Linoleic and arachidonic acid in perinatal asphyxia and prematurity.

OBJECTIVES: Long-chain polyunsaturated fatty acids (LC-PUFA) are important for fetal and infant growth and development. The effects of prematurity and perinatal asphyxia on the levels of linoleic acid (LA) and arachidonic acid (AA) in plasma and red blood cell (RBC) membranes were investigated. METHODS: Fifty-five neonates were studied: 18 full term neonates with perinatal asphyxia (group A), nine preterm neonates (group B), and 28 healthy term neonates (group C). Non-esterified and total levels of LA and AA in plasma and RBC membranes were estimated using gas chromatography within the first day of life. Malondialdehyde (MDA) levels were measured using the thiobarbituric acid (TBA) reactivity method. RESULTS: Compared to group C, statistically significant lower levels of plasma free and total AA and free LA were observed in group A, whereas statistically significant higher levels of RBC total LA and AA were observed in RBC membranes of group B. A negative correlation between MDA and LC-PUFA levels was found. CONCLUSION: Perinatal asphyxia is associated with a reduction in LC-PUFA levels, most likely as a result of increased oxidative stress. Premature infants soon after birth have higher LC-PUFA levels than term neonates, probably reflecting the overall metabolic activity and/or intrauterine transport of LC-PUFA.     

Impact of transient period of metabolic adaptation on perinatal asphyxia in neonates with intrauterine growth retardation

Introduction: Temperature, glycemia and respiration make neonatal energy triangle (NET). In growth retardation (IUGR) neonates pathological metabolic adaptation exists in transient neonatal period.

Aim: The of this study was to examine the occurrence of pathological NET and check its impact on perinatal asphyxia during the transient period in IUGR neonates.

Material and methods: One hundred and fifty-nine neonates with IUGR were classified into – early preterm, late preterm and term neonates. By the presence of hypothermia, hypoglycemia and hypoxia in the first hour after birth neonates were classified into: group of pathological NET, group of unstable NET and group of stable NET. We analyzed distribution per body mass, gestational age, type of IUGR, gender and the frequency of perinatal asphyxia between the groups.

Results: The late preterm neonates were the most frequent in the group of pathological NET. Perinatal asphyxia was diagnosed in 52 (32.7%) neonates, with highest frequency in the group of pathological NET. Univariate binary logistic regression analysis showed that pathological NET in neonates with IUGR is significant predictor for perinatal asphyxia occurrence (OR?=?8.57; CI?=?4.05–18.12; p?R²?=?0.27).

Conclusion: Poor metabolic adaptation in neonates with IUGR in the first hour after birth is significant risk factor for the perinatal asphyxia.     

Does therapeutic hypothermia reduce acute kidney injury among term neonates with perinatal asphyxia? – a randomized controlled trial

Objective: The objective of this study is to evaluate whether therapeutic hypothermia reduces the incidence of acute kidney injury (AKI) among term neonates perinatal asphyxia.

Methods: This randomized controlled trial conducted in a tertiary care teaching hospital, south India included 120 term neonates with perinatal asphyxia who were randomized to receive either therapeutic hypothermia or standard supportive care. Renal parameters of neonates in both the groups were monitored and AKI was ascertained as per Acute Kidney Injury Network criteria.

Results: The incidence of AKI was less in therapeutic hypothermia group compared to standard treatment group (32% versus 60%, p?<?0.05). The incidence of Stages 1, 2, and 3 AKI was 22%, 5%, and 5% in therapeutic hypothermia group compared with 52%, 5%, and 3%, respectively, in the standard treatment group. The mortality was less in therapeutic hypothermia group compared with the standard treatment group (26% versus 50%, p?<?0.05).

Conclusion: Therapeutic hypothermia reduces the incidence and severity of AKI among term neonates with perinatal asphyxia.     

Outcome of preterm and term neonates of mothers with malignant diseases diagnosed during pregnancy

Objective.?To investigate the outcome of preterm and term neonates born to mothers with malignant diseases diagnosed during pregnancy.

Methods.?A retrospective analysis with a matched-paired control group in a third level obstetric department and third level neonatal department of the University Hospital Frankfurt. Patients were preterm and term neonates from mothers with oncologic diseases diagnosed during pregnancy and matched-paired preterm and term neonates from healthy mothers.

