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"Child`s Health" 1 (52) 2014

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Social and biological risk factors of physical growth and development deviations who had perinatal hypoxic-ischaemic encephalopathy

Authors: Pykhtina L.A., FilkinaО.M., Nazarov S.B., ShaninaT.G., Vorobyov E.A., Kocherova O.U., Dolotova N.V.

Categories: Pediatrics/Neonatology

Sections: Clinical researches

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Introduction. The development abnormalities prediction plays an important role in infants who had perinatal hypoxic-ischaemic encephalopathy (HIE). It allows not only to reveal the risk factors, but to determine the point of application in the preventive measures in order to gain a majority of safety factors. The timely realization of preventive measures will help to reduce the frequency of physical growth and development deviationsfor children ingroup risk of the formation of underweight body and short.

The purpose of research to reveal the social and biological risk factors for the formation of short and underweight body in infants who had  HIE.

Materials and methods. We observed 448 children from 1 to 3 years who had  mildor moderate HIE. This group excluded children without HIE and with severe HIE, clinical manifestations of intrauterine infection, malformations, mental deseases, visual and hearing impairment, prematurity less than 36 gestational weeks, genetic disorders and intrauterine growth retardation.

Physical growth and development was assessed by standardized procedure using local age- and sex-specific norms. The formation of subgroups carried out on physical growth and development: the I group consisted of children with normal physical growth and development, the II group – children with underweight body, the III – short children, the IV group – children with a combination of short and underweight body.

The Wald’s sequential analysis technique used to draw up the prognostic tables. The prognostic coefficient was calculated using the formula:

PC = 10 lg (P1/P2) in the presence of factor and PC = 10 lg (1-P1/1-P2) in the absence of the factor, where P1 and P2 – the frequency of a factor in the comparing groups. A positive meaning of the obtained value means the unfavorable prognosis.

Significant factors PC summarized to predicting physical growth and development deviations of the young child, who had HIE. If the PC is equal to the sum of +13 points or more, the prognosis is unfavorable, and these children form the risk group for physical growth and development deviations. If the PC sum is equal to –13 points or less, the prognosis is favorable. If the PC sum in the range from +12 to –12 points, the prognosis is uncertain (focus group).

Results and discussion.It was established the significant risk factors for physical growth and development deviations prediction based on the social and biological past history analysis.  It was found that significant unfavorable prognostic factors for the underweight bodyformation were the abortion threatin the 2ndterm, pregnancy mild anemia, frequent mother’s stressful situations,artificial feeding from the moment of baby’s birth, family substandard income, maternal smoking, chronic intrauterine hypoxia, hydramnion, noncompliance of medical recommendations due to their high costs, uterine inertia, the jobless father’s social status, hostility, conflict, rudeness, hard-heartedness in relations between family members; father’s heavy physical work, fetoplacental insufficiency, the moderate child's general statein birth, mother’s chronic diseases exacerbation in the 2nd term.

It was found that significant unfavorable prognostic factors for the short growth formation werefetoplacental insufficiency, chronic intrauterine hypoxia, child’sbronchopulmonary dysplasia, maternal smoking, the occupational hazzards impact before conception within 5–10 years, frequent mother’s stressful situations, mother’s chronic diseases exacerbation in the 2nd term, noncompliance of medical recommendations due to their high costs, the abortion threatin the 2ndterm, child’sintestinal dysbiosis, the mother’s urinary system pathology.

The data analysis indicates that biological and social factors go a long way to the infants’ underweight body and short growth formation who had HIE (64.7 % and 81.8 %, respectively, and 35.3 % and 18.2 % respectively). At the same time, the amount of biological risk factors significantly higher than social factors in group with short growth (p < 0.01).The amount of biological risk factors higher in group with short growth in 1.3 times than at children with underweight body. This indicates that biological factors have the greater influence to the formation of low growth in infants which take effects mainly in prenatal and intranatal period. But the social factors also have the influence on the formation of underweight body.

The method oflow growth and underweight body prediction to 3 years in children who had HIE developed on the basis of the established social and biological risk factors. It based on determination of risk factors in the first year of life.

Conclusions .  It were identified social and biological risk factors and developed prognostic tables for the low growth and underweight body formation in little children who had HIE. It was found that biological factors have a great impact for the low growth formation, whereas the complex influence of biological social factors are in importance for the underweight body formation.


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