Appropriate For Gestational Age Neonates Research Articles

Correlation of Maternal Anthropometry with Intrauterine Growth Restricted Neonates’ Birth Weight

Objectives: To determine the correlation between weight, height and body mass index (BMI) of the mothers with their term intra-uterine growth restricted (IUGR) neonates’ birth weight. Material and methods: An observational, cross sectional study was conducted involving 322 term IUGR neonates and their mothers, and was compared with 336 term appropriate for gestational age (AGA) neonates matched for that gestational age, and their mothers over a period of one year. The anthropometric measurement was done on birth weight, length, head circumference, ponderal index of neonates, and height and BMI of mothers. The maternal weight was obtained from antenatal cards. Results: Majority (72.04%) of the mothers having IUGR neonates were primi-gravida, 63.04% were of poor economic status. Mean age, weight, height and BMI of the mothers of IUGR neonates were 20.2±0.8 years, 49.1±2.3 kg, 144.1±37.2 cm, and 17.6±2.1 kg/m 2 , respectively. These parameters for the mothers of AGA neonates were 22.3±2.5 years, 54.3±2.7 kg, 155.2±42.1 cm, and 19.2±2.3 kg/m 2 , respectively. Comparison of these maternal parameters between both the groups showed a significantly higher value in the second group (p< 0.01 in all cases). Maternal weight, height and BMI showed a strong negative correlation {Pearson’s correlation coefficient of -0.53, -0.76, and -0.42 respectively; adjusted odds ratio (95% CI) of 0.72 (0.54-0.91), 0.40 (0.28-0.52) and 0.76 (0.54-0.96), respectively with the neonates’ birth weight, but maternal age did not {Pearson’s correlation coefficient of -0.32, adjusted odds ratio (95% CI) of 0.89 (0.10-1.55)}. Conclusion: There are lesser chances of development of IUGR neonates with increase in maternal weight, height and BMI.

The dietary composition of women who delivered preterm and full-term infants

ObjectivesLiterature data show that excess and primary deficiency in particular nutrients, vitamins and minerals may lead to pre-eclampsia, gestational diabetes, hypertension and neural tube defects in the foetus. The aim of the study was to determine differences in average daily consumption of selected nutrients during pregnancy in women who did not supplement their diet and to evaluate the influence of dietary habits on the occurrence of pre-term delivery and hypertension in pregnant women. Sample group and methodsInformation on the course of pregnancy and the newborn's health status at birth was derived from the Charter of Pregnancy and documents recorded by the hospital. Women's eating habits and dietary composition were analyzed on the basis of a dietary questionnaire. The sample group was divided into four groups: women who delivered neonates appropriate for gestational age (AGA), women with gestosis who delivered AGA neonates by means of caesarean sections, women who delivered pre-term neonates (PTB) and women with gestosis who delivered PTB by means of caesarean sections. ResultsIn the case of women with vaginal delivery at term the average intake of iodine was always higher than in other groups. Analysis of average daily intake of folates revealed a higher intake in the group of women who gave birth to full-term neonates with proper neonatal weight in comparison with the groups of women with pre-term delivery. P≤0.05. ConclusionsStatistically significant differences in average daily intake of folates, iodine, retinol, magnesium and iron were observed between the group of women with vaginal delivery at term and the groups of women with diagnosed hypertension who delivered preterm. Correlation was demonstrated between average daily intake of iodine and vitamin D and the occurrence of arterial hypertension. Supplementation of the diet of women in the preconception and prenatal period with minerals and vitamins should be considered.

