Endothelial activity reflects the balance of endogenous factors regulating vasoconstriction and vasodilation. Among these factors, nitric oxide (NO) is the most important contributor to the acute regulation of vascular tone. Altered nitric oxide synthesis by the vascular endothelium plays several important roles in the pathogenesis of neonatal disease through its effects on vascular homeostasis. However, the role of NO in the pathogenesis of perinatal brain injury has not been fully investigated. The present chapter explores how NO synthesis is regulated under physiological and pathological conditions, the impact of acute and chronic hypoxia on NO synthase activity in the vascular endothelium, and the role of perinatal endothelial dysfunction in the pathogenesis of neurodevelopmental disorders later in life.
Part of the book: Nitric Oxide Synthase
Endothelial function plays an important role in the extrauterine adaptation of newborn infants. Endothelium produces different biologically active mediators, which play the central role in physiological and pathological processes and also in the extrauterine adaptation of newborn infants. The imbalance between vasoconstrictive and vasodilatation factors results in impaired cardiovascular adaptation and microcirculation and also brain injury. Microcirculatory disturbances are observed very often in preterm babies, who have a serious risk for perinatal brain injury and further neurodevelopment disabilities. Present chapter presents the pathogenetic role of vascular tone regulators of endothelial genesis in the formation of microcirculatory changes in preterm babies with a high risk of perinatal hypoxic encephalopathy.
Part of the book: Basic and Clinical Understanding of Microcirculation
Premature birth is a pathological condition that requires high-quality medical care due to the infants’ low body mass and gestational age, as well as morphofunctional immaturity. Moreover, such children are at great risk for retardation of mental development; metabolic, cardiovascular, and malignant diseases; and many other health problems at a later age. Early and late complications of preterm birth depend significantly on the gestational age at birth and the intrauterine development conditions of the fetus. Due to the more severe and complicated course of perinatal pathologies, premature babies with fetal growth retardation syndrome constitute a larger risk group. Approximately 50–70% of these children receive long-term treatment in the neonatal intensive care unit after birth. Furthermore, 70% of them face behavioral and memory problems in later life. While the pathologies of the neonatal period in children born prematurely are mainly related to respiratory, gastrointestinal, neurological, and nutritional problems, the complications of premature birth are manifested in children’s early age, preschool, school, adolescence, and other developmental periods.
Part of the book: Maternal and Child Health
Perinatal asphyxia is one of the most frequent causes of perinatal morbidity, accounting for approximately 23% of neonatal deaths worldwide. Fetuses that suffer from hypoxia-ischemia are at high risk of developing multiorgan dysfunction, including the gut. Hypoxie-induced gut injury may result in adverse clinical outcomes, such as feeding intolerance and necrotizing enterocolitis. Increased permeability and subsequently an enhanced entry of bacteria and endotoxins into the systemic circulation can contribute to endotoxin aggression and further trigger numerous diseases. The aim of study is to investigate the effect of perinatal asphyxia on the integrity of the intestinal barrier and the state of antiendotoxin immunity. The study included preterm neonates exposed to perinatal asphyxia, who were comparable with non-asphyxiated infants. The concentrations of intestinal mucosa barrier injury markers (intestinal fatty acid binding protein, liver fatty acid protein, lipopolysaccharide binding protein), neurospecific proteins (neurospesific enolase, NR-2 antibodies), and also endothelial dysfunction markers (endothelin-1, nitric oxide) were determined in serum of included neonates on day of 1 and 7. The high risk of intestinal mucosal injury in newborn exposed to perinatal asphyxia decreases the level of antiendotoxic immunity and should be considered as an unfavorable factor for sepsis.
Part of the book: Maternal and Child Health