Neurobehavioural assessment of newborns

Twenty-one full term appropriate for gestational age (FT-AGA), 18 full term small for gestational age (FT-SGA), 18 preterm appropriate for gestational age (PT-AGA) and 15 babies who suffered birth anoxia constituted study subjects. They were subjected to neurobehavioural assessment using Brazelton neurobehaviour assessment scale. FT-SGA babies performed significantly poorly on motor and interactive processes only. No differences were found in terms of overall state organisation. PT-AGA also performed poorly on interactive and motor processes but were placed better than SGA babies. Here also no definite pattern was observed in organisational dimension. No significant effect of asphyxia on behavioural pattern of FT-AGA babies was observed when compared to FT-AGA non-anoxic babies.     

H-reflex and motor nerve conduction studies in growth retarded newborn babies

OBJECTIVE: To demonstrate the accelerated postnatal maturation/myelination in growth retarded babies compensating the deficit suffered by them during intrauterine life. METHODS: We studied 16 babies within the first 3 days of birth. These included 6 full term appropriate for gestational age babies (FT AGA) and 10 full term intrauterine growth retarded (FT IUGR). A separate group of 16 babies was examined at 2 months of age. In this group 7 were FT AGA and 9 were FT IUGR at the time of birth. H-reflex latency (HRL), motor nerve conduction velocity (MNCV) and H-reflex excitability (H/M) were measured in the right lower limb. Anthropometric measurements of the babies were also recorded meticulously. All the babies were neurologically normal on clinical evaluation. RESULT: At birth, MNCV was significantly lower in FT IUGR babies compared to FT AGA babies. However at the age of 2 months the MNCV of both FT AGA and FT IUGR was comparable. Other parameters (HRL and H/M) in the IUGR babies were comparable with normal babies both at birth and 2 months of age. In FT IUGR babies crown-heel length and weight was significantly lower than FT AGA babies both at the time of birth and at 2 months of age. CONCLUSION AND SIGNIFICANCE: The findings suggest that FT IUGR babies demonstrate accelerated postnatal peripheral neural maturation. At 2 months of age, the motor nerve conduction velocity of these growth retarded babies was comparable to that observed in normal AGA babies of similar age. This provides an insight into the functional aspect of the proven theories of decreased peripheral myelination in FT IUGR babies with subsequent rapid postnatal myelination that renders these babies neurologically equivalent to FT AGA babies despite not achieving comparable anthropometric parameters.     

Fetal macrosomia related to maternal poorly controlled type 1 diabetes strongly impairs serum lipoprotein concentrations and composition

AIMS: To determine the effects of fetal macrosomia related to maternal type 1 diabetes on the lipid transport system. METHODS: Serum lipoprotein concentrations and composition and lecithin:cholesterol acyltransferase (LCAT) activity were investigated in macrosomic newborns (mean birth weight, 4650 g; SEM, 90) and their mothers with poorly controlled type 1 diabetes, in appropriate for gestational age newborns (mean birth weight, 3616 g; SEM, 68) and their mothers with well controlled type 1 diabetes, and macrosomic (mean birth weight, 4555 g; SEM, 86) or appropriate for gestational age (mean birth weight, 3290 g; SEM, 45) newborns and their healthy mothers. RESULTS: In mothers with well controlled type 1 diabetes, serum lipids, apolipoproteins, and lipoproteins were comparable with those of healthy mothers. Similarly, in their infants, these parameters did not differ from those of appropriate for gestational age newborns. Serum triglyceride, very low density lipoprotein (VLDL), apolipoprotein B100 (apo B100), and high density lipoprotein (HDL) triglyceride concentrations were higher, whereas serum apo A-I and HDL3 concentrations were lower in mothers with diabetes and poor glycaemic control than in healthy mothers. Their macrosomic newborns had higher concentrations in all serum lipids and lipoproteins, with high apo A-I and apo B100 values compared with appropriate for gestational age newborns. In macrosomic infants of healthy mothers, there were no significant differences in lipoprotein profiles compared with those of appropriate for gestational age infants. LCAT activity was similar in both groups of mothers and newborns. CONCLUSION: Poorly controlled maternal type 1 diabetes and fetal macrosomia were associated with lipoprotein abnormalities. Macrosomic lipoprotein profiles related to poor metabolic control of type 1 diabetes appear to have implications for later metabolic diseases.     

Narcotic addiction: the expectant mother and her baby

In a retrospective study of the period 1982-1985, the records of 29 narcotic-addicted mothers and their 42 babies were reviewed. All mothers were from socially deprived backgrounds, had a poor record of ante-natal attendance and had frequent admissions to hospital. Thirteen mothers had a past history of hepatitis B and four were HBsAg positive. The babies had significantly lower mean gestational age and mean birth weight than the control group. Features of withdrawal were recorded in 84% of babies where a history was available. A high incidence of twins (10.5%) was also observed. Testing for HIV antibody in more recent cases has revealed positive results in seven mothers and three babies; one infant has since died from acquired immune deficiency syndrome.     

