Appropriate For Gestational Age Babies Research Articles

Comparison of umbilical cord blood lipid profiles between appropriate and small for gestational age newborns with their mothers’ lipid profiles: a case-control study from tertiary care centre of Karnataka

Background: Fetal malnutrition and fetal growth restriction results in dysfunctions of neuroendocrine system, pancreas and adipose-tissue; finally increasing the food intake and decreasing energy use. This results in an increase in adipose deposition and insulin-resistance and ultimately increasing chances of adult metabolic-diseases. This study makes an effort to compare and contrast the lipid-profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA)newborns correlating and with their mother’s lipid-profiles. Methods: This was a case-control study, conducted in the Departments of Pediatrics and OBG of Karwar Institute of Medical Sciences,Karwar, Karnataka,India over a period of twelve months(January-2021 to January-2022). With 500neonates, 357appropriate for gestational age (AGA) and 143 small for gestational age(SGA) babies were included for the study as controls and cases for their lipid profiles using their cord-blood. Results: here, we found that SGA-babies had lower gestational age (37.40±1.01 weeks) at birth compared to AGA-babies (39.22±1.05 weeks) which was statistically significant. The mean Total Cholesterol (TC) level (84.47±27.39 mg/dl) was higher in SGA-babies compared to AGA-babies (56.87±32.28 mg/dl) and this difference was statistically highly significant (p value<0.0001). The mean very low density lipoprotein (VLDL) level (14.10±10.67 mg/dl) was higher in SGA-babies than AGA-babies (7.17±3.69 mg/dl) with p value<0.0001 (highly significant). The mean low density lipoprotein (LDL) level (38.74±19.85 mg/dl) was higher in SGA-babies compared to AGA-babies (25.63±14.15 mg/dl) and this difference was statistically significant (p value<0.0001). The mean high density lipoprotein (HDL) levels of AGA and SGA-babies were comparable with low statistical significance (26.70±14.90 mg/dl of SGA; 24.45±9.567 mg/dl of AGA, p value 0.095). Conclusions: Levels of all lipids were observed to be higher in SGA babies than in AGA babies. Mothers who gave birth to SGA babies were found to have statistically significant high VLDL levels.

Assessment of Obstetric Doppler Ultrasound in High-Risk Pregnancy and Its Perinatal Outcome

Background: Intrauterine growth restriction (IUGR) is associated with an increased risk of perinatal mortality & morbidity. It accounts for a sizeable number of future unhealthy children, which is a significant burden to parents and society. IUGR can be minimized to some extent by timely & accurate detection of IUGR. Aims and objectives: To evaluate various waveforms of the umbilical artery, middle cerebral artery, ductus venosus, and cerebroplacental ratio as a predictor of adverse pregnancy outcomes in high-risk pregnancies. Materials and Methods: Eightywomen with a gestational age of 24 to 36 weeks were studied in the department of Radiodiagnosis of SAMC & PGI, Indore, Madhya Pradesh, from April 2021 to September 2022. Subjects were divided into non-complicated pregnancy [Appropriate for gestational age (AGA); n=40) and high-risk pregnancy [Small for gestational age (SGA); n=40; ≥18 years of age, with or without risk factors]. All underwent Doppler interrogation of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus between 24-36 weeks of gestation. Results: Elevated head circumference (HC)/ abdominal circumference (AC) ratio, elevated femur length (FL)/AC ratio, presence of oligohydramnios without ruptured membrane, and advanced placental grade was more frequently observed among SGA babies. In this series, among the various risk factors, hypertension was a significant risk factor for IUGR, which other workers also accepted. Pulsatility index (PI), resistive index (RI) and systolic/diastolic (SD) ratio of uterine & umbilical arteries was significantly raised in SGA babies compared to AGA babies. In contrast, middle cerebral artery (MCA)'s PI, RI, and SD ratios were significantly lower in SGA babies than in AGA babies. Uterine artery early Diastolic Notch was seen in 11 cases & all of them delivered SGA babies. Hypertension was present in 8 of these 11 cases. Absent Diastolic Flow was detected in only one case, and the foetus ......

