Umbilical activin A concentration as an early marker of perinatal hypoxia

Objective: To evaluate activin A as a potential, early marker of perinatal hypoxia and to analyze factors, other than hypoxia, which influence on activin A concentration. Methods: Umbilical cord blood samples were collected from 86 newborns with gestational age 30–41. Of the 86 newborns, 26 were regarded as hypoxic. Activin A concentrations were measured by means of specific two-site enzyme immunoassays. Activin A concentrations were correlated with newborns’ gender, week gestation, mode of delivery and blood gas measurements. Results: Activin A levels were significantly higher in hypoxic than nonhypoxic newborns (medians, minimum and maximum values: 1.516; 0.149 –1.974 versus 0.368; 0.054 – 1.041 ng/mL, p = 0.0452). Activin A concentration was significantly higher in male newborns (p = 0.0074). Activin A levels were lower in term than preterm babies but the differences were not statistically significant (p = 0.2368 in hypoxic, p = 0.2487 nonhypoxic). Mode of delivery did not influence on activin A concentration (p = 0.8293 hypoxic, p = 0.9458 nonhypoxic). The differences of occurrence of intraventricular hemorrhage (IVH) in both group was not statistically significant (p = 0.61). Conclusions: Umbilical artery activin A combined with other markers of hypoxia could be a useful marker of perinatal hypoxia. Concentration of activin A is significantly higher in male newborns. The mode and time of delivery have no influence on activin A concentration.     

Amniotic fluid glucose concentration as a marker for intra-amniotic infection

This study evaluated the use of amniotic fluid (AF) glucose concentration as a rapid indicator of intra-amniotic infection. Amniotic fluid glucose concentrations were measured in 86 pregnancies and compared with AF cultures. There were 14 positive cultures with a mean AF glucose of 7.1 mg/dL (range 1-24) and 72 negative cultures with a mean AF glucose of 30.4 mg/dL (range 5-66), a significant difference (P less than .001). An AF glucose of less than or equal to 5 mg/dL had a positive predictive value of 90%; an AF glucose of greater than 20 mg/dL had a 98% negative predictive value. Amniotic fluid glucose can be obtained rapidly and inexpensively, and may be of use in the diagnosis of intra-amniotic infection.     

Amniotic fluid Interleukin-8 as a marker for intraamniotic infection

Summary We measured the amniotic fluid Interleukin-8 (AF IL-8) levels of 80 women to see whether or not AF IL-8 levels were of value in the diagnosis of intraamniotic infection. Of twelve patients developing conventional signs of infection, 9 had an AF IL-8 concentration above 10.000 pg/ml serum. In two patients, whose baby had a serious neonatal infection, AF IL-8 concentration also exceeded 10.000 pg/ml. Only one out of 66 apparently uninfected patients had an AF IL-8 level above 10.000 pg/ml. We therefore suggest that measuring the AF IL-8 levels is of value in cases of suspected intraamniotic infection.     

Use of a computer system in perinatal data collection

We present a computer system for obstetrical and perinatological data collection. All deliveries of the years 1984, 1985, and 1986 have been collected with this data collection program, so that there is how a data base containing 7,975 data records. A relational data base was chosen for data collection and storage. Either off-line or on-line data collection is possible by medical users via menu monitoring. Various possibilities of use are described.     

Urinary uric acid/creatinine ratio as an additional marker of perinatal asphyxia.

PURPOSE: To study the validity of urinary uric acid (UA) as a marker of perinatal asphyxia in term and premature infants. METHODS: The urinary ratio of UA to creatinine (Cr) was obtained within 24 hours after birth in four groups of infants: 17 term infants and 18 premature infants with perinatal asphyxia, and 22 healthy term infants and 20 premature infants without perinatal asphyxia. Perinatal asphyxia was defined as an Apgar score of 3 or less at 1 minute or 5 or less at 5 minutes, and/or a first blood gas pH of less than 7.25 and a base deficit of at least 12 mmol/L. RESULTS: The urinary ratio of UA to Cr was significantly higher in term infants with perinatal asphyxia than in term infants without asphyxia (1.53 +/- 0.71 vs 0.73 +/- 0.45; p < 0.005). The same result was found between premature infants with and without perinatal asphyxia (3.89 +/- 1.84 vs 2.45 +/- 0.88; p < 0.01). The urinary ratio of UA to Cr in premature infants was significantly higher than in term infants. When the urinary ratio of UA to Cr was greater than 0.95, perinatal asphyxia was identified with a sensitivity of 80% and a specificity of 71% in term infants. In premature infants, a cut-off value of UA/Cr for perinatal asphyxia of 2.9 had a sensitivity of 71% and a specificity of 70%. CONCLUSIONS: The results of this study indicate that the urinary ratio of UA to Cr may be used as an additional marker of perinatal asphyxia in term and premature infants. In comparison with other markers such as xanthine, hypoxanthine, and ascorbic acid, it is a simple, quick, and inexpensive way to detect hypoxic episodes in a neonatal intensive care unit within 24 hours after birth.     

