Extreme Low Body Weight Research Articles

Кардиологический профиль недоношенных новорожденных с массой тела при рождении менее 2500 граммов в раннем детском возрасте

Purpose of the research was to establish the characteristics of the cardiovascular system in premature newborns with a birth weight below 2500 gram in their early childhood. Methods used: the data of 302 children born in 2014-2020 in the Tomsk Oblast Regional Perinatal Center named after I.D. Yevtushenko and the Maternity Hospital No. 4 (both located in Tomsk, Russia) were analyzed. The control group of 76 was formed from healthy full-term newborns. The comparison group of 226 consisted of premature infants with birth weight below 2500 gram with the three subgroups depending on birth weight: low (LBW), very low (VLBW) and extremely low body weight (ELBW). During the follow-up that lasted for up to 3 years after birth an anamnesis, physical examination and fixation of the results of paraclinical studies (ECG, EchoCG) were carried out. Results: the probability of having a cardiac diagnosis among children with ELBW at birth at the time of discharge from the obstetric institution was 7 times higher compared to children with LBW (OR=7.60; [CI 95% 1.6-35.3]); birth weight below 1500 gram was associated with a 7-fold greater likelihood of PDA persistence compared to children with LBW at birth (OR=7.44; [CI 95% 3.34-16.55]); in the comparison group at the different age periods the low EchoCG parameters of heart size were established, while normal values of the left ventricular ejection fraction were noted. Conclusion: children with ELBW at birth differed in their cardiological profile already in their early childhood.

The impotance of the follow-up deparments of the clinical perinatal center

This paper presents data on the implementation of long-term medical monitoring, correction and prevention of specific disorders characteristic of children born with extremely low body weight (ELBW), very low body weight (VLBW) and intrauterine growth retardation (IUGR). Monitoring and analyzing the treatment results and subsequent development of these children plays an important role in providing them with the best medical care and quality rehabilitation. Regular monitoring and correction of body weight are important to prevent developmental delays and improve psycho-neurological indicators in the future. The long-term experience of the catemnesis department is reflected and the positive aspects of its work are indicated. The main diseases and problems that parents of premature babies may encounter are also noted.

Prevalence of bronchopulmonary dysplasia in infants with very low body weight and extremely low body weight in Perm Krai according to the data of catamnesis department of Perinatal center

Objective. To analyze the prevalence of bronchopulmonary dysplasia (BPD) in the city of Perm and Perm Krai, to state the prevalence dynamics for 3 years and BPD prevalence among infants with very low body weight (VLBW) and extremely low body weight (ELBW) from 2021 to 2021. Materials and methods. Examination of 271 patients aged 0 to 3 years and assessment of clinico-anamnestic, laboratory, instrumental, X-ray data according to diagnostic standards and protocols was carried out. Results. The number of infants diagnosed BPD in the group of preterm newborns was detected to decrease despite the fact that the quantity of preterm labors in Perm Krai is at the same level. Conclusions. In Perm Krai, for the recent 3 years there is a tendency to reduction in the frequency of BPD formation in infants with VLBW as well as decrease in the share of severe BPD forms among premature infants.