Cord Blood Levels of Spexin, Leptin, and Visfatin in Term Infants Born Small, Appropriate, and Large for Gestational Age and Their Association with Newborn Anthropometric Measurements

Children born small for gestational age (SGA) are at risk of future obesity and associated comorbidities. Therefore the identification of risk factors and novel biomarkers which are associated with this risk are needed for early detection and to improve preventive strategies. Spexin (SPX), a novel neuropeptide that is involved in the regulation of obesity and fat metabolism, is a candidate biomarker for predicting obesity and related comorbidities at an early age. The aim of this study was to investigate serum levels of SPX in term infants born small, appropriate, and large for gestational age (LGA) and its association with newborn anthropometric measurements. One hundred and twenty term newborn babies classified as SGA, appropriate for gestational age (AGA), or LGA and their mothers were included. SPX, leptin and visfatin were measured in cord blood and maternal serum by enzyme-linked immunosorbent assay. Fifty-six (46.7%) neonates were girls and 64 (53.3%) were boys. The mean birth weight was 3170.70±663 g, birth length was 48.9±2.79 cm, and head circumference was 34.5±1.67 cm. Birth weights, lengths, and head circumferences of the neonates in the SGA, AGA, and LGA groups were significantly different. Cord blood SPX and leptin levels in the SGA groups were significantly lower than those of both the LGA and AGA groups. Cord blood visfatin levels were significantly lower in the AGA group than the LGA and SGA groups. Maternal SPX levels of SGA babies were significantly lower than those of the mothers in both the LGA and AGA groups, but no significant difference was observed between the SGA and LGA groups. Maternal visfatin levels of the AGA babies were significantly higher than the maternal levels of SGA and LGA groups. There was no difference in terms of maternal leptin levels. Cord blood SPX and leptin levels were positively correlated with birth weight, length and head circumference. Birth weight increased significantly in line with maternal pregestational body mass index. The lowest SPX levels were found in the SGA babies and cord SPX level was significantly correlated with newborn length, weight, and head circumference.

Association of Parental Factors and Insulin-like Growth Factor 2 Polymorphism with Intrauterine Growth Restriction.

Polymorphism of insulin-like growth factor 2 (IGF2) is known to play a role in cell development. Only the paternal IGF2 copy is active, while the copy inherited from the mother is inactive. This study aimed to explore whether maternal and paternal factors influence IGF2 polymorphism in newborns with intrauterine growth restriction (IUGR) compared to appropriate for gestational age (AGA). A cross-sectional exploratory study was conducted from June 2014 to November 2015 at the Neonatology, Gynecology 1 Clinic, Cluj-Napoca, Romania. The ApaI IGF2 genotypes and allele frequencies were similar in the IUGR and AGA groups (p-value > 0.10). The IUGR babies with a protective IGF2 genetic profile had significantly younger parents (a difference in the median age of 8 years for mothers and 9 years for fathers; p-value < 0.009). The IUGR babies had parents with lower birth weights than AGA babies (mothers’ medians: 2800 g vs. 3100 g; fathers’ medians: 3000 g vs. 3400 g; p-value < 0.02). In univariable regression analysis, the mother’s and father’s birth weight proved to be associated with IUGR. The father’s birth weight proved to be the only factor significantly associated with IUGR, independent of the mother’s birth weight or the presence of a protective IGF2 genetic profile (odd ratio = 0.998 [0.996 to 1.000], p-value = 0.032).

