THE INFLUENCE OF THE METHOD OF DELIVERY AND THE CLAMPING TECHNIQUE ON THE RED CELL VOLUME IN INFANTS OF DIABETIC AND NON-DIABETIC MOTHERS

The red cell volume has been investigated in 35 infants of diabetic mothers and in 18 infants of non-diabetic mothers. It is shown that not only the clamping technique but also, the method of delivery has an influence on the red cell volume of the infant. Thus the red cell volume is less in infants delivered vaginally with early clamping, compared with infants delivered by caesarean section with early clamping. These findings support the theory that during vaginal delivery a temporary change in It is suggested that IDM during vaginal delivery with early clamping deposit more blood in the placenta than do the non-IDM, since we found a smaller red cell volume per kg the distrfbution of. the foeto-placental blood volume between placenta and child occurs.     

PERINATAL ACIDOSIS AND PLACENTAL TRANSFUSION1

Umbilical artery pH and residual placental blood volume (RPBV) were determined for 75 full-term newborn infants born by vaginal delivery. For 39 infants of multiparous mothers (IMM), there was a significant relationship between fetal acidosis and reduced RPBV. For 36 infants of primiparous mothers (IPM) a significant relationship was not present. Results of an earlier study suggested that perinatal acidosis was associated with reduced RPBV. The present study confirms this association for IMM's. The reason for the lack of a clearcut effect in IPMs is unknown.     

THE TRANSCAPILLARY ESCAPE RATE OF T-1824 IN HEALTHY NEWBORN INFANTS The Influence of the Placental Transfusion

The transcapillary escape rate of T-1824 was measured in 12 normal newborn infants and found to be significantly higher among infants with late clamping of the umbilical cord (25.0% per hour) than in early-clamped infants (19.1% per hour). The magnitude of the placental transfusion was assessed from the volume of the residual placental blood and it was demonstrated that the transcapillary escape rate of T-1824 increases parallel to the placental transfusion. The disappearance rate of the early-clamped infants was almost the same as that previously found in early-clamped infants of diabetic mothers.     

Delayed umbilical cord clamping in preterm infants: A feasibility study

Objectives: To assess: (i) the size of placental transfusion following a 30 s delay in cord clamping following vaginal and Caesarean births; and (ii) the feasibility of delaying cord clamping in the labour ward and particularly in the operating theatre.
Methods: Fourty-six infants born at 26–33 weeks gestation were randomized to having the umbilical cord clamped either immediately or 30 s after birth. The venous haematocrit was measured at 1 and at 4 h of age.
Results: There were trends towards higher mean haematocrits in the infants following delayed clamping, but these were not significant either at 1 h (55±7.7 vs 52.9±7) or at 4 h of age (55±7 vs 52.5±7). The trends were more marked in the infants born by Caesarean section, and in those born at 26–29 weeks gestation.
Conclusions: A 30 s delay in cord clamping is feasible at both vaginal and Caesarean births, but does not lead to the predicted difference in infant haematocrit. Although physiological studies suggest that a placental transfusion of 15–20 mL/kg occurs within 30 s of delivery, these data suggest that future trials should either delay cord clamping for more than 30 s, or should alter the position of the infant in relation to the uterus in order to facilitate the transfusion. Delayed cord clamping is feasible at Caesarean section.     

Incorporating nutrition into delivery care: delivery care practices that affect child nutrition and maternal health

Delayed umbilical cord clamping, early skin-to-skin contact and early initiation of exclusive breastfeeding are three simple and inexpensive delivery care practices which have the potential to improve short-term and long-term nutrition and health outcomes in mothers and infants. In preterm infants, delayed clamping prevents intraventricular haemorrhage and improves haematological status, and in full-term infants, delayed clamping improves iron status through 6 months of age. Early skin-to-skin contact, in addition to regulating neonatal temperature, improves early breastfeeding behaviours, which has important implications for long-term infant nutrition and health. Finally, early exclusive breastfeeding prevents neonatal mortality and morbidity and provides numerous health and nutritional benefits to the infant, throughout infancy and beyond, as well as to the mother. Though each practice has been the subject of controlled trials and systematic reviews, with evidence of benefit from their implementation, these practices are not common in many delivery settings, nor are their long-term effects on infant and maternal nutrition and health status adequately recognized. We discuss the immediate and long-term health and nutrition benefits of each practice, and identify the policy and programme changes needed for integration and implementation of these practices into standard delivery care.     