Features management of very early preterm birth

The objective: to determine features of tactics of very early preterm birth depending on the gestational age with the assessment of perinatal consequences. Materials and methods. The study involved 166 women of reproductive age with very early preterm birth (VEPB) at 22–27 weeks of gestation (the main criterion of inclusion). The patients were divided into two groups depending on the criteria of live birth: group 1 – 79 women, whose labor was regarded as late miscarriage (retrospective study); group 2 – 87 women, whose labor occurred as a very early premature (prospective study). Exclusion criteria: congenital malformations of the fetus. Patients of both groups had serious general and obstetric anamnesis, high frequency of inflammatory processes of the genitals, surgery and hormonal disorders with diseases caused by them. All women have got a comprehensive examination using clinical, instrumental and laboratory research methods. Results. The main complications of gestation in pregnant women of both groups in the second trimester were the threat of abortion and insufficiency of the fetoplacental (IFP), which caused fetal growth retardation syndrome (FGRS) in both groups – 66% and 63% of children, respectively. IFP in VEPB was confirmed histologically in 68% and 72% of cases in each group of mothers. Vaginal delivery occurred with 55 patients of group 1 and 26 women of group 2 (69,6% and 29,9%), among them in the period of 22–24 weeks – 100% and 57,1%, 25 weeks – 83,3% and 26,7%, 26–27 weeks – 57,7% and 24,1%, respectively, in each group. Indications for cesarean section (CS) in group 1 were mainly from the mother (75%), in group 2 – 27,8% from the mother, from the fetus – 4,9% (IFP), according to the combined indications – 65,6% (deep prematurity). Expansion of indications for CS in VEPB by 41% led to a decrease in perinatal mortality by 1,5 times (p<0,05). In the postpartum period, patients in both groups showed a decrease in purulent-septic complications on the background of preventive treatment from 13,9% (group 1) to 4,6% (group 2) (p<0,05). In the analysis of perinatal mortality, the highest rates were observed at 22–24 weeks of gestation, while they are 1,5 times lower at 25 weeks and 3,5 times lower at 26–27 weeks. The study found that the method of delivery did not affect perinatal outcomes at 22–25 weeks, but at 26–27 weeks, the survival of children born by CS surgery is higher than in spontaneous births, by 10% (p<0,05). Expansion of indications for the prevention of respiratory distress syndrome (RDS) of the fetus from 22 weeks in group 2 (in group 1 was not performed) by 10,7% led to an increase in survival of children with extremely low body weight (ELBW) by 11% (p<0,05). Conclusions. Under threat of VEPB the choice of delivery tactics is determined by the gestation period, the state of health of the mother and fetus, the degree of readiness of the birth canal for delivery. Premature pregnancy is not an indication for CS, except the specific obstetric indications, but abdominal delivery is possible for children in early pregnancy (22–25 weeks). The questions concerning the usage of instrumental care at birth, determination of gestational dates for the beginning of RDS prophylaxis with glucocorticoids, the necessity of using tocolysis remains ambiguous. Proper definition of management of women who give birth prematurely will allow timely implementation of measures aimed at improving the results for mother and newborn, and can be prognostic.

СТРУКТУРА ЗАБОЛЕВАЕМОСТИ И ИСХОДЫ У ДЕТЕЙ, РОДИВШИХСЯ С ОЧЕНЬ И ЭКСТРЕМАЛЬНО НИЗКОЙ МАССОЙ ТЕЛА В РЕГИОНАЛЬНОМ ПЕРИНАТАЛЬНОМ ЦЕНТРЕ