Comparisons of mortality and pre-discharge respiratory morbidities in small for gestational age and appropriate-for gestational age premature infants - An Indian Experience

Background: There is an assumption that fetus with restricted growth with an inappropriate intrauterine environment lies under stress. Although small-for-gestational-age (SGA) infants have higher mortality, difference in the outcome of SGA and appropriate-for-gestational-age (AGA) infants regarding respiratory morbidity is controversial. It seems that respiratory morbidities in SGA neonates is different from neonates with AGA. In this study, we intend to compare the mortality and respiratory morbidity rates between the preterm small for gestational age (SGA) and appropriate for age (AGA) neonates of less than 34 weeks of gestation. Methods: This analytical cross-sectional study was conducted on 498 preterm neonates with gestational age of < 34 weeks, admitted to the Neonatal Intensive Care Unit. These neonates were categorized into two groups of SGA (n=210) and AGA (n=286). The data analysis was performed, using Student’s t-test and Mann-Whitney U test for parametric variables and Chi-square and Fisher’s exact tests for nonparametric data. Results: According to the results of the study, the two groups were significantly different in terms of their birth weight (P<0.001), pregnancy-induced hypertension (P<0.001), and antenatal steroid usage (P=0.011). Furthermore, respiratory distress syndrome (RDS) was found to be more prevalent in the premature AGA neonates than the SGA ones (P=0.011). In addition, surfactant usage was significantly less in the SGA group (P=0.0006). Bronchopulmonary dysplasia (BPD) developed in 14% and 9% of the premature AGA and SGA neonates, respectively (P=0.094). However, there was no significant difference between the two groups regarding the mortality rate, intra-ventricular hemorrhage, and necrotizing enterocolitis. Among the survived neonates, mean length of hospital stay was significantly higher in the premature SGA newborns born within 26-36 weeks of gestation than their AGA counterparts. Conclusion: As the findings of the current study demonstrated, the mortality rate was similar in the SGA and AGA groups; however, the respiratory morbidities such as RDS and BPD were more prevalent in the AGA neonates.

Pregnancies complicated by both preeclampsia and growth restriction between 34 and 37 weeks’ gestation are associated with adverse perinatal outcomes

Objective: To determine whether adverse outcomes were more common in late preterm pregnancies complicated by preeclampsia and growth restriction compared to those affected by preeclampsia alone.Methods: This was a retrospective cohort study of 8927 singleton pregnancies with preeclampsia. Pregnancies with small for gestational age (SGA) neonates (birth weight <10th percentile) were compared to those appropriate for gestational age (AGA) neonates. Maternal outcomes included cesarean delivery (CD) rate, CD for fetal heart rate (FHR) abnormalities, abruption, postpartum hemorrhage (PPH), maternal transfusion, acute renal failure, and peripartum cardiomyopathy. Neonatal outcomes studied included respiratory distress syndrome (RDS), jaundice, hypoglycemia, seizure, asphyxia, neonatal death, and intrauterine fetal demise (IUFD).Results: Women with preeclampsia and SGA infants were more likely to experience abruption (5.3% versus 3.0%, p < 0.001), higher CD rate (66.5% versus 55.0%, p < 0.001), and higher likelihood of a CD for FHR abnormalities (21.7% versus 10.0%, p < 0.001). SGA infants were more likely to experience adverse neonatal outcomes including RDS (10.1% versus 4.9%, p < 0.001), jaundice (59.8% versus 39.2%, p < 0.001), hypoglycemia (8.9% versus 3.9%, p < 0.001), asphyxia (0.6% versus 0.2%, p = 0.015), and IUFD (1.5% versus 0.3%, p < 0.001).Conclusions: Preeclamptic women and their neonates were more likely to experience adverse perinatal outcomes when SGA pregnancies were compared to those with AGA neonates.

Reduction in Cerebral Oxygenation due to Patent Ductus Arteriosus Is Pronounced in Small-for-Gestational-Age Neonates

