Method for discovering newborns threatened by hypoxic ischemic encephalopathy development

FIELD: medicine.

SUBSTANCE: method involves determining interleukine 1α content in peripheral blood by applying immune enzyme assay method. Interleukine 1α concentration being equal to 21.8±0.21 pg/ml, the child is judged to belong to group threatened by hypoxic ischemic encephalopathy development.

EFFECT: high accuracy of the method; enhanced effectiveness in selecting appropriate therapy at early stage.

 

The invention relates to medicine, namely, neurology and Pediatrics.

Despite significant progress in the development of technologies of clinical monitoring and the study of pathology of the fetus and newborn hypoxic-ischemic encephalopathy (wide state telecommunication inspection) remains a serious condition, causing significant mortality, long-term morbidity and disability of children. It is therefore particularly important early diagnosis and clarification severity of hypoxic-ishemicheskoi encephalopathy to more quickly determine the most appropriate treatment of these children in the early stages.

As a prototype, the authors propose a method for studying the blood on the content in the serum interleukin-1b (IL-1b) in neonates with transient disorders of the blood and CSF circulations of hypoxic Genesis in the early period of adaptation ("Pediatric immunology - Current issues in perinatal immunology. VA Tabolin, Not, Mevteeva, Dniestre, Fin. Russian state medical University. Moscow, 2004 Section: Immunopathogenesis of non-communicable diseases of the fetus and newborn.) The authors found that newborns with wide state telecommunication inspection, the concentration of IL-1β in peripheral blood serum was small in the first week of life and was significantly increased in both the second and third weeks of life. CTE is the tier of increasing concentrations of IL-1β in the serum of infants with wide state telecommunication inspection coincided with the severity of the child's condition.

In this sentence, there are no criteria to identify infants endangered by the development of hypoxic-ischemic brain damage, and no description of research methodology in serum IL-1b.

Certain disadvantages of the method, proposed as the prototype are:

IL-1β is a proinflammatory immunocytokines, secretively monocytes, it is the basis of starting a cascade of immune and acute-phase inflammatory responses both locally and at the system level, therefore, the use of IL-1b is less specific for the diagnosis of hypoxic-ischemic brain damage in newborns;

- the presence of transient disturbances hemolymphoreticular newborn hypoxic Genesis;

- the lack of criteria for the diagnosis of hypoxic brain damage in newborns.

The technical result of the proposed method is the determination of the values of interleukin-1α (IL-1α) for early diagnosis of wide state telecommunication inspection and adequate therapy.

The authors suggest that their method of early diagnosis-wide state telecommunication inspection in newborns by examining the serum concentration of IL-1α. The synthesis of IL-1α is one of the components of the immune response to the disease process and reflects tissue damage, treating proinflammatory what Tokina. This cytokine plays a leading role in the implementation of the interaction between the nervous and immune systems.

The results showed that the higher the level of IL-1αthe heavier cerebral disorders. This gives the authors suggests that proinflammatory cytokines play an important role in the pathogenesis wide state telecommunication inspection. As a result of increasing the permeability of the blood-brain barrier immune cells penetrate into brain tissue - this leads to activation of microglia, which promotes the secretion of large amounts of cytokines, including IL-1αin the CNS, which leads to inflammatory damage to the brain tissue. Therefore, the original level of Pro-inflammatory cytokines can talk about early diagnosis of cerebral pathology in the newborn.

The authors examined 141 newborn, including:

1 group - wide state telecommunication inspection II severity - 73 child;

2 group - wide state telecommunication inspection III severity of 27 children;

group 3 - control (healthy) - 41 child.

To determine the levels of IL-1α taking peripheral blood in a volume of 3 ml, on the 2nd day from birth. Spend immune-enzyme assay (ELISA) detection of antigens using monoclonal antibodies to solid-phase basis. The analysis is divided into several stages: in the wells of polystyrene tablet containing the antigen IL-1α, BB is completed with the patient's serum; incubate one hour at room temperature, and then the wells are washed and dried; enter conjugate. Incubated at room temperature for one hour, washed, and dried. Add substrate mixture. After adding it, you receive a color reaction.

To stop immunological response in 15-20 minutes (standard time) to introduce a stop reagent, photometrate on the immune-enzyme analyzer at a wavelength of 450 nm (wavelength standard). The results are in concentration units (the unit automatically builds the calibration curve and the results are in units of concentration in PG/ml).