Introduction. The provision of medical care to children born with very low body weight (VLBW) and extremely low body weight (ELBW) belongs to the category of tertiary level neonatal intensive care (TINC) and reflects the effectiveness of regional obstetric-gynecological, neonatology and pediatric services; and the study of the structure of morbidity and outcomes in this category of newborn babies determines methodological, organizational and medical problems of the territory. The aim of the study. To assess the structure of morbidity and outcomes in premature newborns with ELBW and VLBW at birth in the setting of a Regional Perinatal Center during one year follow-up. Materials and methods. As part of the study, a retrospective analysis of 132 inpatient medical records of infants born preterm with VLBW and ELBW in the Regional Perinatal Center of the Novosibirsk State Regional Clinical Hospital in 2022 was performed. Patients were divided into two groups. Group 1 included 80 babies born with VLBW (birth weight 1000–1499 g), group 2 included 52 babies with ELBW at birth (less than 1000 g). Results. These children with VLBW and ELBW at birth are heterogeneous in the structure of prematurity, which is due to the presence of intrauterine growth retardation (IUGR) in some of them. At the same time, only the group of children born with VLBW is heterogeneous: 77.5% were registered as extremely premature, of which 63.7% were very preterm, and 13.7% were moderately preterm and 8.8% were late preterm. The category of extremely preterm prevailed among children with ELBW – 71,2%. 28% of children born prematurely had IUGR. Its structure was also heterogeneous: among children with VLBW at birth, there were equally wasty for gestational age (GA) – 15% and small for GA – 13.8%. Among children with ELBW, the small for GA – 21.1% dominated, against 5.8% – light for GA. Operative delivery (cesarean section) was chosen as the predominant method in both groups – 77.5 and 78.8% of cases, respectively. Diseases associated with prematurity were more often registered among children with ELBW at birth: severe asphyxia at birth (34.6%) vs VLBW (5%), p < 0.001; HS PDA (38.5%) vs VLBW (17.5%), p < 0.01; IVH III deg. (13.5%) vs VLBW (1.3%), p < 0.01; RP = retinopathy (32.7%) vs VLBW (8.8%), p < 0.001; severe form of BPD (23.8%) vs VLBW (5.6%), p < 0.05; NEC II-III stages (17.3%) vs ONMT (5%), p < 0.05; neonatal sepsis (34.6%) vs VLBW (12.5%), p < 0.01. The duration of inpatient treatment is 2 times higher in children with ELBW at birth: 92 ± 6.4 vs 48.8 ± 2 bed/patient days In the structure of morbidity, there were no differences in grade II IVH, PVL, mild and moderate BPD and Congenital Disorder (p > 0.05). Children with ELBW needed more treatment at birth: treatment of RP required intravitreal administration of ranibizumab (53%) vs VLBW (28.6%); surgical treatment of NEC stage III was carried out only in children with ELBW; the duration of respiratory support, regardless of the method, was longer in children with ELBW and amounted to 686.9 ± 130.3 vs 156.3 ± 26 hours . The mortality rate among all premature infants born with ONMT and ENMT was 13.6% and was 5 times higher in the group of children with ELBW who were mostly born extremely preterm. In terms of nosology, the main cause of death among all children with ELBW and VLBW is neonatal sepsis – in 50% of cases, mortality is 1.9 times higher in the group of children with ELBW at birth (38.8%) vs VLBW (20%), p < 0.05. Conclusion. The presented analysis indicates that preterm neonates with VLBW and ELBW in the setting of a Regional Perinatal Center are a rather heterogeneous group in the structure of prematurity, which, among other things, affects the formation of both extremely negative outcomes (lethal) and the structure of morbidity, the amount of care provided to them at different stages, its comprehensiveness and specialization, as well as the duration of inpatient treatment. Based on the all above, it follows, that of the entire category of preterm children born with VLBW and ELBW, the most difficult, economically costly, with prognostically worse outcomes, is the category of extremely preterm newborns.

Functional state of the kidneys in the neonatal period in children with very low and extremely low body weight

BACKGROUND. Preterm birth is still associated with an increased risk of neonatal morbidity and mortality in the early neonatal period. There is strong evidence demonstrating an association between a decrease in the number of nephrons in preterm infants and an increase in blood pressure, the risk of developing chronic kidney disease, which undoubtedly negatively affects the quality of life. THE AIM: to assess the functional state of the kidneys in children with very low (VLBW) and extremely low body weight (ELBW) in the first 8 weeks of postnatal life. PATIENTS AND METHODS. The study involved 134 newborns less than 37 weeks of gestation, who were divided into three groups depending on birth weight. The levels of protein and fluid intake, serum creatinine concentration, GFR according to Schwartz were taken into account as evaluation parameters. The Python programming language, t-tests, ShapiroWilk and d'Agostino tests were used as statistical methods. A threshold level of 0.05 was chosen to interpret the value of p tests for normality testing. RESULTS. There were no differences in the amount of protein received by preterm infants in the study groups both in the first week and subsequent 2–8 weeks of life. The average level of incoming fluid in the first week of postnatal life increased from 1 to 7 days in all study groups. There was a trend towards a more significant decrease in serum creatinine in children born with a larger birth weight. Analyzing the level of glomerular filtration rate in the studied groups, there is a clear picture of a progressive increase in the rate with age. CONCLUSION. The values of diuresis, creatinine level and GFR in premature babies with birth weight less than 1500 grams in the first 2 months of life have been established, which can be used in practice for comparison in the study of various pathologies.