Sympatho-adrenal activity and metabolic adjustment during the first 12 hours after birth in infants of diabetic mothers

Plasma adrenaline and noradrenaline concentrations at birth were the same in infants of diabetic mothers and controls after both vaginal and abdominal delivery. The infants delivered vaginally had significantly higher noradrenaline concentrations than those delivered by caesarean section. During the first 12 postnatal hours, the concentration of noradrenaline decreased to levels similar to those found in newborn infants with minor respiratory problems. No hypoglycemic values were recorded in infants of diabetic mothers at birth nor during the first twelve hours after birth. The C-peptide concentrations at birth were significantly lower in infants of diabetic mothers delivered vaginally as compared to those delivered by caesarean section. The FFA concentrations increased after birth possibly as a result of the lipolytic action of catecholamines released during labour and delivery. We have not been able to confirm the increased sympatho-adrenal activity previously reported in infants of diabetic mothers. We suggest that the difference is due to better metabolic control in the diabetic mothers during pregnancy and delivery in this study.     

Sympatho-Adrenal Activity and Metabolic Adjustment during the First 12 Hours after Birth in Infants of Diabetic Mothers

Plasma adrenaline and noradrenaline concentrations at birth were the same in infants of diabetic mothers and controls after both vaginal and abdominal delivery. The infants delivered vaginally had significantly higher noradrenaline concentrations than those delivered by caesarean section. During the first 12 postnatal hours, the concentration of noradrenaline decreased to levels similar to those found in newborn infants with minor respiratory problems. No hypoglycemic values were recorded in infants of diabetic mothers at birth nor during the first twelve hours after birth. The C-peptide concentrations at birth were significantly lower in infants of diabetic mothers delivered vaginally as compared to those delivered by caesarean section. The FFA concentrations increased after birth possibly as a result of the lipolytic action of catecholamines released during labour and delivery. We have not been able to confirm the increased sympatho-adrenal activity previously reported in infants of diabetic mothers. We suggest that the difference is due to better metabolic control in the diabetic mothers during pregnancy and delivery in this study.     

PLACENTAL TRANSFUSION IN THE PREMATURE INFANT WITH OBSERVATION ON CLINICAL COURSE AND OUTCOME

Blood volume was measured in 73 truly premature and 10 “small for date” term infants following early or late cord clamping at birth. Forty-five normal full term infants from a previous study were included for comparison. The results demonstrated that placental transfusion occurred if cord clamping was delayed. The amount of placental transfusion in terms of red cell volume per kg b.w. in the premature infants under 2001 g was less compared to that of both normal full term infants and premature infants above 2001 g. The clinical course showed high incidence and mortality from respiratory distress in premature infants under 2001 g. An interesting observation was the apparently higher mortality resulting from idiopathic respiratory distress syndrome in the late-clamped group weighing under 2001 g.     

Effect of caesarean section on breast milk transfer to the normal term newborn over the first week of life

OBJECTIVE: To determine the effect of caesarean section on breast milk transfer (BMT) to the normal term infant over the first week of life. METHOD: A sample of 88 healthy nursing mothers who had a normal vaginal delivery, and 97 mothers who had a caesarean section were recruited from a teaching hospital. Mothers and midwives were instructed to weigh the infants before and after each feed throughout the study period using calibrated portable electronic scales. RESULTS: The volume of milk transferred to infants born by caesarean section was significantly less than that transferred to infants born by normal vaginal delivery on days 2 to 5 (p < 0.05), but by day 6 there was no difference between the two groups (p = 0.08). The difference could not be explained by any of the maternal and infant variables measured. Birth weight was regained by day 6 in 40% of infants born vaginally compared with 20% in those born by caesarean section. CONCLUSION: There is a lag in the profile of the daily volume of breast milk transferred to infants delivered by caesarean section compared with those born by normal vaginal delivery. This study also challenges the widely followed schedules of milk volumes considered to be suitable for the term infant, which appear to be excessive, at least for the first four to five days post partum.     

