Normal Birth Weight Research Articles

Dietary glycine supplementation enhances creatine availability in tissues of pigs with intrauterine growth restriction

Abstract This study tested the hypothesis that dietary supplementation with glycine (Gly) enhances the synthesis and availability of creatine (Cr) in tissues of pigs with intrauterine growth restriction (IUGR). At weaning (21 d of age), IUGR pigs and litter mates with normal birth weights (NBW) were assigned randomly to one of two groups, namely, supplementation with 1% Gly or 1.19% L-alanine (isonitrogenous control) to a corn- and soybean meal-based diet. Blood, kidneys, liver, pancreas, jejunum, longissimus lumborum muscle (LLM), and gastrocnemius muscle (GM) were obtained from the pigs within 1 wk after the feeding trial ended at 188 d of age to determine concentrations of guanidinoacetate (GAA), Cr, creatinine, and phosphocreatine (CrP). The organs were also analyzed for activities and mRNA levels for Cr-synthetic enzymes: L-arginine:glycine amidinotransferase (AGAT; forming GAA from Gly and L-arginine) and guanidinoacetate N-methyltransferase (GAMT; converting GAA and L-methionine into Cr). AGAT activity was present in the kidneys, liver, and pancreas, whereas GAMT activity was found in all the organs analyzed. AGAT and GAMT were most active per g of tissue in the kidneys and liver, respectively. Based on tissue mass, the kidneys had the greatest (P < 0.001) AGAT activity per whole organ, followed by the liver, while skeletal muscle had the greatest (P < 0.001) GAMT activity per whole organ, followed by the liver. Thus, the kidneys played a dominant role in forming GAA, whereas skeletal muscle and liver were the major sites for converting GAA into Cr. Dietary supplementation with 1% Gly enhanced AGAT activity in the kidneys and pancreas but reduced GAMT activity in the pancreas and small intestine, therefore directing GAA to the liver and skeletal muscle for Cr production. IUGR selectively reduced the concentration of Cr in LLM among all the organs studied. Except for the GM that had greater mRNA levels for GAMT in IUGR pigs, neither Gly nor IUGR affected mRNA levels for the selected genes in the tissues examined. Collectively, these novel results indicate that dietary Gly intake upregulates the Cr-synthetic pathway in swine.

Comparison of Physical Growth Between Low Birth Weight and Normal Birth Weight Babies Aged Between 24-36 Months Born in a Selected Hospital of Dhaka, Bangladesh

This study investigates the physical growth disparities between Low Birth Weight (LBW) and Normal Birth Weight (NBW) babies aged 24-36 months in a selected hospital in Dhaka. The research sample comprised 200 babies, evenly split between LBW (birth weight < 2500 grams) and NBW (birth weight ≥ 2500 grams) groups. Physical growth parameters including weight, height and head circumference were measured and analyzed using descriptive statistics and comparative tests. The findings reveal significant differences in all measured parameters between LBW and NBW infants. LBW babies exhibited lower mean values in weight (11.5 kg vs. 13.0 kg), height (85.0 cm vs. 89.0 cm) and head circumference (48.0 cm vs. 49.0 cm) compared to NBW babies. Statistical analyses confirmed these differences to be significant (p < 0.05), highlighting the persistent impact of birth weight on early childhood growth. These results underscore the importance of targeted healthcare interventions for LBW infants to mitigate growth disparities and promote optimal development. Early childhood growth failure in LBW infants has long-term implications for health and developmental outcomes, necessitating comprehensive healthcare strategies that include nutritional support, growth monitoring and developmental assessments. By addressing these challenges, healthcare providers and policymakers can improve the long-term health and well-being of LBW infants, ensuring they have the opportunity to achieve their full developmental potential. This study contributes valuable insights to the field of maternal and child health in Bangladesh, guiding future research and healthcare initiatives aimed at supporting LBW infants and reducing health disparities.

Promotion of breastfeeding in Italian Maternity Hospitals: a pre-intervention study

