EXPRESSION PATTERNS OF SURFACTANT PROTEINS AND APOPTOSIS FACTORS IN PRETERM INFANTS WITH A FATAL OUTCOME IN THE EARLY NEONATAL PERIOD
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Abstract
Respiratory disorders remain a leading cause of early neonatal mortality among preterm infants, despite advances in life-saving respiratory technologies.
The aim of the study – was to identify differences in the clinical course of the neonatal period, as well as in the expression of surfactant proteins and apoptosis factors, in preterm infants who died during the early neonatal period.
Materials and methods. A retrospective study was conducted, analyzing medical records from 35 cases of early neonatal mortality among preterm infants (aged 0-168 hours) born at a gestational age of 28-33 weeks between 2017 and 2024. The infants were divided into two groups: Group 1 consisted of newborns who did not receive surfactant replacement therapy (n = 11), and Group 2 consisted of newborns who received such therapy (n = 24). Statistical hypotheses were tested using Student’s t-test and Fisher’s exact test.
Results. The aggregate clinical and morphological data indicate the existence of two distinct phenotypes of lung tissue injury in newborns. The first – «surfactant deficiency with Bcl-2 overexpression» – predominates in the group that did not receive exogenous surfactant; this morphological profile correlates significantly with extremely low survival rates. The second – «prematurity with therapeutic response» – is characteristic of the group treated with exogenous surfactant and is associated with reduced Bcl-2 expression, elevated SP-C levels, and, consequently, increased survival. A key result of the study is also the extremely strong inverse correlation between Bcl-2 and SP-C (r = -0.94).
Conclusion. The integration of histological and immunohistochemical data using machine learning methods demonstrated that the efficacy of surfactant therapy is determined not only by gestational age but also by the baseline molecular-morphological profile of the lung tissue. A combination of low SP-C levels and BCL-2 overexpression serves as a reliable adverse prognostic marker, reflecting profound impairment of alveolar epithelial function and resistance to standard therapy.
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