COMPARATIVE CHARACTERISTICS OF CLINICAL AND LABORATORY MARKERS OF NUTRITION IN PREMATURE CHILDREN TAKING INTO ACCOUNT GESTATIONAL AGE AT BIRTH

Oleksii  Godovanets; Yuriy  Nechytaylo

doi:10.21272/eumj.2025;13(2):526-535

Oleksii Godovanets Department of Pediatrics, Neonatology and Perinatal Medicine of Bukovinian State Medical University, Chernivtsi, Ukraine http://orcid.org/0000-0003-1474-7642
Yuriy Nechytaylo Department of Pediatrics, Neonatology and Perinatal Medicine of Bukovinian State Medical University, Chernivtsi, Ukraine http://orcid.org/0000-0003-3050-961X

DOI: https://doi.org/10.21272/eumj.2025;13(2):526-535

Keywords: infant, premature babies, gestational age, digestive system, feeding intolerance, gastrointestinal diseases

Abstract

Introduction. Current data from scientific literature indicate the need to create unified recommendations for diagnosing feeding intolerance in premature infants. It is known that clinical manifestations of digestive system dysfunction in the postnatal period are the cause of the subsequent development of persistent functional gastrointestinal disorders, which worsens the patients` quality of life. In general, recommendations for providing medical care to newborns with feeding intolerance in perinatal pathology are an important area of scientific research at the present stage.

Objective. To determine the main clinical and laboratory criteria for feeding intolerance in premature infants based on coprofiltrate parameters, considering gestational age and severity of the condition at birth.

Materials and Methods. A comparative analysis of clinical and laboratory criteria for feeding intolerance in perinatal pathology was conducted in premature children of different gestational ages. The list of laboratory parameters of coprofiltrate included: the levels of fecal calprotectin, albumin, α-1-antitrypsin, fecal elastase-1, and PMN-elastase.

Results. Clinical signs of feeding intolerance in premature infants include gastric residual volume > 50%, regurgitation and/or Banti syndrome, flatulence, blood in stools, acholic stools, and signs of endotoxemia. Laboratory markers of gastrointestinal disorders determined based on coprofiltrate studies are: increased levels of fecal calprotectin, albumin, α-1-antitrypsin, fecal elastase-1, and decreased PMN-elastase.

Conclusions. The results of our study suggest the primary role of the intestinal mucosa inflammation in the pathogenesis of neonatal feeding intolerance under conditions of hypoxia in perinatal pathology. It is accompanied by decreased enzymatic activity, weakened local immunity, and increased intestinal mucosa permeability.

Downloads

Download data is not yet available.

References

Embleton ND, Jennifer Moltu S, Lapillonne A, van den Akker CHP, Carnielli V, Fusch C, et al. Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts. J Pediatr Gastroenterol Nutr. 2023;76(2):248-268. https://doi.org/10.1097/MPG.0000000000003642

Evidence-Based Medicine Group, Neonatologist Society, Chinese Medical Doctor Association. Clinical guidelines for the diagnosis and treatment of feeding intolerance in preterm infants (2020). Zhongguo Dang Dai Er Ke Za Zhi. 2020 Oct;22(10):1047-55. https://doi.org/10.7499/j.issn.1008-8830.2008132

Millar LJ, Shi L, Hoerder-Suabedissen A, Molnár Z. Neonatal Hypoxia Ischaemia: Mechanisms, Models, and Therapeutic Challenges. Front Cell Neurosci [Internet]. 2017[cited 2022 Jan 17];11:78. https://doi.org/10.3389/fncel.2017.00078

Strilchuk LM. [Monocytes to high-density lipoproteins ratio as an indicator of inflammation and oxidative stress in patients with various conditions of the gallbladder]. The Journal of V. N. Karazin Kharkiv National University. Series "Medicine". 2021;41:107-114. https://doi.org/10.26565/2313-6693-2021-41-12

Costa S, Maggio L, Alighieri G, et al. Tolerance of preterm formula versus pasteurized donor human milk in very preterm infants: a randomized non-inferiority trial. Ital J Pediatr. 2018;44(1):96. https://doi.org/10.1186/s13052-018-0532-7

Quigley M, Embleton ND, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants. Cochrane Database Syst Rev. 2018;6(6):CD002971. https://doi.org/10.1002/14651858.CD002971.pub4

Fontenele M.M., Silva C.F., Leite Á.J. et al. SNAPPE II: analysis of accuracy and determination of the cutoff point as a death predictor in a Brazilian neonatal intensive care unit. Rev Paul Pediatr [Internet]. 2020 [cited 2023 Dec 9];38:e2019029. https://doi.org/10.1590/1984-0462/2020/38/2019029

Muktan D, Singh RR, Bhatta NK et al. Neonatal mortality risk assessment using SNAPPE- II score in a neonatal intensive care unit. BMC Pediatr. 2019;19:279. https://doi.org/10.1186/s12887-019-1660-y