Associations of molecular genetic predictors of type 2 diabetes mellitus with hyperglycemia in extremely low birth weight infants

Hyperglycemia in premature newborns is an independent risk factor for death, so blood glucose testing is widely used in the practice of neonatal intensive care units.Objective: to evaluate the associations of the frequency of carriage of allelic variants of polymorphic loci of genes predisposing to type 2 diabetes mellitus in newborns with extremely low body weight and hyperglycemia.Methods. The study design is prospective, controlled, single – center, non-randomized. Genomic DNA samples were studied in newborn infants with extremely low body weight (ELBW) (n = 105). Previously, we compared the distribution of allele frequencies of the studied genes between a group of newborns with ELBW and a population sample of adults (control). Then, the distribution of allele frequencies of the genes was compared depending on the presence of hyperglycemia in newborns with ELBW. For the analysis, loci with already known association with the development of type 2 diabetes mellitus were selected ‒ ADRB2 (rs1042713) and (rs1042714), ADRB3 (rs4994), GNB3 (rs5443), PPARA (rs4253778), PPARD (rs2016520), TCF7L2_IVS3 (rs7903146) and TCF7L2_IVS4 (rs12255372), PPARGC1A (rs8192678), MTHFR (rs1801131), PPARG (rs1801282), MTNR1B (rs10830963), SIRT1 (rs7069102).Results. In newborns with ELBW, we found a more frequent occurrence of the mutant allele A of the polymorphic locus rs8192678 in the PPARGC1A gene and the allele C of the polymorphic locus rs4253778 in the PPARA gene, in contrast to the adult population sample. But in newborns with ELBW, hyperglycemia is most likely associated with the carrier of the allele C rs1801282 of the PPARG gene (χ2 = 18.972, p < 0.001) and the allele T rs7903146 in the TCF7L2 gene (χ2 = 11.496, p < 0.001).Conclusions. The carriage of the allele С rs1801282 of the PPARG gene is characterized by the presence of a strong conjugation with hyperglycemia in newborns with extremely low body weight. It is desirable to monitor the level of glycemia in the conditions of neonatal intensive care units, taking into account the carriage of genes predisposing to hyperglycemia.

Is set-shifting and central coherence in anorexia nervosa influenced by body mass index, anxiety or depression? A systematic review

BackgroundAnorexia nervosa (AN) is a severe eating disorder, recognized by a relentless pursuit for thinness and extreme low body weight. The disorder is often accompanied by comorbid disorders such as anxiety and depression, and altered neuropsychological function in terms of poor set-shifting and reduced central coherence. The aim of this review was to evaluate whether neuropsychological impairments in AN are influenced by body mass index, anxiety or depression.MethodA systematic review approach was used, following the PRISMA guidelines for systematic reviews. Literature was identified via searches in PubMed, PsychInfo and Embase database, by using the search words [anorexia nervosa] AND [central coherence], and [anorexia nervosa] AND [set-shifting]. Studies were included if they were written in English, peer-reviewed, included individuals with AN, included tests measuring set-shifting and/or central coherence, investigated associations between set-shifting/central coherence with anxiety and/or depression and/or BMI. Risk of bias was assessed by using a critical appraisal checklist from the Joanna Briggs Institute. Results were summarized in a narrative synthesis.ResultsAlthough results are heterogeneous, the majority of studies report that neither body mass index (BMI), anxiety or depression is associated with altered central coherence and set-shifting in individuals with AN.ConclusionsFindings indicate that BMI, depression and anxiety does not influence neuropsychological function in AN, suggesting that it could be a characteristic of the disorder. A complete understanding of predisposing, precipitating and maintaining factors in AN needs to be addressed in future research. This could contribute to the development of better and more targeted treatment strategies.