Measurements and results.?Nineteen preterm and three term (1 × twins) neonates from 21 mothers with oncologic diseases and matched-paired neonates from 21 healthy mothers were included. With the exception of one case, pregnancy was terminated because of the necessity for maternal oncological treatment. Children from mothers with malignant diseases had a significantly lower birth weight and a tendency towards a higher incidence of high-grade respiratory distress syndrome. No significant differences concerning Apgar scores, red blood cell (RBC), white blood cell (WBC), and platelet (PLT) counts postpartum, and duration of hospital days between the two groups of neonates were observed.

Conclusion.?Direct perinatal outcome of preterm or term neonates from mothers with malignant diseases diagnosed during ongoing intact pregnancy does not differ from the outcome of a comparable group of neonates from healthy mothers. This might be in contrast to the long-term outcome of this special patient group. In our study we could find no elevated mortality in neonates where pregnancy was terminated because of the need for maternal chemotherapeutic therapy.     

Status of vitamin D,antioxidant enzymes,and antioxidant substances in neonates with neonatal hypoxic-ischemic encephalopathy

Objective: To investigate the concentration of vitamin D (VD), glutathione peroxidase (GP), superoxide dismutase (SOD), malondialdehyde (MDA), and advanced oxidation protein products (AOPP) in neonates with hypoxic-ischemic encephalopathy (HIE).

Material and methods: This study was performed prospectively in term neonates treated for HIE. Samples were collected from the neonates in study and control groups at 6–14 h and on day 5 of their lives for 25-OH vitaminD3, antioxidant enzymes including GP and SOD and oxidants substances including MDA and AOPP.

Results: This study was performed with 31 term neonates with HIE and 30 healthy term neonates. Maternal VD level was statistically lower in the study group (9.8±6.8 ng/mL) than the control (16.4±8.7?ng/mL) (p?=?0.002). SOD and MDA levels were significantly high, and VD level was significantly low in the study group on the first day of life (p?=?0.001 and p?=?0.028, respectively). SOD and GP levels were significantly high in the study group on day 5 (p?<?0.05). VD was significantly low in the study group on day 5 and the proportion of subjects with VD below 5 ng/ml was significantly lower in the control group (p?=?<0.05).

Conclusion: VD has neuroprotective and antioxidant properties. We detected VD levels were low in infants with HIE and their mothers. This finding may be useful for decreasing of brain damage.     

Amino acid and acylcarnitine profiles in perinatal asphyxia: a case-control study

Objective: To estimate cord blood amino acid and acylcarnitine levels in term newborns exposed to perinatal asphyxia.

Materials and methods: We studied 45 asphyxiated term newborns (cases) and 20 gestational age-matched healthy newborns (control). 16 cases developed HIE according to clinical scoring and amplitude-integrated electroencephalography. Asphyxiated cases were accordingly subdivided into: HIE group (n?=?16) and Asphyxia group (n?=?29). Amino acid and acylcarnitine levels were measured in cord blood dried spot samples from all newborns using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Data were analyzed using one-way ANOVA with post hoc test and MetaboAnalyst-2.

Results: Distinct metabolite alterations were detected in cases versus control, in HIE versus Asphyxia, and in Survivors within HIE group (n?=?6) versus nonsurvivors (n?=?10). Principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA) showed increased levels of methionine and certain acylcarnitines, but reduced levels of ornithine, histidine, and arginine. Metabolite set enrichment analysis (MSEA); compared to KEGG library metabolite sets, identified some disorders with similar metabolomic derangements.

Conclusions: We report UPLC-MS detectable alterations of amino acids and acylcarnitines in asphyxiated newborns at birth, that can serve as early diagnostic bedside biomarkers for HIE and predictors for its short-term outcome, and in the near future, as therapeutic targets.     

Vaginal delivery or cesarean section at term breech delivery – chance or risk?

Aim: The aim of the study was to examine maternal age, parity, and estimated neonatal birth weight (BW) depending on the mode of a full-term breech presentation (BP) birth delivery and neonatal outcomes.

Material and methods: One hundred and forty-six singleton term breech presentation pregnancies were included in a retrospective study conducted at the Department of Gynecology/Obstetrics, Clinical Center of Serbia in Belgrade in 2013. Statistical analysis: Student's-t test, χ² likelihood ratio, and the Fisher's exact test. The level of statistical significance was set at p?<0.05.

Results: An ECS was the most common mode of delivery in (81.2%) nulliparous older than 35 years and most of the neonates (66.67%) with an estimated birth weight (BW) above 3500 grams were delivered by elective cesarean section (ECS). Perinatal asphyxia remained increased in the successful vaginal delivery (SVD) group (23.8%) compared with the urgent CS (UCS) group (13.3%) (p?=?0.035). Birth asphyxia was the most common in neonates were delivered by SVD (23.8%). There were no cases of perinatal deaths.