BackgroundIn Italy, exclusive breastfeeding (EBF) rates at hospital discharge range unsatisfactorily between 20–97%.MethodsIn 2023, the Project for Hospital Policy on Breastfeeding (HPB) has been launched to promote breastfeeding in Italian Maternity Hospitals (MHs) as a joint initiative of the Italian Scientific Societies involved in perinatal care together with the National Midwife (FNOPO) and Nurse (FNOPI) Boards and with Vivere Onlus, a family association. The HBP Project has been designed as an uncontrolled before-after study to increase EBF rate at hospital discharge in the population of healthy, term infant with a normal weight at birth following an intervention bundle comprising: 1) Establishment of a local hospital Working Group; 2) Adoption of a hospital policy; 3) Implementation of breastfeeding monitoring; 4) Training for perinatal care professionals; 5) Enhanced implementation of the practices of skin-to-skin contact (SSC) and mother-baby rooming-in; 6) Development/Improvement of perinatal care protocols.ResultsWe report the pre-intervention assessment of 89 out of the 111 enrolled MHs (80.2%) at the beginning of the Project (Time 1 or T1). Almost all MHs (96.6%) have a multi-professional Breastfeeding Working Group, while a hospital policy on breastfeeding is available only in 48.2%. Moreover, only 56.2% of the 9,777 perinatal health workers have been trained in breastfeeding. Over a 1-month period, SSC has been practiced in the delivery room by 76.9% of 6,304 term healthy newborn infants and rooming-in by 83.4% of 6,735 healthy term newborns of normal weight at birth. Over a 4-month period, 69.1% of 33,367 healthy term newborns of normal birth weight were exclusively breastfed at hospital discharge. Noticeably, EBF rate of MHs ranges from 4% up to 100%, the second quartile being 73%.ConclusionAt T1 of the HPB Project, breastfeeding rates at hospital discharge for healthy, term infants with a normal weight at birth appear to be suboptimal among Italians MHs. Particularly, the range of EBF rates among participating centers is wide, with 50% of the MHs having EBF rate lower than 73%. Therefore, the ongoing HPB Project might represent not only an opportunity to increase the initiation of breastfeeding and to improve quality of health care in the whole study group of MHs, but possibly also to level differences between centers.

Maternal, Fetal, and Labour Outcomes of Dupilumab Use for Atopic Dermatitis During Pregnancy: A Systematic Review.

Atopic dermatitis is a chronic complex inflammatory disease that significantly impacts maternal well-being and quality of life during pregnancy, warranting effective therapeutic interventions that prioritize maternal health and fetal safety. Dupilumab is approved for moderate-to-severe atopic dermatitis, but limited data exist regarding its safety during pregnancy. We conducted a systematic review to review and analyze maternal, fetal, and labour outcomes in patients receiving dupilumab for atopic dermatitis during pregnancy. Comprehensive searches were conducted using databases including OVID, Scopus, and Web of Science, covering studies published until May 2024. Our search yielded 285 studies, of which 13 met the eligibility criteria. These studies included 68 patients with 69 pregnancies, revealing 58 live births and 11 spontaneous abortions. Dupilumab therapy was administered continuously throughout pregnancy in 22.2% of cases, while 77.8% received intermittent treatment. Maternal atopic dermatitis outcomes showed significant improvement in disease severity. Most pregnancies (86.3%) progressed without complications. Labour-associated outcomes varied, with 82.4% of women undergoing vaginal deliveries. The majority of births occurred at full term (82.5%), with a mean gestational age of 38.4 weeks. Fetal outcomes demonstrated a normal birth weight in 92.3% of cases, with no reported congenital defects. Our review suggests that dupilumab use during pregnancy is associated with improvement of atopic dermatitis and low or minimal risk of major adverse outcomes in treated patients or their newborns. Prospective studies with long-term follow-up are warranted to confirm the safety of dupilumab in this population.

Risk factors and prediction model for low-birth-weight infants born to women with gestational diabetes mellitus.

To explore the risk factors for low-birth-weight infants born to pregnant women with GDM to develop a prediction model and to construct a prediction nomogram for the risk of low birth weight infants born to pregnant women with GDM. The clinical data of singleton infants diagnosed with gestational diabetes mellitus in Southeast China in 2019 were retrospectively reviewed. Gestational conditions and neonatal weight were assessed. A total of 386 diabetic mothers and infants were enrolled, including 193 in the low birth weight group and 193 in the normal birth weight group. The statistically significant factors were age over 36 years (OR = 1.916, 95% CI 1.048-3.505), junior high school education (OR = 4.454, 95% CI 1.882-10.543), history of fetal distress (OR = 0.120, 95% CI 0.016-0.925), gestational hypertension (OR = 3.681, 95% CI 1.357-9.986), preeclampsia (OR = 24.652, 95% CI 5.956-102.036), threatened preterm birth (OR = 18.393, 95% CI 8.457-39.999), triglycerides (OR = 0.642, 95% CI 0.485-0.850), and inadequate gestational weight gain (OR = 1.997, 95% CI 1.162-3.432). The area under the receiver operating characteristic curve (AUC) was 0.834 (95% CI: 0.794-0.874, p < 0.001), and the sensitivity and specificity were 82.38 and 87.56%, respectively. The goodness-of-fit test likelihood ratio 2 was 2.089 (p = 0.978). The comprehensive nomogram model showed that the discrimination and mean absolute error were 0.834 and 0.015, respectively. The calibration curves showed acceptable agreement between the predictions of the column line plots and the observations. The DCA curves showed good positive net yields in the prediction model. This study established a prediction model and risk score for low birth weight in pregnant women with GDM. It helps pregnancy clinics to identify the risk of low birth weight in newborns promptly, in addition to glycemic control and weight management for pregnant women with GDM, and should improve the appropriate treatment plan for pregnant women with higher risk, to provide personalized and precise treatment for pregnant women with GDM and improve infant outcomes.