Comparison of Lipid Profiles from Cord Blood of Appropriate and Small for Gestational Age Babies in a Tertiary Care Hospital: A Case-control Study

Introduction: Hyperlipidemia and its complications are common health issues in the current era with multifactorial in origin. Foetal malnutrition results in neuroendocrine, pancreatic, and adipose tissue dysfunction, ultimately increasing food intake and decreasing energy utilisation. It leads to an increase in adiposity and insulin resistance and ultimately increase adult diseases in later life. Aim: To compare the lipid profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) babies. Materials and Methods: This case-control study was conducted in the Department of Paediatrics, Obstetrics and Gynaecology of Karwar Institute of Medical Sciences, Karwar, Karnataka, India over a period from December 2020 to March 2021. A total of 133 deliveries were recruited randomly and babies were divided into cases including those small for gestational age and controls including those appropriate for gestational age. Data was analysed and described using descriptive (mean, standard deviation, and range) and inferential statistics (Students’ t-test). Results: There were 99 Appropriate for Gestational Age (AGA) and 34 small for Gestational Age (SGA) babies studied. This study found that SGA-babies had statistically significantly lower gestational age (37.69±2.45 weeks) at birth compared to AGA-babies (Mean 38.55±1.11 weeks) t=-2.351 p=0.022. The mean Total Cholesterol (TC) level (63.62±40.48 mg/dL) was higher in SGA-babies compared to AGA-babies (48.69±2.29 mg/dL) and this difference was statistically significant (p-value=0.007). The mean High Density Lipoprotein (HDL) levels of SGA and AGA babies were comparable with no statistical significance (21.82±13.26mg/ dL of SGA; 21.49±14.64mg/dL of AGA; p-value 0.907). The mean Very Low Density Lipoprotein (VLDL) level (17.11±25.35 mg/dL) was higher in SGA-babies compared to AGA-babies (9.47±9.35 mg/dL) and this difference was statistically significant (p-value=0.012). Conclusion: Levels of all lipids were found to be higher in SGA- babies than in AGA-babies.

Cord Blood Lipid Profile at Delivery and Association with Birth Weight among Term Babies

Background: Abnormal birth weight is a leading risk factor for neonatal morbidity and mortality, abnormal lipid profile levels may be involved. Aim: The aim of this study was to evaluate the relationship between cord blood lipid profile levels and neonatal birth weight of babies. Materials and Methods: Two hundred apparently healthy pregnant women attending antenatal clinics a Specialist Hospital in Benin City were recruited into the study. Five (5 mL) milliliters of cord blood was collected from the umbilical vein into plain bottle. The serum levels of total cholesterol, triglycerides, and high-density lipoprotein (HDL) were determined using spectrophotometric techniques. The low-density lipoprotein (LDL) was calculated using Friedewald's equation, while anthropometric measurements were done using standard techniques. Data were analyzed using Student's t-test and Pearson correlation coefficient. Results: The birth weight (2.34 ± 0.3 versus 3.47 ± 0.4; P &lt; 0.01), head circumference (32.3 ± 1.3 versus 34.4 ± 2.8; P &lt; 0.04), recumbent length (50.2 ± 0.5 versus 54.6 ± 0.2; P &lt; 0.04), and Ponderal Index (2.14 ± 0.5 versus 24.5 ± 0.2; P &lt; 0.02) were significantly lower in babies with small for gestational age (SGA) than appropriate gestational age. The total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol were significantly lower (P &lt; 0.001) in SGA than appropriate for gestational age (AGA) babies. Total cholesterol (r = 0.21; P &lt; 0.004) and triglycerides (r = 0.31; P &lt; 0.001) correlated positively with the weight of babies. Conclusion: AGA babies had significantly higher lipid profile levels compared to SGA babies.

Hypoglycemic status in low birth weight neonates during first 24 hours of life after birth