A computerized perinatal data system for a region

The development of regionalized systems for perinatal care requires a record system which will provide a flow of patient information to and from referring and center hospitals. It should also provide for the risk evaluation of patients being cared for within the region as well as for the quality and statistical evaluation. When the Arizona Perinatal Program was established in 1975 with funding by the Robert Wood Johnson Foundation, the decision was made to adopt and expand a perinatal data system under development at St. Joseph's Hospital in Phoenix. This data system is made up of two major components: (1) a paper record system in which the documents completed by physician or nurse serve both as the medical record and a computer-input document and (2) a computer capable of simultaneous communication with 17 different terminals, directly or by telephone lines. Programs to meet the goals of patient care, quality evaluation, and statistical assessment are described.     

Procalcitonin and C-reactive protein as a markers of neonatal sepsis

OBJECTIVES: Sensitive, reliable and early parameters of bacterial infection are extremely valuable in diagnosis of nosocomial infections in neonatal intensive care unit. In this study procalcitonin (PCT) and C-reactive protein (CRP) were evaluated for their diagnostic relevance in neonatal late onset sepsis. DESIGN: Clinical study MATERIALS AND METHODS: We analysed inflammatory parameters in 48 newborn infants admitted to the Intensive Care Unit of Institute of Paediatrics in Lodz who suffered from nosocomial sepsis. They were sampled for PCT and CRP levels at the time of the onset of signs and 24 hours later. CRP was determined by an nephelometric method and PCT was determined by an immunoluminometric assay. RESULTS: At the onset of Gram negative sepsis 14 from 17 contaminated newborns had significantly increased CRP levels and 15 of them had increased levels of PCT After 24 hours 100% of them had elevated PCT and CRP levels. At the onset of Gram positive sepsis only 18 from 31 neonates with positive blood culture had increased CRP levels and 28 of them had elevated concentrations of PCT. This difference was statistically significant. After 24 hours 26 of them had elevated CRP and 100% had increased PCT concentrations--this difference was not significant. CONCLUSION: Measurement of procalcitonin concentrations may be useful for early diagnosis of late onset sepsis in neonates.     

Measurement error in clinical perinatal data

The error measurement of clinical perinatal variables obtained during the standardization and data-collection periods of a large prospective epidemiologic study is presented. The error is considerably larger during the data-collection period, particularly with regard to uterine height, birth weight, and blood pressure values. This information strongly supports the need to continuously supervise and monitor perinatal data collection systems, even after standardization.     

Cytomegalovirus infection: perinatal implications

Cytomegalovirus (CMV), a member of the herpes virus family, is the most common cause of congenital infection in humans, affecting 0.5-3% of all newborns worldwide. Congenital cytomegalovirus infection is the leading infectious cause of deafness, learning disabilities, and mental retardation in children. The high prevalence of cytomegalovirus in the general population, unpredictability of transmission, and asymptomatic nature of the disease in otherwise healthy women challenge prevention and treatment efforts.     

Detection and evaluation of data in perinatal diagnosis using a personal computer

Imaging, biochemical, genetic, clinical, histological, cytological and morphological examinations methods are practised in perinatal diagnostics. We propose a system of data registration and processing using a personal computer regarding both prenatal therapeutic measures. Data are collected as data store "perinatal diagnostic" which may be expanded prospectively at any time.     

对围产期TORCH感染筛查的重新评价

围产期感染(perinatal infections),尤其是病毒感染,是导致围产儿死亡与病残的重要原因。很多围产期感染,孕妇往往没有明显的临床表现,但对围产儿则构成一定的影响,而发生在妊娠早期的感染,对胎儿危害更大。从20世纪80年代开始,国外学者即试图寻找一些能早期发现孕妇感染与围产儿受     

Sonographically thick placenta: a marker for increased perinatal risk--a prospective cross-sectional study

The aim of this study was to determine placental thickness by ultrasound examination throughout pregnancy and establish the correlation of sonographically thick placenta with perinatal mortality and morbidity.Placental thickness was determined by routine sonographic examination throughout pregnancy in 561 normal singleton pregnancies. Thick placenta was determined as placenta that was above the 90th percentile. Gravidae between 20-22 weeks' gestation (n=193) and 32-34 weeks (n=73) were then divided into two groups according to placental thickness. The study group consisted of 44 gravidae with thick placenta. The control group included 151 gravidae with placental thickness between the 10th and 90th percentile. A comparison of perinatal mortality and morbidity rates as well as the incidence of small and large for gestational age neonates was conducted.A linear increase of placental thickness was found to correlate with gestational age throughout pregnancy. No statistical differences were observed between the two groups with regard to obstetrical variables such as maternal age, parity and gestational age at delivery. No correlation was found between placental thickness and maternal age or parity. The incidence of perinatal mortality was significantly higher among gravidae with thick placentae (6.82% versus 0.66 per cent, P=0.037, 95 per cent confidence interval 1.71-70.29). Birthweight at term was found to be above 4000 g in 20.45 per cent of the thick-placenta group as compared to 5.3 per cent in the control group (P=0.001, 95 per cent CI 2.08-13.85), and birthweight of less than 2500 g was found in 15. 9 per cent of the thick-placenta group as compared to 7.3 per cent in the control group (P=0.03, 95 per cent CI 1.11-8.14). The incidence of fetal anomalies was 9.1 per cent in the thick-placenta group and 3.97 per cent in the control group (not significant). Sonographically thick placenta is associated with increased perinatal risk with increased mortality related to fetal anomalies and higher rates of both small for gestational age and large for gestational age infants at term.     

