Changes in the amino acid profile of umbilical cord blood plasma as a predictor of intraventricular hemorrhage in premature newborns

BACKGROUND: In the structure of pathologies that have a significant impact on the prognosis for the life and health of premature infants, an important place is given to intraventricular hemorrhages. The search for predictors and biomarkers of intraventricular hemorrhage as the basis for new methods of early diagnosis, expanding opportunities for the prevention of long-term complications, reducing the cost of nursing and rehabilitation of premature infants remains highly relevant.

AIM: Identification of changes in the amino acid spectrum of umbilical cord blood plasma that precede the development of intraventricular hemorrhages in premature infants.

MATERIALS AND METHODS: The study was conducted from May 2023 to May 2024. Umbilical cord blood was obtained from physiological and operative deliveries of preterm neonates of gestational age 36 weeks or less, taking into account the mother’s informed consent and non-inclusion/exclusion criteria. Children included in the study were observed until discharge. Based on the results of observation of patients, a confirmed diagnosis of intraventricular hemorrhage, the timing of its development and severity were recorded. The concentration of amino acids in umbilical cord blood plasma was determined by capillary electrophoresis. Based on the results of monitoring patients and diagnosing the disease, 2 groups were retrospectively formed: a comparison group — premature newborns who did not develop intraventricular hemorrhages during the entire observation period (n=67), and a main group — patients with intraventricular hemorrhages (n=14). Children in the study groups were initially comparable in terms of gestational age, body weight, Apgar and Ballard scores, as well as the frequency of key risk factors for intraventricular hemorrhage.

RESULTS: In the main group, intraventricular hemorrhages were diagnosed within 72 hours from birth, of which: grade 1 — in 12 children, grade 2 — in one child, and grade 3 — in one child. The development of the disease is preceded by: increased levels of leucine (55.9%), valine (60.8%) and isoleucine (8.1%); p=0.001, p=0.004 and p=0.048, respectively. There was also detected an increase in levels of taurine (35.9%), cysteine (38.5%), methionine (13.4%), proline (26.2%) and citrulline (28.0%); p=0.027, p=0.003, p=0.042, p=0.011 and p=0.029, respectively.

CONCLUSION: Hypoxia and ischemia in the perinatal period can limit the catabolism of amino acids, interfere with the adequate production of high-energy compounds and the implementation of anaplerotic processes that ensure the synthesis of compounds critical for the normal functioning of the central nervous system. An increase in the levels of a number of amino acids in umbilical cord blood is highly likely a consequence of a violation of their consumption in the central nervous system during hypoxia, in itself forms the basis for brain damage, and can be a reliable predictor of intraventricular hemorrhages in premature infants.