A new wrinkle: Umbilical cord management (how,when, who)

In the past five years, umbilical cord management in both term and preterm infants has come full circle, going from the vast majority of infants receiving immediate cord clamping to virtually all governing organizations promoting placental transfusion, mainly in the form of delayed cord clamping (DCC). Placental transfusion refers to the transfer of more blood components to the infant during the first few minutes after birth. The different strategies for ensuring placental transfusion to the baby include delayed (deferred) cord clamping, milking of the attached cord before clamping, and milking of the cut cord. In this review, we address the current evidence to date for providing placental transfusion in different circumstances and the methods for implementation. We also highlight the gaps in knowledge and areas for future research.     

IMMUNOELECTROPHORETIC DETERMINATION OF SERUM GLOBULINS 1N NEWBORN INFANTS OF DIABETIC MOTHERS

ABSTRACT. Davidsen, Otto (Diabetes Centre, Royal Maternity Department B, Rigshospitalet and Department of Clinical Chemistry, Sundby Hospital, Copenhagen, Denmark) Immunoelectrophoretic Determination of Serum Globulins in Newborn Infants of Diabetic Mothers. Acta Paediatr Scand, 63: 833, 1974.—Serum globulins were investigated by means of crossed immunoelectrophoresis in the cord blood from 40 infants of diabetic mothers and 92 infants with non-diabetic mothers. In infants of non-diabetic mothers the concentration of most globulins was lower than in adults and positively correlated to the gestational age of the infant. For α₂-HS-glycoprotein and an unidentified α₂-glob-uEn, however, a negative correlation to the gestational age was observed. Infants of diabetic mothers had a higher Concentration of transferrin and lower concentrations of α₂-macroglohulin and α₁-lipoprotein as compared with infants of the reference group. In the diabetes group the globulin concentrations were correlated neither to the gestational age nor to their increased birth weight, but the ratio α₂,-macroglobulin/α₂-HS-glycoprotein, which was expected to be independent of variations in the degree of hydremia of the infants, was significantly correlated to the gestational age. As judged from this parameter, infants of diabetic mothers are comparable to infants of non-diabetic mothers of about 4 weeks lower gestational age.     

Effect of delayed cord clamping on iron stores in infants born to anemic mothers: a randomized controlled trial

OBJECTIVE:To study the effects of cord clamping on iron stores of infants born to anemic mothers at 3 months of age. DESIGN: Randomized controlled trial. SETTING: Teaching hospital. METHODS: Infants born to mothers with hemoglobin (Hb)<100 g/L were randomized at delivery to either immediate cord clamping (early group) or cord clamping delayed till descent of placenta into vagina (delayed group). The outcome measures were infant's hemoglobin and serum ferritin 3 months after delivery. RESULTS: There were 102 neonates randomized to early (n = 43) or delayed cord clamping (n = 59). The groups were comparable for maternal age, parity, weight and supplemental iron intake, infant s birth weight, gestation and sex. The mean infant ferritin and Hb at 3 months were significantly higher in the delayed clamping group (118.4 microg/L and 99 g/L) than in the early clamping group (73 microg/L and 88 g/L). The mean decrease in Hb (g/L) at 3 months adjusted for co-variates was significantly less in the delayed clamping group compared to the early clamping group (-1.09, 95% CI-1.58 to -0.62, p >0.001). The odds for anemia (<100 g/L) at 3 months was 7.7 (95% CI 1.84-34.9) times higher in the early compared to the delayed clamping group. CONCLUSION: Iron stores and Hb in infancy can be improved in neonates born to anemic mothers by delaying cord clamping at birth.     

