Markers of myocardial dysfunction in neonates with sepsis of various gestational age

Abstract

Introduction: Nowadays, the issues of early diagnostics of cardiovascular disorders in neonates with sepsis with the use of up-to-date methods of examination that can be applied as screening methods with the aim to verify the possible development of cardiovascular dysfunction remain urgent. To study certain clinical-instrumental parameters and biochemical markers in neonates depending on the gestational age to improve the prognosis with neonatal sepsis (NS). Materials and Methods: To realize the objective, 57 neonates were under our observation with verified diagnosis “NS.” I Group (23 patients – 40.3%) included neonates with the term of gestation 37–42 weeks, II Group– 34 preterm neonates (59.7%) with gestational age under 36 weeks inclusive. The latter group was subdivided depending on the term of gestation into IIA subgroup including 21 preterm neonates with NS and the term of gestation 32–36 weeks, IIB-subgroup included 13 neonates born in the term under 32 weeks of gestation. Results: Term males were found to suffer from sepsis more often (odds ratio = 5.19). Delivery by cesarean section for preterm neonates increased reliably the risk of NS development compared with term neonates (OR = 2.7). It was found that the average values of LDH activity in the groups were not higher than normal parameters with a tendency to decrease as the duration of pregnancy decreased. At the same time, in almost all examined patients, there was an excess of serum activity of Creatine phosphokinase-MB fraction (CPK-MB) (86.96% of cases in Group I and in 91.18% of cases in Group II) and in some patients an increase in serum aspartate aminotransferase (ACT) activity in 52.17% of patients with Group I, in 47.06% of cases from Group II, P > 0.05). The correlation analysis conducted showed that in preterm neonates suffering from NS increase of the myocardial functional ability of the left ventricle was associated with females and the number of days of inotropic support. Conclusions: Analysis of clinical-anamnestic findings determined that term males suffer from NS reliably more frequent which is clearly associated with the risk of NS development. Increase of CPK-MB serum activity can be considered as a sign of myocardial dysfunction development caused by NS. The analysis of echocardiographic parameters conducted in the group or preterm neonates found a direct correlation of the ejection fraction with initiation of cardiovascular resuscitation immediately after birth and the period of introduction of inotropic drugs.