Term Appropriate For Gestational Age Neonates Research Articles

The value of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) parameters in analysis with fetal malnutrition neonates

Objective To assess the association between fetal malnutrition (FM) and the neutrophil-to-lymphocyte ratio (NLR) and the platelet-to-lymphocyte ratio (PLR) in singleton term appropriate for gestational age (AGA) neonates. Methods This cross-sectional observational study was performed with 4340 singleton, term AGA neonates without perinatal disease over a two-year period. Results A total of 4320 neonates were evaluated in this study. Those diagnosed with fetal malnutrition, 284 (6%) neonates, were compared with 150 healthy term AGA neonates. Gestational week, birth weight, birth height, head circumference, maternal age, last pregnancy weight, and status of income of the FM group were found to be lower when compared to the control group (P = 0.011). Low last pregnancy weight (P = 0.017) and low level of income (P = 0.042) were found to be factors that affect the presence of FM. The NLR and PLR were found to be significantly higher in the FM group compared with term AGA healthy controls. In correlation analyses, there was a negative correlation between the NLR and PLR with fetal nutritional status (P = 0.011 and P < 0.001, respectively). When the NLR level was taken as 4.51, the sensitivity and specificity of the test for FM were calculated as 81.2% and 80.8%, respectively [area under the receiver-operating characteristic curve (AUROC): 0.81]; when the PLR level was taken as 155.4, the sensitivity and specificity of the test for FM were calculated as 87.0% and 85.4%, respectively (AUROC: 0.94). Conclusion Cord-blood NLR and PLR negatively correlate with term FM AGA neonates.

Determination of cord blood lipid profile in neonates and its correlation with birth weight and maternal anthropometry

Introduction: Serum lipid disorders have their roots in childhood and atherogenic changes are postulated to originate early in life. Cord lipid profile is a useful tool in the earlier detection of babies at a higher risk. Objectives: The objectives of the study were to assess the early onset dyslipidemia by determining cord blood lipid profile in healthy term newborns and to compare the cord blood lipid profile between terms small for gestational age (SGA) and appropriate for gestational age (AGA) newborns. Materials and Methods: This prospective observational study was conducted from October 2013 to October 2014 in the Department of Pediatrics of a Tertiary Care Institution of Central India. All normal term newborns with gestational age between 37 and 42 weeks were included in the study. After thorough examination, their weight, length, and ponderal index (PI) were recorded. Cord blood was collected immediately after the delivery and cord lipid profile was measured. Data were recorded and correlated statistically. Results: Of 114 neonates, 71 were AGA, 40 were SGA, and three were large for gestational age. There were 59 (51.8%) female and 55 (48.2%) male neonates. Birth weight, length, gestational age, head circumference, and PI were significantly higher in AGA neonates than SGA neonates (p&lt;0.001, 0.013, 0.022, 0.02, and &lt;0.001, respectively). Total cholesterol (TC), triglycerides (TGs), low-density cholesterol (LDL), and very low-density cholesterol (VLDL) levels were significantly higher in term SGA than term AGA neonates. Conclusion: Birth weight correlated negatively with LDL, VLDL, TC, and TG. Lipid profile parameters were also higher in babies with maternal body mass index ?25 kg/m2.

Central Hematocrit Levels in Fetal Malnourished Term Infants.

Fetal malnutrition is especially important for common chronic diseases in adult life. They could potentially be prevented by achieving optimal fetal nutrition. The aim of this study was to investigate hematocrit levels of malnourished, term, appropriate for gestational age (AGA) neonates. A total of 80 AGA neonates (between 10% and 90% percentiles interval according to birth week), born with spontaneous vaginal delivery between 37 and 42 weeks of gestation, detected by both last menstrual period and ultrasonography measurements, were included in the study. Neonates with fetal malnutrition constituted the study group and the control group consisted of well-nourished neonates. We analyzed central venous hematocrit levels obtained 4 hours after birth and maternal risk factors for both groups. Although there were no differences in gestational age, head circumference, maternal factors (gravidity, parity, abortions and curettage counts, maternal tobacco use, preeclampsia, hypertension, diabetes mellitus, gestational diabetes mellitus, and history of urinary tract infections), first minute APGAR scores, and sex, Clinical Assessment of Nutritional Status score was lower (29.91±2.87 vs. 21.25±1.65) and hematocrit levels were higher (51.33±2.740 vs. 59.53±5.094) in the fetal malnutrition group (P<0.0001). Central hematocrit levels in malnourished term AGA neonates were found significantly higher than well-nourished term AGA newborns.

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.

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.

Ghrelin and obestatin plasma levels and ghrelin/obestatin prepropeptide gene polymorphisms in small for gestational age infants

To investigate plasma ghrelin and obestatin levels, and ghrelin/obestatin prepropeptide gene polymorphisms, in sequentially enrolled small for gestational age (SGA) infants. Neonates were sequentially enrolled into this study and were then subdivided into different groups, according to different study aims and availability of study materials. Consequently, plasma ghrelin and obestatin levels were measured in term SGA, term appropriate for gestational age (AGA), term large for gestational age (LGA), preterm SGA and preterm AGA neonates. Levels of both peptides were also measured in AGA infants of different gestational ages, and in term AGA neonates at different days following birth. Three ghrelin/obestatin prepropeptide gene single nucleotide polymorphisms (SNPs), Arg51Gln, Leu72Met, and Gln90Leu, were measured in neonates. The study involved a total cohort of 581 neonates. Out of 150 neonates (30 term AGA, 30 term SGA, 30 term LGA, 30 preterm AGA, and 30 preterm SGA), plasma obestatin levels were significantly higher in term SGA versus term LGA neonates (0.21 ± 0.02 ng/ml versus 0.17 ± 0.01 ng/ml, respectively). Out of a wider cohort, there were no significant differences in genotypes and allele frequencies of Arg51Gln, Leu72Met, and Gln90Leu SNPs between term SGA and AGA neonates, or between preterm SGA and AGA neonates. Ghrelin/obestatin prepropeptide polymorphisms were not found to be associated with SGA status in neonates; however, ghrelin and obestatin levels may be involved in growth and development. Further studies are required to understand the relationship between ghrelin, obestatin and prenatal development.