Dietary pattern and prevalence of malnutrition among lactating mothers and their under-five children attending primary health centres in Owo, Ondo State

Background: The lactation period is crucial in developing countries due to its positive impact on infant health and nutrition. Objective: This study assessed the dietary patterns and malnutrition among lactating mothers and their under-five children attending primary health centres in Owo, Ondo State. Method: A simple random sampling method was used to select 250 healthy lactating mothers with infants aged 0-59 months. Information on socio-demographic variables, health-seeking behaviours, food consumption patterns, and nutritional status was obtained using a well-structured questionnaire. Data were analyzed using SPSS, version 25. The chi-square test determined associations between variables, with significance considered at p&lt;0.05. Result: The study revealed that 68.4% of the mothers were aged 20-29, 94.4% were married, and 48.0% had household sizes of 1-3. About 97.6% of the mothers had babies of normal birth weight, while 54.0% received health services at the health centres. Approximately 89% of the mothers did not consume alcohol, and 55.2% ate cereal or cereal products daily. The Food Consumption Score (FCS) showed that 53.6% had an acceptable score, while 8.4% had a poor score. For the Dietary Diversity Score (DDS), 73.6% had a highly diverse diet, while 19.6% had low dietary diversity. The prevalence of obesity among the mothers was 31.2% based on BMI, 38.8% based on waist circumference, and 68.0% based on waist-hip ratio. Among the children, 17.4% of males and 11.1% of females were underweight, while 72.0% had a normal weight for their age. Only 14% were overweight, and stunting was observed in 16% of the children, more prevalent among males. Wasting was seen in 10.0% of the under-five children. Conclusion: There was a high prevalence of a double burden of malnutrition among the mothers and their children.

Evaluation of laparo-endoscopic single-site surgery for adnexal mass in pregnant women

BackgroundSurgery for adnexal mass does occur in pregnant women and therefore the choice of surgery during pregnancy needs to be carefully considered and studied. This study aimed to evaluate the safety and feasibility of Laparo-endoscopic Single-site Surgery (LESS) for adnexal mass during pregnancy and investigate the perioperative condition, pregnancy complications, and obstetric outcomes of operative women during pregnancy.MethodsThis study retrospectively collected medical records and surgery videos of 20 pregnant women who underwent LESS for adnexal mass between November 2019 and January 2022. Baseline characteristics, operative-related variables, and pregnancy outcomes were followed up.ResultsLESS for adnexal mass was successfully performed in 20 pregnant women, with very satisfactory surgery outcomes reported in all cases. The average gestational age at operation was 15+2 weeks (range, 5+1- 25+4 weeks). The median operative time was 80.8 min (range, 40 -185 min) and the average operative bleeding was 28.0 ml (range, 10–50 ml). The average VAS of 24 h postoperatively was 1 (range, 0–2), and the average length of hospital stay was 5.15 days (range, 3–7 days). All these women delivered a healthy newborn at full term except 1 woman induced abortion for her own reasons at 16+5 weeks gestational age (GA). The average GA of delivery was 39+1 weeks (range, 37–40+1 weeks), the average birth weight was 3228.95 g (range, 2740–3930 g), and the average Apgar score at 5 min was 9.95 (range, 9–10).ConclusionsLESS for adnexal mass is safe and feasible for pregnant women.

A-062 Determination Neonatal 17-Hydroxyprogesterone Cutoff Levels for Congenital Adrenal Hyperplasia in Korea: 3 years' experience

