Higher serum retinol-binding protein concentration in Indonesian neonates in Surabaya than Japanese neonates in Kobe.

The concentrations of serum retinol-binding protein (RBP), prealbumin (PA) and vitamin A of Indonesian neonates were compared with those of Japanese neonates. The mean serum concentrations of both PA and vitamin A did not differ significantly in Indonesian and Japanese neonates. Indonesian neonates had significantly higher serum RBP (2.75 +/- 0.87 mg/dl, mean +/- SD) than Japanese neonates (1.65 +/- 0.55 mg/dl, p less than 0.01). The molar ratio of vitamin A:RBP in Indonesian infants was significantly lower than in Japanese infants (p less than 0.02), and this in turn is indicative of increased concentrations of retinol-free RBP in the plasma of Indonesian neonates. The results suggest that RBP metabolism in Indonesian neonates differs from that in Japanese neonates.     

The relationship between abdominal aortic intima-media thickness and lipid profile in neonates born to mothers with preeclampsia

Neonates born to mothers with preeclampsia are known to be associated with lipid alterations that might increase the risk for cardiovascular disease in adult life. The aim of this study was to investigate the effect of preeclampsia on lipid metabolism, aortic intimamedia thickness (aIMT) and subsequent atherogenic risk in newborn infants. Aortic intima-media thickness was measured in 60 neonates of mothers with preeclampsia (group I; 30 neonates of mothers with preeclampsia and group II; 30 neonates of mothers with severe preeclampsia) and 30 healthy neonates (group III). Maternal and cord serum lipid profiles were determined in all groups. Mean abdominal aIMT measurements were higher in the neonates born to mothers with preeclampsia (group I; 0.36 +/- 0.03 mm and group II; 0.36 +/- 0.04 mm) compared with the control group (group III; 0.33 +/- 0.03 mm, p = 0.006). Serum triglyceride levels were significantly higher in the neonates born to mothers with preeclampsia (group I; 39.2 +/- 42.0 mg/dl and group II; 39.5 +/- 56.5 mg/dl) compared with the control group (group III; 14.9 +/- 18.8 mg/dl, p = 0,039). Serum HDL cholesterol levels were significantly lower in the neonates born to mothers with preeclampsia (group I; 17.3 +/- 12.3 mg/dl and group II; 17.1 +/- 12.8 mg/dl) compared with the control group (group III; 27.6 +/- 13.0 mg/dl, p = 0.002). In conclusion; neonates of mothers with preeclampsia have significantly higher aIMT with lipid alterations. This may play a role in the pathogenesis of atherosclerosis in adult life.     

The influence of gestational age, size for dates, and prenatal steroids on cord transferrin levels in newborn infants

Serum transferrin levels assess protein status in older children and adults. To generate standards for its use in newborn infants, we measured umbilical cord serum transferrin levels in 161 appropriate (AGA), 25 large (LGA) and 16 small (SGA) for gestational age infants between 25 and 43 weeks' gestation. We also assessed the effects of intrauterine growth, exposure to prenatal steroids, and presence of pulmonary maturity on neonatal transferrin levels. Cord transferrin levels in AGA infants were significantly correlated with increasing gestational age (r = 0.60; p less than 0.001). Infants born before 37 weeks' gestation had significantly lower transferrin levels, when compared with those born at term (p less than 0.001). LGA infants had significantly higher levels than age-matched AGA infants (253 +/- 75 vs. 214 +/- 53 mg/dl; p less than 0.025). Despite significantly lower mean birth weights (p less than 0.001), SGA infants also had significantly higher levels than gestational age-matched AGA controls (227 +/- 63 vs. 167 +/- 40 mg/dl; p less than 0.005). For infants less than 35 weeks' gestation, neither the 20 preterm infants with exposure to prenatal steroids (maternal betamethasone), nor the 26 infants with pulmonary maturity had significantly elevated transferrin levels, when compared with gestational age-matched control infants. Newborn transferrin levels correlate well with gestational age and are significantly affected by size for dates, but not by a brief course of prenatal steroids or by pulmonary maturity.     