Placental findings in malnourished term neonates

The aim of the present study was to investigate placental pathologies in malnourished term neonates. A group of term newborns was evaluated at birth for fetal malnutrition (FM) using the Clinical Assessment of Nutritional Status (CANS) score. The study group consisted of 37 malnourished neonates and 13 well-nourished newborns, including their placentas. Infants with FM were subdivided into two groups: appropriate for gestational age (AGA) and small for gestational age (SGA). The proportion of subjects having antepartum complications was 18.9% in the FM group, whereas none was found in the control group. Similarly, a significant portion, 83.8% of the study group, had gross placental abnormalities, while the control group had none. The placental microscopic findings in the study group included perivillous fibrin deposition, calcification, necrosis, retroplacental hematoma, and infarction. In contrast, the control group had only perivillous fibrin deposition and calcification. Placental histopathological findings between FM term AGA and SGA neonates were also compared, and no statistically significant differences were found (P < 0.05). Placental findings in malnourished term AGA neonates are not different from findings documented in malnourished SGA cases, but they are different from those in well-nourished term AGA newborns.

Serum levels of resistin and its correlation with adiponectin and insulin in healthy full term neonates

Resistin and adiponectin are two adipokines involved in the regulation of insulin sensitivity, and have been suggested as mediators of adult metabolic syndrome. Aim The aim of this study was to investigate cord blood levels of resistin, and their postnatal changes in full-term appropriate for gestational age (AGA) neonates. Interrelations between resistin, adiponectin, and insulin, and between resistin and neonatal and maternal anthropometric parameters were also assessed. Design Blood samples were obtained from 30 full term AGA neonates at birth and on the 4th day of life. Anthropometric variables studied included birth weight, length, body mass index (BMI), neonatal weight loss, and mother's BMI. Resistin and adiponectin were determined by ELISA, and insulin by radioimmunoassay method. Data were analyzed using Wilcoxon test and Spearman's correlation coefficient. Results Resistin levels were high at birth and did not change on the 4th day of life. Resistin levels were not correlated to insulin, nor adiponectin levels, nor any anthropometric parameter of neonates or their mothers. Instead, adiponectin levels increased on the 4th day of life, and were correlated to insulin levels. Conclusion High levels of resistin in full-term AGA neonates suggest that this hormone may play a role in maintenance of metabolic neonatal homeostasis, but its physiological significance needs further investigation.

Neonatal echocardiograms of macrosomic neonates.

To compare echocardiograms of macrosomic and healthy full term neonates whose weight was appropriate for gestational age (AGA). Echocardiography was performed on 9 healthy full term AGA neonates and 15 macrosomic neonates. A data base was generated from valid echocardiographic measurements on each infant. Macrosomic infants were heavier than control infants and had a greater body surface area, but their mean cardiac dimensions were similar. The mean LVES volume was smaller than that of the control group when expressed as a fraction of individual LVED values (0.61 +/- 0.04 vs 0.64 +/- 0.02; p = 0.02). When comparing IVS/PW, it was observed that the ratio was up to and including 1.33 in the control group, while the upper limit of the ratio of the nondiabetic macrosomic infants was 1.6. The shortening fraction (SF%) was increased in comparison to infants of normal weight (40.67% +/- 3.34 vs 36.00% +/- 1.89; p = 0.0009). The thickened IVS did not elevate SF% by decreasing LVES; the macrosomic infants had a smaller LVES mean volume. IVS/PW ratio of macrosomic infants fell outside of the normal range. Macrosomic neonates were found to have an increased SF% secondary to a proportionally smaller LVES volume, regardless of IVS thickness.

Gastric Retention in Neonates

Forty-seven healthy neonates were fed by nasogastric tube 10 to 20 ml/kg of 5-gm/dl glucose in water containing 0.24 mg/dl of phenol red as a marker. The proportion of test meal remaining in the stomach 30 minutes after feeding was measured. Gestational ages ranged from 34 to 44 weeks and birth weights ranged from 1,300 to 4,680 gm. Thirteen of 29 term neonates were appropriate for gestational age (AGA), six were small for gestational age (SGA), and nine were large for gestational age (LGA). Of the 18 preterm neonates, 6 were AGA and 12 were SGA. Each baby was studied three times: at 4 to 12 hours after birth, before any other feeding, at 22 to 36 hours, and at 46 to 60 hours. Preterm AGA babies retained more than term AGA neonates at both 4 to 12 hours and 22 to 36 hours. Preterm SGA neonates retained more than their term peers at 4 to 12 hours only. In both term and preterm neonates, 30 minute gastric retention decreased significantly from the 4- to 12-hour period to the 22- to 36-hour period, but it was similar at 22 to 36 hours and 46 to 60 hours. At no time were there significant differences in retention between AGA, SGA, and LGA babies-except at 22 to 36 hours when preterm SGA neonates retained less than their AGA peers. Thus 30-minute gastric retention was affected mainly by gestational maturity and postnatal age rather than by the quality of intrauterine growth.