Morphopathology of myocardial hypoxic-ischemic injuries in newborns at 22-27 weeks' gestation

To determine the parameters of myocardial structural injuries developed in chronic intrauterine hypoxia conditions in newborns at 22-27 weeks' gestation. A battery of morphological techniques, including organometry studies and separate weighing of the heart; 3D histology; morphometry with the determination of the area of cardiomyocyte nuclei, the specific area of the muscular and interstitial components of the right ventricular myocardium; immunohistochemistry with monoclonal antibodies to transforming growth factor βı (TGF-βı), cardiac troponin T (cTnT), and transmission electron microscopy, was used to examine heart samples from 30 deceased newborns at 22-27 weeks' gestation who developed in chronic intrauterine hypoxia conditions. A control group consisted of hearts from 20 extremely low body weight (ELBW) newborns, the main cause of whose death was asphyxia caused by the premature detachment of a normally positioned placenta. Analysis of the organometric parameters of heart samples from newborns at 22-27 weeks' gestation, who had experienced chronic intrauterine hypoxia, revealed right ventricular hypertrophy with increases in the area of cardiomyocyte nuclei and in the specific area of the muscle component compared to the control group. Impaired myocardial microcirculation and destructive changes in cardiomyocytes were diagnosed in conjunction with the decreased troponin T and increased TGF-β1 expressions. Incomplete differentiation of cardiomyocytes and their myofibrillar component was revealed at the myocardial ultrastructural level in ELBW newborns who had experienced chronic intrauterine hypoxia. The parameters of myocardial structural rearrangement in ELBW newborns who had experienced chronic intrauterine hypoxia are compensatory right ventricular hypertrophy, microcirculatory disorders, destructive changes in cardiomyocytes, decreased cTnT and increased TGF-β1 expressions in conjunction with impaired cardiomyocyte differentiation.

Mortality of Children Born on Early Gestational Age: is it the Impassable Barrier or the Reserve for Reducing the Infants Mortality?

The problem of premature infants is well recognized in Russia and all over the world. The article discusses the mortality level and structure of extremely premature infant during 2015–2019. The aim of the study was to identify significant cause-effect relations for high mortality of premature infants and infants with extremely low body weight (ELBW) according to reports from obstetric departments, pediatric outpatient clinics, children's hospitals, statistical agencies, queries results from Territorial Compulsory Medical Insurance Fund (TCMIF) in Saint Petersburg and Russian Association of Human Reproduction (RAHR). The main demographic indices are presented by the Petrostat association. Russian Federal State Statistics Service (Rosstat) forms provided by the Center for Analysis and Prediction of Maternal and Child Health of the Saint Petersburg Health care Committee (No. 32 “Information on medical care for pregnant women, women in labour and new mothers” (approved by order of Rosstat No. 591 of 27.11.2015); No. 19 “Information on children with disabilities” registered in children's clinics (approved by order of Rosstat No. 866 of 27.12.2016); No. 14 “Information on the activities of medical facilities units providing inpatient medical care” (approved by order of Rosstat No. 723 of 05.12.2014); No. 30 “Information on the medical facility” (approved by order of Rosstat No. 483 of 03.08.2018 “On the approval of statistical tools for the organization of federal statistical observation in the field of healthcare by the Ministry of Health of the Russian Federation”) presented by Saint Petersburg Medical Informational and Analytical Center (MIAC)), and answers from TCMIF in Saint Petersburg and RARCH have been investigated. The authors have analyzed the fertility and mortality rates of premature infants, the group of children with ELBW has been established. High mortality levels have been revealed in the first weeks of life (22–23), they were mainly associated with infectious processes. The authors associate the premature delivery increase with the widespread implementation of assisted reproductive technology (ART). ART can be performed either via compulsory medical insurance funds, or other non-government sources. The assumption was proposed that there are possible violations of ART indications, contraindications, and the number of procedures. The ART efficacy is difficult to estimate as well due to insufficient information provided by Rosstat report form No. 32. The need of implementation of the new statistical form that will cover the data on the of ART administration, the possibility of efficacy estimation of modern invasive methods for infertility treatment and mandatory submission of reports about the use of these methods by medical facilities is discussed.