Thymidine factor in human cord sera and relationship to birth size, gestational age and insulin

Thymidine factor was studied in human cord sera from 44 neonates with gestational ages ranging between 36 and 43 weeks. Thymidine factor was determined by the uptake of 6-3H-thymidine using isolated chick embryo cartilage cells. The thymidine factors increased with gestational age and those of neonates at 40 weeks of gestation were 0.89 +/- 0.17 U/ml (mean +/- SD), but were significantly lower after 42 weeks of gestation. There was no correlation between thymidine factor in cord sera and birth weight or size. There was a positive correlation (p less than 0.02) between insulin level and thymidine factor in cord sera. Our data suggest that somatomedin measured as thymidine factor might not have a major role in fetal growth and insulin might be an important factor in the synthesis of somatomedin by the fetus.     

Effect of asphyxia on free thyroid hormone levels in full term newborns

Alterations in the thyroid metabolism of hypoxic, fasted, and chronically ill adults and older children have been described. We evaluated the effects of asphyxia on thyroidal indices of term newborns and compared them to those of a control population. Blood was drawn from the cord and then serially at 5 min and 3, 24, and 48 h after delivery in all patients. Seven term healthy newborns (group 1)increased their free thyroxine (FT4) concentrations significantly after delivery from a mean +/- SD baseline of 0.94 +/- 0.13 ng/dl in cord blood to a mean +/- SD peak of 2.6 +/- 0.6 ng/dl 48 h after delivery (p less than 0.001 at 3, 24, and 48 h), while their free triiodothyronine (FT3) levels increased from a mean +/- SD baseline level of 2.3 +/- 0.5 pg/ml in cord blood to a mean +/- SD peak of 3.7 baseline level of 2.3 +/- 0.5 pg/ml 48 h after delivery (p less than 0.001 at 24 and 48 h). Seven term newborns with transient low Apgar scores at birth (group 2) and seven term neonates born to mothers with toxemia or hypertension (group 3) failed to increase their FT4 and FT3 concentrations above baseline during the first 48 h of life. FT4 and FT3 values at 3, 24, and 48 h were significantly higher in the control group than in groups 2 and 3. Cord blood thyroid-stimulating hormone, FT4, and FT3 levels were not statistically different in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Hypersomatotropism in the dysmature infant at term and preterm birth

Growth hormone (GH) concentrations were measured in cord serum of small (less than 2.4 kg), appropriate (3.4 +/- 0.1 kg) and large (greater than 4.4 kg) infants born at term (38-42 weeks), and in cord serum of prematurely born twins (28-36 weeks) which were either appropriate (greater than P10) or small (less than P10) for gestational age. Cord serum GH levels were found to be significantly elevated in small for gestational age infants, both at term and preterm birth. In view of the insulin-antagonizing action of fetal GH, these results further support a homeostatic function for GH in the late-gestational human fetus.     

Alpha fetoprotein levels in neonatal hyperbilirubinaemia

Serum alpha fetoprotein (AFP) levels were studied in 15 neonatally hyperbilirubinaemic children and 15 controls matched for sex and gestational age. All children were born between 38 and 40 weeks of gestation. During the first seven weeks of postnatal life hyperbilirubinaemic children had serum AFP concentrations over twice as high as controls. At the age of 5-7 days the mean (+/- S.E.M.) serum AFP values were 52.4 +/- 5.8 mg/l for hyperbilirubinaemic children and 24.8 +/- 4.3 mg/l for controls (p less than 0.001). At 20-25 days of age they were 7.28 +/- 1.10 and 2.75 +/- 0.45 mg/l, respectively (p less than 0.001), and at 40-49 days 1.39 +/- 0.21 and 0.46 +/- 0.07 mg/l (p less than 0.001). However, no correlation was found between serum bilirubin and AFP concentrations in hyperbilirubinaemic children.     

