Ultrasonic and biochemical characteristics of the hepatobiliary system in congenital cytomegalovirus infection in dead full-term

Aim. To give an echographic and biochemical characterization of the hepatobiliary system in case of congenital cytomegalovirus infection (CMVI) in dead full-term infants.

Materials and methods. A research was carried out at birth and during the first day of 59 children who died on the 2^nd-5^th day of life. Group 1 (control) consisted of 25 full-term newborns from mothers who did not have moderate and severe obstetric and somatic pathologies, as well as respiratory viral diseases and sexually transmitted infections. Group 2 (experimental) included 18 newborns whose mothers suffered from an exacerbation of CMVI in the second trimester of pregnancy without markers of congenital viral infection in their offspring. Group 3 (main) was represented by 16 newborns with congenital CMVI. The main cause of death in 1st group of children was prolonged intranatal hypoxia, atelectasis and hyaline membrane of the lungs; in group 2 - ante-, intra- and postnatal hypoxia, as well as common lung atelectasis; in group 3 - cerebral ischemia of moderate and severe degrees, ventriculomegaly, pseudocysts of the vascular plexus and subarachnoid hemorrhages, local and generalized forms of congenital infection. Ultrasound analysis determined the size, echostructural picture of the liver and the structure of the gallbladder. The activity of alanine aminotransferase, aspartate aminotransferase, y-glutamyltranspeptidase and alkaline phosphatase was evaluated by biochemical methods in blood serum from the umbilical vein.

Results. In newborns of group 2, hepatomegaly was detected in 5.6%, increased echogenicity of blood vessels and portal tracts in 11.1%, and S-shaped deformation of the gallbladder in 5.6%. However, statistically significant differences in the frequency of increase in echogenicity of the parenchyma in children of groups 2 and 1 were not established (p>0.05). In the cord blood serum of newborns in group 2, the level of alanine aminotransferase was 19.4±2.16 IU/L, aspartate aminotransferase - 21.7±2.31 IU/L, γ-glutamyltranspeptidase - 124.7±15.51 IU/L and alkaline phosphatase - 136.3±13.39 IU/L (in group 1, respectively, 16.6±1.61 IU/L, p>0.05; 21.7±2.31 IU/L, p>0.05; 120.8±13.98 IU/L, p>0.05; 130.7±11.21 IU/L, p>0.05). In children of group 3 compared with group 2, the frequency of detection of hepatomegaly (43.8%, p<0.05), increased echogenicity of the parenchyma (50%, p<0.01), blood vessels and portal tracts (56%, p2<0.05). Twice more often S-shaped deformation of the gallbladder was detected (p>0.05). The activity of y-glutamyltranspeptidase increased to 185.2±19.83 IU/L (р2<0.05) and alkaline phosphatase to 192.2±16.89 IU/L (p<0.05), which are markers of cholestasis in the setting of the absence of statistically significant differences between the indices of alanine aminotransferase (p>0.05) and aspartate aminotransferase (p>0.05). However, in three cases, the highest rates of alanine aminotransferase (more than 40 IU/L) were diagnosed, indicating the dominance of cytolysis and inflammation in the liver.

Conclusion. The above ultrasound and biochemical changes confirm the important role of the echostructure picture of the hepatobiliary system and its biochemical assessment in the diagnosis of inflammation and cholestasis in the liver in newborns with congenital CMVI.

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