Acute Respiratory Distress Syndrome in Preterm Newborns (Morphological Study)

The aim of the study is to provide a rationale for the morphological diagnostic criteria of respiratory distress syndrome (RDS) and acute respiratory distress syndrome of the newborn (ARDSN) in extremely preterm newborn infants.Materials and methods. Autopsy protocols of 31 newborns were studied. The average gestational age of children was 28.9±5.3 weeks, body weight at birth was 1404±945 grams. Fifty eight percent of newborns in the sample had extremely low body weight (ELBW). At birth, all newborns were found to have severe asphyxia, and the median score on the Apgar scale at the 1st minute of life was 3 [2; 5] points. In all cases there was an unfavorable course of the disease. The median life span was 72 [22; 181] hours.The results of the study. The study revealed two variants of hyaline membrane formation in preterm newborns with acute respiratory failure. Hyaline membranes in the lungs were found in 93.5% of newborns, in 51.6% of cases there was ARDSN due to the primary surfactant deficiency, in 41.9% of children ARDS was due to immature lung being exposed to various direct and indirect damaging factors. In all cases a distinct morphological pattern in newborns with the hyaline membranes was identified: immaturity and antenatal damage to air-blood barrier, pneumonia, microaspiration, ischemia of the lungs.Conclusion. Acute respiratory distress syndrome is typical for 41.9% of extremely preterm infants, its development is favored by exposure of immature lungs to direct (congenital pneumonia, amniotic fluid aspiration) and indirect (severe perinatal hypoxia with ischemia, shock, hemorrhagic syndrome) damaging factors. Morphological signs of ARDS were most often found in newborns with congenital pneumonia, asphyxia, neonatal aspiration of amniotic fluid.

Клинические и лабораторные предикторы неблагоприятного исхода у глу- боко недоношенных детей

Study Objective: to find out the relation between clinical and laboratory values and unfavourable outcomes in extremely premature infants. Study Design: prospective comparative cross-sectional study. Materials and Methods. We examined 38 extremely premature infants. First group is 16 infants with extremely low body weight (ELBW); second group is 15 infants with very low body weight. Third group is 7 infants with ELBW who died later on. All infants had their clinical tests, complete and biochemical blood assays on day 1, day 3, and day 7 after birth. Study Results. Differences were found among infants in a number of parameters. On day 1, differences were recorded in Hb (Н = 6.19, р = 0.0453), total protein (Н = 7.2198, р = 0.027), albumin (Н = 7.0028, р = 0.03), banded neutrophils (Н = 9.2091; р = 0.01); on day 3 — in Hb (Н = 6.864, р = 0.0323), hematocrit (Н = 6,4395, р = 0,04), lactate (Н = 8.1527, р = 0.017), RBC (Н = 6.7644, р = 0.034), WBC (Н = 6.24, р = 0.0442), segmented neutrophils (Н = 6.157, р = 0.046). On day 7, there were significant differences in WBC (Н = 8.6595, р = 0.0132) and segmented neutrophils (Н = 10.7165, р = 0.0047), total protein (Н = 8.009, р = 0.0122), creatinine (Н = 8.4861, р=0.0144), and lactate (Н = 7.6604, р = 0.0217). Infants in the third group had lower Hb, total protein and albumin levels from the very first days of their life. Conclusion. Associated with severe infection, clinical and laboratory parameters of an inflammation in extremely premature infants can remain normal. Congenital hypoproteinemia, hypoalbuminemia and anaemia are the most promising predictors of unfavourable outcome in extremely premature infants with ELBW at birth. Keywords: extremely premature infants, RBC, Hb, anaemia, hypoproteinemia.

