Omonova Umida Tulkinovna

Title: Clinical, diagnostic and pathogenetic aspects of gastrointestinal disorders in infants with hypoxic-ischemic central nervous system injury

Abstract

Introduction: One of the pressing issues in modern pediatrics is the high prevalence of comorbid pathology, in particular gastrointestinal disorders in children with perinatal nervous system injury. Early diagnosis and correction of these conditions are crucial for preventing delays in physical and cognitive development.

Aim of the study: To identify the characteristics of the disease course and to develop criteria for early diagnosis of gastrointestinal disorders in infants during the first year of life against the background of perinatal pathology of the central nervous system.

Materials and methods: The study included 20 children aged from 1 month to 1 year who were receiving inpatient treatment with the following diagnoses: unspecified functional intestinal disorder — 7 patients (35%), functional diarrhea — 6 patients (30%), constipation — 7 patients (35%). All children underwent a comprehensive examination, which included: analysis of perinatal history;  clinical and neurological examination with assessment of autonomic status;  anthropometric measurements (weight, height);  neurosonography and ultrasound examination of the brain and abdominal organs; laboratory tests: complete blood count and stool analysis.

 Results and discussion: Among mothers of children with perinatal nervous system pathology, maternal age over 30 years predominated (66.92% versus 13.34% in the control group (CG), p < 0.01). Somatic pathology during pregnancy in mothers of the main group was observed in 80.83% of cases (versus 33.33% in the CG), with a predominance of anemia (62%), gastrointestinal diseases (44%), and endocrine disorders (12%). In the main group, spontaneous vaginal delivery occurred in only 28.57% of cases (versus 73.33% in the CG); operative delivery by cesarean section accounted for 41.35%, and labor stimulation for 30.08%. All children in the main group were found to have autonomic–visceral dysfunction syndrome in combination with a leading neurological syndrome (muscle dystonia — 67.3%, increased neuro-reflex excitability — 20.5%). The severity of autonomic disorders (changes in dermographism, acrocyanosis, pulse lability, sleep disturbances) correlated with the severity of brain injury. All patients demonstrated a combination of dyspeptic and pain syndromes with autonomic lability. Dynamic ultrasound diagnostics of the upper gastrointestinal tract (before, during, and after feeding) showed high informativeness. In children with predominance of sympathicotonia, decreased gastric motility, cardia insufficiency, and gastroesophageal reflux were detected. Vagotonia was characterized by accelerated evacuation function, narrowing of the pyloric canal, and duodenogastric reflux.

Conclusions: Gastrointestinal disorders in infants during the first year of life are predominantly functional in nature and are pathogenetically associated with autonomic–visceral dysfunctions resulting from hypoxic-ischemic injury of the central nervous system.