Медицина/6. Педиатрия
Yurkiv O.I., PhD
Higher state
educational establishment Ukraine
«
FEATURES OF CLINICAL SYMPTOMS
OF GASTROINTESTINAL TRACT DISORDERS IN INFANTS WITH PERINATAL PATOLOGY HISTORY
Annotation: A comprehensive clinical examinations of
infants with perinatal pathology history suffering
from the disorders of the functional state of gastrointestinal tract were
conducted. Intestinal microbiocenosis changes were
revealed; they are most likely to extend liver and bile-excreting tract
dysfunction. Early diagnosis of the detected changes makes possible to improve
functional state of intestine in infants and ignore dysbiosis
signs.
Keywords: infants, gastrointestinal tract, clinical symptoms.
Introduction. In infants dysbiotic disorders occur more frequently than in adults; that is determined by morphological and
functional immaturity of the gastrointestinal tract (GIT) in this age. There exists a point of view that severe clinically significant forms of dysbiotic
disorders in the first years of life can be regarded as a prerequisite to the
development of inflammatory bowel disease [1, 42-48]. The peculiar features of the GIT functional state in children of infant
age are hydrochloric acid lack and proteolytic enzymes
in the stomach, decreased secretion of bile by the liver, and increased oxygen
concentration in the large intestine.
Normal microflora
agents of GIT provide protection from exogenous infectious agents through the
synthesis of different substances, inhibiting the growth and multiplication of
pathogens as well as by means of successful fight between them for the places
of attachment to the surface of mucous membrane of the intestine and source of
nutrition. Another mechanism of ensuring colonization resistance of normal
intestinal microflora agents is the one associated
with their ability to cause significant non-specific stimulation of humoral and cellular immunity [2, p. 56].
Breaking up extracellular
polysaccharides and glycoproteins by extracellular glycosidases of microbial origin leads to monosaccharides (glucose, galactose,
etc.) formation. Another important effect is the stimulation of local immunity,
first of all – the production of secretory
immunoglobulin (IgA) [3, 120].
Materials and methods of
research. The main study group consisted of 25 infants with perinatal pathology history; the infants had clinical
symptoms of gastrointestinal tract disorders; group of comparison numbered 25
infants without these disorders. Analysis of the obtained results was made by
means of application programs package «STATGRAPHICS Plus 5.1» using
conventional statistical methods of research.
Results and
discussion.
The retrospective study of infant development maps at birth showed that in
children of the first group in 12 (48%) cases intrauterine growth retardation
by hypotrophic type was diagnosed; neonatal
encephalopathy was detected in 13 (52.0%) cases. Exploration of pregnancy and
delivery peculiar characteristics of mothers in the main group showed that most
of them had some complications. In 3 (12.0%) mothers this very pregnancy was
third and fourth. 4 (16.0%) children were born by means of cesarean section.
At the time of the study regurgitation was detected in
one infant that constitutes 4.0%. Frequent symptoms in the infants of this
group were flatulence, constipations and abdominal pain, which constitute 7
(28.0%), 8 (32.0%) and 6 (24.0%) cases respectively. Isolated cases of
regurgitation, flatulence, poor sucking and constipation were observed in
children of the second group.
Developmental factors concerning disorders of the
intestinal functional state in infants were severe illnesses, they had suffered
from, and with which they were repeatedly admitted for treatment to the
pediatric hospitals. Thus, 3 (12.0%) children recovered from acute obstructive
bronchitis, 3 (12.0%) suffered from enterocolitis; in
2 (8.0%) cases tracheobronchitis was in past history;
1(4.0%) infant recovered from upper respiratory tract infections (URTI) and in 1 (4.0%) case salmonellosis
was revealed in the past history. Children were treated in accordance with
existing protocols and clinical guidelines, including antibiotic therapy, nonsteroidal anti-inflammatory, bronchospasmolytic
and anticonvulsant medical preparations that, along with the basic pathology,
contributed to an increased risk of intestinal disorders development.
Examination of all infants in the first group revealed clinical symptoms
of abdominal dysfunctions, among which there are: constipation – in 8 (32.0%)
infants, predisposition to the liquid stool – in 4 (16.0%) infants; signs of
flatulence with abdominal distension, intestinal colic and characteristic
infant pose with adduction of the legs – in 7 (28.0%) cases. 5 (20.0%) children
had appetite abnormalities (dysorexia); in 1 (4.0%)
case regurgitation was observed. Clinical manifestations of jaundice were noted
in 1 (4.0%) infant; enlargement of the liver was also observed in 1 (4.0%)
case. 4 (16.0%) children experienced nervousness and constant crying. In
addition, macroscopically the faeces of infants
contained mucus and undigested food. Coprogram in
most cases was characterized by a high content of neutral fat, amount of
epithelium and white blood cells.
Conclusion. Dysbiosis gastrointestinal manifestations in infants are a
consequence of perinatal pathology in the neonatal
period that usually occur in combination with functional disorders of other
organs and systems, including, hepatobiliary one.
Early signs of the appearance of gastrointestinal tract dysbiosis
may be detected by means of diagnostic research complex and prevented by early
administration of correcting therapy (prebiotics, probiotics, functional food). Prospects for further
research consist in studying pathogenic mechanisms of intestinal dysfunctions development,
diagnostics and correction methods.
Literature.
1. Шадрін О.Г. та ін. Функціональне харчування та
хронічні запальні захворювання кишечнику у дітей раннього віку. / О.Г. Шадрін, Р.В. Марушко, Т.С. Брюзгіна, В.Л. Місник, О.В. Муквіч // Современная педиатрия 6(34) /
2. Шумилов П.В. Нерешенные вопросы
патогенеза воспалительных заболеваний кишечника у детей. Роль пристеночной
микрофлоры кишечника. / Шумилов П.В. //
Педиатрическая фармакология. – 2010. –Т. 7., № 5 С. 54-58
3. Захарова И.Н. и
др. Формирование
кишечной микробиоты у детей первого полугодия жизни и
характер вскармливания / Захарова И.Н., Сугян Н.Г.,
Дмитриева Ю.А., Суркова Е.Н., Бегиашвили Л.В.//
Вопросы практической педиатрии – 2010. – Т. 5. - №5, С.- 115-121.
4. STATGRAPHICS Plus
5.1 (2001, Statistical Graphics Corp.)