Objective: The study aimed to determine the frequency of hypoglycemia in low birth weight neonates during the first 24 hours of life after birth.&#x0D; Materials and Methods: This cross-sectional study was conducted from 1st March 2016 to 31st August 2016 in the NICU and postnatal ward of POF Hospital, Wah Cantt. All the babies with birth weight less than 2.5 kg including preterm and term were included in the study. After the aseptic measure blood, sugar was checked and a value less than 45 mg/dl was labelled as hypoglycemia.&#x0D; Results: Out of 96 neonates,51 (53%) were male and 45 (47%) were female. The minimum weight of the patient was 1.6kg and the maximum was 2.40 kg. Hypoglycemia was noted in 49 (51%) babies after 2 hours of birth whereas 36 (37.5%) had hypoglycemia at 4 hours and 13 (13.5 %) had at 24 hours. 68 (70.8%) babies included in the study were appropriate for gestational age (AGA) and 28 (29.1%) babies were small for gestational age (SGA). After 2 hours of birth, hypoglycemia was present more in SGA babies i.e.20 (71.4%) as compared to AGA babies i.e. 29 (42.6%) which had statistical significance also (p-value 0.01).&#x0D; Conclusion: Neonatal hypoglycemia is a well-recognized complication in newborns and low birth weight infants are more susceptible to hypoglycemia. Early identification of vulnerable infants and the use of preemptive measures can result in better outcomes.

Myocardial performance index in term appropriate and small for gestational age neonates - a cross sectional study.

It is known that small for gestational age (SGA) babies may be at an increased risk of cardiovascular diseases during adulthood. There is paucity of literature regarding comparative cardiac functions of SGA and appropriate for gestational age (AGA) babies in neonatal period. The present study was conceived to compare the cardiac function of term small and appropriate for gestational age (AGA) babies through a relatively novel echocardiographic index in early neonatal period. To compare values of myocardial performance index (MPI) index (MPI = IVCT + IVRT/ET) at 48-72 hours of age among AGA and SGA babies. Morphological and anthropometric assessment of serially born term babies was done at time of birth to recruit hundred each of AGA and SGA babies. Tissue Doppler Imaging (TDI) was done between 48-72 hours for each enrolled baby to assess both right and left ventricle MPI in each group. Mean±SD values for right ventricular MPI in AGA and SGA groups were 0.268 + 0.007 and 0.30 + 0.026 respectively (p < 0.001). Mean±SD values for left ventricular MPI in AGA and SGA groups were 0.25 + 0.012 and 0.30 + 0.017 respectively (p < 0.001). There was significant negative correlation between MPI values for either ventricles and the birth weight (spearmen's rho of -0.66) (p < 0.001). Mean±SD values for LVET in AGA and SGA group were 0.304 + 0.026 and 0.266 + 0.032 respectively (p < 0.001). MPI had a higher absolute value in the SGA babies as compared to AGA babies. These observations point towards suboptimal cardiac performance among SGA babies as compared to AGA babies on the basis of myocardial performance index.

Association between maternal nutrition and fetal developmental profile: Do leptin and adiponectin have a significant role?.

Background: Leptin and adiponectin, which are primarily produced by adipose tissue, have recently been identified as key mediators in the foetal developmental process. Modulation of these adipokines in early life, therefore, provides potential opportunities to improve or reverse the adverse complications associated with an abnormal foetal developmental profile. Aim: The purpose of this study was to determine the effect of maternal dietary habits on foetal leptin and adiponectin levels on foetal developmental outcomes. Subjects and Methods: Sixty-two mothers between the ages of 18 years and 38 years, as well as their full-term neonates, were enrolled in this study, whether they had a normal delivery or a Cesarean section, with no birth complications. All mothers were subjected to a full pregnancy history in order to determine their gestational age, as well as a full examination that included measuring and recording all of their anthropometric measurements. Clinical examinations were performed on newborns, and the Apgar score was also recorded. Newborns were classified as Small for Gestational Age (SGA), Appropriate for Gestational Age (AGA), or Large for Gestational Age (LGA) based on their birth weight (LGA). ELIZA measured leptin and adiponectin levels in both mother's serum and cord blood serum. Results: Mothers who consumed fish and fats during pregnancy were not at risk of having SGA babies, and SGA babies had significantly lower adiponectin levels than AGA and LGA babies. Leptin levels increased significantly as they passed from SGA to LGA. Leptin distribution was significantly higher in infants of mothers who consumed daily breakfast during pregnancy than in infants of mothers who did not consume breakfast. Infant adiponectin distribution was significantly higher in infants of mothers who ate regular fats than in infants of mothers who ate a low fat diet. Infant adiponectin distribution was significantly higher in infants of mothers who consumed sugary drinks once per day than in infants of mothers who did not consume sugary drinks. Furthermore, there is a significant positive correlation between infant weight, infant length, infant head circumference, infant mid-arm circumference, and levels of both infant leptin and infant adiponectin. A highly significant negative correlation was found between mother adiponectin and infant leptin levels, while a highly significant positive correlation was found between mother leptin and infant leptin levels. Conclusion: This study shed light on the important role of maternal nutrition during pregnancy in foetal body fat composition. This study also provides clear evidence for the influence of leptin and adiponectin on foetal development.

