THE PSYCHO-EMOTIONAL DEVELOPMENT OF PREMATURE INFANTS AND DETERMINANTS THAT DEFINE IT

Kozakevich O. B., Kozakevich V. K., Demidenkova G. G., Martynenko N. V., Kashchenko A. Y.

CLINICAL AND EXPERIMENTAL MEDICINE

Scentific article

Improvement in obstetric and neonatal care contributed to a significant reduction in the mortality rate of premature babies, but increased the percentage of children with cognitive impairment. Therefore, it is especially important to identify in time the manner of the risk groups of violations of psycho-emotional development in a given cohort of children for early intervention in order to avoid the formation of disability in the future. Aim: to establish the clinical and genetic determinants of the formation of delayed psycho-emotional development in infants with very low and extremely low birth weight and to develop a prediction algorithm for this condition. Object and methods of research. A cohort prospective study was conducted, which included 155 infants with very low and extremely low birth weight. Their psycho-emotional development in 6, 12, 18, 24 and 36 months of life was studied and determinants determined. In accordance to the Order of the Ministry of Health of Ukraine dated March 20, 2008 No. 149 “Clinical protocol for medical care for a healthy child under the age of 3 years”. The study was carried out in accordance to the standards of bioethics. The material for genetic study was peripheral venous blood. A molecular genetic study was conducted using polymerase chain reaction techniques. Forecasting of the delay of psycho-emotional development was carried out with the help of simple and stepwise multiple logistic regression analysis. Results. In the 24 months of the corrected age 19% of children have psycho-emotional retardation, and in 36 months – almost 15% of children born with very low and extremely low body weight. Forcasting model for delayed psycho-emotional development in early age for children born with low and extremely low body weight is devised. Contributing factors to the psycho-emotional development of these determinants were demographic characteristics, socio-economic status of the family, peculiarities of antenatal and intranatal periods, the state of the child immediately after birth and the volume of primary reanimation, diagnoses, and volumes of treatment at the inpatient and non-stationary stages. Four reliable predictors of psycho-emotional development delay were revealed: severe VSK, body weight at discharge from a neonatal hospital less than 3 percentiles, artificial feeding at the discharge, and socio-economic status of the family, namely the upbringing of a child in an incomplete family.To find out the role of genetic determinants in delaying the psycho-emotional development of the examined children, we studied the association between the polymorphism of the genes of the glutathione-S-transferase family, dominant models of ACE genes; AGT2R1, e NOS and delayed psycho-emotional development in the examined children in 24 months of life. None of the genetic models studied GSTT1, GSTM1, GSTR1, ACE, AGT2R1 and eNOS genes were associated with a violation of the psycho-emotional development of infants born with body weight less than 1500 g. The model of prediction of early psycho-emotional development delay in children with very low and extremely low body weight at birth has been developed by our model has a moderate sensitivity (37.04%) and high specificity (92.86%). Conclusions. The high specificity of the developed model of prediction of delayed psycho-emotional development in prematurely born children indicates the possibility of its application in practical medicine. Our further research will focus on identifying specific candidate genes that are involved in the development of psycho-emotional development disorders in a larger cohort of prematurely born children with very low and extremely low body weight to prove the role of genetic mechanisms in the development of extremely premature infants

forecasting, psycho-emotional development, very low body weight, extremely low body weight, premature children.

