Introduction. Post-asphyxia syndrome in newborn infants due to experienced intrauterine hypoxia and asphyxia at birth remains a relevant issue in neonatology. The intestines and glands of internal and external secretion are target organs of pathologic hypoxic influence. Their ischemic damage can be a cause of digestive disorders against the background of multiple organ damage of a newborn child.
Objective of this study is to determine peculiarities of the exocrine secretory functions of the pancreas in full-term neonates with perinatal pathology.
Material and methods. One hundred fifty five Full-term neonates with the signs of perinatal pathology were examined. I group included 82 neonates with severe perinatal pathology, II group – 73 moderate pathology, 50 healthy infants constitute III control group.
Inclusion criteria were gestational age more than 37 full weeks, clinical-paraclinical signs of maladjustment syndrome at birth and/or during the early neonatal period, parents’ written consent to participate in the study. Exclusion criteria were gestational age less than 37 full weeks; congenital defects; low body weight (size) at birth; signs of infectious processes.
Clinical examination of patients and biochemical blood tests were carried out on the base of the clinical laboratory of the Municipal Non-Profit Institution «Municipal Clinical Maternity Home №2» of Chernivtsi Municipal Council, and German-Ukrainian laboratory «Bukintermed» (Chernivtsi).
The study was conducted in accordance with the 'Rules of Ethical Principles of Conducting Scientific Medical Research with Human Participation,' approved by the Declaration of Helsinki (1964-2013), ICH GCP (1996), EU Directive No. 609 (24.11.1986), the Order of the Ministry of Health of Ukraine No. 690 (23.09.2009), and the approval of the Biomedical Ethics Board of Bukovinian State Medical University.
For statistical analysis, licensed software programs were used, including Statistica (StatSoft Inc., Version 7), Microsoft Excel (AtteStat, Version 12.5), and MedCalc Software Ltd (Version 22.021).
Results and discussion. The examination groups were representative according to their gestational age and anthropometric parameters at birth, and gender characteristics.
A comprehensive clinical-paraclinical examination of infants showed that severe disorders of infants in I group were caused by the signs of severe (13.4 %) and moderate (13.4 %) asphyxia at birth, meconium aspiration syndrome (20.7 %), severe respiratory disorders (53.6 %), hypoxic-ischemic damage of the central nervous system (39.0 %), convulsive syndrome (13.4 %), birth trauma (7.3 %) etc. Moderate maladjustment in infants from II group were associated with the signs of perinatal damage of the central nervous system (65.8 %), hemolytic diseases of the newborns (27.4 %), neonatal jaundice (28.8 %), respiratory disorders (35.6 %) etc. The condition of neonates from ІІІ group was satisfactory during the period of early postnatal adaptation.
The results of additional examination methods found certain peculiarities of the exocrine secretory function of the pancreas in full-term neonates with perinatal pathology. Thus, blood amylase activity in the first day of life in the infants from І group was 0.39 ± 0.03 Un/L, ІІ group – 0.29±0.02 Un/L, ІІІ group – 0.14±0,01 Un/L (рІ-ІІ = 0.016, рІ-ІІІ < 0.0001, рІІ-ІІІ < 0.0001). According to the examination group, activity of the enzyme in the blood of infants at the end of their first week of life was 17.8 ± 0.81, 15.28 ± 0.22 and 14.81±0.06 Un/L respectively (рІ-ІІ = 0.006, рІ-ІІІ = 0.009, рІІ-ІІІ = 0.0435). The study found similar tendencies in changes of lipase activity in the blood of full-term infants. During the first day of life it was 0.35±0.01 Un/L in I group, ІІ group – 0.31±0.01 Un/L, ІІІ group – 0.32 ± 0.01 Un/L (рІ-ІІ = 0.003, рІ-ІІІ = 0.01, рІІ-ІІІ > 0.05). Activity of the enzyme in the blood of infants at the end of their first week of life was 19.7±0.22, 19.1±0.13 and 18.9±0.37 Un/L respectively (рІ-ІІ = 0.021, рІ-ІІІ > 0.05, рІІ-ІІІ > 0.05).
Conclusion. The results obtained were indicative of a reliable increase of amylase and lipase activity in the blood of full-term neonates in all the examination groups in the dynamics of observation. It is associated with physiological stimulation of the exocrine secretory function of the pancreas in the early neonatal period. Attention should be paid to a direct correlation between an increased activity of the enzymes and severity of perinatal pathology both in the first day of life and at the end of the first week. It can be indicative of an excessive activation of pancreatic function due to pathologic hypoxic damage.
