Morphofunctional characteristics of the liver in full-term newborns with cerebral ischemia born to mothers with exacerbation of chronic cytomegalovirus infection in the second trimester of gestation

   Introduction. Exacerbation of chronic cytomegalovirus (CMV) infection in pregnant women is often accompanied by disruptions of the protein-synthesizing and pigment functions of the liver in their newborns. These functions regulate growth and inactivate toxic forms of bilirubin, which affect the functional state of the central nervous system. Despite this, the relationship between ultrasound and biochemical indicators of the liver in varying severities of cerebral ischemia in offspring of mothers who experienced an exacerbation of CMV infection has not been studied to date.

   Aim. To provide a morphofunctional characterization of the liver in varying severities of cerebral ischemia in full-term newborns from mothers with an exacerbation of chronic CMV infection in the second trimester of pregnancy.

   Materials and methods. We investigated the ultrasound features of the liver and gallbladder, along with levels of total protein, albumin, and total, indirect, and direct bilirubin in the cord blood serum of 43 newborns with an uncomplicated antenatal history (control group) and 69 newborns with cerebral ischemia that developed on the background of chronic CMV infection exacerbation in their mothers at 21–24 weeks of gestation (main group). Among those with perinatal lesions of the central nervous system, 37 newborns presented with Grade I cerebral ischemia (first subgroup), and 32 newborns presented with Grade II cerebral ischemia (second subgroup).

   Results. In comparison with the control group, the first subgroup of the main group demonstrated statistically significantly lower Apgar scores at 1 and 5 minutes, as well as lower birth weight. No significant differences were found in liver size, frequency of high echostructural density areas in the parenchyma, small inclusions, increased echogenicity of portal tract structures and gallbladder body deformation, or levels of total protein, albumin, total, indirect, and direct bilirubin. In the second subgroup, compared to both the control group and the first subgroup, there were lower Apgar scores at 1 and 5 minutes and lower birth weight, along with an increased incidence of elevated echogenicity of the liver parenchyma, enhanced signals of portal tract structures, small inclusions, and gallbladder deformation. These newborns also showed decreased total protein and albumin, and increased total, indirect, and direct bilirubin.

   Conclusion. In full-term newborns from mothers with exacerbation of chronic CMV infection in the second trimester of pregnancy, Grade II cerebral ischemia, compared to Grade I under similar antenatal conditions, is characterized by more pronounced echostructural changes, decreased protein levels, and increased total and indirect bilirubin concentrations. This reflects the negative impact of intrauterine hypoxia and postnatal asphyxia on the morphofunctional state of the liver in newborns whose mothers experienced an exacerbation of chronic CMV infection in the second trimester of gestation.

1. Volodin N.N., editor. [Neonatology : National Guidelines]. Moscow: GEOTAR-Media; 2007 (in Russian). ISBN: 978-5-9704-0567-3.

2. Tsinzerling V.A., Mel'nikova V.F. [Perinatal infections. Pathogenesis, morphological diagnostics and clinical-morphological comparisons : practical manual]. St. Petersburg: Elbi SPb; 2002 (in Russian). ISBN: 5-93979-043-7.

3. Shabalov N.P. [Neonatology]. Moscow: GEOTAR-Media; 2019 (in Russian). ISBN: 978-5-9704-4692-8.

4. Vasil'yev A.Yu., Ol'khova Ye.B. [Ultrasound diagnostics in pediatric practice: a teaching aid for the system of postgraduate education of doctors]. Moscow: GEOTAR-Media; 2008 (in Russian). ISBN: 978-5-9704-0772-1.

5. Shiff Yu.R., Sorrel M.F., Meddrey U.S. [Introduction to Hepatology. In: Ivashkina V.T., Buyeverova A.O., Mayevskoy M.V., editors. Liver Diseases According to Schiff.]. Moscow: GEOTAR-Media; 2011 (in Russian). ISBN: 978-5-9704-1969-4.

6. Kamyshnikov V.S. [Handbook of clinical and biochemical diagnostics (Vol.1)]. Minsk: Belarus; 2002 (in Russian). ISBN: 985-01-0032-X.

7. Kishkun A.A. [Clinical laboratory diagnostics: a tutorial]. Moscow: GEOTAR-Media; 2020 (in Russian). ISBN: 978-5-9704-4830-4.

8. Prakhov A.V., Girshovich Yu.D. [Left ventricle myocardium functional state in neonates with hyperbilimbinemia]. Pediatriya. Zhurnal im. G.N. Speranskogo 2004; 83(1):23–28 (in Russian).

9. Kirilochev O.K. [Neonatal liver insufficiency – criteria of severity]. Pediatriya. Zhurnal im. G.N. Speranskogo 2008; 87(3):57–61 (in Russian).