Year: 2025
Type: article
Study design: Observational Study
Abstract: The frequency of gastrointestinal system pathology in premature infants (PI) ranges from 33.8% to 53.45%. Premature babies need time for the structural and functional maturation of the digestive system after birth, resulting in insufficient absorption of essential nutrients through enteral feeding. It is important to discuss the pathophysiological mechanisms of digestive dysfunction in children from birth for timely diagnosis, correction of therapeutic measures in the postnatal period, and prevention of functional gastrointestinal disorders in later life. Objective. To analyse clinical and laboratory markers of nutritional deficiency in perinatal pathology in premature infants for the diagnosis of gastrointestinal dysfunction and to clarify the pathophysiological mechanisms of its development. Materials and methods. The total number of newborns included in the study programme was 355 PNDs with a gestational age of 26-36/6 weeks, of which: Group I consisted of 54 children with a gestational age of 26-31/6 weeks and severe condition at birth; Group II consisted of 149 children with a gestational age of 32-33/6 weeks, of which: Subgroup IIA consisted of 67 children with severe forms of perinatal pathology, Subgroup IIB consisted of 82 children with moderate perinatal pathology; Group III consisted of 102 children with a gestational age of 34-36/6 weeks, of which: Subgroup III A – 41 children with clinical forms of severe perinatal pathology, Subgroup III B – 61 children with moderate perinatal pathology; Group IV – 50 conditionally healthy newborns with a gestational age of 34-36/6 weeks. The complex of laboratory tests included a list of blood serum markers that characterise the functional state of the hepatobiliary system and pancreas, as well as coprofilter indicators that show intestinal function. Approved by the Bioethics Committee of Bukovinian State Medical University (Minutes No. 2 of 09.02.2015). Statistical processing of the results was performed on a Pentium MMX CPU personal computer using the Statistica software package (StatSoft Inc., Version 13, USA), Microsoft Excel (2010), Microsoft Office (2010) and MedCalc Software (Version 16.1). The study was conducted as part of the comprehensive research work of the Department of Paediatrics, Neonatology and Perinatal Medicine of the BSMU on the topic: ‘Improvement of forecasting, diagnosis and treatment of perinatal pathology in newborns and young children, optimisation of follow-up observation and rehabilitation schemes’, state registration number 0115U002768; term of implementation 01.2015-12.2019. Results. The severity of the condition in PND was due to hypoxic damage to the body under conditions of morpho-functional immaturity. The following clinical diagnoses were noted: asphyxia, respiratory distress syndrome, primary pulmonary atelectasis, hyaline membrane disease, multiple organ failure syndrome with damage to the central nervous, respiratory, cardiovascular, urinary, and gastrointestinal systems; haemorrhagic, convulsive, and anaemic syndromes. Clinical markers of nutritional deficiency were: residual volume greater than 50%, regurgitation and/or vomiting, enlarged liver or hepatolienal syndrome; intestinal flatulence, blood in the coprofilter, acholic stools, jaundice, and endotoxicosis syndrome. Additional laboratory criteria confirming the presence of nutritional dysfunction and characterising the pathophysiological mechanisms of its formation in newborns are: on the part of the hepatobiliary system - increased levels of AlAT, AsAT, LDH (cytolysis syndrome); increased levels of LF and total bilirubin (cholestasis syndrome); decreased total protein levels, increased cholesterol levels (hepatic cell failure syndrome); on the part of the pancreas - decreased levels of amylase, lipase, trypsin and LAP (decreased exocrine function); intestinal disorders - increased levels of FC, albumin, A1AT, FE-1 and decreased PMN-elastase (local inflammation, insufficient enzyme activity, increased mucosal permeability). The severity and frequency of food tolerance disorders correlated with the severity of perinatal pathology and lower gestational age of newborns. Conclusion: The results of the studies allowed us to substantiate the necessary list of clinical and laboratory indicators that can be used to confirm nutritional deficiency in a complex of signs of perinatal pathology, with the determination of the main components of hepatobiliary system, pancreas and the intestine, as well as the pathophysiological mechanisms of the development of disorders. Understanding this area of organ dysfunction allows for timely correction of therapeutic interventions in the acute phase of diseases, as well as planning appropriate rehabilitation measures and dynamic monitoring of children in the future.
Author: O. Godovanets
Institution: Bukovinian State Medical University
Language: English
Topic: Infant Nutrition and Health
Subfield: Nutrition and Dietetics
Field: Nursing
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4412477759