Intensity of Endogenous Intoxication in Newborns with Congenital Intestinal Obstruction and Its Grade after Surgical Treatment of the Disease

摘要

Urgency of problem. Congenital intestinal obstruction in newborns causes insufficient digestion and elimination of enterotoxins, makes a significant contribution to the development of endogenous intoxication, dramatically worsening the adaptive capabilities of the child's body. The presence of endotoxemia at newborns with congenital intestinal obstruction due to increased permeability of the intestinal wall, the catabolic orientation of metabolism, exacerbated by water-electrolyte disturbances can affects the intensity of reparative processes after surgical correction of the defect. The aim of the research was to determine the type and grade of endogenous intoxication in newborns with various clinical and anatomical forms of congenital intestinal obstruction before and after surgical treatment. Material and methods. The parameters of endogenous intoxication (middle-weight molecular peptides, malondialdehyde, lactate, bilirubin, creatinine levels) were measured in the blood serum of 208 newborns with various clinical and anatomical forms of congenital intestinal obstruction. Results. It was proved that endogenous intoxication (EI) in newborns with congenital intestinal obstruction is multiplex and composed of metabolic and resorption components. Metabolic component of EI includes middle-weight molecular peptides (MMP), malondialdehyde (MDA). Concentration of middle-weight molecular peptides was statistically significant (p <0.05) increase versus control in all cases of congenital intestinal obstruction in newborns, furthermore MMP level increase was more expressed at newborns with low congenital intestinal obstruction. The resorption component of endogenous intoxication at congenital intestinal obstruction was increased due to bilirubin, it was significantly higher at newborns with low congenital intestinal obstruction versus patients with high congenital intestinal obstruction. The lactate level was within the reference interval for all newborns, regardless of the level of congenital intestinal obstruction. Before surgery the metabolic component of the endogenous intoxication - malondialdehyde, as well as protein-energy, water-electrolyte disorders and weight loss were more evident at newborns with high congenital intestinal obstruction. In spite of this, regression of endogenous intoxication after surgery was faster in this patients with high intestinal obstruction versus newborns with low intestinal obstruction. Conclusion. Congenital intestinal obstruction in newborns is accompanied by EI of mixed genesis with a predominance of metabolic and resorption components. Before surgery high level of MDA, as a result of hypoxia, membrane destruction and tissue necrosis is a distinctive feature of high congenital intestinal obstruction and malrotation. After surgery regression of MDA level was faster in patients with high intestinal obstruction versus newborns with low intestinal obstruction, that had significantly high level of MMP.