Newborns Vitamin A in Relation to Sex and Birth Weight

Cord serum vitamin A values were determined in 256 male and 294 female neonates born in Tehran. The mean cord serum vitamin A values (micrograms/dl +/- SD) was 24.04 +/- 6.87 and ranged from 3.16 to 49.71 micrograms/dl. Males had significantly lower mean cord serum vitamin A values than females (P less than 0.001), and the prevalence of low serum vitamin A (below 20 micrograms/dl) was higher in male neonates than female ones (35 and 21 per cent, respectively). Serum retinol values increased gradually with birth weight. The mean serum vitamin A for premature neonates was significantly lower than term neonates. A significant r value for the linear correlation between cord serum retinol and parity was obtained for mothers aged more than 35 years.     

Cord prealbumin values in newborn infants: effect of prenatal steroids, pulmonary maturity, and size for dates

We assessed cord prealbumin concentrations in 214 appropriate for gestational age newborn infants, 21 small for gestational age infants, and 27 large for gestational age infants to establish normal values and to assess the effect of intrauterine growth, prenatal steroids, and pulmonary maturity on prealbumin levels. Cord prealbumin values were significantly correlated with increasing gestational age (r = 0.33; P less than 0.001) and birth weight (r = 0.40, P less than 0.001) in the AGA neonates. Neonates born before 37 weeks gestation had significantly lower prealbumin levels than those born at term (P less than 0.001). The SGA infants had significantly lower levels than age-matched AGA controls (P less than 0.01), and LGA infants had significantly higher levels than age-matched AGA controls (P less than 0.001). In preterm infants, those with exposure to prenatal steroids (betamethasone or premature rupture of membranes) had significantly higher prealbumin values than control infants of comparable age and weight (P less than 0.001). Infants without respiratory distress syndrome had higher levels than those of comparable age and weight with hyaline membrane disease (P less than 0.05). This study demonstrates that a correlation of gestational age and birth weight exists with cord prealbumin levels, and that the large variability at each gestational age may be accounted for in part by appropriateness of size for dates, prenatal steroid exposure, and pulmonary maturity.     

Liver vitamin A reserves of very low birth weight neonates

This study assessed the liver vitamin A concentrations at birth in a group of very low birth weight neonates (n = 25) (less than 1500 g birth weight, less than 32 wk gestation), dying within 24 h of birth, prior to possible changes in vitamin A status induced by postnatal intervention. Serum concentrations of vitamin A and retinol-binding protein were also measured in 16 of these neonates. The mean (+/- SD) liver vitamin A concentration was 30.0 +/- 12.9 micrograms/g (range 2.0-49.0 micrograms/g). The mean (+/- SD) serum vitamin A concentration was 13.0 +/- 4.7 micrograms/dl (range 6.7-22.8 micrograms/dl). The mean (+/- SD) serum retinol-binding protein concentration was 2.2 +/- 0.8 mg/dl (range 1.5-4.8 mg/dl). Liver vitamin A, serum vitamin A, and serum retinol-binding protein concentrations did not correlate significantly with gestational age or birth weight. Linear regression analysis did not show a significant correlation between liver vitamin A, and serum vitamin A or retinol-binding protein concentrations. This study provides reference values for vitamin A concentrations at birth in very low birth weight neonates, which may be helpful in future studies designed to evaluate postnatal changes in the vitamin A status of these high-risk neonates.     

Retinol-binding protein and prealbumin in cord blood of term and preterm infants

Retinol-binding protein (RBP) and prealbumin (PA) are potentially useful indicators of inadequate protein and/or energy intake. Concentrations of RBP and PA were determined in cord blood of 117 infants and were found to be lower before 37 weeks gestation than at term. Adult subjects had substantially higher concentrations of RBP and PA than found in cord blood.     

