FEATURES OF THE PROGRESSION OF THE INFLAMMATORY RESPONSE IN NEWBORNS WITH NEONATAL ENCEPHALOPATHY

Abstract

Introduction. Neonatal encephalopathy (NE) is one of the most common diseases of the newborn period; worldwide the incidence of NE is more than 1 million newborns, most of which are registered in developing countries. Inflammation and hypoxia-ischemia play a vital, key role in neonatal encephalopathy. A persistent inflammatory response in neonates with NE is observed during the first week of life, which correlates with the severity of brain damage, but can persist for weeks, months and even years, due to tertiary mechanisms of damage that include inflammation and epigenetic changes, decreased plasticity and decreased number of neurons. Materials and methods. The study was conducted in 74 full-term newborns with neonatal encephalopathy. The gestational age of the children was 36 weeks or more, weight of more than 2500g. The presence and severity of neonatal encephalopathy were determined using the modified Sarnat scale. At 2 weeks of life, the examination was carried out in 74 children, and at 5 weeks of life – in 59 children, so the case monitoring was possible only for 59 newborns. The newborns were divided into subgroups 1 and 2. Subgroup 1 included children who were classified as having moderate neonatal encephalopathy. At 2 weeks of life, 55 such patients were examined, at 5 weeks – 43. Subgroup 2 included children with severe neonatal encephalopathy – 19 and 16 newborns at 2 and 5 weeks, respectively. In turn, each of the subgroups was divided into subgroups A and B, and into subgroup B newborns who received the probiotic. The biological product included bifidum bacteria; it was administered orally before the first blood draw for analysis. The levels of IL-1β and IL-10, C-reactive protein (CRP) were determined using the ELISA and the semiquantitative method. Results. The data obtained showed an increase in the level of both the pro-inflammatory interleukin IL-1β and the anti-inflammatory interleukin IL-10 at 2 weeks of life. This was observed both in children with moderate NE and in children with severe NE. However, in the latter, the level of increase in the studied cytokines was higher. At the 5th week of life, there was a significant decrease in IL-1β and IL-10, noted in all study groups. At the same time, high values of IL-1β and IL-10 remained in children with severe neonatal encephalopathy. The results of CRP showed a higher value in children with severe NE. Over time, a decrease in CRP was noted, but it was not significant for newborns with severe NE. There were no significant differences in mean IL-1β, IL-10, and CRP values between the non-probiotic and probiotic-treated groups, although there was a trend toward lower IL-1β, IL-10, and CRP values. However, there was a higher incidence of IL-1β values within the normal range by 5 weeks of life in infants with moderate NE who received the probiotic. Also, the frequency of IL-10 values within the normal range was higher in children with severe NE who received the probiotic. Conclusions. The levels of IL-1β, IL-10 and CRP were increased in children with neonatal encephalopathy, more significant for severe encephalopathy at both 2 and 5 weeks of life, while a decrease in IL‑1β, IL-10 and CRP was determined from 2 by 5 weeks of life. Administration of the probiotic resulted in a higher incidence of IL‑1β values within the normal range in the group of children with moderate neonatal encephalopathy and IL-10 in children with severe neonatal encephalopathy.