INFLAMMATORY CYTOKINES (IL-6, TNF-α) AS A PROGNOSTIC FACTOR IN THE SEVERITY OF BRAIN DAMAGE IN NEWBORNS

Introduction. Hypoxic-ischemic encephalopathy (HIE) of newborn infants leads to unfavorable long-term consequences and violates the quality of life of the child and the whole family.Objective. Establish the connection between the level of proinflammatory cytokines studied in the first week of life of children with HIE, and the remote adverse consequences.Materials and methods. Under observation, there were 40 full-term newborns with HIE. The average gestation period was 39.1 ± 1.9 weeks gestation. Weight at birth was 3290 ±454 g, height 51.6 ±2.96 cm. The control group consisted of 20 virtually healthy newborns. At the age of 3 days, samples of blood were obtained, in which the content of interleukins was studied by solid-phase immunoassay using the ProKon firmware sets. The state of health was estimated at the age of 12 months. The remote adverse consequences of HIE were considered by children's cerebral palsy, delayed psychomotor development, hydrocephalus, episride.Results. All children were born in the state of asphyxia from pregnancy, which had a pathological course and received emergency care in accordance with modern protocol recommendations. According to the results of catamnestic observation, it was determined that at the age of 12 months, 14 children were assigned social assistance in disability, which was 35 %. The causes of disability were cerebrospinalemia in 9 children (22.5 %), hydrocephalus - 3 children (7.5 %), episride - 2 children (5 %). 8 children in the first year of life had a delay in psychomotor development and motor disorders, accounting for 20 % of children with HIE. The development of the remaining 18 (45 %) patients in the main group occurred in accordance with physiological patterns and at the age of 12 months they had no adverse effects of HIE. Indicator interleukin-6 (IL-6) in newborns with HIE was 76.32 ± 20.3 ng/l and significantly exceeded the values of this cytokine in the control group (p<0.05). Tumor necrosis factor - α (TNF-α) was 336.37 ± 79.3 ng/l, which is significantly higher than healthy newborns (p <0.05). Further analysis of cytokine parameters was performed in groups of children formed according to the effects of HIE. The content of IL-6 in children with disabilities was 3 times higher than in children with HIE without adverse long-term consequences. The TNF-α index in these groups was higher by 30 %. The analysis of the specificity and sensitivity of the indicator of serum IL-6 content in the early neonatal period to predict the adverse long-term effects of HIE using ROC curves showed that the AUC area under the ROC curve was 0.759 [95 % CI 0.579-0.939]. The cut-off point is 27.8 ng/l (sensitivity 73.3 %, specificity 72.2 %).Conclusions. HIE in newborns leads to adverse long-term effects in 35 % of children 12 months of age. There was established a connection between the level of proinflammatory cytokines examined in the first week of life of termedated children with HIE and the consequences of brain damage at the age of 12 months. Thus, IL-6 was 3 times higher than in children with HIE without adverse long-term consequences. The TNF-α score in this group was higher by 30 %. Indicators correlate with the estimate for Apgar at birth, duration of mechanical ventilation and oxygen therapy. Indicator of serum IL-6 content in the early neonatal period is sensitive (73.3 %) and a specific (72.2 %) marker in predicting adverse long-term effects of HIE.