Abstract Background Newborn screening for congenital adrenal hyperplasia (CAH) is a crucial practice with significant global adoption. While it offers substantial benefits, it also presents challenges due to high false positive rates, which can lead to mental strain for families and unnecessary hospital visits. Our research delved into the impact of birth weight (BW), gestational age (GA), and GA combined with sampling time on 17-hydroxyprogesterone (17-OHP) concentration. Specifically, we aimed to establish appropriate 17-OHP cutoff values for preterm, low birth weight weight (LBW), and sick newborns. Methods A total of 2,429 newborns born between October 2020 and January 2024 were screened for CAH. Samples were collected from neonates on a filter paper with a heel prick method. The 17-OHP concentration was measured by AutoDELFIA Neonatal 17-hydroxyprogesterone kit (PerkinElmer, Turku, Finland). This assay is a solid phase, time-resolved fluoroimmunoassay based on the competitive reaction between europium labeled 17-OHP and sample 17-OHP for a limited amount of binding sites on 17-OHP specific polyclonal antibodies. The 99.5 percentile was applied to the cutoff of 17-OHP for CAH. Results 17-OHP concentrations in newborns with lower BW and GA were significantly higher than those in normal BW and term newborns. 17-OHP concentration showed a statistically significant negative correlation with BW (r = -0.512, p &amp;lt; 0.001) and GA (r = -0.578, p &amp;lt; 0.001). Not only the full-term subgroup, but also preterm subgroups had a same tendency of 17-OHP concentration decrease with increasing sampling time. Application of newly establishing 99.5 percentile cutoff criteria significantly reduced recall rates to 1.02%, 0.81%, and 1.45% according to each criterion of BW, GA, and GA with sampling time, respectively. Conclusions This research introduces novel 17-OHP cutoff values for preterm, low birth weight (LBW), and sick newborns in the context of congenital adrenal hyperplasia (CAH). We analyzed the distribution of these cutoff values, considering factors such as birth weight, gestational age, and the timing of sample collection. Notably, applying the newly established cutoff criteria led to a significant reduction in false positive rates. Our laboratory’s data can serve as a valuable reference for other institutions aiming to set appropriate cutoffs, thereby minimizing unnecessary follow-up tests and enhancing the efficiency of CAH screening. As we continue to accumulate additional data, further reserch in this field remains promising.

Prenatal Surgery for Open Fetal Spina Bifida in Patients with Obesity: A Review of Current Evidence and Future Directions.

Background: Obesity rates have significantly increased globally, affecting up to 40% of women of childbearing age in the United States. While prenatal repair of open fetal spina bifida has shown improved outcomes, most fetal surgery centers exclude patients with a body mass index (BMI) ≥ 35 kg/m2 based on criteria from the Management of Myelomeningocele Study (MOMS) trial. This exclusion raises concerns about healthcare equity and highlights a significant knowledge gap regarding the safety and efficacy of fetal spina bifida repair in patients with obesity. Objective: To review the current state of knowledge regarding open fetal surgery for fetal spina bifida in patients with obesity, focusing on safety, efficacy, and clinical considerations. Methods: A comprehensive literature search was conducted using the PubMed and EMBASE databases, covering articles from the inception of the databases to April 2024. Studies discussing fetal surgery for neural tube defects and documenting BMI measurements and their impact on surgical outcomes, published in peer-reviewed journals, and available in English were included. Quantitative data were extracted into an Excel sheet, and data synthesis was conducted using the R programming language (version 4.3.3). Results: Three retrospective studies examining outcomes of prenatal open spina bifida repair in a total of 43 patients with a BMI ≥ 35 kg/m2 were identified. These studies did not report significant adverse maternal or fetal outcomes compared to patients with lower BMIs. Our pooled analysis revealed a perinatal mortality rate of 6.1% (95% CI: 1.76-18.92%), with 28.0% (95% CI: 14.0-48.2%) experiencing the premature rupture of membranes and 82.0% (95% CI: 29.2-98.0%) delivering preterm (<37 weeks). Membrane separation was reported in 10.3% of cases (95% CI: 3.3-27.7%), the mean gestational age at birth was 34.3 weeks (95% CI: 32.3-36.3), and the average birth weight was 2651.5 g (95% CI: 2473.7-2829.4). Additionally, 40.1% (95% CI: 23.1-60.0%) required a ventriculoperitoneal shunt. Conclusion: While current evidence suggests that fetal spina bifida repair may be feasible in patients with obesity, significant limitations in the existing body of research were identified. These include small sample sizes, retrospective designs, and a lack of long-term follow-up data. There is an urgent need for large-scale, prospective, multicenter studies to definitively establish the safety and efficacy of fetal spina bifida repair in patients with obesity. Such research is crucial for developing evidence-based guidelines, improving clinical outcomes, and addressing healthcare disparities in this growing patient population with obesity.