Conclusion: ECS remained the recommended mode of breech term delivery in nulliparous women older than 35 years, as well as in neonates with an estimated BW above 3500 grams.     

Neuronal apoptosis in the neonates born to preeclamptic mothers

Abstract

Objective: Preeclampsia may result in uteroplacental insufficiency and chronic intrauterine fetal distress. The aim of this study is to address this issue investigating neuronal apoptosis in an experimental model of preeclampsia and to evaluate the neurological outcome of the perinatal asphyxia in the neonates born to preeclamptic mother.

Materials and methods: Two out of four pregnant Sprague–Dawley rats (preeclamptic group) were given water containing 1.8% NaCl on gestation day 15 and 22 in order to establish the model of preeclampsia whereas other two (non-preeclamptic group) received normal diet. A model of perinatal asphyxia was established on the postnatal 7th day to one preeclamptic and one non-preeclamptic dam. Overall 23 pups born to overall four dams were decapitated to assess neuronal apoptosis by the TUNEL assay.

Results: The number of apoptotic neuronal cells was significantly higher in the preeclampsia groups in comparison with the control group (p?=?0.006 and p?=?0.006, respectively). It was also significantly higher in the asphyctic/non-preeclamptic group than the count in the control group (p?=?0.01). There was also significant difference between both asphyctic groups (p?=?0.003).

Conclusion: We conclude that preeclampsia causes small babies for the gestational age and cerebral hypoplasia. Both preeclampsia and perinatal asphyxia can cause increased neuronal apoptosis in the neonatal brains. However, the prognosis for neurological outcome is much worse when the perinatal asphyxia occurs in newborns born to preeclamptic mothers.     

Effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia – a randomized controlled trial

Objective: To evaluate the effect of therapeutic hypothermia on myocardial dysfunction in term neonates with perinatal asphyxia.

Material and methods: This randomized controlled trial (RCT) conducted in a tertiary care teaching hospital, south India included 120 newborns with perinatal asphyxia that were randomized to two groups (therapeutic hypothermia and normothermia). Cardiac enzyme profile changes between groups were assessed at 0, 24, 72?h CPK-MB and troponin I levels were estimated by immune inhibition and quantitative immunochromatography methods, respectively. Electrocardiography (ECG) and Echocardiography (ECHO) were done at 0 and 72?h to evaluate the cardiac function and pulmonary hypertension. Neurodevelopment was assessed at 6 months of age in both groups using Developmental Assessment Scales for Indian Infants.

Results: The median values of CPK-MB in the normothermia and hypothermia groups at 0, 24, and 72?h were 198, 127, and 92?IU/L and 202, 111 and 64?IU/L, respectively. The median values of troponin I in normothermia and hypothermia groups at 0, 24, and 72?hrs were 2.45, 1.53, and 0.9?ng/mL and 1.97, 0.93, and 0.01?ng/mL, respectively. ECG and ECHO findings also suggest lesser myocardial dysfunction in therapeutic hypothermia group compared with the normothermia group.

Conclusions: Therapeutic hypothermia significantly decreases the myocardial damage in term asphyxiated neonates.     

Activated protein C resistance in cord blood from healthy and complicated newborns

Objectives. Newborns are susceptible to thrombosis secondary to the immature hemostatic system and maternal and fetal complications. The contribution of activated protein C resistance (APCR) to thrombosis tendency has not yet been established. This study was conducted to investigate the effects of maternal and fetal complications on APCR levels.

Methods. APCR levels were determined in cord blood from healthy term infants and compared with those in healthy preterm and complicated neonates as well as that in adult venous blood.

Results. The mean value of APCR in cord blood from healthy term infants (166 ± 40 s) was not significantly different from that in adult venous blood (173 ± 40 s). No significant differences in the mean cord blood APCR values were observed between healthy term and preterm infants, infants with vaginal and cesarean delivery, infants from preeclamptic and non-eclamptic mothers, and infants with or without perinatal asphyxia. The activity levels of protein C, protein S, and antithrombin III were not significantly different between these groups except for lower levels in preterm babies.

Conclusions. The level of APCR in cord blood is comparable to that in adults and not influenced by maternal and fetal complications. It appears that APCR does not contribute to the thrombotic tendency in newborns.     

