DOI: https://doi.org/10.22141/2224-0586.7.94.2018.150816

Informativity on the routine diagnosis of gastrointestinal failure in neonatal intensive care

D.A. Kholod

Abstract


Background. Newborns are most susceptible to gastrointestinal failure. However, diagnostic criteria for this syndrome among newborns have been understudied. The purpose of the work is to evaluate the information significance of clinical and instrumental methods for the diagnosis of gastrointestinal failure in neonatal intensive care. Materials and methods. A clinical interventional cohort study was conducted involving 30 infants requiring intensive care and having gastrointestinal failure degree 1 (n = 13) or 2 (n = 17). An evaluation was made of delayed gastric emptying, abdominal circumference, intra-abdominal pressure, abdominal perfusion pressure. Results. Among newborns with gastrointestinal failure degree 1 and 2, reliable differences were established only in terms of intra-abdominal pressure (Me = 3 mmHg and Me = 12 mmHg, respectively, p < 0.01). There was no significant difference between the indicators of delayed gastric emptying, abdominal circumference and abdominal perfusion pressure, depending on the degree of gastrointestinal failure. At the same time, significant correlation was found between delayed gastric emptying, the pH of the blood (R = –0.5; p = 0.03), pH of the stool (R = –0.5; p = 0.03) and the proportion of hydrocarbons in nutritional mixture (R = 0.5; p = 0.03); between the dynamics of abdominal circumference, the administration of probiotics (R = –0.8; p = 0.02); the frequency and volume of evacuations (R = –0.6; p = 0.02) and the level of intra-abdominal pressure (R = 0.7; p = 0.02); between levels of intra-abdominal pressure, arterial perfusion pressure (R = –0.7; p = 0.02), lactic acid (R = 0.6; p = 0.03), CD4 (R = 0.5, p = 0.03), CD4/CD8 (R = 0.5; p = 0.03), interleukin-1β (R = 0.6; p = 0.03), diuresis rate (R = –0.8; p = 0.02). Conclusions. Indicator of intra-abdominal pressure is relatively significant in the diagnosis of early stages of gastrointestinal failure among newborns. Delayed gastric emptying may be informative for the evaluation of enzymatic disorders, and the dynamics of the abdominal circumference — for the detection of motility disorders.


Keywords


newborns; gastrointestinal failure; diagnosis

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