Characteristic differences between full-term and premature infants with intermittent exotropia

Strabismus is prevalent among preterm infants of low gestational age and birth weight in Southeast Asian countries, with intermittent exotropia (IXT) being the most common type in South Korea. In this retrospective, cross-sectional study, we investigated the differences between full-term and premature infants with IXT. IXT patients with available childbirth history were divided into two groups: preterm vs. full-term and low birth weight (LBW) vs. normal birth weight (NBW). Parameters related to exotropia including parental heredity, surgical history, and treatment options were investigated. In univariate regression for gestational age, a result of ≥ 100 s in the Titmus test was 1.352 times more frequent in preterm than in full-term infants. When birth weight was considered instead, a result of ≥ 100 s in the Titmus test was 1.412 times more frequent in the LBW compared to the NBW group. In multivariate regression for birth weight, the frequency of a result of ≥ 100 s in the Titmus test for the LBW group was 2.032 times higher than that for the NBW group. It is particularly important to examine stereopsis in preterm and LBW patients affected by IXT to ensure timely surgical planning and avoid potential recurrence after surgery.

Pregnancy Outcome Among Grand Multiparous Women at Delta State University, Oghara, Nigeria

Abstract Background: Grand multiparity presents a significant challenge to the obstetrician, especially in developing countries, including Nigeria. Objective: To determine the incidence and complications associated with grand multiparity at the Delta State University Teaching Hospital (DELSUTH), Oghara, Delta State, Nigeria. Materials and Methods: A retrospective descriptive study of grand multiparous women in DELSUTH between July 1, 2014, and June 30, 2023. Data retrieved from the hospital records and case files were analyzed. Results: The results revealed that during the period under review, the incidence of grand multiparity was 7.8% (146 grand multiparous women in 1874 deliveries). The majority (79.1%, n = 106) were para 5 and 6 (mean age: 37 ± 4.2 years). They were mostly farmers (49.3%) and housewives (17.9%) with a primary level of education (41.8%). Fifty-one percent (51.5%) were booked. Anemia (30.6%) and hypertensive disorders (12.7%) were the most common complications in the antenatal period, whereas hypertensive disorders (14.2%) were the most common complications seen during labor. The majority (61.9%) of the women had vaginal delivery. There was one case of maternal mortality (0.7%). The majority of the babies were of normal birth weight (57.3%, n = 82). One hundred and thirty-one of the babies (91.6%) were live births, whereas 8.4% (n = 12) suffered perinatal death. Conclusion: This study concludes that grand multiparity contributes to maternal and perinatal morbidity and mortality in Oghara, Nigeria.

Red Blood Cell Transfusion for Incidence of Retinopathy of Prematurity: Prospective Multicenter Cohort Study.

Retinopathy of prematurity (ROP) is a leading cause of visual impairment and blindness in preterm infants. This study sought to investigate the association between red blood cell (RBC) transfusion and ROP in very preterm infants (VPIs) to inform clinical strategies for ROP prevention and treatment. We designed a prospective multicenter cohort study that included VPIs and follow-up data from January 2017 to December 2022 at 3 neonatal clinical medicine centers. They were categorized into a transfusion group (infants who received an RBC transfusion within 4 wk) and a nontransfusion group. The relationship between RBC transfusion and ROP incidence was assessed using binary logistic regression, with subgroup analyses based on gestational age, birth weight, sex, and sepsis status. Inverse probability of treatment weighting and propensity score matching were applied to account for all potential confounding factors that could affect ROP development, followed by sensitivity analysis. The study included 832 VPIs, including 327 in the nontransfusion group and 505 in the transfusion group. The transfusion group had a lower average birth weight and gestational age and a greater incidence of ROP, ≥stage 2 ROP, and severe ROP. Logistic regression analysis revealed that the transfusion group had a significantly greater risk of ROP (adjusted odds ratio [aOR] 1.70, 95% CI 1.14-2.53, P=.009) and ≥stage 2 ROP (aOR 1.68, 95% CI 1.02-2.78, P=.04) but not severe ROP (aOR 1.75, 95% CI 0.61-5.02, P=.30). The trend analysis also revealed an increased risk of ROP with an increasing number of transfusions and a larger volume of blood transfused (P for trend<.001). Subgroup analyses confirmed a consistent trend, with the transfusion group at a higher risk for ROP across all subgroups. Inverse probability of treatment weighting and propensity score matching analyses supported the initial findings. For VPIs, RBC transfusion significantly increases the risk of ROP, and the risk increases with an increasing number of transfusions and volume of blood transfused.

Endoplasmic Reticulum Stress Contributes to Intestinal Injury in Intrauterine Growth Restriction Newborn Piglets.