Ontogenic changes in serum immunoglobulins and C3 in vitamin-D deficient and malnourished rats

In both protein energy malnutrition and vitamin D deficiency, defects in some immunological functions have been noted, but the effects on complement and immunoglobulin concentrations have not been evaluated. We assessed the effects of malnutrition and vitamin D deficiency on immunoglobulins and C3 in rats in early postnatal life during weaning and early adulthood using the rocket immunoelectrophoresis technique. In well-nourished rats, the serum levels of IgG increased from 88.5 +/- 10.2 mg/dl in the newborn period to 883.4 +/- 104.8 mg/dl at weaning (day 19). The adult levels, 1,325.9 +/- 60.8 mg/dl, were attained by 35 days of age. Serum IgA was not detectable by our method until 20 days of age (1.1 +/- 0.2 mg/dl) and reached adult levels (13.4 +/- 3.2 mg/dl) by day 35. IgM was detectable in the serum of pups at 5 days of age (0.4 +/- 0.07 mg/dl), increased to 27.5 +/- 6.9 mg/dl at weaning and approached adult levels (93.7 +/- 9.9 mg/dl) at day 35. C3 levels at birth were only 36% of adult levels and did not change during the suckling period. They then increased to levels comparable to those of adults at the age of 35 days. Serum immunoglobulins and C3 in malnourished rats were not significantly different from age-matched control pups. In pups born to dams fed a vitamin-D-deficient diet from 3 weeks of age, only the serum IgG and C3 levels were significantly lower than those of normal pups at day 1 (IgG level: 65.2 +/- 6.1 vs. 88.5 +/- 10.2 mg/dl; C3 level: 20.3 +/- 6.9 vs. 36.2 +/- 3.1% of an adult level; p less than 0.005). Thus the increased susceptibility of malnourished young animals to infection does not appear to be related to a lowering of serum immunoglobulin and complement concentrations.     

Gender difference in cord serum ferritin concentrations.

We measured cord serum ferritin concentrations in a total of 255 infants (116 females and 139 males), and evaluated the association between these values and various neonatal as well as maternal characteristics. The mean ferritin concentration in females (166 +/- 110 microg/l) was significantly higher than that in male infants (123 +/- 77 microg/l). The gender differences in ferritin were significant within groups of infants with fetal growth restriction, those who weighed <3,000 g, those whose mothers were African Americans or <25 years old. Maternal serum ferritin concentrations at 36 weeks of gestation significantly correlated with cord serum ferritin of male infants (r = 0.32, p < 0.001), whereas the association was not significant for females (r = 0.09, p > 0.41). Although the mechanism of the gender difference is unknown, it may be important to consider the sex of neonates when evaluating their iron nutriture immediately after birth.     

Clinical significance of serum and cerebro spinal fluid bilirubin indices in neonatal jaundice

To assess the value of unbound bilirubin (UB) and saturation index (SI) in serum and CSF as indicators of Kernicterus, we studied 50 icteric neonates (serum indirect bilibrubin (IB) greater than or equal to 7 mg/dl) and 20 controls (IB less than 7 mg/dl) during the first week of life. Serum and CSF were obtained simultaneously in all neonates. Of 36 neonates with IB greater than 12 mg/dl 19 had evidence of kernicterus. UB was estimated by Sephadex gel filtration and SI by salicylate displacement technique. Positive correlation (r = +0.85) was obtained between serum and CSF UB levels. There was a significant difference (p less than 0.05) between mean serum and CSF UB levels in kernicterus and non-kernicterus neonates (kernicterus serum UB = 0.71 +/- 0.22) mg/dl, CSF UB = 0.16 +/- 0.06 mg/dl: non-kernicteric serum UB = 0.40 +/- 0.10 mg/dl, CSF UB = 0.10 +/- 0.03 mg/dl). A critical serum UB level 0.5 mg/dl and a danger zone of CSF UB (0.1 to 0.15 mg/dl) was observed in presence of kernicterus. Neonates with kernicterus and 30% non-kernicteric had serum SI greater than or equal to 8. Mean values of serum and CSF SI were comparable in all neonates. The serum and CSF UB and SI, and the mean percentage cross over of UB from serum to CSF when statistically compared were not significantly influenced by risk factors.     