Background: A haemodynamically significant patent ductus arteriosus (hsPDA) reduces cerebral oxygenation in appropriate-for-gestational-age (AGA) preterm neonates. Reduced cerebral oxygenation has been associated with brain injury. Preterm small-for-gestational-age (SGA) neonates show higher cerebral oxygenation than AGA peers throughout the first postnatal days. To date, no studies have investigated the effect of hsPDA on cerebral oxygenation in preterm SGA neonates. Objective: We aimed to assess the effect of hsPDA on cerebral oxygenation in preterm SGA neonates compared to AGA peers. We hypothesised that higher baseline cerebral oxygenation would reduce the impact of hsPDA on cerebral oxygenation in preterm SGA neonates. Methods: We monitored regional cerebral oxygen saturation (rScO₂) with near-infrared spectroscopy and calculated the cerebral fractional tissue oxygen extraction (cFTOE) for 72 h after birth. Retrospective analysis compared 36 preterm SGA neonates (birth weight <10th percentile, 18 with hsPDA) to 36 preterm AGA neonates (birth weight 20th to 80th percentile, 18 with hsPDA). Results: In contrast to the other groups, SGA-hsPDA neonates demonstrated a significant fall in rScO₂ [69% (SEM 2.5) at 4-8 h to 61% (2.7) at 68-72 h, p < 0.001] with a concurrent rise in cFTOE [0.26 (0.026) at 4-8 h to 0.34 (0.030) at 68-72 h, p < 0.001]. Conclusions: Contrary to our hypothesis, hsPDA had a significant negative effect on cerebral oxygenation in preterm SGA neonates. Future studies should explore the potential benefits of early screening and treatment for hsPDA on long-term neurodevelopmental outcome in preterm SGA neonates.

Early-Onset Thrombocytopenia in Small-for-Gestational-Age Neonates: A Retrospective Cohort Study

Thrombocytopenia is a common finding in small for gestational age (SGA) neonates and is thought to result from a unique pathophysiologic mechanism related to chronic intrauterine hypoxia. Our objective was to estimate the incidence and severity of early-onset thrombocytopenia in SGA neonates, and to identify risk factors for thrombocytopenia. We performed a retrospective cohort study of all consecutive SGA neonates admitted to our ward and a control group of appropriate for gestational age (AGA) neonates matched for gestational age at birth. Main outcome measures were incidence and severity of thrombocytopenia, hematological and clinical risk factors for thrombocytopenia, and bleeding. A total of 330 SGA and 330 AGA neonates were included, with a mean gestational age at birth of 32.9 ± 4 weeks. Thrombocytopenia (<150x109/L) was found in 53% (176/329) of SGA neonates and 20% (66/330) of AGA neonates (relative risk (RR) 2.7, 95% confidence interval (CI) [2.1, 3.4]). Severe thrombocytopenia (21-50x109/L) occurred in 25 neonates (8%) in the SGA and 2 neonates (1%) in the AGA group (RR 12.5, 95% CI [3.0, 52.5]). Platelet counts <20x109/L were not recorded. Within the SGA group, lower gestational age at birth (p = <0.01) and erythroblastosis (p<0.01) were independently associated with a decrease in platelet count. Platelet count was positively correlated with birth weight centiles. In conclusion, early-onset thrombocytopenia is present in over 50% of SGA neonates and occurs 2.7 times as often as in AGA neonates. Thrombocytopenia is seldom severe and is independently associated with lower gestational age at birth and erythroblastosis.

31 Fetal abdominal circumference growth velocity as a predictor of neonatal outcome and birth weight in appropriate-for-gestational-age neonates