Global DNA Methylation in Cord Blood and Neurodevelopmental Outcome at 18 Months of Age among Intrauterine Growth Restricted and Appropriate for Gestational Age Infants.

Intrauterine growth restriction (IUGR) is associated with faltered growth and development later in life. Alteration in DNA methylation may occur among IUGR babies and it can have bearing on the outcome. To compare the DNA methylation in the cord blood among IUGR and appropriate for gestational age (AGA) babies and find it is association with their neurodevelopmental outcome at 18 months of age. Genomic DNA methylation among 40 IUGR and equal number of AGA neonates was estimated by using 5-mC ELISA kit in the cord blood. Infants were assessed at birth and their anthropometric measurements were taken. They were regularly followed up and assessed for neurodevelopment outcome till 18 months of age using DASII (Developmental Assessment Scale for Indian Infants). DNA methylation was correlated with neurodevelopmental outcome. Numbers and percentages were used for categorical data. Mean and SD were used for continuous variables. The significant mean difference between IUGR and AGA was determined by independent Student t-test. To study the association between the DNA methylation and outcome, Spearman correlation was used. A p < 0.05 was considered as statistically significant. Significant difference in DNA methylation was observed between IUGR and AGA infants (IUGR: 3.12 ± 1.24; AGA: 4.40 ± 2.03; p < 0.001). Anthropometry (weight, length and head circumference) at birth was significantly decreased among IUGR infants. Hospital stay was significantly longer for IUGR infants. Motor (IUGR: 89.98 ± 18.77; AGA: 101.75 ± 9.62; p < 0.001), and mental (IUGR: 90.81 ± 11.13; AGA: 105.71 ± 7.20; p < 0.001) scores were significantly decreased among IUGR compared with AGA neonates at 18 months of follow-up. Global DNA methylation had a significant positive correlation with mental score but not with motor developmental score. IUGR babies had lower motor and mental score compared with AGA babies. Cord blood global DNA methylation significantly correlated with mental development score but not with motor development at 18 months of age.

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English

Neonatal Outcome of Macrosomia

Introduction: Macrosomia is an emerging public health problem, both in the developed as well as in the developing countries. This study was aimed to examine the maternal and neonatal risk factors associated with macrosomia and compare adverse neonatal outcome between appropriate for gestational age (AGA) and macrosomia.&#x0D; Methods: Records of all live singleton AGA and macrosomic babies delivered at a tertiary care teaching hospital in Lalitpur, Nepal, between 14th April 2013 and 13th April 2014 were retrospectively reviewed. &#x0D; Results: Of the 769 deliveries, 684 neonates were eligible of which 93 were born macrosomic with an incidence of 12.1%. We observed the most significant neonatal outcome to be neonatal sepsis (14%; p = 0.005) compared to AGA babies (5.9%). Macrosomia was found to be associated with increasing maternal age and parity (p = 0.007) relative to mothers of AGA babies, most of whom underwent caesarean section (55.9%) whilst the same outcome was fewer for mothers of AGA babies (29.9%). A higher incidence of pregnancy induced hypertension (PIH) as maternal comorbidity (5.4%) was associated with macrosomia contrasted with mothers of AGA babies (4.4%). &#x0D; Conclusion: Macrosomic birth was found to be associated with relatively higher adverse neonatal outcome, warranting prolonged hospital admission than AGA births.

