The study of gastrointestinal distress markers in children of gestational age less than 32 weeks with pathological conditions of the newborn period

Abstract

Background. Feeding intolerance in preterm infants is currently one of the most common clinical problems in neonates, causing a delay in complete enteral absorption of food components and may lead to prolonged hospitalization.  Prevention and control of nutritional deficiencies in children play an important role in improving the survival rates of premature babies.

Aim. To study the clinical and paraclinical features of food intolerance in premature babies under 32 weeks of gestation in perinatal pathology.

Materials and Methods. Clinical and paraclinical features of gastrointestinal disorders in perinatal pathology were analyzed in 54 severely preterm infants (group 1); the control group included 50 conditionally healthy newborns at 34–36/6 weeks gestational age (group 2). Laboratory tests included a biochemical analysis of blood serum, which characterizes the functional state of the hepatobiliary system and pancreas, as well as coprofiltrate parameters. Statistical analysis of the data was carried out using Statistica 13.0 (StatSoft Inc., USA). Quantitative values in samples with normal distribution were assessed using Student's t-test, with statistical significance p<0.0001. Approval of the Bioethics Commission of the Bukovinian State Medical University (Protocol No.2 on February 9, 2015).

Results. The clinical criteria for nutritional deficiency, which have shown their significance in the course of studies in newborns, are as follows: residual gastric volume greater than 50%, regurgitation and vomiting, enlarged liver, including hepatolienal syndrome; flatulence, blood in coprofiltrate, acholic stools, jaundice, edema, endotoxemia. The detected changes in blood chemistry parameters confirming enteral nutrition deficiency included: increased levels of Alanine Aminotransferase, Aspartate Aminotransferase and Lactate Dehydrogenase (cytolysis syndrome), Gamma-glutamyl Transferase, Alkaline Phosphatase and Bilirubin (cholestasis syndrome); decreased levels of Total Protein with increased levels of Cholesterol (liver and cell failure syndrome); low levels of Amylase, Lipase, Trypsin, and Leucine Aminopeptidase (pancreatic dysfunction); high levels of Calprotectin, Albumin, Alpha-1-Antitrypsin, and Faecal Elastase-1; decreased levels of PMN Elastase (inflammation of the intestinal mucosa).

Conclusions. Our findings demonstrate that the use of  set of clinical and laboratory parameters allows early diagnosis of food intolerance in preterm infants, which enables appropriate correction of treatment in perinatal pathology.

Keywords: preterm infants, food tolerance disorders, clinical and laboratory diagnostics.

Archived: https://doi.org/10.5281/zenodo.15170574