Complex Evaluation Oxygen Status and Lipid Metabolism Indexes in Newborns with Perinatal Hypoxia and Hypovolemic Shock

Aim. To asses of metabolism, lipid metabolism and oxygen status parameters in newborns with perinatal hypoxia.

Materials and Methods. 53 newborn babies born with signs of severe hypoxia and low Apgar scoring equal to 2 at the 1st minute of life were enrolled in the study. Newborns were divided into 2 groups depending on the presence of the clinical presentation of shock: Group 1 «Shock» and Group 2 «Acute intranatal hypoxia» (AIH). All newborns underwent testing for blood gas and acid-base balance, lactate level. Cholesterol and triglyceride levels in the central venous blood were also tested immediately after the birth and on the 5th day of life. Mechanical ventilation mode and parameters were registered. The mean airway pressure (MAP) and the oxygen saturation index (OSI) were calculated.

Results. Severe decompensated metabolic lactic acidosis was diagnosed in a «Shock» group newborns at birth, thus indicating severe perinatal hypoxia which had triggered the development of shock. As for the «AIH» group newborns, they had hyperlactatemia alone. The most severe hypoxemia at birth was diagnosed in newborns of the «Shock» group; the OSI value in these infants was significantly higher than that in «AIH» infants (P<0.01). Despite the treatment and mechanical ventilation, during the posthypoxic period, newborns from the «Shock» group were characterized by increased OSI values over 12 hours after birth. Significantly high levels of OSI persisted for 48 hours after the delivery. Severe hypotriglyceridemia and hypocholesterolemia were found in both group newborns.

Conclusion. The study demonstrated that there was intranatal complex metabolism impairment in the case of perinatal hypoxia; at birth, it manifested by metabolic acidosis of various degrees of severity and imbalance of triglycerides and cholesterol levels. The longer and more severe hypoxia is, the more severe acid-base balance and blood lactate level impairment at birth become. Critical pH and lactate values, blood buffer base deficiency, hypotriglyceridemia, are hypocholesterolemia are pathognomonic for perinatal hypoxia and shock development in newborns. This study demonstrated a relationship between the levels of triglycerides and cholesterol with parameters of the acid-base balance and blood lactate levels, and the duration of the mechanical ventilation.

1. Fattuoni C., Palmas F., Noto A., Fanos V., Barberini L. Perinatal asphyx- ia: a review from a metabolomics perspective. Molecules. 2015; 20 (4): 7000–7016. http://dx.doi.org/10.3390/molecules 20047000. PMID: 25898414

2. Jones J.G., Smith S.L. Shock in the critically ill neonate. J. Perinat. Neonatal. Nurs. 2009; 23 (4): 346–354. http://dx.doi.org/10.1097/ JPN.0b013e3181ba5842. PMID: 19915418

3. Boskabadi H., Zakerihamidi M., Sadeghian M.H., Avan A., Ghayour Mobarhan M., Ferns G.A. Nucleated red blood cells count as a prognos- tic biomarker in predicting the complications of asphyxia in neonates. J. Matern. Fetal. Neonatal. Med. 2016; 24: 1–6. http://dx.doi.org/ 10.1080/14767058.2016.1256988. PMID: 27809621

4. Perepelitsa S.A., Golubev A.M., Moroz V.V., Alekseyeva S.V. Causes of acute intranatal and postnatal hypoxia in neonatal infants. Obshchaya Reanimatologiya = General Reanimatology. 2012; 8 (6): 17–22. http://dx.doi.org/10.15360/1813-9779-2012-6-17. [In Russ., In Engl.]

5. Sharma D., Sharma P., Shastri S. Golden 60 minutes of newborn’s life: part 2: term neonate. J. Matern. Fetal. Neonatal. Med. 2016; 29: 1–6. http://dx.doi.org/ 10.1080/14767058.2016.1261399. PMID: 27844484

6. Gardiner M., Ruttan T.K., Kienstra A.J., Wilkinson M. Making the quick diagnosis: a case of neonatal shock. J. Emerg. Med. 2016; 13: pii: S0736- 4679(16)30991-X. http://dx.doi.org/10.1016/j.jemermed.2016.11.003. PMID: 27986330

7. Fareitor E.V., Litvinova A.M., Zakharova S.Yu., Pestryaeva L.A. Blood gas homeostasis and oxygen-transport function in very low and extremely low birth weight infants during the first year of life. Rossiisky Vestnik Perinatologii i Pediatrii. 2015; 60 (2): 57–65. [In Russ.]