A randomised controlled trial of delayed cord clamping in very low birth weight preterm infants

This study was carried out to assess the feasibility of late cord clamping of 45 s in preterm infants delivered mainly by caesarean section and the effects on post-partal adaptation and anaemia of prematurity. Prior to delivery, 40 infants of <33 gestational weeks were randomised to either 20 s or 45 s of late cord clamping. After the first shoulder was delivered, oxytocin was given intravenously to the mother in order to enhance placento-fetal transfusion while the infant was held below the level of the placenta. The 20 infants in group 1 (20 s) had a mean birth weight of 1070 g and a mean gestational age of 29 + 4/7 weeks versus 1190 g and 30 weeks in group 2 (45 s). On day 42 of life there were ten infants without transfusions in group 2 versus three in group 1 (P < 0.05). Out of the 20 infants in group 1, 19 and 15/19 in group 2 were delivered by caesarean section. There were no significant differences in Apgar scores, temperature on admission, heart rate, blood pressure and requirements for artificial ventilation. Conclusion Delayed cord clamping of 45 s is feasible and safe in preterm infants below 33 weeks of gestation. It is possible to perform the procedure at caesarean section deliveries and it should be performed whenever possible. It reduces the need for packed red cell transfusions during the first 6 weeks of life. Received: 10 February 2000 / Accepted: 12 April 2000     

Resuscitation of extremely preterm infants - controversies and current evidence

Despite significant advances in perinatal medicine, the management of extremely preterm infants in the delivery room remains a challenge. There is an increasing evidence for improved outcomes regarding the resuscitation and stabilisation of extremely preterm infants but there is a lack of evidence in the periviable (gestational age 23-25 wk) preterm subgroup. Presence of an experienced team during the delivery of extremely preterm infant to improve outcome is reviewed. Adaptation from foetal to neonatal cardiorespiratory haemodynamics is dependent on establishing an optimal functional residual capacity in the extremely preterm infants, thus enabling adequate gas exchange. There is sufficient evidence for a gentle approach to stabilisation of these fragile infants in the delivery room. Evidence for antenatal steroids especially in the periviable infants, delayed cord clamping, strategies to establish optimal functional residual capacity, importance of temperature control and oxygenation in delivery room in extremely premature infants is reviewed in this article.     

延迟脐带结扎对胎龄<32周早产儿的影响

目的评价延迟脐带结扎(DCC)对胎龄32周早产儿的影响。方法将2015年1~12月自然分娩的90例胎龄32周早产儿随机分为DCC组(46例)和早期结扎(ICC)组(44例),对比两组的血常规、红细胞输注总量、血气、平均动脉压、胆红素峰值、光疗总时间,以及坏死性小肠结肠炎、晚发性败血症、颅内出血和视网膜病、支气管肺发育不良的发生几率。结果 DCC组的血红蛋白、红细胞压积、平均动脉压、标准碱剩余(s BE)高于ICC组,而接受扩容及多巴胺升压治疗的早产儿比例以及红细胞输注量低于ICC组,差异有统计学意义(P0.05)。两组间体温、p H值、HCO3-浓度、血清胆红素峰值、总光疗时间以及晚发型败血症、视网膜病、Ⅱ级以上颅内出血及Ⅱ级以上新生儿坏死性小肠结肠炎的发生率差异无统计学意义(P0.05)。结论 DCC是一项安全的、可以改善胎龄32周早产儿预后的临床干预措施。     

Insulin and Leptin Levels in Appropriate-for-Gestational-Age Infants of Diabetic Mother

Objective

Intensified management of gestational diabetes mellitus can normalize birth weight. However, it is still unknown whether intrauterine exposure to maternal diabetes is a risk factor for changing hormone levels involved in the development of insulin resistance in these infants. We compared insulin and leptin levels in appropriate for gestational age (AGA) infants of diabetic and non diabetic mothers.

Methods

We performed a cross-sectional study in the department of Neonatology of the Hospital of Gynecology-Pediatrics, in Leon, Mexico. We evaluated 182 full term AGA newborns (86 infants of diabetic and 96 of non-diabetic mothers). A venous blood sample was taken from cord blood immediately after the separation of the placenta and glucose, insulin and leptin levels were measured. In all diabetic mothers HbA1c was also evaluated immediately post-partum.

