Objective: to identify the dependence of the severity of cerebral disorders in newborns and children of the first year of life on the indicators of blood flow in the utero-placental complex. Materials and methods: a total of 184 full-term newborns were examined in the period from birth to one year of life. The main group included children with cerebral ischemia of II and III severity and its consequences (group II, n=78; group III, n=42). Group I included newborns without signs of central nervous system damage, 14 of them had neurological symptoms by the end of the neonatal period (after a month, group I n =50, group II n =92). All children underwent general clinical examination, assessment of neurological status, ultrasound examination of the brain, transcranial dopplerography of cerebral vessels, electroencephalography. Maternal medical records were analyzed to identify hemodynamic parameters in the "mother-placenta-fetus" system at 12-13, 20-21, 28-32, and 36-40 weeks of gestation. Results: The features of uterine and fetal blood flow in the dynamics of gestation in mothers of the examined groups of children were determined. The associations between the values of Pi AUD, AUS, and AUM in the second and third trimesters of pregnancy in different groups were shown. The relationship between disorders of uteroplacental hemodynamics and the severity of cerebral pathology was revealed. A "method of antenatal prediction of the severity of cerebral disorders in newborns" was proposed. Conclusions: The obtained results make it possible to predict the risk of hypoxic-ischemic damage to the central nervous system in newborns antenatally using hemodynamic parameters in the mother-placenta-fetus system at 36 weeks of gestation.

Background. In recent years erythropoietin has received particular attention due to the discovery of its important non-haematological effects. Erythropoietin is recognized as a pluripotent glycoprotein, manifesting neurotropic and neuroprotective properties as well as participating in angio-, neuro- and oligodendrogenesis, interferes with the effects of hypoxia-ischemia, oxidative stress and associated with them inflammation and apoptosis in the brain. During fetal hypoxia, the dominant production of erythropoietin switches to the placenta, starting its active synthesis to protect the brain, heart and other vital organs from harmful effects of severe hypoxia.Objectives. The study was aimed at determining the correlation between the severity of hypoxic ischemic brain injury and erythropoietin level in the artery and vein of the umbilical cord.Methods. A clinical observational cross-sectional study was conducted on the basis of the Maternity Hospital, Neonatal Pathology and Pediatric Departments №1 and №2 of the Research Institute of Obstetrics and Pediatrics under the auspices of Rostov State Medical University, Russian Federation. The study included 184 newborns with moderate (group II, n = 78) and severe hypoxic ischemic injury of the central nervous system (group III, n = 42). Group I consisted of 64 children without signs of central nervous system injury in the early neonatal period. Among which, following the maternal medical histories, 40 newborns were allocated to the group with the apparent development of delayed manifestation of neurological pathology. The evaluation of erythropoietin concentration in the umbilical cord blood was conducted separately in the artery and vein with Erythropoietin-EIA-BEST, a set of reagents for the enzyme-linked determination of erythropoietin concentration in the blood serum. Statistical analysis was carried out via MS Excel 2019 (Microsoft, USA), Statistica 12.5, (IBM, USA), SPSS27.001.Results. Erythropoietin concentrations in the blood of the artery and vein of the umbilical cord in the groups of newborns were determined according to the severity of hypoxic-ischemic brain injury. The authors of the study showed the correlation between the “maternal-placental-fetal” blood flow at 36–40 weeks of gestation, which parameters are important antenatal predictors of the central nervous system injury, and the values of erythropoietin in arterial and venous umbilical cord blood as diagnostic markers.Conclusion. The severity of cerebral abnormalities is determined by a high level of erythropoietin, while a decrease in erythropoietin level with severe cerebral deficit can mark a disabling injury.

Th is literature review addresses a number of modern concepts of aetiopathogenetic mechanisms in placental dysfunction and their role in development of CNS pathology in the foetus. A complex analysis of literature data has made it possible to understand the complexity and multifaceted nature of placental disorders modulating brain development from the moment of trophoblast implantation. Th e eff ects of prenatal factors on the foetus are limited to the protective function of the placenta retaining the placental reserve. Nevertheless, gestation pathology beginning from embryogenesis defi nes genetic and epigenetic impairments confi rming the concept of the placenta being “the third brain” connected to the maternal brain and the foetus’s developing brain and conditioning the severity of hypoxic-ischaemic injury and the nature of further neurological impairments. Th e review has been written based on analysis of literatures presented in eLIBRARY.RU, Cyberleninka, PubMed, ScienceDirect and Web of Science databases published in 2005-2021 (predominantly within the past 5-7 years) using the following keywords: molecular and genetic predictors, preeclampsia, angiogenesis, neurogenesis, vascular endothelial growth factor and VEGF.

Perinatal pathologies serve as the basis for a great variety of diseases in teenagers and adults including the especially frequent and important diseases of the nervous system which is vulnerable during the period of ante- and early postnatal development, especially against the background of genetic predisposition to it. This leads to development of pathology also manifesting at later stages of life. In this connection, the review presents molecular and genetic predictors of endothelial dysfunction and impairment of angio- and neurogenesis during the perinatal period. The article presents facts related to the influence of endothelial dysfunction as a trigger for pregnancy pathology and fetal-programmed diseases. A discussion regarding the contribution made by the congenital and by the acquired into basic mechanisms of fetal development including the brain and its pathologies

Erythropoietin is recognized as a pluripotent glycoprotein with unique biochemical and epigenetic properties that are important for fetal growth and development, as well as in critical conditions in subsequent periods of ontogenesis. In recent decades, researchers and clinicians have increased interest in the problem of the biological significance of erythropoietin, which can form the basis for constructing algorithms for early prognosis and diagnosis, optimizing the treatment of pathology of the perinatal period, including perinatal hypoxic-ischemic damage to the brain and spinal cord, which are at risk of disability and have a risk of disability significant role in neonatology and perinatal neurology.