8. Parshin E.V., Aleksandrovich Yu.S., Kushnerik L.A., Blinov S.A., Pshenisnov K.V., Nurmagambetova B.K. Oxygen status parameters as markers of renal dysfunction in neonatal infants with critical status. Obshchaya Reanimatologiya = General Reanimatology. 2010; 6 (2): 62–67. http://dx.doi.org/10.15360/1813-9779-2010-2-62. [In Russ., In Engl.]

9. Simovic A., Stojkovic A., Savic D., Milovanovic D.R. Can a single lactate value predict adverse outcome in critically ill newborn? Bratisl. Lek. Listy. 2015; 116 (10): 591–595. https://doi.org/10.4149/bll_2015_ 115. PMID: 26531869

10. Perepelitsa S.A., Sednev O.V. Pathogenetic role of cholesterol and triglyceride metabolic disturbances in the development of critical conditions. Obshchaya Reanimatologiya = General Reanimatology. 2015; 11 (5): 67–74. http://dx.doi.org/10.15360/1813-9779-2015-5-67-74. [In Russ., In Engl.]

11. Kimmoun A., Novy E., Auchet T., Ducrocq N., Levy B. Hemodynamic consequences of severe lactic acidosis in shock states: from bench to bedside. Crit. Care. 2015; 19: 175. http://dx.doi.org/10.1186/s13054- 015-0896-7. PMID: 25887061

12. Bröer S., Schneider H.P., Bröer A., Rahman B., Hamprecht B., Deitmer J.W. Characterization of the monocarboxylate transporter 1 expressed in Xenopus laevis oocytes by changes in cytosolic pH. Biochem. J. 1998; 333 (Pt 1): 167–174. https://doi.org/10.1042/bj3330167. PMID: 9639576

13. Gunnerson K.J., Saul M., He S., Kellum J.A. Lactate versus non-lactate metabolic acidosis: a retrospective outcome evaluation of critically ill patients. Crit. Care. 2006; 10 (1): R22. http://dx.doi.org/10.1186/ cc3987. PMID: 16507145

14. Jung B., Rimmele T., Le Goff C., Chanques G., Corne P., Jonquet O., Muller L., Lefrant J.Y., Guervilly C., Papazian L., Allaouchiche B., Jaber S.; AzuRea Group. Severe metabolic or mixed acidemia on intensive care unit admission: incidence, prognosis and administration of buffer therapy. A prospective, multiple-center study. Crit. Care. 2011; 15 (5): R238. http://dx.doi.org/10.1186/cc10487. PMID: 21995879

15. Vavilala M.S., Richards T.L., Roberts J.S., Chiu H., Pihoker C., Bradford H., Deeter K., Marro K.I., Shaw D. Change in blood-brain barrier per- meability during pediatric diabetic ketoacidosis treatment. Pediatr. Crit. Care Med. 2010; 11 (3): 332–338. http://dx.doi.org/ 10.1097/PCC.0b013e3181c013f4. PMID: 19838141

16. Perepelitsa S.A., Sednev O.V. Perinatal triglyceride and cholesterol meta- bolic disturbances in newborn infants. Obshchaya Reanimatologiya = General Reanimatology. 2015; 11 (6): 28–37. http://dx.doi.org/ 10.15360/1813-9779-2015-6-28-37. [In Russ., In Engl.]

17. Perepelitsa S.A., Alekseyeva S.V., Luchina A.A. The impact of perinatal metabolic disorders choice mode mechanical ventilation in newborns. Anesteziologiya i Reanimatologiya. 2016; 61 (4): 275–280. http://dx.doi.org/10.18821/0201-7563-2016-61-4-275-280. [In Russ.]

18. Volodin N.N. (red.). Neonatology. National guide. Moscow: GEOTAR- Media; 2008: 749. [In Russ.]

19. Rawat M., Chandrasekharan P.K., Williams A., Gugino S., Koenigsknecht C., Swartz D., Ma C.X., Mathew B., Nair J., Lakshminrusimha S. Oxygen saturation index and severity of hypoxic respiratory failure. Neonatology. 2015; 107 (3): 161–166. http://dx.doi.org/10.1159/ 000369774. PMID: 25592054

20. Satriano A., Pluchinotta F., Gazzolo F., Serpero L., Gazzolo D. The potentials and limitations of neuro-biomarkers as predictors of outcome in neonates with birth asphyxia. Early Hum. Dev. 2017; 105: 63–67. http://dx.doi.org/10.1016/j.earlhumdev.2016.12.005. PMID: 27993431

21. Bhat B.V., Plakkal N. Management of shock in neonates. Indian J. Pediatr. 2015; 82 (10): 923–929. http://dx.doi.org/10.1007/s12098- 015-1758-7. PMID: 25990594