Evaluation of ceruloplasmin in neonatal septicemia.

Serial serum ceruloplasmin (Cp) levels were estimated in healthy and septicemic neonates, using single radial immunodiffusion. In 25 healthy neonates mean Cp levels were 19.82 mg/dl at birth, 18.20 mg/dl at 12-24 hours, 17.26 mg/dl at 14 +/- 4 days and 17.68 mg/dl at 28 +/- 4 days of life. For the entire neonatal period the mean Cp levels were computed to be 18.24 mg/dl. In 20 culture positive, septicemic neonates, mean Cp levels were 27 mg/dl at onset of disease, 28.65 mg/dl 12-24 hours later and 36.2 mg/dl after 7 +/- 3 days of start of illness (p less than 0.001 for all sampling intervals as compared to healthy group values in first month of life). The mean Cp levels were unaffected by gestational age in both groups. In the septicemic neonates, the mean Cp levels in dying neonates did not differ significantly from recovering neonates for all sampling intervals. It is concluded that estimation of serum Cp levels may help in diagnosis of neonatal septicemia, but it is not useful as an early diagnostic aid or for prognostication.     

The accuracy of transcutaneous bilirubin measurements in neonates: a correlation study

A prospective observational study was conducted on 212 neonates born between 24 and 42 weeks of gestation who required blood sampling to determine total serum bilirubin (TSB) in the first week of life, prior to phototherapy. The transcutaneous bilirubin (TcB) measurements were performed on the infant's forehead using BiliCheck within +/-30 min of a blood sample being drawn. There was significant (r = 0.78) correlation between bilirubin levels obtained transcutaneously and those measured in the infant's blood. The correlation was not affected by birth weight and was dependent on the bilirubin levels. The negative nonsignificant correlation appears when TSB levels are greater than 11 mg/dl. Thus, TcB measurements can accurately predict TSB values lower than 11 mg/dl in a multiracial preterm and term neonatal population.     

Retinol-binding protein and prealbumin: useful measures of protein repletion in critically ill, malnourished infants

Plasma prealbumin (PA) and retinol-binding protein (RBP) concentrations were serially measured in 25 critically ill, malnourished infants requiring parenteral nutrition to determine if these visceral protein markers are useful in assessing acute protein repletion. Significant increases in both proteins (p less than 0.05) were noted as early as 5 to 7 days after institution of parenteral nutrition and continued significantly above baseline values through 2 weeks of observation. Gestational development (in infants less than 4 weeks old) and mean protein intake influenced visceral protein responses. Appropriate for gestational age neonates had more rapid and quantitatively greater PA responses (p less than 0.05) than small for gestational age neonates. Small for gestational age neonates never exceeded baseline RBP responses. Average protein intake of less than or equal to 2 g/kg/day resulted in PA and RBP concentrations below baseline and significantly lower than infants on higher protein intakes (p less than 0.05), at the end of 2 weeks. Average calorie intake of greater than 100 cal/kg/day had no differential influence on PA or RBP when compared with infants on less calories. Prealbumin values correlated with RBP values observed simultaneously (r = 0.588, p less than 0.0001). We conclude that PA and RBP are useful measures of protein repletion in critically ill infants requiring parenteral nutrition.     

