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0THE IMPORTANCE OF MATERNAL FACTORS IN THE ADAPTATION OF NEWBORNS WITH CONGENITAL INTESTINAL OBSTRUCTION
1Ergasheva N.N., 2Ergasheva N.N.,3Ergashaliyev S.D.
1,2,3Tashkent pediatric medical Institute, Tashkent, Uzbekistan https://doi. org/10.5281/zenodo. 14160789
Abstract. The article presents data on obstetric and gynecological anamnesis of mothers of children with congenital intestinal obstruction; information on the condition of 208 newborns in the acute phase of postnatal adaptation. Extragenital pathology and diseases of the mother's genitals are the main aggravating factors of obstetric and gynecological anamnesis. Indicators of the Apgar scale in 142 (68.35%) cases were 7-10 points, which, regardless of the clinical and anatomical form of the disease, were lower than in the control group. The results of the study showed that the unfavorable somatic status and gynecological history of the mother, the pathological influence of various factors of the ante-and intra-Natal periods of development, including fetal hypoxia, is the main starting and supporting mechanism for the occurrence of VCS, burdens postnatal adaptation and prognosis.
Keywords: obstetric and gynecological history, congenital intestinal obstruction, postnatal adaptation, newborns.
Relevance. Aggravating factors of maladaptive conditions in newborns in the presence of the main pathology can be a small gestational age, slow fetal growth, low body weight, intrauterine infection, genetic or somatic pathology. Ante-and intra-natal factors associated with the somatic and obstetric history of mothers play an important role in the development of maladaptive conditions in newborns. The nature of pathological changes in the form of electrolyte imbalance disorder with the development of exsiccosis, progressive endotoxiccosis and dysbiosis in the newborn with HCN affects neonatal adaptation. Diseases of the nervous system that lead to disability and maladaptation of children are caused by perinatal factors in 70-80% of cases [2,4,7,9]. Involvement of the central nervous system (CNS) in the pathological process is a natural complication of hypoxia, which is manifested by hypoxic-ischemic encephalopathy (HIE) [14,7,9-12]. The significance of these factors in the process of adaptation to congenital intestinal obstruction (VCH) is practically absent. Knowledge of these software feature scan efficiently organize nursing, therapy and rehabilitation, and reduce the mortality rate of children with this pathology. Postnatal adaptation in newborns with HCN is the least studied area of neonatology.
The aim of the study was to identify the significance of somatic status and obstetric and gynecological history of mothers on the course of postnatal adaptation of newborns with congenital intestinal obstruction.
Material and methods. We analyzed the somatic status and obstetric and gynecological history of mothers of 208 children with different clinical and anatomical forms, including 68 (32.6%) with high intestinal obstruction, 93(44.7%) with low intestinal obstruction, and 47(22.5%) with intestinal malrotation. The newborns were treated in the Neonatal Surgery Department of the Republican Perinatal Center of the Ministry of Health of the Republic of Uzbekistan. The health status of mothers was determined taking into account the obstetric and gynecological history, the
course of real pregnancy and childbirth. Data collection was carried out on the basis of an individual map of the mother and child. The health status of newborns was assessed by general condition, vital functions, anthropometric indicators at birth, and laboratory examination results.
Results and discussions. Mothers of children with HCN were aged from 19 to 39 years old with different health conditions and somatic background. Newborns with HCN were born from various pregnancies and deliveries: -81(38.94%) from the first, 59(28.36%) from - the second, and 68(32.69%) - from the third (Table 1).