Intrauterine growth retardation (IUGR) in piglets is associated with a high rate of morbidity and mortality after birth due to gut dysfunction, and the underlying mechanisms remain poorly understood. This study selected six pairs of IUGR newborn male piglets and normal birth weight newborn piglets (Large White × Landrace) to investigate differences in intestinal structure and digestive functions, intestinal ERS and apoptosis, intestinal barrier function, and inflammatory response. The results showed that IUGR significantly reduced the jejunal villi height (p < 0.05) and the ratio of villus-height-to-crypt-depth (p = 0.05) in neonatal piglets. Additionally, the microvilli in the jejunum of IUGR neonatal piglets were shorter than those in normal-weight piglets, and swelling of the mitochondria and expansion of the endoplasmic reticulum were observed. IUGR also significantly reduced serum glucose and lactase levels (p < 0.05) while significantly increasing mRNA levels of jejunal IRE1α, EIF2α, CHOP, Bax, Caspase9, Mucin2, Claudin-1, Occludin, ZO-1, Bcl-2, IL-6, and IFN-γ (p < 0.05), as well as GRP78 protein levels in neonatal piglets (p < 0.05). These findings suggest that IUGR impairs intestinal structure and barrier function in newborn piglets by enhancing intestinal inflammatory responses, activating intestinal ERS and the signaling pathways related to the unfolded protein response, thereby inducing ERS-related apoptosis.

First-Trimester Cell-Free DNA Fetal Fraction and Birth Weight in Twin Pregnancies.

The relationship between fetal fraction and birth weight in twin gestations is poorly understood. To investigate the relationship between first trimester cfDNA fetal fraction and birth weight < 10th percentile in twin gestations. This is a planned secondary analysis of the Twin cfDNA Study, a 17-center retrospective cohort of twin pregnancies screened for aneuploidy using cfDNA in the first trimester from 12/2011 - 2/2022, excluding those with positive screen results for chromosomal aneuploidy. CfDNA testing was performed by a single lab using massively parallel sequencing (MPSS). Baseline characteristics and birth weight of pregnancies with normal fetal fraction were compared to those with low (<5%) and high (>95%) fetal fraction using univariable analyses and multivariable regression. A total of 1041 twin pregnancies were included. Chronic hypertension, elevated BMI, and self-identified Black race were associated with fetal fraction <5th percentile. There was no difference in median fetal fraction between those with birth weight <10th percentile in at least one twin (median [IQR] fetal fraction 12.2% [9.8, 14.8] versus those with normal birth weight (10th percentile) in both twins (median [IQR] fetal fraction 12.3% [9.7, 15.2] for normal birth weight, p = 0.49). There was no association between high or low fetal fraction and birth weight <10th percentile for one (p=0.45) or both (p=0.81) twins, and there was no association between high or low fetal fraction and birth weight <5th percentile for one (p=0.44) or both (p=0.74) twins. The results were unchanged after adjustment for potential confounders. In this large cohort, there was no association between the extremes of cfDNA fetal fraction and birthweight < 10th percentile, suggesting that first trimester fetal fraction may not predict impaired fetal growth in twin gestations.

Comparative Analysis of Demographic and Clinical Profiles of Conventional Retinopathy of Prematurity with Aggressive Posterior Retinopathy of Prematurity

Aim: To compare the demographic and clinical profile of conventional retinopathy of prematurity (ROP) with aggressive posterior retinopathy of prematurity. Material and methods: A prospective, unmasked, and observational study involving 150 ROP patients was conducted over a period of one year. The risk factors including maternal and neonatal risk factors were recorded. The data was entered into the Excel sheet and analyzed to compare the risk factors between the conventional ROP and APROP. Results: A total of 17 (11.3%) babies were found to have AP-ROP and 133 (88.7%) babies were found to have conventional ROP. There was no significant difference in average gestational age between infants diagnosed with AP-ROP (29.6 ± 2.9 weeks) and those with Conventional ROP (30.1 ± 2.2 weeks) (p = 0.428). However, infants with AP-ROP had a significantly lower average birth weight (1022.7 ± 123.5 g) compared to infants with Conventional ROP (1208.2 ± 261.0 g) (p = 0.004). Multivariate logistic regression analysis revealed that birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis were independently associated with the development of AP-ROP. Conclusion: The development of APROP is multifactorial and complex. Although we have identified factors such as birth weight, surfactant use, number of days of oxygen supplementation, and metabolic acidosis in the causation of APROP, further long-term multicentric studies are required for validation.

Risk factors for cardiovascular disease in women with preeclampsia and intrauterine growth restriction.