In the control group, the content of IL-1α serum 2,17±0,48 PG/ml, but had 14 children from this group noted the high content of IL-1α serum to 21.8±of 0.21 PG/ml

In neonates with wide state telecommunication inspection II severity of the contents of IL-1α in the serum at the first fence was 50,31±10,30 PG/ml or more, and in neonates with wide state telecommunication inspection III the severity of the content of IL-1α serum was 93,16±of 0.85 PG/ml or more.

Newborns of the control group, in which when you first define the level of IL-1α was raised, there was no neurological symptoms, during the control study serum after 7 days showed increased levels of IL-1α up to 35 PG/ml - 45 PG/ml On the Sabbath. concurrently with this, or a little earlier for 2-3 days in children was observed neurological symptoms: there was a tremor of a chin, extremities, spontaneous Moro reflex, increased muscle tone in the proximal in flexor. These children authors were selected in the group of children threatened by development-wide state telecommunication inspection.

The proposed method is simple, accessible, does not require expensive equipment, enough blood. It allows you to improve the quality of diagnostics-wide state telecommunication inspection, to identify the severity of CNS lesions in the early stages and to select the optimal therapy for the treatment of these children.

Clinical case # 1: case history No. 3/1112.

Patient N., 2 days. From the first pregnancy occurring without specifics, from the first term labor at 40 weeks of gestation, duration of labour 9 hours and 45 minutes, anhydrous period of 1 hour 45 minutes. A girl was born weighing 3520 g, length 51 cm, head circumference 34 cm, chest circumference 33 cm, score Apgar 8-9. In neurological status at birth without features. In the study of blood serum on the 2nd day from birth revealed a high content of IL-1α to 21.4 PG/ml This gave the opportunity to assume the existence of a wide state telecommunication inspection of the newborn. On the 5th day of life, the child has been marked tremor of the limbs, there is a common concern, wince, a moderate decrease in muscle tone, intermittent, spontaneous Moro reflex.

When determining IL-1α serum on the 7th day of being in the office was found to be increasing it is equal to 38 PG/ml

Clinical data and changes in the content of IL-1α in the serum of the newborn gave reason to select it in the group of children threatened by development-wide state telecommunication inspection, and determine further tactics and treatment of this child.

Clinical example # 2: case history No. 15/7185. Patient C., 2 days. Diagnosis: wide state telecommunication inspection II severity, hypertensive syndrome, subependymal cyst on the left.

The child from 3rd pregnancy occurring on the background of chronic bronchitis with asthmatic component. From the first birth (in history 2 megabit), 40 weeks of pregnancy, duration of birth 4 hours and 50 minutes, anhydrous period of 5 hours and 20 minutes, premature rupture of the membranes. The boy was born weighing 3190 g, length 50 cm, head circumference 33 cm, chest circumference 32 cm, score Apgar 8-9. After birth was marked tremor of the limbs, drooping of the head back. On the fifth day revealed the divergence of the sagittal suture from 0.5 to 1.5, see the big fontanel 3×3 cm, small fontanel 1,5×1.5 cm for admission to the Department head circumference 35 cm, large fontanel 5,0×5.0 cm sagittal suture of 1.5-2.0 cm, small spring 3,0×3,0 see Revealed tremor of the extremities, reduced grasping reflex, spontaneous Moro reflex, muscle tone in the hands of the reduced leg elevated in the proximal in flexor. The tendon reflexes of high cross, with extended reflexogenic zone (=). Doubtful syndrome Lesage. ECG signs of post-hypoxic myocardial ischemia. Dilatation of the fundus. The people's Assembly: NS - 2.0 mm, contains fluid; PRBI - S-4 mm, D - 3 mm. to the Left subependymal cyst, echostructure brain diffuse increased echogenicity.

The content of IL-1α serum: at admission: 44,14 PG/ml, 7-10 days 111,14 PG/ml.

Was diagnosed with wide state telecommunication inspection II severity of the hypertension-hydrocephalic syndrome, subependymal cyst on the left.

Increased levels of IL-1α in the serum of the patient was consistent with moderate wide state telecommunication inspection.

The way to identify newborns, threatened by the development of hypoxic-ischemic encephalopathy, including the definition in the peripheral blood interleukin method of immune-enzyme analysis, characterized in that on the 2nd day of life the newborn determine the content of interleukin-1α and when the value of the concentration of interleukin 1α = (21,8±0,21) PG/ml child belongs to a group of children, threatened by the development of hypoxic-ischemic encephalopathy.



 

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