Introduction Fetal growth restriction (FGR) is still a major cause of perinatal mortality despite advances in fetal ultrasound scanning. The traditional 10th birth weight percentile as a cut-off for defining FGR could miss many cases of relative FGR falsely labelled as appropriate for gestational age (AGA) by having a birth weight > 10th percentile, but actually have a reduced growth velocity possibly due to a higher growth potential of a milder degree of placental dysfunction. Objectives Our objective was to study the role of reduced growth velocity in AGA neonates and its influence on adverse perinatal outcome. Methods We performed a retrospective study of singleton AGA (birth weight > 10th centile) neonates born in the Maastricht University Medical Centre between 2011-2015, of whom fetal biometry scans were available in two periods: 18–22 weeks and 30–34 weeks of gestational age. Growth velocities of biparietal diameter (BPDv), head circumference (HCv), abdominal circumference (ACv) and femur length (FLv), were calculated in mm/week and compared between categories of birth weight percentiles (BWp) using logistic regression, one-way ANOVA and posthoc test, and correlated to a composite adverse perinatal outcome using chi-square test. Macroscopic and histological placental analysis were collected from the pathology register, and correlated to ACv and birthweight using chi-square test. Results We identified 407 AGA neonates with available neonatal outcomes: BWp 10–16 (N = 43), BWp 16–20 (N = 21), BWp 20–50 (N = 143), BWp 50–80 (N = 119), BWp > 80 (N = 81). There was a significant linear correlation between growth velocities and BWp: BPDv (B = 6651 p = 0.016), ACv (B = 4286 p = 0.0001) and FLv (B = 9657 p = 0.0001). There was a significant difference in AC velocity (in mm/week, mean ± SD) between the BWp 50-80 (11,34 ± 0,14, reference group) and BWp 10–16 (10,58 ± 0,14 p = 0.002), BWp 16–20 (10,45 ± 0,17, p = 0.008) and BWp 20–50 (10,61 ± 0,13 p = 0.0001). A similar trend was observed with other growth parameters. We identified 39 placental analysis, there was no significant difference between ACv (in mm/week, mean ± SD) in the group with placental dysfunction (11,10 ± 0,18) vs normal(10,98 ± 0,18 p=0.789). However birthweight (in grams, mean ± SD) was significant lower in the group with placental dysfunction (2623 ± 537) vs normal (3041 ± 610, p = 0.029). Neonates with ACv p25 (vs. > p75) had more composite adverse neonatal outcome OR = 2.02 95% CI = (1.012–4.03). Conclusions Detection of relative FGR remains a clinical challenge. Our findings suggest that AC growth velocity in early third trimester determine eventual birth weight and that neonates at the lower end of the AGA spectrum have a reduced AC velocity and a worse neonatal outcome. Larger studies are needed to confirm these findings in prospective cohort.

Early-Onset Thrombocytopenia in Small-For-Gestational-Age Neonates: A Retrospective Cohort Study.

Thrombocytopenia is a common finding in small for gestational age (SGA) neonates and is thought to result from a unique pathophysiologic mechanism related to chronic intrauterine hypoxia. Our objective was to estimate the incidence and severity of early-onset thrombocytopenia in SGA neonates, and to identify risk factors for thrombocytopenia. We performed a retrospective cohort study of all consecutive SGA neonates admitted to our ward and a control group of appropriate for gestational age (AGA) neonates matched for gestational age at birth. Main outcome measures were incidence and severity of thrombocytopenia, hematological and clinical risk factors for thrombocytopenia, and bleeding. A total of 330 SGA and 330 AGA neonates were included, with a mean gestational age at birth of 32.9 ± 4 weeks. Thrombocytopenia (<150x109/L) was found in 53% (176/329) of SGA neonates and 20% (66/330) of AGA neonates (relative risk (RR) 2.7, 95% confidence interval (CI) [2.1, 3.4]). Severe thrombocytopenia (21-50x109/L) occurred in 25 neonates (8%) in the SGA and 2 neonates (1%) in the AGA group (RR 12.5, 95% CI [3.0, 52.5]). Platelet counts <20x109/L were not recorded. Within the SGA group, lower gestational age at birth (p = <0.01) and erythroblastosis (p<0.01) were independently associated with a decrease in platelet count. Platelet count was positively correlated with birth weight centiles. In conclusion, early-onset thrombocytopenia is present in over 50% of SGA neonates and occurs 2.7 times as often as in AGA neonates. Thrombocytopenia is seldom severe and is independently associated with lower gestational age at birth and erythroblastosis.

Time to spontaneous ductus arteriosus closure in full-term neonates

ObjectiveThe mean closure time of the ductus arteriosus (DA) in full-term neonates is presumed to be 1–2 days after birth; however, whether this rate is accurate throughout the neonatal period...

