ANALISIS OF ORAL HEALTH IN NEWBORNS WITH MACROSOMIA IN KHARKIV CITY

Based on the checkup of 53 children and using clinical and statistical methods, the features of dental state of newborns with a birth weight large for gestational age (fetal macrosomia) were analyzed. a newborn with fetal macrosomia was proved to have a high risk of developing dental pathology. The most severe violations of maxillofacial area among the individuals with fetal macrosomia were found in children with birth weight equal to or more than 4.5 kg. Multidisciplinary approach allowed revealing dental violations in the stage of marginal clinical manifestations, which facilitate successful prevention and treatment.

Introduction.Despite the fact that the problems associated with the large baby delivery have been studied for a long time and they are being resolved, this topic remains extremely relevant for a number of reasons: an increase in number of fetal macrosomia cases; complications which occur during pregnancy and delivery; high level of perinatal morbidity [11].
The majority of systemic violations in the body of a newborn to a certain degree affects the maxillofacial area including oral cavity.Close interdependence between the course of antenatal period and the formation of maxillofacial area is a well-known fact [1].
Numerous studies, including those made by scientists in the Kharkiv National Medical University (KhNMU), deal with the direct and long-term consequences of the effects of child's large body weight for gestational age.
However, there are only a few references (see, e. g., [15,17]) where foreign scientists are concerned with the issue of oral cavity organs state in children born with macrosomia, even so, they are mostly concerned with risks of caries development in children and adolescents.
The aim of this research was to compare the state of the maxillofacial area of the newborns with large (macrosomia) and standard (normosomia) body weight for gestational age.
Materials and Methods.The study has been carried out by research fellows in the Department of Therapeutic Dentistry in KhNMU at the Kharkiv Municipal Perinatal Center (Ukraine) base.We have analyzed medical documentation and examined 53 children (18 girls and 33 boys) aged from 1 to 10 days born in 2015.The main group included 25 children (14 boys and 11 girls) whose height-weight parameters were above 90 percentile, meaning they were born with macrosomia.
Twenty eight (14 boys and 14 girls) children with standard height-weight parameters were considered as a comparison group.The neonatology physicians of the Kharkiv Municipal Perinatal Centre verified the macrosomia diagnoses.Parents of all children have signed informed consents to perform the study.
During the evaluation of dental state of newborns, we have examined skin health, face and neck symmetry, the mouth slit limits, lip proportion in the sagittal plane, the size and shape of the vermilion border of the lip, the size of the sucking pad, the parallelism of gum pads.We have also drawn our attention to the condition of lip internal surfaces, cheeks and tongue [7].The tongue-tie (frenum) state was evaluated according to the classification of F.Y. Horosholkina [6] taking into account the shape, size, density, and features of attachment of frenulum to the inferior tongue surface and to the mucosa of alveolar process.We have also evaluated size, density, and level of attachment of superior labial maxillary, and the mandibular labial frenum according to О. В. Гармаш.Аналіз стоматологічного здоров'я у новонароджених із макросомією у Харкові Kotlow's assessment [14].The examination of the hard palate shape and tongue size was performed.
Results and Discussion.All of the participants of the study were born within the normal term range of 37 to 42 weeks.The distribution of children with fetal macrosomia according to mothers' gestation duration was as follows: 3 children were born at term of 38 weeks, 5 children were born at term of 39 weeks, 16 children were born at term of 40 weeks, 1 child was born at term of 41 weeks.While the comparison group contained 8, 12, 7 and 3 children, respectively.
The babies in the main group were born with body weight equal to 4-5 kg.It is significant to note that 5 children had birth weight above 4.5 kg.The average body weight of the children in the main group at birth was equal to (4.29 ± 0.12) kg (P < 0.05), the average value of the newborns lenght in the main group was (56.60 ± 0.81) cm (P < 0.05).The babies in the comparison group were born with body weight equal to 2.85-3.75kg.The average body weight of the children in the comparison group at birth was equal to (3.37± 0.08) kg (P < 0.05), the average value of the newborns lenght in the comparison group was (52.61 ± 0.62) cm (P < 0.05).
