MENTAL DEVELOPMENT DELAY IN INFANTS WITH HYPOXIC-ISCHEMIC ENCEPHALOPATHY BORN FROM MOTHERS WITH METABOLIC SYNDROME

Among neonates, 2 per 1,000 experience hypoxia/ischemia at birth, resulting in hypoxic-ischemic encephalopathy (HIE) and subsequent neurodevelopmental disorders, which impose a lifelong burden on families and society. Infants with stage 3 HIE exhibit a high incidence of convulsive syndrome and severe neurodevelopmental delay. Even in the absence of profound impairments, affected children may present with motor, cognitive, or behavioral abnormalities. The aim of our study was to analyze and identify maternal and neonatal risk factors associated with psychomotor developmental delay. Materials and methods of the study. The study enrolled 45 infants born to mothers with metabolic syndrome who were diagnosed with moderate or severe HIE in the early neonatal period; among them, 30 were preterm and 15 were full-term. Follow-up of infants continued until 9 months of age; сontinued observation was possible in 27 (17 preterm, 10 full-term) of the 45 infants diagnosed with moderate or severe HIE. Statistical analysis was performed using standard descriptive methods and simple and multiple logistic regression, including Poisson regression. The predictive value of maternal history, metabolic parameters, and other variables was evaluated using receiver operating characteristic (ROC) curve analysis with calculation of the area under the curve (AUC) in STATA 14.0. According to the decision of the Bioethics Commission of Poltava State Medical University No. 217 dated 12.06.2023, the study adhered to ethical standards for the humane treatment of patients, as defined by the Tokyo Declaration of the World Medical Association, the Helsinki Declaration, the Universal Declaration of Human Rights, the Council of Europe Convention on Human Rights and Biomedicine, current Ukrainian legislation, orders of the Ministry of Health, and the Code of Ethics for Physicians of Ukraine. Informed consent was obtained from all parents. The study was conducted as part of the scientific research project of the Department of Pediatrics No. 1 with Neonatology, Poltava State Medical University, No. 0120U102856: “Development of clinical and laboratory criteria and methods for predicting and preventing metabolic disorders in young children.” Research results. Most infants included in the study were diagnosed with moderate asphyxia at birth. The Apgar scores at 1 and 5 minutes were 5.83 ± 0.23 and 6.7 ± 0.14 points, respectively, in preterm infants, and 5.8 ± 0.52 and 7.2 ± 0.34 points in full-term infants. Mechanical ventilation was required immediately after birth in 16.7% of preterm infants with HIE and 46.7% of full-term infants; the duration of mechanical ventilation was 4.26 ± 0.7 days in preterm infants and 5.47 ± 1.26 days in full-term infants. The most common neurological conditions at 9 months of age were hypoxic-ischemic CNS injury and psychomotor delay. The frequency of hypoxic-ischemic CNS injury was 88.2% in preterm infants and 60% among full-term infants. The incidence of psychomotor delay was 20.0% in preterm infants and 17.6% in full-term infants. Multivariate logistic regression analysis, adjusted for gestational age at birth, was used to develop predictive models for psychomotor delay. The Apgar score and duration of mechanical ventilation were identified as the strongest prognostic factors. . The predictive model including the duration of mechanical ventilation demonstrated a reliable predictive coefficient (β = 0.31; 95% CI, 0.11–0.50) with an area under the ROC curve of 0.9180. Conclusion. Approximately 20% of infants with HIE, both preterm and full-term, exhibited delayed neurodevelopment at 9 months of age. Multivariate logistic analysis identified low Apgar scores and prolonged mechanical ventilation as the most significant prognostic factors, with the predictive model incorporating ventilation duration demonstrating the highest predictive accuracy. These findings highlight the need to optimize medical monitoring and follow-up of infants with HIE born to mothers with metabolic syndrome.