Classifying neonatal growth outcomes: use of birth weight, placental evaluation and individualized growth assessment

Objective: To compare neonatal growth outcomes determined by birth weight (BW), placental assessment (Plac Assess) and individualized growth assessment (IGA). Methods: This retrospective analysis was carried out in 45 selected pregnancies at risk for fetal growth restriction. Serial fetal biometry was carried out in the 2nd and 3rd trimester. First and second trimester placental biomarkers, 2nd trimester uterine artery (Ut A) velocimetry and postnatal placental pathology were evaluated as indicators of placental insufficiency. At delivery, weight (WT), head circumference (HC) and crown–heel length (CHL) were measured. BWs were categorized as large-for-gestational-age (LGA), appropriate-for-gestational-age (AGA) and small-for-gestational age (SGA) (<10th, 10th–90th and >90th percentiles). In these categories, neonatal growth outcomes were classified as growth restricted (GR), normal (NORMAL) or macrosomic (MACRO) based on BW plus Plac Assess (Ut A velocimetry, biomarkers, pathology) or IGA [growth potential realization index profile (WT, HC and CHL)]. Results: There were 6 LGA, 14 AGA and 25 SGA neonates in this sample. All 14 AGA neonates were considered NORMAL by both IGA and BW + Plac Assess. All six LGA neonates were classified as MACRO by BW + Plac Assess but only four by IGA (the remaining two were NORMAL and high NORMAL). The 25 SGA cases could be divided into five subgroups based on IGA and BW + Plac Assess. The largest subgroup (56%) was GR and the next largest (24%) was NORMAL by both classification methods. In the remaining 20%, there was some evidence of GR but IGA and BW + Plac Assess were not in complete agreement. Conclusions: Agreement was good for all three methods in the LGA and AGA groups. The SGA group was heterogeneous but agreement between IGA and BW + Plac Assess was 89%. These results, using more sophisticated growth assessment methods, confirm placental insufficiency as a primary cause of growth restriction. Most normal and GR SGA neonates can be identified with conventional anatomical measurements if IGA is used.

Fetal ve erken postnatal serum endoglin düzeylerinin doğum ağırlığı ve maternal preeklampsi ile ilişkisi

Aim: The aim of the present study was to evaluate the role of fetal and early postnatal serum endoglin levels in fetal growth and to investigate the association between neonates of preeclamptic mothers and endoglin levels. Material and Methods: Fiftyfive neonates were prospectively enrolled into the study and divided into four groups: 1) Normal pregnancy and small for gestational age (SGA) neonates (n:13), 2) normal pregnancy and large for gestational age (LGA) neonates (n:19), 3) appropriate for gestational age (AGA) neonates of preeclamptic mothers (n:12), and 4) control group: AGA neonates born to mothers without preeclampsia or any other disease (n:11). Blood was collected from umbilical cords (UC) with both ends clamped, and from peripheral vein in the postnatal 4th hour. Serum endoglin levels were measured by employing an ELISA kit. Results: Endoglin was detectable in the serum of all studied umbilical cord and neonates. No statistically significant differences were found between fetal and early postnatal serum endoglin levels in SGA, LGA, preeclamptic and control groups. Fetal and early postnatal serum endoglin levels of SGA group were significantly higher than the values of AGA group. Conclusion: Fetal and early postnatal serum endoglin levels seem to be unchanged in neonates.We showed that SGA neonates are characterized by a alterations in serum endoglin levels.Our results suggest that increased endoglin levels may play a role in the pathophysiology of SGA. Further studies with larger patient series are required to determine the role of endoglin in fetal growth in normal neonates and in neonates born after a complicated pregnancy.

Iron Stores in Term and Late Preterm Small for Gestational Age and Appropriate for Gestational Age Neonates at Birth and in Early Infancy.