The Thin But Fat Phenotype is Uncommon at Birth in Indian Babies

Indian babies are hypothesized to be born thin but fat. This has not been confirmed with precise measurements at birth. If it is true, it could track into later life and confer risk of noncommunicable diseases (NCDs). Primarily, to accurately measure percentage of body fat (%BF) and body cell mass (BCM) in Indian babies with normal birth weight, compare them across different gestational ages and sex, and test the hypothesis of the thin but fat phenotype in Indian babies. Secondarily, to examine the relation between body weight and body fat in Indian babies. Term newborns (n=156) weighing ≥2500 g, from middle socioeconomic status mothers were recruited in Bengaluru, India, and their anthropometry, %BF (air displacement plethysmography), and BCM (whole-body potassium counter) were measured. Maternal demography and anthropometry were recorded. The mean %BF and its dispersion were compared with earlier studies. The relation between newborn %BF and body weight was explored by regression analysis. Mean birth weight was 3.0±0.3 kg, with mean %BF 9.8±3.5%, which was comparable to pooled estimates of %BF from published studies (9.8%; 95% CI: 9.7, 10.0; P>0.05). Appropriate-for-gestational age (AGA) babies had higher %BF (1.8%) compared to small-for-gestational age (SGA) babies (P<0.01). Mean %BCM of all babies at birth was 35.4±10.5%; AGA babies had higher %BCM compared to SGA babies (7.0%, P<0.05). Girls in comparison to boys had significantly higher %BF and lower %BCM. Body weight was positively associated with %BF. Indian babies with normal birth weight did not demonstrate the thin but fat phenotype. Body weight and fat had positive correlation, such that SGA babies did not show a preservation of their %BF. These findings will have relevance in planning optimal interventions during early childhood to prevent NCDs risk in adult life.

Identification of differentially methylated candidate genes and their biological significance in IUGR neonates by methylation EPIC array

Background Intrauterine growth restriction (IUGR) is a pregnancy-associated disease manifested by decreased growth rate of fetus than the normal genetic growth potential. It is associated with increased susceptibility to metabolic diseases later in life. Although the mechanisms underlying the origin of metabolic diseases are poorly understood, DNA methylation is a crucial investigation for the identification of epigenetic changes. Objectives To assess the degree of change of DNA methylation in IUGR neonates and compare with that of appropriate for gestational age (AGA) neonates and to explore the differentially methylated candidate genes and their biological significance. Methods This cohort study was conducted in the Neonatology Department of JIPMER during the period of November 2017 to December 2018. Forty each of IUGR and gestation matched AGA neonates were recruited. Umbilical cord blood samples were collected at birth. DNA was separated from the blood samples; and, using 5-mC DNA ELISA method, the percentage of genomic DNA methylated in these neonates was established. Data were expressed as mean ± standard deviation. Methylation EPIC array was performed to identify the differentially methylated candidate genes. David analysis was used to find out the functional annotation chart by KEGG pathway. Results Genomic DNA methylation varied significantly between IUGR and AGA neonates (IUGR: 3.12 ± 1.24; AGA: 4.40 ± 2.03; p value: <.01). A global shift toward hypomethylation was seen in IUGR compared with AGA, targeted to regulatory regions of the genome, and specifically promoters. Pathway analysis identified deregulation of pathways involved in metabolic diseases. Altered methylation of PTPRN2 & HLADQB1 genes leads to dysregulation of T-cells and reactive oxygen species (ROS). These changes may lead to complications later among these neonates subjected to IUGR. Conclusion Our findings show significant changes in the methylation pattern of genes among IUGR and AGA babies. Steps for correcting the changes may help in reducing later complications among IUGR babies.