Findings

Leptin, insulin and insulin resistance index were significantly higher in infants of diabetic mothers. Leptin levels were positive correlated with insulin, parents‘ body mass index and age in the entire group. In infants of diabetic mothers only insulin levels showed a significantly correlation, whereas in those of non-diabetic mothers only mothers‘ age was significantly correlated with leptin levels.

Conclusion

AGA infants of diabetic mothers showed higher leptin, insulin levels and insulin resistance index than those of non-diabetic mothers.     

Are the neonatal outcomes similar in large-for-gestational age infants delivered by women with or without gestational diabetes mellitus?

Background

Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus.

Methods

This was a retrospective study of LGA infants of ??36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006?C2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student??s t test were used for comparing variables.

Results

Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045).

Conclusions

The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.     

Thyroid function tests in preterm infants born to preeclamptic mothers with placental insufficiency

OBJECTIVE: Since preeclampsia causes placental insufficiency, it can be hypothesized that it decreases placental passage of thyroxine (T4) from mother to infant and thus may deepen the transient hypothyroxinemia seen in preterm infants after birth. The aim of this study was to compare thyroid function tests of preterm infants born to preeclamptic mothers with placental insufficiency with preterm infants born to mothers without placental insufficiency. METHODS: Thirty-one preterm infants born to preeclamptic mothers with placental insufficiency were included in the study (group I) and 31 preterm infants born to mothers without placental insufficiency were included as the control group (group II). Thyroid hormone levels were assayed from blood samples obtained from the women before birth and thereafter from the infants at delivery (cord) and on the 1st, 3rd, 7th, and 21st days of life. RESULTS: Cord blood triiodothyronine (T3), free T3 (FT3) and free thyroxine (FT4) levels in group I were lower than in group II, whereas thyrotropin (TSH) and thyroxine binding globulin (TBG) levels were higher. No statistical difference in hormone levels studied at postnatal 1st, 3rd, 7th, and 21st day was found between the two groups. CONCLUSION: Low levels of thyroid hormones and high level of TSH in cord blood in premature infants born to preeclamptic mothers with placental insufficiency suggest intrauterine hypothyroidism. Increase in TSH and thyroid hormone concentrations after birth reveal that the hypothalamic-pituitary-thyroid axis is intact.     

Levels of total and free tryptophan in maternal and in umbilical blood of infants born by vaginal delivery and by elective cesarean section

The variations of total and free tryptophan levels in samples of maternal and umbilical blood obtained on the occasion of elective cesarean section have been compared with similar samples taken from vaginal deliveries. In the neonates studied the umbilical blood levels of total and free tryptophan have been found to be higher than in the blood of the respective mothers, while the percentage of free tryptophan is comparable. In addition, the umbilical blood levels of both fractions of tryptophan appeared to be higher in newborn infants after spontaneous delivery than in those after elective cesarean section. These data show an active transport of tryptophan through the placental barrier that seems to be favored by spontaneous delivery.     

Neonatal B lymphocyte subpopulations and method of delivery.

We studied four groups of healthy term newborn infants: (1) 11 infants born by vaginal delivery; (2) 11 infants born by elective cesarean section; (3) 10 infants born by emergency cesarean section with labor, and (4) 10 infants born by complicated vaginal delivery. Total and differential leukocyte counts, cortisol blood level, and B lymphocyte subpopulations (SmIg, sIgD, sIgM, CD19, CD20, CD21, CD23) were evaluated in cord blood samples from the four infant groups. Furthermore, the Pentothal blood level was measured in infants born by elective cesarean section and in their mothers at delivery. Higher total and differential leukocyte counts and cortisol blood levels were observed in group 1 and 4 infants as compared with group 2 and 3 infants. A significant correlation was observed between cortisol blood level and leukocyte counts. The percentages of positivity to cell surface markers of B lymphocyte subpopulations were significantly higher in infants born by elective cesarean section. A negative significant correlation of thiopentone with sIgM and CD21 was observed. These data indicate a significant influence of method of delivery and of thiopentone on B lymphocyte subpopulations.