To identify the risk factors for cardiovascular disease in women with pre-eclampsia and intrauterine growth retardation. This cross sectional study was conducted in Department of Gynecology and Obstetrics, Liaquat University Hospital, Hyderabad, from April 2022 to October 2022. Patients with history of intrauterine growth retardation or preeclampsia after 20 weeks of gestation, age more than 18 years were included in this study. Patients were assessed for cardiovascular risk factors during pregnancy. The average age and gestational age were almost equal in preeclampsia and IUGR patients, (p≤0.050). The primparous were higher in preeclampsia than IUGR, n=286 (73.5%) and n=80 (52.3%), respectively, (p=0.000). The average birth weight of IUGR was lower than preeclampsia patients, 925.19±6.35 gram and 1324.76±10.19 gram, respectively, (p=0.000). The average systolic and diastolic blood pressure of IUGR patients was less than preeclampsia patients, (p=0.000). But, the chronic hypertension was higher in preeclampsia patients n=99 (25.4%) as compare to IUGR n=13 (8.5%) patients, (p=0.000). The average cholesterol level in IUGR was 5.52±0.58(mmol/L) versus preeclampsia 5.34±1.01(mmol/L), (p=0.043). The average triglycerides was almost equal in both the groups, (p=0.924). The mean Lp(a) in preeclampsia patients was 177.15±20.15(mg/L) versus 202.94±24.83 (mg/L), (p=0.000). Findings of this study help conclude that women with known history of IUGR or preeclampsia must be screened for possible cardiovascular risk factors and treated for these risk factors in order to avoid future mortality and morbidity associated with cardiovascular diseases.

Dietary Supplementation with 25-Hydroxyvitamin D3 on Reproductive Performance and Placental Oxidative Stress in Primiparous Sows during Mid-to-Late Gestation.

The placenta plays a crucial role in nutrient transport and waste exchange between the dam and fetus, sustaining fetal growth. While the positive effects of 25-hydroxyvitamin D3 (25-OH-D3) on animal performance have been reported, its impact on placental function remains largely unknown. Therefore, this study aimed to investigate the effects of supplementing 25-OH-D3 in the diet of primiparous sows on reproductive performance, antioxidant capacity, placental oxidative stress, nutrient transport, and inflammatory response during mid-to-late gestation. A total of 45 healthy Landrace × Yorkshire primiparous sows on day 60 of gestation were selected and randomly allocated to three treatment groups based on body weight and backfat thickness: the control group (corn-soybean meal basal diet), the VD3 group (basal diet + 2000 IU VD3), and the 25-OH-D3 group (basal diet + 50 μg/kg 25-OH-D3). The results demonstrated that supplementation with 25-OH-D3 in the diet enhanced sows' average litter weight and birth weight during mid-to-late gestation. Additionally, plasma malondialdehyde (MDA) concentrations in sows significantly decreased in the VD3 and 25-OH-D3 groups (p < 0.05). Furthermore, lower gene expressions of placental HO-1, GPX2, IL-8, and IL-6 were found in the VD3 or 25-OH-D3 groups (p < 0.05 or p < 0.10), while higher gene expressions of GLUT1 and SNAT2 in the placenta of sows were observed in the VD3 and 25-OH-D3 groups, respectively (p < 0.05). These findings indicate that the supplementation of VD3 and 25-OH-D3 in the diet of sows can improve their plasma oxidative stress status, enhance placental antioxidant capacity and nutrient transport, and reduce placental inflammatory responses, with more pronounced improvements in sow performance observed in sows fed diets supplemented with 25-OH-D3.

Clinical Phenotypes and Etiological Risk Factors in Children with Cerebral Palsy: A Retrospective Study

Background: Cerebral palsy is a motor impairment syndrome that arises from a lesion in the developing brain. The condition varies based on the timing of the lesion, as well as differences in clinical presentation, location, and severity. Objectives: The aim of this study is to determine the clinical features of patients with cerebral palsy, identify the associated risk factors, and analyze cranial MRI findings in relation to the different types of cerebral palsy. Methods: This study retrospectively evaluated the medical records of children diagnosed with cerebral palsy. Data collected included demographic information, details of potential relevant abnormalities during pregnancy, birth, and the neonatal period, comorbidities, types of cerebral palsy, cranial MRI findings, and classifications of motor impairments. Results: The mean age of the 202 patients with cerebral palsy in the study was 8.02 years, with a male predominance (60.4%). The most common type of cerebral palsy observed was spastic cerebral palsy, accounting for 81.6% of the cases. The most frequent cranial MRI finding was white matter damage of immaturity, present in 36.1% of the patients, while 8.4% of the cases had normal cranial MRI results. Epilepsy was the most common comorbidity, affecting 50.5% of the patients. White matter damage of immaturity was most commonly associated with spastic diparesis, and the identified risk factors for these patients included prematurity, low birth weight, oligohydramnios, multiple pregnancy, and neonatal sepsis/meningitis. Spastic tetraparesis was most frequently linked to miscellaneous MRI findings, with risk factors such as term birth, normal birth weight, polyhydramnios, asphyxia/resuscitation, and a history of neonatal convulsions. Focal infarction/hemorrhage was most often associated with spastic hemiparesis, while basal ganglia-thalamus damage was frequently seen in patients with choreoathetotic and dystonic cerebral palsy. In patients with dystonic cerebral palsy, vaginal delivery and a history of hyperbilirubinemia were identified as common risk factors. Cerebellar damage and malformations were most frequently associated with ataxic cerebral palsy. Conclusions: In this study, it was determined that MRI findings can serve as a valuable guide for identifying different types of cerebral palsy. Additionally, the risk factors, disease severity, and accompanying comorbidities were found to vary according to the specific type of cerebral palsy.