To compare body iron stores in late preterm and term small for gestational age (SGA) infants with gestation matched appropriate-for-gestational age (AGA) infants at birth and at 2 mo of age. In this prospective observational study, live births of 34-42 wk gestation and SGA (<10th centile for GA) were enrolled along with gestation matched AGA (10th-90th centile for GA) infants. Infants' blood samples were taken within 2h of delivery, and repeated at 60±7 d of life. Primary outcome was serum ferritin at birth and 60 d of age. Secondary outcomes were hematocrit at birth and 60 d and need for transfusion until 60 d of life. A total of 37 SGA (gestation 37.2±1.9 wk, birth weight 1861±401g) and 30 AGA infants (gestation 37.3±1.9 wk, birth weight 2607±405g) were enrolled in the study. There was no difference in the serum ferritin between AGA and SGA infants at birth {median [IQR]: 254.0 [214.3-293.8] vs. 259.7 [217.8-301.5] μg/L; p=0.85} or 60d of life {147.2 [101.4-193.0] vs. 155.0 [106.6-203.6] μg/L; p=0.81}. Mean hematocrit was 55.5±9.6 vs. 52.4±5.0 at birth (p=0.10) and 32.1±4.9 vs. 31.6±3.8 at 60 d (p=0.77) in SGA and AGA infants respectively. No infant required blood transfusion during the study period. Iron stores of late preterm and term SGA infants are comparable to term AGA infants at birth and 2 mo of age. Recommendations on iron supplementation to these infants need to be formulated through appropriately designed randomized trials.

Adiponectin, leptin and insulin levels at birth and in early postnatal life in neonates with hypoxic ischemic encephalopathy.

BackgroundHypoxic ischemic encephalopathy (HIE) occurs in one to three per 1000 live full-term births. Fifteen to twenty percent will die in the postnatal period, and an additional 25 % will develop severe and permanent neuropsychological sequalae. The control of growth and nutritional status in the fetus and neonate is a complex mechanism, in which also hormones produced by adipose tissue, such as adiponectin and leptin are involved. The aim of this study was to measure the levels of adiponectin, leptin and insulin in neonates with HIE at birth and in early postnatal life and comparing them with normal healthy AGA and SGA neonatesMethodsThis study carried out on 80 full-term neonates born in Minia university hospital during the period from May 2013 to December 2014. They were divided into group I included 25 neonates with HIE and group II included 55 normal healthy neonates (30 appropriate for gestational age (AGA) and 25 small for gestational age (SGA)). Weight, length, head circumference, body mass index (BMI), glucose, adiponectin, leptin and insulin levels were measured for all neonates. Adiponectin, leptin and insulin levels were compared between neonates with HIE and normal healthy neonates as well as between AGA and SGA neonates at birth, 2nd and 6th days of life.ResultsAdiponectin and leptin levels were significantly higher at birth then began to decrease during the first postnatal week in all neonates while insulin level increased during the same period. Serum adiponectin levels were significantly lower while serum leptin and insulin levels were significantly higher in neonates with HIE than healthy neonates. In all neonates, the serum adiponectin level was positively correlated at birth with weight, length, BMI and leptin levels but not with insulin level. In neonates with HIE, serum adiponectin level was not correlated with weight, BMI, leptin level or insulin level. In all neonates, the serum leptin level was positively correlated at birth with body weight, height and BMI. In neonates with HIE serum leptin levels were not correlated with weight, BMI or insulin level after birth. There were no correlations between either leptin or adiponectin serum levels or any of the studied parameters in neonates with HIEConclusionsNeonates who are suffering from HIE had lower serum levels of adiponectin and higher serum levels of leptin and insulin than normal healthy neonates at birth and during the early postnatal period. The decline of leptin and increased the insulin levels after birth in all neonates may be important for the stimulation of feeding behavior and the acquisition of energy homeostasis during the early postnatal life. Positive significant correlations between adiponectin, leptin, body weight and body mass indices were present in normal healthy neonates but not in neonates with HIE reflecting the effect of hypoxia on the regulatory mechanisms controlling the adipose tissue functions.

Growth restriction and gender influence cerebral oxygenation in preterm neonates

ObjectiveTo investigate the effect of fetal growth restriction and gender on cerebral oxygenation in preterm neonates during the first 3 days of life.DesignCase–control study.SettingNeonatal Intensive Care Unit of the Wilhelmina...

Differential effects of low birthweight and intrauterine growth restriction on umbilical cord blood insulin-like growth factor concentrations.