N-terminal propeptide of type-III procollagen concentrations in the cord blood: an index of newborn maturity

Cord serum concentrations of the N-terminal propeptide of type-III procollagen(PIIIP), insulin-like growth factor I (IGF-I), thyroid-stimulating hormone (TSH) and free thyroxine were measured in 149 neonates, consisting of 22 small for gestational age, 95 appropriate for gestational age, 21 large for gestational age and 11 neonates of less than 24 weeks of gestation. Their gestational ages (GAs) ranged from 20 to 41 weeks. A significant negative correlation was found between PIIIP levels and GA (r = -0.83, p less than 0.001). No significant difference was found in PIIIP levels between SGA and LGA neonates, when there were no difference in their GAs, in spite of a significant difference in their birth body weights (p less than 0.01). The high concentrations of the cord serum PIIIP did not appear to be influenced by either IGF-I or thyroid hormones, nor was there any relationship between PIIIP and the birth body weight, but only with GA, suggesting that determining cord levels of PIIIP seems to provide a useful parameter for the assessment of newborn maturity.     

Cord and maternal serum IgM in IUGR babies

Due to constraints in conducting specific tests for diagnosis of perinatal infection, the present study was carried out to find out the value of cord serum IgM levels as a screening procedure for intrauterine infection in full term intrauterine growth retarded (IUGR) babies. Thirty five consecutively born full term IUGR singleton babies and their mothers (having weight greater than 40 kg, height greater than 145 cm, Hb 8 g/dl and normal blood pressure) formed the study group. Ten full term singleton babies weighing greater than or equal to 3000 g and their mothers served as controls. In the study population both mean cord serum IgM (26.8 mg/dl) and mean maternal serum IgM (142.42 mg/dl) were raised as compared to the mean cord serum IgM (13.76 mg/dl) and mean maternal serum IgM (100.16 mg/dl) of the control group. However, statistically the rise was significant only between the maternal cord serum IgM levels. But all the same, cord serum IgM levels exceeding 20 mg/dl and 30 mg/dl were found in 51.43 and 22.8% of full term IUGR neonates, respectively whereas among the control neonates only 20.0% had levels exceeding 20 mg/dl and none had levels above 30 mg/dl suggesting possible intrauterine antigenic challenge to perinatal infection in higher proportion of IUGR babies. Cord serum IgM levels were also seen to increase with increase in birth weight. Idiopathic IUGR babies having cord serum IgM levels greater than 30 mg/dl should undergo specific immunological tests and follow up.     

Intrapartum magnesium sulfate exposure attenuates neutrophil function in preterm neonates

BACKGROUND: Prenatal exposure to magnesium sulfate, a drug that is frequently used for attempted tocolysis in preterm labor, could alter neutrophil functional activity in infants born preterm. OBJECTIVES: To determine the association between maternal tocolysis with magnesium sulfate and the cord blood neutrophil functional activity of preterm neonates. METHODS: The chemotaxis, random motility, and chemiluminescence of neutrophils were compared in the cord blood of 10 preterm neonates born to mothers tocolysed with magnesium sulfate, 10 preterm infants whose mothers had not received any tocolysis, and 10 term infants. Data regarding the maternal and neonatal magnesium and calcium levels were collected and analyzed in association with the cord blood neutrophil functional activity of the preterm infants. RESULTS: Neutrophil functional activity in the cord blood of the preterm neonates was significantly lower than in term neonates. However, the alteration of neutrophil chemotaxis, random motility and chemiluminescence was more noticeable in neonates with intrapartum exposure to magnesium sulfate as compared to preterm infants whose mothers received no tocolysis (30.9 +/- 2.3 vs. 36.7 +/- 2.7 microm, p < 0.01; 26.6 +/- 1.9 vs. 33.1 +/- 3.1 microm, p < 0.01; and 74.3 +/- 6.5 vs. 89.9 +/- 6.25 x 10(3) counts per min (cpm), p < 0.01, respectively). Furthermore, the reduction in neutrophil functional activity of preterm infants with intrapartum exposure to magnesium was directly correlated with the maternal serum magnesium levels (r = -0.90 to -0.85, p < 0.01). CONCLUSION: In infants born preterm, intrapartum exposure to magnesium sulfate is a risk factor contributing to the alteration in neutrophil motility and post-phagocytic bactericidal capacity.