Table 1
Course of pregnancy in mothers of children with HCN (n= 208)
Pregnancy and its High KN Low KN MK Total
course (n=68) (n=93) (n=47)
Abs. % Abs. % Abs. % Abs. %
Sy O ¿J S e au ö 5 5g O 1 24 35.3 35 37,6 29 61,7 88 42,3
2 13 19.1 26 28,0 9 19,1 48 23
Hi O a PH 3 31 45.6 32 34,4 9 19,1 72 34,6
£ 1 26 38,2 39 41,9 21 44,7 86 41,3
2 20 29,4,4 26 28,0 15 31,9 61 29,3
o 3 22 32.33 28 20,1 11 23,4 61 29,3
àj üg a under 20 years 4 59 2 2.2 1 2.1 7 3.3
%H ai 20-35 years 62 91.2 90 96.8 45 95.7 197 94.7
£ ot s Over 35 years 2 2.9 1 1.1 1 2.1 4 1.92
s Physiological 51 75 65 69.9 32 68 148 71.1
ai ir deliveries
_> 13 Q Operative deliveries 17 25 28 30.1 15 10.9 60 28.8
Preterm deliveries 15 22.1 17 18.3 6 4.4 38 18.2
Rapid delivery 6 8.8 7 7.5 2 4.3 15 7.2
Bad habits 3 4.4 12 12.9 4 8.5 19 9.1
73 (35.1%) women had a burdened obstetric history: 38(1 [8.3%) - preterm birt hs, 21(10.1%
- medical abortions, 10 (4.8%) - spontaneous miscarriages, and 4(1,9%) - intrauterine fetal death. 19(9,1%) mothers had such a bad habit as smoking. Smoking mothers were more likely to have such complications of pregnancy and childbirth as anemia - 18(94.7%), umbilical cord entanglement - 9 (47.4%), threat of termination of pregnancy - 7 (36.8%), prenatal discharge of amniotic fluid - 4 (21%), lack of water supply - 3(15,8%). 60(29.0%) babies were born via natural birth canal, and 60 (29.0%) were born by Caesarean section (31(51.7%) - with maternal indications; 12(20%) - with infant indications; 17 (28.3%) - with maternal indications). In 4(1.9%) cases, a vacuum extractor was used in childbirth. We analyzed the diseases that were observed in mothers who gave birth to children with HCN, which can burden the antenatal period of fetal development (Table 2).
In most cases, pregnancy occurred against the background of extragenital diseases: blood diseases were detected in 134(64.4%), pathology of the gastrointestinal tract - in 101(48.6%),
urinary system - in 85(40.9%) and respiratory diseases - in 55(26.4%) mothers. Newborns born to women with iron-deficient anemia (134 - 64.4%) often had asphyxia of varying severity, low
weight, and the threat of termination of pregnancy.
Somatic pathology in mothers of children with HCN (n= 208)
Table 2
Diseases of organs and systems High CI (n=68) Low CI (n=93) MC (n=47) total
Abs. % Abs. % Abs. % Abs. %
Respiratory diseases 17 8.2 20 9.6 18 8.7 55 26.4
Blood diseases 45 66.2 66 70.1 23 48.9 134 64.4
Gastrointestinal diseases 33 48.5 41 44.1 27 57.4 101 48.5
CVD diseases 1 1.5 3 3.2 3 6.3 7 3.3
Endocrine pathology 1 1.5 10 10.8 5 10.6 16 7.7
MVS diseases 23 33.8 41 44.1 21 44.7 85 40.8
Infectious diseases 12 17.6 32 34.4 13 27.7 57 27.4
Pre eclampsia 20 29.4 27 29 17 36.1 64 30.7
Gynecologists medical conditions:: inflammato ry 17 25 33 35.5 21 44.7 71 34.1
non-inflammato ry 20 29.4 30 32.3 14 29.8 64 30.7
Among the diseases recorded in 101(48.6%) mothers, the digestive organs had manifested as gastritis in 37(17.8%), cholecystitis - in 23(11.1%) and chronic constipation - in 41 (19.7%), as an independent disease or a combination of them. Diseases of the gastrointestinal tract in women during pregnancy often require a diet, restrictions on the intake of a number of products, which can disrupt the assimilation of food substrates, contribute to the development of deficient conditions that are negative for the normal development of the fetus. In the structure of diseases of the urinary system that were detected in 85(40.98%) mothers, inflammatory processes of unspecified localization prevailed in 44(21.2%) and urinary tract infections - in 35(16.8%) women. Renal and urinary tract malformations of a compensated nature were rarely observed - in 6 (2.9%) patients. Among respiratory diseases: allergic rhinitis was observed in 29(13.9%), acute and chronic bronchitis - in 26(12.5%). Endocrine pathology was manifested in the form of iodine deficiency - in 11(5.3%), type 1 diabetes mellitus - in 5(2.4%), obesity - in 3(1.4%). Infectious diseases of the mother were detected in 57 (27.4%) mothers. In their structure, agents that are part of TORCH infection were detected in 51(89.5%) mothers: herpes - in 23 (40.3%); cytamegalovirus - in 16(28.1%); chlamydia - in 10(17.6%); ureaplasmosis - in 2(3.5%) and hepatitis - in 6 (10.5%) of mothers. It can be assumed that some women did not know about the
presence of infections or did not indicate them when collecting an anamnesis. Infections, as a rule, can provoke preterm labor and contribute to infection of the fetus in the ante-and intranatal period.