Plasma copeptin may not be a sensitive marker of perinatal stress in healthy full-term growth-restricted fetuses

Objective: Intrauterine-growth-restriction-(IUGR) is associated with chronic fetal stress, as well as a phase of enhanced fetal/early postnatal insulin sensitivity, followed by a later emergence of insulin resistance. We aimed to prospectively investigate concentrations of copeptin, a sensitive marker of stress and insulin resistance, in IUGR versus appropriate-for-gestational-age-(AGA) fetuses.

Methods: Cord blood copeptin concentrations were determined by ELISA in well-defined, non-distressed at birth, asymmetric IUGR (n?=?30) and AGA (n?=?20) full-term pregnancies. Doppler studies were indicative of placental insufficiency.

Results: Cord blood copeptin concentrations were similar in IUGR cases and AGA controls, after controlling for delivery mode. Copeptin concentrations were markedly elevated in vaginally delivered fetuses (p?=?0.001). No association was recorded between fetal copeptin concentrations and maternal age, parity, gestational age, or fetal gender.

Conclusions: Cord blood copeptin concentrations are probably not affected by IUGR at term, in the absence of fetal distress, possibly due to a balance between copeptin up-regulation by chronic fetal stress, on one hand, and copeptin down-regulation in the presence of increased insulin sensitivity, on the other hand; thus, copeptin may not be a sensitive marker of chronic perinatal stress in healthy asymmetric IUGR infants. Cord blood copeptin seems to primarily reflect perinatal stress associated with delivery mode.     

Congenital and perinatal cytomegalovirus lung infection

Abstract

Background: Cytomegalovirus (CMV) pneumonitis may be severe, even lethal, following congenital infection or in premature infants with perinatal infection.

Objective: To review the epidemiological, pathogenetic, clinical and therapeutic features of prenatal and perinatal CMV lung diseases.

Methods: Evaluation of all published papers listed on PubMed describing CMV pneumonitis in infants.

Results: CMV is frequent and severe in immunosuppressed infants but infrequent in full-term neonates and occurs more frequently after perinatal than after congenital infection, particularly in premature infants. In premature infants, CMV infection is often protracted and causes a diffuse interstitial pneumonitis leading to fibrosis and bronchopulmonary dysplasia (BPD). Congenital CMV infection should also be considered in newborns with severe acute respiratory distress syndrome and refractory respiratory failure with progression to early chronic lung disease. The association between breast milk-transmitted CMV and development of cystic lung disease and Wilson–Mikity syndrome has also been reported. Data on the efficacy of antiviral therapy for infants with respiratory CMV diseases are lacking and only anecdotal case reports are available.

Conclusions: Persistent CMV infection appears to cause a diffuse necrotizing pneumonitis with fibrosis leading to BPD, in both immunocompromised or preterm infants and, less frequently in immunocompetent infants. The role of antiviral therapy remains to be elucidated.     

围产期巨细胞病毒感染的前瞻性研究

目的 分析围产期要儿巨细胞病毒(cytomegalovirus,CMV)感染的相关因素,以及围产期CMV感染对婴儿健康的影响. 方法 对围产期婴儿CMV感染进行多中心队列研究.采用巢式聚合酶链反应技术对非先天性巨细胞病毒感染婴儿在12周龄时进行尿CMV DNA检测,根据检测结果将婴儿分为围产期CMV感染组和非感染组.对两组婴儿的新生儿期状况、12周龄时的体格发育和临床情况进行比较,对影响围产期CMV感染的危险因素进行非条件Logistic多因素回归分析. 结果 518例婴儿中12周龄时尿CMV DNA阳性105例(感染组),阴性413例(非感染组),围产期CMV感染率20.27%.感染组中黄疸持续3个月者2例,曾患间质性肺炎者2例,但与非感染组(分别为2例)比较差异均无统计学意义(P均=0.184).围产期CMV感染影响因素的非条件Logistic多因素回归分析显示有妇科病史为独立危险因素(OR=2.275,95%CI:1.137～4.551,P=0.020),非母乳喂养(混合喂养:OR=0.392,95%CI:0.185～0.830;人工喂养:OR=0.101,95 0ACI:0.013～0.769)和人均居住面积大(0R=0.948,95%CI:0.917～0.980)为保护性因素. 结论 母乳喂养是围产期CMV感染的重要影响因素;围产期CMV感染对足月儿和近足月儿近期健康没有明显影响.