SIGNIFICANCE OF CLINICAL AND LABORATORY MARKERS IN DISORDERS OF THE FUNCTIONAL CONDITION OF THE HEPATOBILIARY SYSTEM IN NEONATAL JAUNDICE
Keywords:newborn, jaundice, liver, hepatobiliary system, biochemical markers
INTRODUCTION: The liver is the central organ of metabolic activity in the body.
OBJECTIVES: The purpose of this study was to determine predictors, major clinical features, and laboratory criteria for the severity of disorders of the functional state of the hepatobiliary system in newborns with neonatal jaundice (NJ). The study included 164 full-term infants. The main group - 92 children, with manifestations of pathological jaundice, was divided into two subgroups, depending on the severity of the pathology, considering concomitant perinatal pathology. IA group (46 children) includes children, condition of which was defined as moderate, IB (46 children) – children, condition of which was defined as severe, the control group consisted of 72 healthy term infants.
METHODS: The complex of examination methods includes: collection of anamnesis of antenatal and perinatal periods in the mother, clinical examination of the newborn and laboratory methods of examination: blood biochemical analysis (TSB blood, bilirubin fractions, activity of ALT enzymes, AST, ALP , γ-GT, glucose level of blood serum, cholesterol, triglycerides) ultrasound examination of infants' liver.
RESULTS: Clinical symptoms that confirmed the functional impairment of the hepatobiliary system (HBS) in newborns who had signs of NJ in perinatal pathology are: hepatosplenomegaly, impaired bowel function, hypoglycemia, anemic syndrome, hemorrhagic disorders. The results of biochemical studies of the blood showed an increase in the severity of the pathology, an increase in the level of TSB and the fraction of indirect bilirubin, activation of the cytolysis markers of ALT and AST, increase of LDH activity, decrease in the activity of g-GT and ALP, as well as decrease in the level of total protein, albumin, glucose, increase in the level of urea, cholesterol and triglycerides. The most explicit manifestations of HBS dysfunction were found in newborns with a severe condition at birth and in the early neonatal period caused both by the NJ and other comorbidities. Taking into account the revealed deepening of biochemical changes in indicators of blood serum in correlation with the increase of clinical manifestations of pathology, the diagnosis of changes in the early stages will allow to diagnose in time the disorders of the functional state of HBS in NJ for the purpose of appropriate therapeutic correction.
CONCLUSION: The results of the analysis of anamnestic and clinical-laboratory parameters in newborns with NJ showed on the background of a clinical signs of dysfunction of the hepatobiliary system, the presence of significant biochemical changes, especially enzymatic activity, including, ALT, AST, LDH, ALP, and g-GT and, also an increase in TBS levels and an indirect bilirubin fraction, a decrease in total protein and albumin, glucose, a rise in urea, cholesterol and triglycerides.
The use of a biochemical markers in newborns with clinical manifestations of neonatal jaundice, especially in cases of significant severity of the condition with concomitant perinatal pathology, requires more detailed analysis in order to determine the main pathogenesis of disorders of the functional state of the hepatobiliary system for the purpose of timely correction and improvement of the outcome of treatment.
Anil Batta, D. (2017). Bilirubin as savior of biological system. International Journal Of Current Research In Medical Sciences, 3(2), 21-27. https://doi.org/10.22192/ijcrms.2017.03.02.004
Biomarkers in Liver Disease. (2017). https://doi.org/10.1007/978-94-007-7675-3
Birrer, R., Takuda, Y., & Takara, T. (2007). Hypoxic Hepatopathy: Pathophysiology and Prognosis. Internal Medicine, 46(14), 1063-1070. https://doi.org/10.2169/internalmedicine.46.0059
Chee, Y., Chung, P., Wong, R., & Wong, K. (2018). Jaundice in infants and children: causes, diagnosis and management. Hong Kong Medical Journal. https://doi.org/10.12809/hkmj187245
Dhanjal, G., Kaur, N., & Kaur, H. (2016). Study of Liver Function Test in Perinatal Asphyxia at a Tertiary Care Center in Haryana. International Archives Of Biomedical And Clinical Research, 2(4). https://doi.org/10.21276/iabcr.2016.2.4.6
Jenniskens, M., Güiza, F., Haghedooren, R., Verbruggen, S., Joosten, K., Langouche, L., & Van den Berghe, G. (2018). Prevalence and Prognostic Value of Abnormal Liver Test Results in Critically Ill Children and the Impact of Delaying Parenteral Nutrition*. Pediatric Critical Care Medicine, 19(12), 1120-1129. https://doi.org/10.1097/pcc.0000000000001734
Khurshid, F., & Medves, J. (2018). Effectiveness of universal hyperbilirubinemia screening on newborn health. JBI Database Of Systematic Reviews And Implementation Reports, 16(2), 287-290. https://doi.org/10.11124/jbisrir-2016-003338
Papazovska Cherepnalkovski, A., Krzelj, V., Zafirovska-Ivanovska, B., Gruev, T., Markic, J., & Aluloska, N. et al. (2015). Evaluation of Neonatal Hemolytic Jaundice: Clinical and Laboratory Parameters. Open Access Macedonian Journal Of Medical Sciences, 3(1), 694. doi: 10.3889/oamjms.2015.129
Patel, V., & Preedy, V. (2019). Biomarkers in Liver Disease. Springer Netherlands.
Pettengill M, Matute JD, Tresenriter M, Hibbert J, Burgner D, Richmond P, et al. (2017) Human alkaline phosphatase dephosphorylates microbial products and is elevated in preterm neonates with a history of late-onset sepsis. PLoS ONE 12(4): e0175936. https://doi.org/10.1371/ journal.pone.0175936
Shutova O.V., & Bahatska N. V (2017). Otsinka endohennykh ta ekzohennykh faktoriv ryzyku formuvannia zhovchnokamianoi khvoroby v dytiachomu ta pidlitkovomu vitsi.[ Assessment of endogenous and exogenous risk factors for cholelithiasis in childhood and adolescence] Bulletin of problems of biology and medicine, 3 (4), 245-249. DOI 10.29254/2077–4214–2017–4–3–141–245-249
Singh,J.Poonia,A.K.,(2019).Liver Dysfunction in Perinatal Asphyxia, 7(3), PO06-PO08. https://www.doi.org/10.7860/JCDR/2019/41616/2253
Thomson, S., Cowan, M., Johnston, I., Musa, S., Grounds, M., & Rahman, T. (2009). ‘Liver function tests’ on the intensive care unit: a prospective, observational study. Intensive Care Medicine, 35(8), 1406-1411. https://doi.org/10.1007/s00134-009-1511-7
Torre G. (2017) Gastroenterology: Focus on Children with Liver Problems. In: Garganese M., D'Errico G. (eds) Conventional Nuclear Medicine in Pediatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-43181-9_18
Zahmatkeshan, M., Serati, Z., Freydooni, S., Safarpour, A. R., Esmailnejad, A., & Haghbin, S. (2019). Prediction of Early Liver Failure in Pediatric Patients Admitted to Intensive Care Unit. Middle East journal of digestive diseases, 11(3), 141–146. doi:10.15171/mejdd.2019.140
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