Non-inflammatory and inflammatory diseases of the genital organs are registered among gynecological diseases. Among non-inflammatory diseases of the female genital organs, ovarian cysts prevailed in 37(17.8%) and cervical erosive processes - in 27(13.0%) mothers. The most common inflammatory diseases were cervicitis in 36(17.3%), oopharitis - in 31(14.9%), and salpingitis - in 4(1.92%). 89 (42.7%) women with chronic inflammatory gynecological diseases experienced complications of pregnancy and childbirth, which affected the condition of the fetus and newborn. Combined burdened obstetric and gynecological anamnesis is of the greatest importance for the development of HCN and adaptation disorders in newborns. A complicated course of pregnancy with the development of pre-and eclampsia was observed in 64(30.8%) women, the risk of preterm birth - in 57 (27.4%) women. Somatic diseases of mothers also negatively affected labor activity. 54(26%) mothers had a relatively safe obstetric and gynecological history; in 154 (74%) mothers, the history was burdened by various unfavorable ante-and intra-natal factors.
As is known, the Apgar score clinically reflects the state of the first phase of neonatal adaptation and characterizes the main vital signs at the time of birth. Additional research methods and laboratory diagnostics based on the indications that have occurred allow us to judge functional disorders of individual organs or multiple organ disorders, and help identify the genesis of the changes that have occurred. With high CI in newborns, the Apgar scale values at the 1st min. They were 4-9 points- 6.4±0.13; with low CI and intestinal malrotations (MC) - 0-9 and 5-10 points-6.5±0.15 and 7.0±0.11. On the 5th min. These indicators were 7.6±0.11 for high KN 4-10 points-7,6±0,11, 7.6±0.13 for low KN 3-9 points-7,6±0,13, and 8.0±0.12 for MC 6-10 points. The average values were different depending on the type of pathology. With indicators of less than 7 points after 5 minutes, 66 (31.7%) newborns were dynamically evaluated for 3 hours. In 25(37.9%) of them, the indicators reached the lower limit of normal, in 41(62.1%) they remained below 7 points.
