Khimenko T. Pathogenetic substantiation of treatment and prevention of vitamin and elemental deficiency in preterm infants

The aim of the work was to develop a differentiated approach to the management of deficiency of some elements in preterm infants with delayed growth based on the identification of factors associated with it and to study the pathogenetic mechanisms of its development. The features of the development of preterm babies during the first year of life were investigated and a new solution to an urgent scientific and practical issue was presented - the prevention of micronutrient deficiency in preterm infants, taking into account potential risk factors and using a substantiated integrated approach of drug prevention and nutritional correction. There were 203 babies born preterm under observation. Growth delay at 6 months of corrected age was found in 37.93% of children (95% CI 31.54 - 44.77%) and was significantly more often determined among children with a birth weight <1500 g (χ² = 24.9, p <0.001). A delay in psychomotor development for more than 1 month was observed at the age of 6 months of corrected age, approximately two times more often than growth delay (76.85%, 95% CI 70.58 - 82.12%). It was revealed that the further growth and psychomotor development of a preterm baby are influenced not only by pathological conditions of the neonatal period against the background of morpho-functional immaturity, but also by insufficient weight gain and micronutrient deficiency during the first year of life as a result of inappropriate nutrition. Children with a growth delay at 6 months of corrected age have a significantly greater risk of delay in growth, psychomotor and speech development at 12 months corrected age (p <0.05). The level of macro- and microelements in the whole blood of preterm infants 6 months old was determined and a probable zinc deficiency among children with delayed growth was revealed (3.66 mg / l 95% CI 3.33-3.99 mg / l). A risk factor for micronutrient deficiencies is the late introduction of complementary foods. It was found that among children with growth delay at 12 months corrected age, complementary foods and meat puree were introduced significantly later than among children without delay (the average age of the introduction of complementary foods (t = -2.33, p = 0.02) and meat puree (t = -2.44, p = 0.01)). The current level of awareness of the parents of preterm infants and health care workers about their dietary habits was studied and compared with the current international recommendations based on evidence. A pathogenetically substantiated scheme for the treatment of elemental deficiency in preterm infants with the use of a vitamin-mineral complex preparation containing zinc and nutritional correction has been proposed and used, which has demonstrated its safety and therapeutic efficacy. Based on data obtained during the study, an counseling algorithm was developed to advise parents on the specifics of the introduction of complementary foods to infants, born preterm, which includes the following recommendations: start introducing complementary foods from 4 months to 6 months of CA, in the presence of signs of readiness and reaching a body weight of 5 kg, the first food products should be rich in iron, zinc, calcium and magnesium, to carry out drug prevention of iron and vitamin D deficiency in accordance with current guidelines, at the age 5-6 months to prescribe a complex of vitamins and minerals containing zinc (1 – 2 mg/day) for a period of 1 month. Key words: preterm infants, growth and psychomotor development, nutrition of preterm infants, prevention of elemental deficiency, counseling algorithms.