The impact of transient hypothermia and poor metabolic adaptation to perinatal morbidity in newborns with intrauterine growth retardation

[T. Lazić Mitrović]

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Uvod: Novorođenčad sa intrauterusnim zastojem u rastu (IUZR), zbog svojih karakteristika osetljivija su na stres rashlađenjem. Hipotermija je komponenta patološke varijante neonatalnog energetskog trougla (patološki NET), koji je pokazatelj loše metaboličke adaptacije u tranzitornom periodu - prvih šest do 12 sati nakon rođenja, a dovodi do povećanog morbiditeta. Cilj istraživanja: U okviru studije, ispitivan je uticaj prolazne hipotermije u prvom satu nakon rođenja, nezavisno ili u kombinaciji sa ostalim komponentama patološkog NET, na rani neonatalni morbiditet kod IUZR. Metod: Klinička opservaciona kohortna studija, obuhvatila je 159 preterminske i terminske novorođenčadi, oba pola, sa IUZR, koji je definisan vrednostima TM na rođenju ispod 10. percentila na populacijskim normogramima rasta. Ispitivana je učestalost prolazne hipotermije i varijanti NET (patološkog, nestabilnog, stabilnog) u tranzitornom periodu, u zavisnosti od gestacijske starosti, tipa zastoja u rastu, telesne mase, pola i uticaj hipotermije i patološkog NET na perinatalni morbiditet. Patološki NET definisan je udruženim prisustvom hipotermije, hipoksije, hipoglikemije; nestabilan NET prisustvom jedne ili dve komponente patološkog NET; stabilan NET odsustvom komponenti patološkog NET. Statistička analiza je izvršena statističkim testovima analitičke i deskriptivne statistike. Ispitivanje uticaja urađeno je binarnom logističkom regresionom analizom. Nivo verovatnoće ustanovljen je na p<0,05. Rezultati: Prosečno gestacijsko doba ispitanika iznosilo je X ±SD: 36,6 ± 2,1 g.n., prosečna TM Me=2050g, učestalost asimetričnog tipa 86,8 %, simetričnog tipa 13,2% (p<0,001), 53,5% bili su muškog pola, a 46,5% ženskog pola (r>0,05). Hipotermija je registrovana kod 57,9% novorođenčadi, zauzima vodeće mesto u morbiditetnoj strukturi (r<0,05). Patološki NET imalo je 33,3%, nestabilan NET 39,0%, stabilan NET 27,7% novorođenčadi (r>0,05). Patološki NET je najčešći kod kasne preterminske novorođenčadi (64,2%) (r<0,001). Novorođenčad patološkog NET, imala su značajno nižu prosečnu telesnu masu (1913,2 ± 360,7g) u odnosu na stabilan i nestabilan NET (r<0,05). Hipotermija je značajan prediktor za hipoksiju (OR=11,35), hipoglikemiju (OR=8,59), RDS (OR=5,76), hipokalcemiju (OR=2,43), acidozu (OR=2,21). Patološki NET je značajan prediktor za perinatalnu asfiksiju (OR=8,57), RDS (OR=5,08), hipokalcemiju (OR=4,60), acidozu (OR=2,05). Zaključak: Prolazna hipotermija nezavisno, ili u kombinaciji sa ostalim komponentama patološkog NET, može se koristiti u predikciji perinatalnog morbiditeta kod IUZR, što je značajno za dalju evaluaciju poremećenog intrauterusnog rasta.

Introduction: Newborns with intrauterine growth restriction (IUGR), due to characteristics are more sensitive to lower temperature stress. Hypothermia is a pathological component in the neonatal energy triangle (Pathological NET), which is an indicator of poor metabolic remodeling in the transitory period – the first six to 12 hours after birth, but leads to increased morbidity. Research goal: In the study, the influence of transient hypothermia was tested in the first hour after birth, independently or in combination with the other components of the pathological NET, in the early neonatal morbidity with IUGR. Method: Clinical observational cohort study, included the 159 premature and newborn infants, of both sexes, with IUGR, which is defined by values of a TM at birth under the 10th percentile of the population growth nomogram. The frequency of transient hypothermia and NET variants (pathological, unstable and stable) were tested in the transitory period, depending on the gestational age, type of growth retardation, body weight and sex, and the influence of hypothermia and pathological NET on the perinatal morbidity. Pathological NET is defined by the presence of associated hypothermia, hypoxia, hypoglycemia; unstable NET by the presence of one or two components of the pathological NET; stable NET by the absence of the components of the pathological NET. The statistical analysis was done via statistical tests of analytical and descriptive statistics. Investigation of the effect was done via binary logistic regression analysis. The level of probability is set to p˂0,05. Results: Average gestational age of patients was X ±SD: 36,6 ± 2,1g.n.; avarage TM Ме=2050g, frequency of the asymmetric type 86,8 %, symmetrical type 13,2% (p<0,001), 53,5% were male, and 46,5% female (р>0,05). Hypothermia was registered with 57,9% newborns, occupies a leading position in the structure of morbidity (р<0,05). Pathological NET was registered with 33,3%, unstable NET with 39,0%, stable NET with 27,7% of newborns (р>0,05). Pathological NET is most common in late preterm infants (64,2%) (р<0,001). Newborns with pathological NET, had a significantly lower avarage body weight (1913,2 ± 360,7g) in comparison to stable and unstable NET (р<0,05). Hypothermia is a significant predictor for hypoxia (OR=11,35), hypoglycemia (OR=8,59), RDS (OR=5,76), hypocalcemia (OR=2,43), acidosis (OR=2,21). Pathological NET is a significant predictor of perinatal asphyxia (OR=8,57), RDS (OR=5,08), hypocalcemia (OR=4,60), acidosis (OR=2,05). Conclusion: Transient hypothermia independently, or in combination with the other components of the pathological NET, can be used in the prediction of perinatal morbidity of IUGR, which is important for the further evaluation of the intrauterine growth disorder.

novorođenče, intrauterusni zastoj u rastu, hipotermija, neonatalni energetski trougao

Newborn, intrauterine growth restriction, hypothermia, neonatal energy triangle, perinatal morbidity

618.33:616-053.2-063.8

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