The value of serum pro-oxidant/antioxidant balance in the assessment of asphyxia in term neonates

Objective: Asphyxia is a major cause of disabilities in term-born infants. Here we have explored the value in HIE (hypoxic-ischemic-encephalopathy) of using a combination of serum pro-oxidant/antioxidant balance (PAB) assay for predicting the prognosis of asphyxia.

Method: Ninety term neonates with asphyxia were enrolled and followed up for two years. Serum PAB, demographic/biochemical characteristics of mothers, and their neonates were determined. The Denver II test was used to assess outcomes.

Results: Of the 90 asphyxiated neonates, 47 (52.2%) had a normal outcome and 43 babies (47.8%) had abnormal outcome. Serum PAB levels in neonates with normal and abnormal outcomes were 17.1?±?9.23 and 48.27?±?41.30 HK, respectively. A combination of HIE intensity and PAB, compared to other indicators, had a higher predictive-value (95.2%) for outcomes in asphyxiated babies.

Conclusion: We demonstrate that PAB in combination with HIE grade may have a better predictive value for the prognosis of asphyxiated babies and predicting future neurologic problems in asphyxiated term infants.     

Neuroprotective effects of hypothermia and erythropoietin after perinatal asphyxia in newborn rats

Abstract

Objective: Evaluation of neuroprotective effects of hypothermia, erythropoietin and their simultaneous use after perinatal asphyxia in newborn rats.

Method: Histerectomy was performed to Wistar female rats on the last day of gestation. Perinatal asphyxia was induced by submersion of uterus containing pups in saline for 15?min. After resuscitation, pups were randomized into 4 groups, 15 animals in each: G1 – asphyxia; G2 – asphyxia?+?hypothermia (rectal temperature 33?°C for 1?h); G3 – asphyxia?+?erythropoietin (Darbepoetin-α 2.5?μg, intraperitoneally) and G4 – asphyxia?+?erythropoietin?+?hypothermia. Pups were sacrificed on 7th day of life and histopathological analysis of hippocampus was performed.

Results: Measure of damage to dorsal, ventral and entire hippocampus was significantly lower in groups G2, G3 and G4 than in group G1 (p?～?0.00; respectively). Measure of damage to hippocampus in group G4 was significantly lower than in group G2 (p?=?0.029).

Conclusions: This study demonstrates that simultaneous use of hypothermia and erythropoietin has more expressed neuroprotective effects than sole use of hypothermia after perinatal asphyxia in newborn rats.     

Effects of sildenafil citrate on torsion/detorsion-induced changes in red blood cell and plasma lipid peroxidation, antioxidants, and blood hematology of male rats

Objective

The aim of this work was to determine effects of intrapertoneally-administered sildenafil citrate (SC) for prevention testicular injury after unilateral testicular torsion/detorsion (T/D) in rats on red blood cell (RBC) and plasma lipid peroxidation, antioxidants and blood hematology.

Study design

Thirty seven adult male wistar albino rats were divided into four groups: sham operated (group 1), T/D + saline (group 2), T/D + 0.7 mg SC (group 3) and T/D + 1.4 mg SC (group 4). Testicular torsion was created by rotating the right testis 720° in a clockwise direction for 2 h in all the groups, except for group 1.

Results

Our results showed that that testicular injury significantly induced erythrocyte reduced glutathion (GSH) (p < 0.05), malondialdehyde (MDA) in RBC (p < 0.01) and plasma (p < 0.05) and blood lymphocyte (p < 0.01) counts.Administration of low dose SC led to significantly increase in the levels of RBC GSH (p < 0.05), plasma paraoxonase (PON1) (p < 0.01), nitric oxide (NO) (p < 0.01) and blood lymphocyte counts (p < 0.01), but to decreases in the levels of MDA in plasma and RBC, blood mean corpuscular volume (MCV) (p < 0.05) and eosinophil counts (p < 0.05). Treatment with high dose SC caused a significantly increase in PON1, vitamin E and β-carotene in plasma, levels of GSH in RBC and blood lymphocyte counts. On the other hand, results showed that high dose sildenafil significantly decreased plasma and RBC MDA levels. Total tissue damage scores of the group 2 were significantly higher than group 1 and 3.

Conclusion

Low dose SC appears to be beneficial in reducing the effects of injury to the testicular torsion.     

Nucleated red blood cells count as a prognostic biomarker in predicting the complications of asphyxia in neonates

Objective: Nucleated-red-blood-cells (NRBC) count in umbilical cord of newborns is been suggested as a sign of birth asphyxia. The present study was conducted to explore the value of NRBC count in prognosis of asphyxiated neonates.

