ІНТЕГРОВАНА МОДЕЛЬ ПРЕДИКЦІЇ РОЗВИТКУ ОРГАННИХ ДИСФУНКЦІЙ У НОВОНАРОДЖЕНИХ З АСФІКСІЄЮ ТА ПРИКЛАДНІ ТОЧКИ ЇЇ ЗАСТОСУВАННЯ

Relevance of the research. The causes of asphyxia are well known, but the debates about the importance of antenatal and intranatal factors in its development are still ongoing. Identification of clear predictors for the development of the dysfunction in vital and non-vital organs will improve the existing algorithms for monitoring neonates who are subject to hypoxia/asphyxia, and will enable the doctors to make decisions on the timely use of personalized therapeutic and diagnostic measures aimed at reducing mortality, morbidity, childhood disability and enhancing the quality of their life. The aims of the research are substantiation and development of the integrated model for prediction of organ dysfunctions, and improvement of the algorithm for monitoring newborns with asphyxia in the early neonatal period. Materials and methods. The study included 72 full-term infants with asphyxia and 35 healthy newbornswho were born at the perinatal centre of M.V. Sklifosovsky Poltava Regional Clinical Hospital and Poltava City Clinical Maternity Hospital in 2011-2013. We studied the associations between the development of organ dysfunction and risk factors characterizing the somatic, obstetric, antenatal/intranatal history of the mother, the condition of the infant, the volume of primary resuscitation, as well as the metabolic, inflammatory and vascular biomarkers. The prediction of lesions of organs and systems of the newborn is considered from the point of view of pathophysiological mechanisms of circulatory and non-circulatory adaptation reactions in newborns with asphyxia, when against the background of increased cerebral, coronary and adrenal blood flow, there is a decrease in perfusion in the kidneys, lungs, gastrointestinal tract, liver and their dysfunctions. Results of the research. The proposed integrated model for the prediction of lesions of vital and non-vital organs demonstrates the insignificant role of ante and intranatal factors in the prognosis of multiorgan dysfunction development. It was determined that the prognostic model for the development of hypoxic and ischemic encephalopathy, which includes poor uterine contraction strength (odds ratio 13.2), administering 0.9% solution of sodium chloride during primary intensive care (OR 9.2), LDH level >1700 units/l (OR 7.4) and creatinine>110 mmol/l (OR 15.9) for 1 day of life has an area under the ROC curve of 0.8711. The development of myocardial dysfunction is reliably associated with glucose levels 7.0 mmol/l (OR 21.3) and NO2¯+ NO3¯ <21 mmol/l in urine (OR 15.2) and the prognostic model of its development has an area under the ROC curve of 0.8368. The prognostic models for the development of lesions of non-vital organs, in particular, the dysfunction of the gastrointestinal tract (Apgar score of <5 points on the 5th min., administering 4% NaHCO3 solution during the course of reanimation measures, glucose level <3.3 mmol/l, urea <6.0 mmol/l) and acute myocardial infarction (Apgar score <4 points on the 5th min. of life, meconial aspiration), have the corresponding areas under the ROC curves − 0.8424 and 0.8054. Taking into account the pathophysiological mechanisms of organ dysfunction development in newborns with asphyxia, 4 possible clinical scenarios were suggested for the aforementioned disease, which allow to assume the time hypoxic / asphyxial episode. The algorithm for monitoring infants with possible or present hypoxic episode has been improved, in particular, if a child has at least one of the following symptoms: sentinel event, Apgar score less than 7 points on the 5th min. of life, pH of umbilical cord blood less than 7.25, use of artificial lung ventilation during resuscitation. In addition to the recommendations provided by the Order of the Ministry of Healthcare No. 255 as of 2014, it is advisable to prescribe the following studies: complete blood count, blood glucose level, creatinine, urea in blood serum at the obstetrical inpatient establishments of the 2nd level, and in addition to the abovesaid − NO2¯ + NO3¯ in the urine − for obstetric hospitals of the 3rd level. Conclusions. The integrated model for the prediction of organ dysfunctions development in newborns with asphyxia has been substantiated; the applied points of its implementation have been determined; and the algorithm for monitoring the newborns with a score less than 7 points on the 5th min. of life has been suggested.