Characteristics of the period of early adaptation and key predictors of its complicated course in underweight and small for gestational age newborns

Abstract

Objective. To assess the characteristics of early neonatal adaptation in underweight and small for gestational age newborns and to determine the key predictors of its complicated course.Materials and methods. The study was conducted at the Republican Scientific and Practical Center “Mother and Child” and included a group of 115 full-term newborns. The main group consisted of 77 newborns with low body mass index (BMI) at birth, among whom 2 subgroups were distinguished: study group 1 (Gr1) ‒ 52 underweight and small for gestational age newborns with adaptation disorders, study group 2 (Gr2) ‒ 25 newborns without signs of maladaptation. Lipid status indicators, levels of adipokines and vitamin D were studied in mother-child dyads. To control the correct operation of the identified predictors and the regression model, an examination sample including 38 underweight newborns was studied.Results. Maternal history of placental insufficiency, fetal growth retardation, and hypertensive disorders was associated with a significant increase in the risk of maladaptation in the early neonatal per (p = 0.036, p < 0.001, and p = 0.029, respectively). Pregravid body weight and BMI of the Gr1 women were significantly higher (p = 0.026 and p = 0.035). It has been found that the most significant quantitative neonatal factors associated with the risk of maladaptation in underweight for gestational age newborns, were gestational age (p = 0.002), z-score BW at birth (p=0.003), mean corpuscular volume erythrocyte (p = 0.001), cord blood leptin level (p = 0.033). A multifactor model has been developed to determine the probability of a complicated course of the early neonatal period in underweight for gestational age newborns. AUC = 0.95 ± 0.025 (0.902–0.998), p < 0.001. A high degree of reproducibility of the developed model was established on the examination sample of underweight newborns.Conclusion. The search for objective criteria for the development of neonatal maladaptation is an important and complex task of modern neonatology. A comprehensive assessment of the totality of ante-, intraand postnatal predictors has a high accuracy in predicting the likelihood of a complicated course of the neonatal period.