Methods: Sixty-three neonates with asphyxia were followed up for two years. Maternal and neonatal information was recorded follow by clinical and laboratory evaluation. NRBC-level was determined per 100 white-blood-cells (WBC). After discharge, follow-up of asphyxiated infants was performed using Denver II test at 6, 12, 18 and 24 months. Neonates were divided into two groups, with favorable and unfavorable outcome based on developmental delay or death.

Results: We observed that NRBC count with more than 11 per 100 WBC, had sensitivity of 85% and specificity of 90% in predicting complications of asphyxia, while in absolute NRBC count with more than 1554, the sensitivity and specificity were 85% and of 87%, respectively. Combination of NRBC?+?HIE (hypoxic ischemic encephalopathy) grade had a high-predictive power for determining the prognosis of asphyxia in neonates.

Conclusion: We demonstrate that NRBC/100 WBC and absolute NRCB count can be used as prognostic marker for neonatal asphyxia, which in combination with the severity of asphyxia could indicate high infant mortality, and complications of asphyxia. Further studies in a larger and multi center setting trail are warranted to investigate the value of NRBC and HIE in asphyxiate term infants.     

Evaluation of the coronary arteries in the foetus and newborn and their physiologic significance

Abstract

Objective: To review the current literature addressing the visualisation and clinical applicability of coronary artery blood flow in various foetal and neonatal settings.

Method: We reviewed original research papers, commentaries and review articles which studied the usefulness of coronary flow assessments in the growth restricted foetus, healthy neonates and neonates with clinical conditions such as asphyxia, congenital heart disease and post-surgical duct ligation myocardial failure.

Results: Relevant literature showed that visualisation of coronary blood flow in growth restricted foetuses is considered an ominous sign and identifies a subgroup of foetuses with a poorer foetal and neonatal outcome. A direct relationship between coronary blood flow and echocardiographic parameters in healthy term infants was noted. These assessments also provided useful information in infants with heart disease and perinatal asphyxia. Coronary perfusion has been noted as an important haemodynamic marker in the peri-operative evaluation of preterm infants undergoing surgical duct ligation.

Conclusions: The available literature suggests that these assessments play an important role in improving the understanding of the underlying clinical physiology of the disease process in both the foetus and the newborn. Future research should focus on the evolution of coronary blood flow in clinical situations such as hypotension and inotropic support.     

Random urine uric acid to creatinine and prediction of perinatal asphyxia: a meta-analysis

Objective: The purpose of the present review is to evaluate whether urine uric acid to creatinine ratio is increased in perinatal asphyxia and hypoxic-ischemic encephalopathy (HIE), as well as to assess its predictive accuracy in the disease.

Methods: We used the Medline (1966–2017), Scopus (2004–2017), Clinicaltrials.gov (2008–2017), Embase (1980–2017), Cochrane Central Register of Controlled Trials CENTRAL (1999–2017), and Google Scholar (2004–2017) databases in our primary search along with the reference lists of electronically retrieved full-text papers. The hierarchical summary receiver operating characteristic (HSROC) model was used for the meta-analysis of diagnostic accuracy.

Results: Fourteen studies were finally included in the present review, that investigated 1226 neonates. Urinary uric acid to creatinine ratio was significantly higher in neonates with perinatal asphyxia than in healthy controls (mean differences (MD): 1.43 95%CI [1.17, 1.69]). Specifically, the mean difference for Sarnat stage 1 was 0.70 (95%CI [0.28, 1.13]), for stage 2 1.41 (95%CI [0.99, 1.84]), and for stage 3 2.71 (95%CI [2.08, 3.35]). The estimated sensitivity for the summary point was 0.90 (95%CI (0.82–0.95)), the specificity was 0.88 (95%CI (0.73–0.95)) and the diagnostic odds ratio was calculated at 63.62 (95%CI (17.08–236.96)).

Conclusions: Urinary uric acid to creatinine ratio is a rapid and an easily detected biomarker that may help physicians identify neonates at risk of developing perinatal asphyxia and HIE. However, large-scale prospective studies are still needed to determine its value in predicting mortality, as well as short- and long-term adverse neurological outcomes.     

Impact of intrapartum factors on oxidative stress in newborns

Objective.?To determine the impact of the method of delivery and type of obstetric anesthesia on oxidative stress in neonates.