Özcan B, Kavurt AS, Aydemir Ö et al. SNAPPE-II and risk of neonatal morbidities in very low birth weight preterm infants. Turk J Pediatr. 2017;59(2):105-112. https://doi.org/10.24953/turkjped.2017.02.001

Godovanets OS. Diagnostic value of laboratory markers of enteric dysfunction in preterm infants. Wiadomości Lekarskie. 2024;77(11):2154-2160. https://doi.org/10.36740/WLek/197086

Matsyura ОІ. [Algorithm of conducting oral provocation tests with milk in 1–3-year-old children: analysis of existing standards and own experience]. The Journal of V. N. Karazin Kharkiv National University. Series "Medicine". 2021;41:74-83. https://doi.org/10.26565/2313-6693-2021-41-08

Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants. Nutrients. 2015;7(1):423–442. https://doi.org/10.3390/nu7010423

Weeks CL, Marino LV, Johnson MJ. A systematic review of the definitions and prevalence of feeding intolerance in preterm infants. Clin Nutr. 2021 Nov;40(11):5576-86. https://doi.org/10.1016/j.clnu.2021.09.010

Li F, Ma J, Geng S et al. Fecal calprotectin concentrations in healthy children aged 1-18 months. PLoS One. 2015;10(3):e0119574. https://doi.org/10.1371/journal.pone.0119574

Vidova V, Benesova E, Klanova J et al. Simultaneous quantitative profiling of clinically relevant immune markers in neonatal stool swabs to reveal inflammation. Sci Rep. 2021;11:10222. https://doi.org/10.1038/s41598-021-89384-0

Godovanets O, Nechytailo Yu. Klinichna kharakterystyka ta mozhlyvosti laboratornoi diahnostyky hastrointestynalnykh porushen pry perynatalnii patolohii u peredchasno narodzhenykh ditei. [Clinical characteristics and possibilities of laboratory diagnosis of gastrointestinal disorders in perinatal pathology in prematurely born children]. Neonatol. hìr. perinat. med. 2024;14(2(52):28-33. https://doi.org/10.24061/2413-4260.XIV.2.52.2024.5

Kryvoruchko I, Lurin IA, Krasnoselskyi M, Honcharova N, Tamer AH, Nessonova M, Honcharov A, Kuzmenko O, Kolesnyk V. Significance of preoperative levels biomarkers TGF-β1 and CA 19-9 in distinguishing benign and malignant pancreatic neoplasms. Ukrainian Journal of Radiology and Oncology. 2024;32(4),428-447. https://doi.org/10.46879/ukroj.4.2024.428-447

Sokou R, Tritzali M, Piovani D et al. Comparative Performance of Four Established Neonatal Disease Scoring Systems in Predicting In-Hospital Mortality and the Potential Role of Thromboelastometry. Diagnostics (Basel). 2021;11(11):1955. https://doi.org/10.3390/diagnostics11111955

Koninckx CR, Donat E, Benninga MA et al. The Use of Fecal Calprotectin Testing in Paediatric Disorders: A Position Paper of the European Society for Paediatric Gastroenterology and Nutrition Gastroenterology Committee. J Pediatr Gastroenterol Nutr. 2021;72(4):617-640. https://doi.org/10.1097/MPG.0000000000003046

Korkmaz B, Horwitz MS, Jenne DE et al. Neutrophil elastase, proteinase 3, and cathepsin G as therapeutic targets in human diseases. Pharmacol Rev. 2010;62(4):726-759. https://doi.org/10.1124/pr.110.002733

Wieczorek-Filipiak M, Drzymała-Czyż S, Szczepanik M et al. Fecal elastase-1 in healthy children up to 2 years of age: a cross-sectional study. Dev Period Med. 2018;22(2):123-127. https://doi.org/10.34763/devperiodmed.20182202.123127.

Rigo J, Hascoët JM, Picaud JC et al. Comparative study of preterm infants fed new and existing human milk fortifiers showed favourable markers of gastrointestinal status. Acta Paediatr. 2020;109(3):527-533. https://doi.org/10.1111/apa.14981

Wieczorek-Filipiak M, Drzymała-Czyż S, Szczepanik M et al. Fecal elastase-1 in healthy children up to 2 years of age: a cross-sectional study. Dev Period Med. 2018;22(2):123-127. https://doi.org/10.34763/devperiodmed.20182202.123127

Kaverinska A, Shevchenko N, Osetsky A, Sukhodub L, Lazurenko V, Zhelezniakov O, Prokopiuk V. The Effect of Lyophilized and Frozen Umbilical Cord Cryoextract on L929 Cell Culture. Innovative Biosystems and Bioengineering. 2025;9(1),3-12. https://doi.org/10.20535/ibb.2025.9.1.313718