Influencing variables for fetal growth in malnourished mothers: A nested case-control study

ObjectiveMaternal malnutrition, inadequate weight gain in pregnancy, and maternal anemia are the modifiable variables commonly implicated for intrauterine growth retardation in the community. We aimed to evaluate the frequency of growth retardation and iron deficiency among babies born to malnourished mothers and its association with maternal anthropometry, hemoglobin, and ferritin. MethodsA nested case-control study was carried out as analysis of subset data with subjects enrolled for a randomized controlled trial(CTRI Trial no.2018/04/013096)in government facilities of Kasturba Medical College, Mangalore, affiliated to Manipal Academy of Higher Education from May to August 2018. Eighty-eight newborns born to malnourished primigravidae by vaginal delivery were included. Neonatal anthropometry and cord blood ferritin along with maternal hemoglobin and ferritin was measured. The maternal pre-pregnancy body mass index (BMI) and weight gain in pregnancy were calculated using documented pre-pregnancy weight, height, and present weight. ResultsThe average birth weight was 2.6 kg. (95% CI, SD = 0.5). Fifty-eight percent of babies were appropriate for gestational age(AGA). The number of AGA babies born to mothers who had weight gain 7 kg, and above was significantly higher.[Correlation:0.41,p = 0.0001]. Nine babies had depleted iron stores, three babies being small for gestational age(SGA). (RR:0.77,95% CI = 0.29–2.05,p = 0.72).Thirty-four percent mothers were anemic who had higher chance of having SGA babies.[RR = 1.47,95% CI 0.91–2.38,p = 0.12].Thirteen mothers had low ferritin levels and 5 of them had SGA babies[RR = 1.51,95% CI = 0.68–3.4,p = 0.33]. Fifty mothers had pre-pregnancy BMI <18.5, out of which 19 had SGA babies. [RR:0.80,95% CI = 0.49–1.31,p = 0.38]. ConclusionAdequate weight gain in pregnancy can help achieve desired fetal growth in malnourished and anemic mothers.

Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction.

AIM:This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA).METHODS:The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital “Koço Gliozheni” in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated.RESULTS:Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups.CONCLUSION:Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies.

Glycemic status in exclusively breast fed low birth weight babies In first 72 hours of life in a teriary care hospital

Background: Neonatal hypoglycaemia, a common metabolic problem, often goes unnoticed owing to lack of specific symptoms. It can lead to considerable mortality and morbidity with long term neurological sequelae. Adequate breast feeding play an important role in maintaining normal glucose levels. So, this study is done to assess the incidence of hypoglycaemia in exclusively breast fed low birth weight babies, both term and preterm neonates and evaluate the impact of early breast feeding on glycaemic status upto 72 hours of life.Methods: This study was conducted over 12 month period involving 236 AGA (Appropriate for gestational age), SGA (Small for gestational age) babies with birth weight between 1.6-2.49 kg. Blood glucose values were measured at birth, 3h, 6h, 12h, 24h, 48h and 72h of life after delivery which was independent of feeding time. Hypoglycaemia was assessed against age of onset, gestational age, sex of baby, mode of delivery and time of initiation of breast feeding.Results: Total 56 episodes of hypoglycaemia were recorded in 52 babies of which 46 (27%) were term SGA babies and 6(8%) were preterm AGA babies (p=0.00148). The incidence of hypoglycaemia was found to be 22%, highest during the first 24 hours of life (93%) and delayed breast feeding is the most commonly noted risk factor (p=0.00024).Conclusions: Low birth babies are more prone to develop hypoglycaemia especially in first 24 hours of life with delayed introduction of breast feeding being one of the common risk factors and asymptomatic hypoglycaemia can be managed with frequent breast feeding without any formula feeds.