Methods.?The trial included 164 women in two groups of elective cesarean delivery (CD) and uncomplicated vaginal delivery (VD) at term. The CD group was randomized to either a spinal or general anesthesia and the VD group was randomized to either a local or a spinal saddle block. The main outcome measures were the umbilical venous blood glutathione and malondialdhyde (MDA).

Results.?Neonates of CD had significantly higher levels of MDA and pO₂ and lower glutathione levels than VD. However, in regression analysis, the mode of delivery and type of anesthesia were independent factors that determine the level of MDA but not the level of glutathione. Gestational age was a significant predictor of the glutathione level while birth weight was a significant predictor of the MDA level.

Conclusion.?The oxidative status of the newborn is not simply a reflection of the mode of delivery and type of anesthesia. The impact of gestational age and birth weight appears to be crucial. This must be considered when planning elective delivery.     

The relationship between serum visfatin,adiponectin, and insulin sensitivity markers in neonates after birth

Aim.?The aim of this study was to assess the adiponectin and visfatin concentrations in small-for-gestational age (SGA), appropriate-for-gestational age (AGA), and large-for-gestational age (LGA) newborns and their mothers. Sixty parturients giving birth to 20 term AGA singleton infants, 20 term singleton SGA infants, and 20 term singleton LGA infants were included into the study.

Results.?Mean visfatin levels were found significantly higher in the SGA (p?<?0.001) and LGA (p?<?0.001) groups, and adiponectin levels were found significantly lower in the SGA group (p?<?0.001) when compared with the AGA group. The SGA and LGA groups had higher insulin concentrations and HOMA-IR in comparison with the AGA group. The visfatin, glucose levels, and HOMA-IR (p?<?0.001, p?<?0.001, and p: 0.002, respectively) were higher in the LGA group than SGA group.

Conclusion.?We found significantly higher insulin and visfatin levels in LGA neonates and lower adiponectin levels in SGA neonates. We concluded that the relationship between adiponectin and visfatin and insulin sensitivity (metabolic disturbances) is very complex with little evidence of correlation in SGA and LGA neonates.     

Ponderal index for discrimination between symmetric and asymmetric growth restriction: Percentiles for neonates from 30 weeks to 43 weeks of gestation

Aims.?The ponderal index describes body proportionality at birth thus distinguishing symmetric from asymmetric growth restriction. We aimed to develop ponderal index percentiles for preterm and term neonates born in a European population.

Methods.?Auxologic data were obtained from neonates born from January 1990 to December 1998 from the datasets reported to the perinatal quality assurance system of the Federal State of Hesse, Germany. We excluded data from neonates with lethal malformations, with chromosomal aberrations, from multiple births, from neonates with uncertain gestational age, and from neonates of a gestational age of less than 30 completed weeks. We calculated the weekly 5th, 10th, 25th, 50th, 75th, 90th, and 95th ponderal index percentile values.

Results.?A total of 480 841 neonates (233 662 females and 247 179 males) were included. Charts and tables of ponderal index values show percentiles for males, females, and for the total group. There were no significant differences between boys and girls.

Conclusion.?Our data offer the ability to refer a neonate's body proportionality to updated percentiles. The percentiles allow the discrimination between symmetric and asymmetric growth restriction in preterm and term infants.     

Male disadvantage for neonatal complications of term infants,especially in small-for-gestational age neonates

Abstract

Objective: Sex differences in long and short-term outcomes for infants are observed. This has also been shown for several neonatal complications in preterm neonates. We aimed to evaluate whether sex impacts neonatal outcome among term neonates. Furthermore, we were interested in whether small-for-gestational age male and female neonates at term presented with different patterns of neonatal complications.

Methods: Data on all term singleton deliveries and respective neonatal outcomes between 2004 and 2008 at a single tertiary medical center were utilized for this retrospective cohort study. Immediate neurological complications were defined as one or more of the following: intraventricular hemorrhage, convulsions, asphyxia and acidosis. Neonatal complications were compared between male and female term infants, as well as male and female term small-for-gestational age (SGA) neonates.

Results: 37?342 singleton neonates were born ≥37 weeks’ gestation. 19?112 neonates were males. Birth weight, cesarean sections and operative deliveries were significantly higher for males. Neonatal hypoglycemia and immediate neurological complications were significantly more frequent in males. For term SGA’s, low 5-min apgar scores (<7) at 39–40 weeks were 2.65 times higher for males compared with females, as was hypoglycemia.

Conclusions: Male infants at term, especially male SGA infants, are more likely to encounter complications during labor and require special neonatal care due to metabolic and/or neurological complications.