In 142 (68.3%) newborns with HCN, the Apgar score was 7-10 points, which, regardless of the clinical and anatomical form of the disease, were lower than in the control group. In newborns with HCN without acute asphyxia, manifestations of chronic hypoxia (pallor and dryness of the skin, decreased muscle tone and physiological reflexes, regurgitation, tachypnea, muffling of heart tones) were noted, indicating maladaptive conditions. Disruptions of postnatal adaptive mechanisms associated with congenital intestinal obstruction in newborns progressed with impaired motor-evacuation function of the intestine, increased discharge from the stomach and duodenum, increased endotoxicosis, dysbiosis, and withdrawal of enteral feeding of the child. 4-6 points were detected in 63 (30.3%) newborns with signs of cardiorespiratory depression with respiratory and hemodynamic disorders. In 3 (1.4%) newborns with Apgar scores of 0-3 on the 1st and 5th min, there were obvious signs of moderate and severe asphyxia with combined disorders of the function of individual organs confirmed by laboratory test studies (blood electrolyte imbalance in 42 (66.7%), hypoglycemia - in 18(28.6%), hypocoagulation - in 21(33.3%). The severity of the condition and pronounced maladaptive states in these cases are equally due to perinatal factors, including a burdened obstetric and gynecological history, and complications (peritonitis - in 35-55. 5%, perforations-in 18-28. 6%, or intestinal necrosis - in 10-15. 9%) of intestinal obstruction before birth. These observations confirm the literature data indicating the common pathogenetic mechanisms of the occurrence of congenital intestinal obstruction and the
development of its complications, which are important for vascular-circulatory disorders against the background of hypoxic-ischemic disorders caused by unfavorable perinatal factors [1,5-6,89,10]. Involvement of the central nervous system in the pathological process is a natural complication of hypoxia, which is manifested by hypoxic-ischemic encephalopathy. In the first phase of adaptation, cerebral disorders in 72 (34.6%) patients were manifested in the form of: vegeto-visceral disorders syndrome in 12 (16.7%), depression syndrome in 11 (15.3%), hyperexcitability syndrome in 35 (48.6%). In 14(19.4%) cases, a combination of several neurological syndromes or their combinations was observed. The obtained data indicate that hypoxic lesions of varying severity are the main factor in disrupting adaptive mechanisms, making the course of postnatal adaptation more difficult, with a negative prognosis for the development of maladaptive conditions on the part of the gastrointestinal tract. The results of the study showed that the somatic status and gynecological history of the mother, the pathological influence of various factors of the ante-and intra-natal period of development with fetal hypoxia significantly affect the postnatal adaptation of newborns. Most newborns from mothers with a burdened obstetric and gynecological history had concomitant pathology: congenital aspiration pneumonia 68(32.7%), intrauterine infection-26(12.5%), body weight deficit-16(7.7%), necrotic enterocolitis-10(4.8%), DIC-10(4.8%), purulent-inflammatory diseases - 9(4.3%), sclerema - 7(3.4%), the burdened antenatal period is a factor in the occurrence of malformations of various organs and systems. Combined malformations were detected in 33 (15.9%) newborns with VCD: CHD - in 18(8.7%), Down syndrome - in 11(5.3%), MPS - in 4(1.9%).
In conclusion, a favorable course of early postnatal adaptation is observed in 54(25.9%) cases of HCN. In isolated forms of pathology in the form of partial intestinal obstruction in newborns born at term, they did not have somatic pathology and obstetric aggression. Disruptions in early postnatal adaptation in 154(74%) newborns are associated with the pathological influence of various factors of the ante-and intra-natal periods of fetal development. The combined effect of a burdened obstetric and gynecological history during childbirth is of the greatest importance. In HCN, a violation of the motor-evacuation function of the intestine against the background of cardiorespiratory depression and hypoxic-ischemic encephalopathy are the initial disorders of the maladaptive process, in conditions of ongoing hypoxia, it contributes to the progression of dysbiosis, endotoxiccosis, multiple organ failure with the development of specific complications of intestinal obstruction.
Conclusions.
In 74% of mothers who gave birth to children with congenital intestinal obstruction, an unfavorable course of the ante - and intra-natal period was noted, due to a burdened somatic and obstetric anamnesis.
The severity of the condition and pronounced maladaptive states of a newborn with HCN in the acute phase of adaptation are caused by unfavorable perinatal factors and complications (peritonitis, perforation or necrosis of the intestine) of intestinal obstruction that occur before the birth of the child.
The progression of disruptions of postnatal adaptive mechanisms in HCN in a significant part of newborns is observed with a violation of the motor-evacuation function of the intestine and an increase in other manifestations of intestinal obstruction.
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