Causes of perinatal hypoxia during resuscitation in premature newborns with low and extremely-low body weight

The aim of the study was to identify the causes of perinatal hypoxia in the deep-preterm neonates.

Neurodevelopment of children born very preterm with extremely low and very low body weight

To evaluate the characteristics of neurodevelopment by the age of 5-8 years in children who were born very preterm with extremely low body weight (ELBW) and very low body weight (VLBW). Seventy-two patients, aged from 5 years to 8 years were examined. Patients were divided into group I (36 patients born preterm with ELBW (16 boys, 20 girls)) and group II (36 patients born with VLBW (16 boys, 20 girls)). The control group included 30 healthy peers (16 boys, 14 girls). All children were assessed by means of the Griffiths Mental Development Scales, Extended Revised: 2 to 8 years (GMDS-ER 2-8). The value of general quotient (GQ) in patients born with ELBW (73.4±2.1) was significantly lower compared to their healthy peers (80.9±2.1; p=0.036). The same tendency was found in patients born with VLBW who's GQ was decreased by 73.1±3.0 (p=0.101). Concurrently the patients demonstrated lower scores on all six scales, which achieved significant difference with the controls for the 'Locomotor' and 'Performance' scales in group I, and for the 'Performance' and 'Practical reasoning' scales in group II. The boys born with ELBW tended to demonstrate lower results on all six scales and received significantly lower scores on the 'Locomotor' and 'Language' scales. The boys born with VLBW demonstrated significantly lower scores on the 'Language', 'Eye and hand co-ordination' and 'Practical reasoning' scales. In girls significantly lower score on the 'Performance' scale only was shown for those, who were born with ELBW. Early diagnosis and characterization of developmental delays in children born very preterm determine the effectiveness of therapeutic measures based on the individual approach and comprehensive medical-psychological-pedagogical support.

Reduced amylin levels are associated with low bone mineral density in women with anorexia nervosa

ContextAnorexia nervosa, characterized by extreme low body weight due to reduced nutrient intake, is associated with severe bone loss. Peptide hormones, including amylin, GIP, and GLP2, are released immediately after nutrient intake and may be involved in the regulation of bone turnover. ObjectiveTo investigate fasting levels of amylin, GIP, and GLP2 and their relationships with bone mineral density (BMD) in women with anorexia nervosa compared to healthy controls. DesignCross-sectional. SettingClinical Research Center. Study participants15 women with anorexia nervosa and 16 healthy controls. InterventionNone. Main outcome measuresFasting serum amylin, GIP, and GLP2, and BMD. ResultsWomen with anorexia nervosa had significantly lower fasting serum amylin and GIP levels than healthy controls. Fasting serum GLP2 levels were not significantly different between groups. Fasting amylin levels were positively associated with BMD and Z-score at the PA spine, total hip, and femoral neck. Fasting amylin levels were also positively associated with weight and percent fat; after controlling for these variables, amylin was still a significant predictor of BMD and Z-score at the femoral neck and of Z-score at the total hip. In the anorexia nervosa group, there was a trend toward an inverse association between amylin and C-terminal telopeptide (CTX) levels (R=−0.47, p=0.08). GIP and GLP2 levels did not predict BMD at any site. ConclusionDecreased secretion of amylin may be a mechanism through which reduced nutrient intake adversely affects BMD in anorexia nervosa.

Ligation of Medically Refracted Patent Ductus Arteriosus (PDA) in an Extremely Low Body Weight Premature Infant

Ligation of Medically Refracted Patent Ductus Arteriosus (PDA) in an Extremely Low Body Weight Premature Infant