Study of foot length as an alternate measurement for assessment of gestational maturity in neonates

Background: The aim was to study neonatal foot length as a simple method for quick gestational age assessment which can be done by basic healthcare personnel overcoming the technicality required by other assessment methods.Methods: Prospective descriptive study was done. Live born neonates at Saveetha Medical College, Kanchipuram from June 2016 to June2017 were enrolled. Gestational age was assessed by New Ballard’s Scoring and footlength was measured using the paddle blades of automated digital Vernier calipers within 24 hours while birth weight was taken within 72 hours of birth. Based on gestational age, babies were grouped into preterm, term and post term and were subclassified as small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) based on Lubchenco’s intrauterine growth chart. Correlation and regression analysis and Scattergram was done.Results: Out of 300 neonates, term, preterm and post-term were 70.3%,28.3% and1.3% while SGA, AGA, and LGA babies were 9%, 88% and 3%. Mean foot length was 7.728cm±0.59 with a range of 5-8.8cm. Foot length strongly correlated with gestational age in Preterm AGA, SGA and Term AGA babies (&lt;0.001). Correlation coefficient of foot length with gestational age was higher in preterms (r=0.95). Gestational age in 54% of study population could be calculated with the derived regression equation derived.Conclusions: Foot length maybe useful for quick estimation of gestational age in preterm and term neonates for early referral of newborns requiring special care and can even be done by basic healthcare personnel.

Neurodevelopment and growth outcome at one year in babies born at term to mothers having pregnancy induced hypertension

Background: Hypertensive disorder in pregnancy remains an important cause of perinatal morbidity and mortality. Being small for gestational age (SGA) may be associated with poor neurodevelopmental outcomes compared to being appropriate for gestational age (AGA). The aim of this paper is to evaluate neurodevelopmental scores as well as growth monitoring in SGA and AGA infants born at term to PIH mothers followed till one year of age.Methods: This is a prospective, observational, hospital-based study, conducted in a tertiary care mother and child institute in Andhra Pradesh, South India.Results: Two hundred babies born at term to PIH mothers are included in the study and are followed up over a period of 12 months. Data is analyzed using Statistical Package for Social Sciences (SPSS). Growth retardation is seen in 12 % of term, SGA and 3.5% of term, AGA babies. SGA babies have a statistically significant correlation (p value = 0.02) in physical growth compared to AGA babies. Neurodevelopmental delay is present in 30% of SGA babies and 5% of AGA babies. The association between SGA and neurodevelopmental disability is statistically significant (p value &lt;0.01).Conclusions: Pregnancy induced hypertension has a statistically significant effect on neurodevelopment and physical growth of a child when followed up to 12 months of age, in SGA babies, more so in VLBW babies. Early intervention programmes through medical, developmental, neuromotor, neurosensory interventions and other stimulation programs, might help in reducing the burden of the disease as well as improving the quality of life.

A prospective observational study comparing cardiac function of small for gestational age with appropriate for gestational age babies using serial echocardiographic studies

Background: Approximately 30% of babies born in India are low birth weight (LBW) and about 70% of LBW babies are small for gestational age (SGA). Though there are several trials that have evaluated cardiac function of intrauterine growth restricted (IUGR) babies in utero, there is limited data about postnatal cardiac function in SGA babies during early neonatal period. This study was conducted to evaluate the cardiac functions of SGA babies by serial echocardiographic measurements and compare this with appropriate for gestational age (AGA) babies during the early postnatal period. Material and methods: Seventy babies were enrolled in this prospective observational study with 35 each in the SGA and AGA groups. Echocardiography was performed for all babies on days 1, 2, and 3 of life. Myocardial performance index (MPI) was used as the primary measure to compare cardiac function. MPI was calculated for both ventricles using pulse wave Doppler and tissue Doppler. Results: MPI of the left ventricle was significantly higher in the SGA group as compared to AGA babies during all the three measurement periods with SGA babies having significantly higher MPI of right ventricle on day 1 and day 2 but not on day 3. Left ventricular internal diameter index during diastole and systole (LVIDD index and LVIDS index), left atrium: aortic root ratio (LA:AO ratio) were significantly increased in SGA babies on all the occasions. Fractional shortening, ejection fraction, and area shortening were similar in two groups. Conclusions: Myocardial performance index of left and right ventricle, which evaluates both systolic and diastolic function of ventricles, was significantly increased in SGA babies in comparison to AGA babies during the first 3 days of life except MPI of the right ventricle on day 3. Thus, SGA babies have compromised cardiac function through all phases of the cardiac cycle with the performance improving spontaneously over time.