DEBATING ISSUES AS TO THE PROGNOSIS AND DIAGNOSIS OF HYPOXIC-ISCHEMIC MYOCARDIAL INJURY BY ASPHYXIA IN NEWBORNS

Abstract

Introduction. Perinatal asphyxia is one of the three most significant causes of neonatal morbidity and mortality in the world. Due to cessation of blood flow and gas exchange, an infant develops hypoxia of tissues and cells which results in failure of many organs, including the heart and kidneys – two major extracerebral target organs. Scientific sources indicate that myocardial injury which occurs in 28-65% and even 73% of infants with asphyxia may have adverse long-term consequences.However, it is quite difficult to diagnose and predict hypoxic-ischemic myocardial injury (HIMI) in the early stages due to the lack of standard diagnostic criteria and sensitive laboratory tests.Over the last decade, there is a growing interest among scientists is searching sensitive biomarkers to reflect the rapid changes taking place in the metabolism of an infant with perinatal asphyxia, and for the purpose of accurate prediction of the severity of injury.The aim of the research is to determine the frequency of HIMI in neonates with asphyxia and identify the early clinical and metabolic markers of development.Materials and methods. A prospective cohort study which included 107 full-term newborns diagnosed with moderate or severe asphyxia was conducted. The first group (n = 90) consisted of infants without HIMI, the second group (n = 17) – infants with HIMI. The biomarkers that may be associated with the development of HIMI have been determined: activity of lactate dehydrogenase (LDH); metabolism of nitric oxide according to total number of anions NO2 ¯ and NO3 ¯ in urine, blood gases, levels of urea, serum glucose in the first days of life.Research results. Out of 107 children included in the study, 19 (17.8%) had diagnostic criteria of HIMI which were significantly lower than the frequency of this pathology, as suggested by other scientists. We believe this is conditioned by low detection of HIMI due to the lack of clear criteria for its diagnosis.