NEW DEFINITIONS IN THE MANAGEMENT OF NEONATES WITH OXIDATIVE STRESS DISEASES

Abstract

Introduction. The problem of premature infants’ management remains extremely relevant and has acute medical, social and economic significance. Tissue damage due to oxidative stress is an important pathogenetic factor in the leading diseases among premature infants. Сorrection of the antioxidant status of a newborn is one of the promising areas in the therapeutic approach to oxidative stress diseases. While searching for some safe and effective medications, researchers pay great attention to melatonin, a neurohormone secreted by the pineal gland, which has an outstanding antioxidant and anti-inflammatory effect. The aim of the work is to analyze current data on the ontogenesis of the pineal gland, the world experience of melatonin therapy for the etiopathogenetic justification of the use of melatonin in the management of newborns with perinatal pathology and to highlight problems and prospects. Results. Reactivity and adaptability of the pineal gland is an important link in the compensation of perinatal pathology. Formation of neuroendocrine functional activity of the pineal gland occurs postnatally, so the fetus totally depends on transplacental melatonin. Premature infants have a significant delay in the rhythmic production of melatonin and its significant deficiency compared with fullterm newborns, in addition, the existence of desynchronosis in neonates with perinatal pathology and premature babies is a proven fact. Current scientific data on the use of exogenous melatonin as an antioxidant replacement therapy for oxidative stress diseases in premature infants is quite reasonable and promising. Numerous studies have proven the effectiveness of melatonin in the treatment of perinatal pathology such as hypoxic brain injury, respiratory distress syndrome, bronchopulmonary dysplasia, retinopathy of prematurity, neonatal sepsis and usage of melatonin as an antenatal neuroprotective agent. However, there is no single view on the target therapeutic concentration and dosage of melatonin in neonatal practice. Controversial pharmacokinetic data is one of the limitations of the widespread use of melatonin in the management of premature infants. For the etiopathogenetic substantiation of the optimal therapeutic dose of melatonin, further studies of the adaptive and compensatory capabilities of the pineal gland in premature infants are needed. Conclusions. The direction of future clinical research on the expansion of the melatonin usage panel in premature infants, the establishment of a therapeutic range and the possibility of dynamic adjustment of the dose depending on pineal function is promising.