PREDICTORS OF THE DEVELOPMENT OF HYPOXIC-ISHEMIC ENCEPHALOPATHY IN FULL-TERM AND PREMATURE INFANTS BORNFROM MOTHERS WITH METABOLIC SYNDROME IN THE EARLY NEONATAL PERIOD
Recent studies have demonstrated a direct association between hypoxic-ischemic encephalopathy (HIE) and maternal overweight or obesity. HIE remains one of the leading causes of neonatal mortality and long-term neurological impairment in newborns. It represents a systemic condition affecting not onl...
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| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Bukovynian State Medical University
2025-07-01
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| Series: | Неонатологія, хірургія та перинатальна медицина |
| Subjects: | |
| Online Access: | https://neonatology.bsmu.edu.ua/article/view/334799 |
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| Summary: | Recent studies have demonstrated a direct association between hypoxic-ischemic encephalopathy (HIE) and maternal overweight or obesity. HIE remains one of the leading causes of neonatal mortality and long-term neurological impairment in newborns. It represents a systemic condition affecting not only the central nervous system but also multiple peripheral organs, including the liver. One of the indirect biochemical indicators of hypoxic injury is elevated hepatic transaminase activity — specifically, alanine aminotransferase (ALT) and aspartate aminotransferase (AST). Particular emphasis has been placed on the involvement of nitric oxide (NO) in the pathophysiology of HIE
Objective: to analyze and identify risk factors for hypoxic-ischemic encephalopathy in full-term and premature infants born to mothers with metabolic syndrome, to build clinical prognostic models.
Materials and methods. The study cohort consisted of 125 neonates. The study cohort consisted of 125 neonates. Group 1 included infants born to mothers with metabolic syndrome who were diagnosed with HIE (n = 45), while Group 2 included infants born to mothers without metabolic syndrome and without clinical manifestations of HIE (n = 79). ). Nitrite concentrations were measured by quantifying the diazo compounds formed via reaction with sulfanilic acid, followed by a subsequent reaction with the Griess-Ilosvai reagent. The bioethical principles of the study were confirmed by the Commission on Ethical Issues and Bioethics of Poltava State Medical University (protocol No. 233 dated 21 December 2024). Statistical analysis was conducted using the STATA 14.0 software package. Statistical analysis was performed using the STATA 14.0 software package. The work was carried out within the research project of the Department of Paediatrics No. 1 with Neonatology of Poltava State Medical University ’’To develop clinical and laboratory criteria, methods for predicting and preventing metabolic disorders in young children’’ (state registration number 0120U102856, term of completion 2020-2024).
Results of the study and their discussion. Initial clinical assessments were performed immediately postnatally. Among term infants, the most frequently diagnosed conditions included neonatal depression syndrome, respiratory distress syndrome, heart failure, seizures, and muscular dystonia. In preterm infants, depression syndrome, muscular dystonia, and seizures were the predominant clinical manifestations. HIE in term neonates is typically characterized by multisystem involvement, whereas in preterm infants, clinical signs are predominantly neurological. A metabolic profile analysis confirmed the multisystemic nature of HIE. On day one of life, AST and ALT levels in preterm infants with HIE were significantly elevated compared to preterm infants without HIE (p = 0.055 and p = 0.049, respectively). The urinary nitrite level in preterm infants with HIE was significantly higher compared to that in preterm infants without HIE (p = 0.025). Similar findings were observed in term infants, where those with HIE exhibited elevated urinary nitrite levels (p = 0.042). Based on these data, we developed predictive models for the early neonatal onset of HIE. After adjusting for gestational age and ALT or AST activity, urinary nitrite concentration proved to be a reliable prognostic marker for HIE in both preterm and term neonates. The areas under the ROC curves for models incorporating urinary nitrite levels, gestational age, and either ALT or AST were 0.9952 and 0.9279, respectively.
Conclusions. HIE in neonates is associated with multisystem involvement, affecting various organs in addition to the central nervous system. In light of the systemic nature of the condition, potential metabolic biomarkers were evaluated. Among these, serum ALT and AST levels, as well as urinary nitrite concentration, emerged as significant risk factors for early neonatal HIE in infants born to mothers with metabolic syndrome. Due to the heterogeneity of the cohort in terms of gestational age, multiple logistic regression analysis with obligatory adjustment for gestational age was employed to ensure accurate interpretation of the findings. A predictive model for HIE development was constructed, incorporating urinary nitrite and ALT levels. Newborns diagnosed with HIE and born to mothers with metabolic syndrome require close monitoring of ALT and AST levels during the early neonatal period. Furthermore, urinary nitrite concentration serves as an optimal biomarker for predicting HIE onset.
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| ISSN: | 2226-1230 2413-4260 |