1. Shunko YeYe, Laksha OT, Bielova OO. Shliakhy rozvytku neonatolohii v Ukraini u ХХI stolitti – vprovadzhennia svitovykh standartiv nadannia medychnoi dopomohy hlyboko nedonoshenym ditiam ta yikh podalsha medyko-sotsialna reabilitatsiia. Sovremennaia pedyatryia. 2010;1(29):10-2. [in Ukrainian].
2. Shunko YeYe, Bielova OO, Laksha OT. Analiz perynatalnoi patolohii ditei, yaki narodylys z duzhe maloiu masoiu tila, i stanu zdorovia yikh materiv. Zdorove zhenshchynу. 2016;1(107):176-9. [in Ukrainian].
3.  Yablon OC, Vlasenko DYu. Nadzvychaino mala masa tila pry narodzhenni katamnez yakosti zhyttia. Neonatolohiia, khirurhiia ta perynatalna medytsyna. 2014;2(12):62-8. [in Ukrainian].
4. Znamenska TK, Shunko YeYe, Kovalova OM, Pokhylko VI, Mavropulo TK. Priorytety natsionalnoho planu dii z prypynennia smertei novonarodzhenykh, yaki mozhna poperedyty, v ramkakh hlobalnoi stratehii OON «Kozhna zhinka, kozhna dytyna». Neonatolohiia, khirurhiia ta perynatalna medytsyna. 2016;6(19):5-11. [in Ukrainian].
5. Gladstone M, White S, Kafulafula G. Post-neonatal Mortality, Morbidity, and Developmental Outcome after Ultrasound Dated Preterm Birth in Rural Malawi: A Community-Based Cohort Study. PLoS Med. 2011;8(11):1001-121.
6. Kumar P, Shankaran S, Kendrick DE. Characteristics of extremely low birth weight infant survivors with unimpaired outcomes at 30 months of age. J. Perinatol. 2013;33(10):800-5.
7. Iwata S, Nakamura T, Hizume E. Qualitative Brain MRI at Term and Cognitive Outcomes at 9 Years After Very Preterm Birth. Pediatrics. 2012;129(5):1138-47.
8. Linda D, Breeman D, Jaekel J, Baumann N, Bartmann P. Preterm Cognitive Function Into Adulthood. Pediatrics [Internet]. 2015. [cited 2016 Feb 19];136(3):415-22. Available from: http://pediatrics.aappublications.org/content/early/2015/08/05/peds. 2015
9.  Moore T, Hennessy EM, Myles J. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ. 2012;345:7961.
10. Orchinik LJ, Taylor HG, Espy KA. Cognitive Outcomes for Extremely Preterm/Extremely Low Birth Weight Children in Kindergarten. J Int Neuropsychol Soc. 2011;17(6):1067-79.
11. Korzhynskyi YuS, Slivinska-Kurchak KhB. Osoblyvosti fizychnoho, psykhomotornoho rozvytku ta zakhvoriuvanosti u ditei rannoho viku, yaki potrebuvaly provedennia shtuchnoi ventyliatsii lehen u neonatalnomu periodi. Medytsyna transportu Ukrainy. 2013;4(48):69-76. [in Ukrainian].
12.  Fevang SE, Hysing M, Markestad T, Sommerfelt K. Mental Health in Children Born Extremely Preterm Without Severe Neurodevelopmental Disabilities. Pediatrics [Internet]. 2016 [cited 2016 Feb 19];137(4). Available from: http://pediatrics.aappublications.org/content/137/4/ peds.2015-3002
13. Spittle A, Orton J, Doyle LW, Boyd R. Early developmental intervention programmes post-hospital discharge to prevent motor and cognitive impairments in preterm infants. Cochrane Database Syst Rev. 2007 Apr 18;(2):CD005495.
14. Kozakevych OB. Fizychnyi rozvytok vkrai nedonoshenykh ditei uprodovzh pershykh trokh rokiv zhyttia ta faktory ryzyku, shcho vplyvaiut na yoho znachnu zatrymku. Sovremennaia pedyatryia. 2016;4(76):36-9. [in Ukrainian].
15. Horovenko NH, Znamenska TK, Kovalova OM. Henetychnyi monitorynh novonarodzhenykh u viddilenniakh intensyvnoi terapii (napryklad i heniv simeistva hlutation-s-transferaz). Metodychni rekomendatsii. Poltava. 2010. 35 s. [in Ukrainian].
16. Znamenska TK, Horovenko NH, Pokhylko VI. Analiz polimorfizmu heniv GSTT1, GSTM1 u novonarodzhenykh, yaki perenesly perynatalnu asfiksiiu. Pediatriia, akusherstvo ta hinekolohiia. 2009;71(5):28-9. [in Ukrainian].
17. Pokhylko VI, Kozakevych OB, Kaliuzhka OO. Vplyv polimorfizmu heniv simeistv hlutation-S-transferaz na rozvytok ta zakhvoriuvanist peredchasno narodzhenykh ditei z bronkholehenevoiu dysplaziieiu. Aktualni pytannia pediatrii, akusherstva ta hinekolohii. 2015;1(15):75-80. [in Ukrainian].
18. Rossokha ZI. Rol henetychnykh ta seredovyshchnykh faktoriv u rozvytku patolohichnykh staniv na rannikh etapakh ontohenezu [avtoreferat]. Kyiv; 2007. 149 s. [in Ukrainian].
19. Salminen LE, Schofield PR, Pierce KD. Impact of the AGTR1 A1166C polymorphism on subcortical hyperintensities and cognition in healthy older adults. Age (Dordr). 2014;36(4):9664.
20. Klinichnyi protokol medychnoho dohliadu za zdorovoiu dytynoiu vikom do 3 rokiv: Nakaz MOZ Ukrainy №149 vid 23.03.2008. Ofitsiinyi visnyk Ukrainy. 2008. 67 s. [in Ukrainian]
21.  Arand MA, Muhlbauer R, Hengstler J. Multiplex Polymerase Chain Reaction Protocol for the Simultaneous Analysis of the Glutathione S-Transferase GSTM1 and GSTT1 Polymorphisms. Analytical Biochemistry. 1996;236:184-6.
22. Riha OO. Rezultaty katamnestychnoho sposterezhennia za ditmy hrupy ryzyku. Likarska sprava. 2016;1(2):96-101. [in Ukrainian].

«Bulletin of problems biology and medicine» Issue 2 Part 1 (150), 2019 year, 139-144 pages, index UDK 616.89-008-053.32

10.29254/2077-4214-2019-2-1-150-139-144