Alterations in the growth hormone-insulin-like growth factor (IGF) axis have been considered as a causal factor for intrauterine growth restriction (IUGR) and for the increased risk of metabolic disease in later life. We compared members of the IGF axis in umbilical cord blood between IUGR neonates, small for gestational age without foetal restriction (SGA) and appropriate for gestational age (AGA) neonates. Prospective controlled multicenter study. Sixteen ultrasound-proven IUGR, 8 SGA and 40 AGA neonates. Concentrations of total IGF-I and total IGF-II by immunoassays, bioactive IGF by cell-based bioassay and IGFBP-I in mixed venous and arterial umbilical cord blood samples at birth. Auxological parameters at birth. IGF-I concentrations in IUGR [17·7 μg/l (CI 13·8;21·6)] were clearly below those in AGA [48·3 μg/l (CI 43·7;52·9)] and SGA neonates [36·0 μg/l (CI 26·6;45·4)]. IGF-II levels were significantly reduced in IUGR [201·4 μg/l (CI 190·2;212·6)] compared to AGA neonates [231·2 μg/l (CI 220·6;241·9)]. A trend for lower IGF-II concentrations was observed in IUGR when compared to SGA neonates [232·0 μg/l (CI 207·2;256·8)]. These differences could not be explained by confounding. For IGFBP-1, a trend towards higher values in IUGR was observed. Low IGF-I cord blood concentrations in hypotrophic neonates after IUGR might not only result from low birthweight per se, but also reflect prenatal placental environment. Alterations of the IGF axis could be in the causal pathway of IUGR and thus constitute a potential surrogate marker for IUGR in the assessment of foetal programming.

The difference of lymphocyte subsets including regulatory T-cells in umbilical cord blood between AGA neonates and SGA neonates.

PurposeThis study aimed to compare the regulatory T cells in cord blood of appropriate for gestational age (AGA) neonates with those of small for gestational age (SGA) neonates.Materials and MethodsUmbilical cord blood was collected upon labor in 108 healthy full-term (between 37 and 41 gestational weeks) neonates, who were born between November 2010 and April 2012. Among them, 77 samples were obtained from AGA neonates, and 31 samples were obtained from SGA neonates. Regulatory T cells and lymphocyte subsets were determined using a flow cytometer. Student's t-test for independent samples was used to compare differences between AGA and SGA neonates.ResultsRegulatory T cells in cord blood were increased in the SGA group compared with normal controls (p=0.041). However, cytotoxic T cells in cord blood were significantly decreased in the SGA group compared with normal controls (p=0.007).ConclusionThis is the first study to compare the distribution of lymphocyte subsets including regulatory T cells in cord blood between AGA neonates and SGA neonates.

Study of serum zinc in low birth weight neonates and its relation with maternal zinc.

Assessment of serum Zinc in LBW (Low Birth Weight) and appropriate for gestational age (AGA) neonates in relation to their maternal zinc level. A prospective study was conducted in a tertiary care teaching hospital of central India between August 2011 to July 2012. Serum samples were collected from the eligible LBW (preterm & term IUGR) and term AGA healthy neonates and their mothers for zinc level estimation. Serum zinc was measured by atomic absorption spectrophotometer. Newborn of mothers having any medical illness, on any medication, with anaemia (Hb <10 gm/dl) were excluded from the study. Neonates with any perinatal insult were also excluded. Out of 100 newborn-mother pairs enrolled in the study, 46 newborns (18 preterm and 28 term IUGR) with birth weight <2.5kg comprised the case group and rest 54 term AGA newborns (birth weight >2.5kg) were categorized as control group. Mean serum zinc level was significantly low in LBW neonates (83.45±16.74 μg/dl) in comparison to term AGA newborns (93.74±19.95 μg/dl), (p-value <0.05). Similarly, zinc level was also low in mothers of LBW babies (67.02±15.99 μg/dl) in comparison to mothers of term AGA newborns (83.59±18.46 μg/dl), (p-value < 0.05). Low maternal zinc levels were significant correlated with lower serum zinc in LBW neonates (Pearson correlation value - 0.938). However, maternal zinc levels have shown no significant correlation with neonatal serum zinc levels in term AGA (0.029). LBW neonates and their mothers have significant zinc deficiency as compared to term AGA neonates and their mothers and this deficiency is correlated with zinc deficiency in mothers of these LBW neonates.