P215 EFFECT OF OXYGEN LOADING MODEL ON RETINOPATHY OF PREMATURITY IN INTRAUTERINE GROWTH RETARDED MICE

Background and Objective: Fetal growth retardation (IUGR) not only induces various complications in newborns, but is also known to be associated with the future development of lifestyle-related diseases and conditions. Therefore, the neonatal treatment often struggles between life-sustaining and oxygen administration. We have previously reported that IUGR mice born from mothers raised on a low-protein diet show enhanced vascular remodeling. The mechanism is influenced by an increased inflammatory response associated with a decreased angiogenic response due to hypoxic loading in a femoral artery cuff implantation model. Based on this, we hypothesized that in IUGR mice, the reduced angiogenic response in retinopathy of prematurity may work to suppress the onset of the disease. To test this hypothesis, we examined the effects of oxygen loading on the retinal neovasculature using the mouse oxygen-induced retinopathy of prematurity (OIR) model. Methods The OIR model was created in newborns born from mothers raised on a normal protein diet (20%) and in IUGR newborns born from mothers raised on a low protein diet (8%). Specifically, the newborns were exposed to 75% hyperoxia for 5 days starting at 7 days of age, and retinal neovascularization was histologically evaluated 5 days later at 17 days of age for comprehensive transcriptome analysis. Results: Compared to normal birth weight OIR mice, retinal neovascularization was significantly suppressed in OIR mice with FGR. Retinal RNA sequencing revealed decreased expression of angiogenic factors that trigger pathological retinal neovascularization, such as the mitogen-activated protein kinase pathway (MAPK) pathway and corresponding upstream signaling pathways. Conclusions Our findings suggest that IUGR neonates have a weaker response to retinal oxygen stress and consequently are likely to have reduced retinopathy of prematurity. These results indicate that the risk of developing retinopathy of prematurity is attenuated in IUGR neonates compared to mature neonates with normal birth weight.

Acute Kidney Injury Among Asphyxiated Neonates In Sokoto, North West Nigeria

Background: Birth asphyxia and its attendant complications remain a common problem in our neonatal intensive care units. Compelling evidence from various epidemiologic studies shows that Acute Kidney Injury (AKI) is indeed one of the commonest complications of birth asphyxia. The kidneys are sensitive to oxygen deprivation, renal insult may occur within few hours of hypoxic-ischemic episode, which if prolonged could lead to irreversible cortical and or tubular necrosis. Aim: To determine the prevalence and factors associated with AKI among asphyxiated term neonates in Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto, Nigeria Materials and methods: One hundred and nineteen asphyxiated term neonates admitted into the special care baby unit of UDUTH Sokoto participated in the study. Birth asphyxia was defined as failure to initiate and sustain breathing at birth with Apgar scores ≤ 5 at 5 minutes in the presence of arterial cord blood pH &lt; 7 and base deficit &gt;12mmol. Blood samples were taken for arterial blood gas analysis within one hour of life. Moderately and severely asphyxiated neonates who satisfied the inclusion criteria were consecutively recruited into the study and serum creatinine assay was done on day 3 and day 5 of life. AKI was defined as a rise in serum creatinine ≥ 0.3mg/dl over 48 hours. Quantitative variables such as birth weight, length, occipitofrontal circumference (OFC) were expressed using mean, standard deviation and range, while qualitative variables like gender, mode of delivery and grade of asphyxia were summarised using frequency and percentages. Chisquare and fisher’s exact tests were applied to determine if any relationship exists between sociodemographic/clinical factors and AKI. A p-value of &lt; 0.05 was considered statistically significant. Results: Of the 119 asphyxiated term neonates 74 (62.2%) were males while 45 (37.8%) were females giving a M:F ratio of 1.6:1. Majority 96 (80.7%) of the subjects had normal birth weight with a mean birth weight of 3.1 ± 0.6kg. The mean gestational age recorded was 38.2 ± 1.1 months The prevalence of AKI in the study subjects was 42.9%. The grade of birth asphyxia was significantly associated with AKI with a prevalence odds ratio of 7.2 (95CI 2.8-18). Conclusion: The prevalence of AKI in asphyxiated term neonates in UDUTH Sokoto was high and the grade of birth asphyxia was found to be significantly associated with AKI