In the main group, 11 (44 %) children had a condition at birth evaluated as "satisfactory" and scored 8-9 points on the Apgar scale, 10 (40 %) children were scored 8-9 points; 4 (16 %) children had moderately grave condition and were scored 6-7 points on the Apgar scale.The majority of the children (71 %) in the comparison group had satisfactory condition at birth and were scored 8-10 points on the Apgar scale, 5 (18 %) were scored 7-8 points, and only 3 (11 %) of the children had state of moderate severity at birth and were scored 6-7 points on the Apgar scale.
Dental violations were found in 16 (64 %) children in the main group and in 4 (14 %) children in the comparison group.
upper lip frenulum.Besides facial asymmetry, the asymmetrical position of the maxillary labial frenum relative to the facial midsagittal plane had one (4 %) child in the main group.
Eighteen children (72 %) in the main group and nine children (32 %) in the comparison group had dense and low attached upper lip frenulum.Among all the infants, 5 (20 %) babies in the main group and 2 (7 %) in the comparison group had the Class IV upper lip frenulum (Fig. 1).There is no consensus among doctors on whether the Class III and IV upper lip frenulum should be considered as pathology, so the question of the necessity and treatment tactics short and dense upper lip frenulum in newborns and infants remains open.
Furthermore, it was proved that such changes of upper lip frenulum determine specific features of child's sucking act.Frenulum insufficient length leads to overtax of lip muscles and makes it more difficult for the child to open its mouth wide.Researches also note, that short upper lip frenulum prevent tightening, because nipple is normally grasped tightly by dampened part of mucosa, which create negative pressure difference and facilitate sucking action.Thereby, short upper lip frenulum interferes with the normal course of physiological sucking action [13].
Tongue frenulum.Thirteen (52 %) newborns in the main group (with high body weight to gestational age norms) an ankyloglossia was diagnosed.It should be mentioned that ankyloglossia was observed in 4 out of 5 children born with body weight exceeding 4.5 kg.According to scientific investigations, tongue frenulum pathology is observed only in 16 % of newborn children [16].In the comparison group, 2 (7 %) children have had this pathology.
One (4 %) child in the main group born with body weight equal to 5 kg had the Class V tongue frenum (Fig. 4).Two (8 %) children had the Class IV tongue frenum; one (4 %) child had Class III tongue frenum (Fig. 5); two children (8 %) had the Class II tongue frenum (Fig. 6), and 7 children (28 %) had the Class I tongue frenum.Among newborns in the comparison group, only one child (4 %) had the Class I tongue frenum and one child (4 %) the Class II tongue frenum.
Ankyloglossia is known as one of the most common causes of difficulties during breast-feeding and can be a reason for a slow increase in body weight due to insufficient weight gain [5].It is not obligatory that newborns will have difficulties during breastfeeding [9], although the timely frenuloplasty increases breast-feeding efficiency [12].
high palate.Two (8 %) children in the main group were revealed to have high or "gothic" hard palate.There is an opinion that the high arched hard palate could be an outcome of hypothalamic dysfunction and hypothyroidism [10].
Similar violations in the endocrine system could be attributable to large for gestational age newborns [8].
It is known that the high arched hard palate complicates sucking movement, what leads to lower jaw growth block and retrognathia formation.A similar anatomic feature could be a cause of pathology during the process of mouth-breathing formation.The latter could cause the further development of the periodontal and hard dental tissues diseases [4].It is of importance, that the high arched hard palate was not observed in children in the comparison group.
The short and dense upper lip and tongue frenuli and high palate are indicators of connective tissue dysplasia [3].During the first year of life, these conditions violate normal course of children's sucking and swallowing action and have negative effect on the formation of maxillofacial area, and could be a cause of complication in swallowing and speaking in later life.In future, the insufficiency or lack of functional load could arrest development of tissues of the upper and lower jaws, cause development of "thin" gingival biotype [2], affect the terms of teeth eruption.The formation of teeth overcrowding and pathological occlusion are also possible.

Fig. 1 .Fig. 2 . 4 ВFig. 3 .Fig. 4 .
Fig. 1.Image of the frontal area of the oral cavity of infant D., two-day-old girl with macrosomia; Class IV lip-tie Fig. 2. Image of the frontal area of the oral cavity of infant L., one-day-old boy with macrosomia; Class III lip-tieThirteen infants (52 %) in the main group and eight children (29 %) in the comparison group had the Class III upper lip frenulum (Fig.2).Seven (28 %) and seventeen (61 %) children in the main and comparison groups, respectively, had the Class II upper lip frenulum (Fig.3), and one child (4 %) in the comparison group had the Class I upper lip frenulum.