Lipid profile in neonates and its relation with birth weight and gestational age.

This study was undertaken to compare lipid profile of small for gestational age (SGA) and appropriate for gestational age (AGA) neonates. A total of 103 neonates were included; of which 63 were AGA and 40 SGA. Venous blood (2 ml) was obtained 2 h after the previous feed between 8 and 10 am on Day 3 or Day 4 of life and lipid profile was done. In AGA neonates, mean TC (total cholesterol), LDL (low density lipoprotein cholesterol), HDL (high density lipoprotein cholesterol) and triglycerides were 103.92 ± 47.79, 51.70 ± 23.03, 23.35 ± 11.41 and 187.62 ± 144.44 mg/dl respectively. AGA neonates had more TC and LDL than SGA neonates (P < 0.05). There was no significant difference in mean lipid profile between preterm and term neonates. Thus, normal lipid profiles in neonates in the index study are higher than that of the neonates from other parts of the world. The authors recommend further studies in India to outline normal values of lipid profile across various gestations and birth weights.

Brainstem Evoked Response Audiometry (BERA) in Neonates with Hyperbillirubinemia

(1) To study the BERA changes in neonates with unconjugated hyperbilirubinemia. (2) To compare the BERA changes in the neonates with unconjugated hyperbilirubinemia before and after therapy. Thirty consecutive term appropriate for gestational age (AGA) neonates presenting to NICU with total serum bilirubin requiring intervention (using the American Academy of Pediatrics guidelines) were included in the study as cases and thirty normal term AGA neonates with uneventful peri-natal period and a maximum measured serum bilirubin <12mg/dl in case of term baby were included as controls after obtaining informed consent. Initial BERA was done within 3-24h of hospitalization after obtaining informed consent from parents, at the time of discharge and at 3month followup. Machine used for recording BERA was intelligent hearing system version 3.3. In our study out of the 30 cases 10 (33.3%) cases were found to have BERA changes in the form of absent wave forms, raised threshold, prolonged latencies or prolonged inter peak latencies. In our study, it was observed that there was statistically significant correlation (p value<0.005) between increasing bilirubin level and BERA changes. Correlation of the findings of this study with previous few studies indicates that BERA can be used as a useful non invasive tool to determine auditory functions in the neonate especially changes of early bilirubin toxicity.

Nomogram-based evaluation of thyroid function in appropriate-for-gestational-age neonates in intensive care unit.

The objective of this study was to help neonatologists to interpret the thyroid hormone results accurately, and also to provide reference ranges and/or nomograms of FT4 (free thyroxine) and thyrotropin against gestational age at postnatal 1 week and 1 month in order to assess thyroid function in AGA (appropriate for gestational age) neonates in intensive care unit. This is a retrospective study. We included a total number of 515 AGA neonates between 24 and 42 weeks of gestation. Routine results of serum FT4 and TSH that had been analyzed with an immunoassay were collected from existing laboratory data. Least square regression analyses were used to estimate both the mean and the s.d. curves as polynomial functions of gestational age. Free T4 levels were correlated with gestational age both at postnatal 1 week (r=0.39, P<0.001) and 1 month (r=0.26, P<0.001). Serum TSH levels at postnatal 1 week and 1 month did not show any correlation with gestational age. Scatterplots of FT4 levels against gestational age at 1 week and 1 month, showing the predicted 2.5th, 50th and 97.5th percentiles and central 95% reference ranges for TSH were provided. Gestational age-specific nomograms for FT4 and reference ranges for TSH at postnatal 1 week and 1 month in AGA neonates have been developed. This can help neonatologists to interpret the thyroid hormone results accurately. Further studies providing reference ranges/nomograms for thyroid function in small-for-gestational-age neonates are needed.