Antioxidant status and circulating lipids are altered in human gestational diabetes and macrosomia

Fetuses from mothers with gestational diabetes are at increased risk of developing neonatal macrosomia and oxidative stress. We investigated the modulation of antioxidant status and circulating lipids in gestational diabetic mothers and their macrosomic babies and in healthy age-matched pregnant women and their newborns. The serum antioxidant status was assessed by employing anti-radical resistance kit (KRL; Kirial International SA, Couternon, France) and determining levels of vitamin A, C, and E and the activity of superoxide dismutase (SOD). Circulating serum lipids were quantified, and lipid peroxidation was measured as the concentrations of serum thiobarbituric acid-reactive substances (TBARS). As compared with non-diabetic mothers, gestational diabetic women exhibited decreased levels of vitamin E and enhanced concentrations of vitamin C without any changes in vitamin A. Vitamin A and C levels did not change in macrosomic babies except vitamin E whose levels were lower in these infants than in the newborns of non-diabetic mothers. Gestational diabetes mellitus (GDM) and macrosomia were also associated with impaired SOD activities and enhanced TBARS levels. Globally, total serum antioxidant defense status in diabetic mothers and their macrosomic babies was diminished as compared with control subjects. Triglyceride and cholesterol concentrations did not differ significantly between gestational diabetic and control mothers; however, macrosomia was associated with enhanced plasma cholesterol and triglyceride levels. These results suggest that human GDM and macrosomia are associated with downregulation of antioxidant status, and macrosomic infants also exhibit altered lipid metabolism.     

Lower whole blood ionized magnesium concentrations in hypocalcemic infants of gestational diabetic mothers.

Infants of insulin dependent (class B and above) diabetic mothers (IDM's) have a high rate of neonatal hypocalcemia (NHC) and hypomagnesemia. We carried out this study to test the hypotheses that: (1) infants of gestational diabetic (class A) mothers (IGDM's) are also at risk for NHC and (2) NHC in IGDM's relates to decreased whole blood Mg(2+) concentration. Thirty one term infants born to gestational diabetic mothers of classes A1 (diet controlled, n = 23) and A2 (requiring insulin, n = 8) of White's classification, were compared at 24 +/- 2 hours of age to 32 healthy, appropriate for gestational age controls, born after uncomplicated pregnancy, labor and delivery. Whole blood Mg(2+) and Ca(2+) were measured using an ion-specific electrode (Nova 8, Nova biomedical, Waltham, MA). The rate of NHC was higher in the IGDM group as compared to the control group (9 out of 31 [29%] vs. 1 out of 32 [3.1%] infants; p < 0.01). Whole blood Mg(2+) was lower in the IGDM group than in controls (p < 0.05). In multiple regression analysis, when Ca(2+) was used as the dependent variable and Mg(2+), diabetes class, gestational age, macrosomia and one minute Apgar scores were the independent variables, only Mg(2+) and diabetes class were significant (R2 = 0.4374; p < 0.01). Our results are consistent with the theory that Mg deficiency plays a role in NHC encountered in IGDM's, similar to what occurs in infants of insulin-dependent diabetic mothers.     

Median nerve F wave conduction in healthy subjects over age sixty-five

Parameters of the median nerve F wave and peripheral motor nerve conduction in 51 healthy male and female human subjects 67 to 89 years of age are described. F wave responses were elicited by stimulation of the nerve at the wrist. Motor nerve conduction velocity (MNCV) was determined for the forearm segment. Major results of this study of an older group of subjects demonstrate that: 1) the shortest F wave latency (SFWL) and the MNCV were slower in our older subjects than values in younger subjects; 2) there was no significant correlation between SFWL and age within the age group examined; 3) distal motor conduction latency was significantly slower in subjects age 75-89 years than in those age 67-74 years; 4) SFWL and MNCV of females were significantly faster than that of males; 5) a positive correlation was found between SFWL and arm length and a predictive formula is derived. An upper limit of normal F wave wrist latency of 31 msec for females and 34.4 msec for males over 65 years of age is proposed as a guideline.     

Ethnic and environmental factors affecting fetal growth in Papua New Guinea

We studied 738 live singleton births in Papua New Guinea to examine the contribution of ethnic origin and environmental factors to birth weight and gestation. Maternal history, examination and post-partum anthropometry, infant anthropometry and clinical gestational assessment were performed, and placental blood slides and histology were examined. Mothers from Highlands provinces who delivered on the coast had larger babies (mean birthweight 3.34 SD 0.48 kg) than either indigenous coastal mothers (mean 3.10 SD 0.51 kg) or those migrating to Port Moresby from other coastal regions (mean 3.14 SD 0.51 kg). This was due to a combination of longer gestation and better intrauterine growth (assessed by birthweight standard deviation scores). Gestation was slightly longer in Highlands mothers delivering on the coast compared with those delivering in the Highlands, but birthweight standard deviation scores were unchanged. Malarial infection of the placenta was almost never found. Stepwise regression analysis showed that parity, maternal height, Highlands origin and maternal body mass index (weight/height2) were all significant predictors of birthweight standard deviation score, while maternal body mass index and Highlands origin were predictors of gestational length. We conclude that Highland mothers have a tendency to deliver heavier babies, and do not demonstrate the fetal growth-retarding effects of altitude seen in other races. Although the incidence of low birthweight was only 7.1% in our study, we found that indices of maternal nutrition were predictors of birth weight.     

Markers of hepatitis-viral infection in children born of mothers with hepatitis B

Sixty-two women suffering from hepatitis B (HB) and their newborn babies were examined by a highly sensitive radioimmunoassay (RIA). The fluorescent antibody technique was also used to examine autopsy specimens of livers of 7 fetuses, 1 stillborn, and 3 babies dying in the first days of life whose mothers during pregnancy or delivery had experienced HB. Frequent infection of babies (77.8%) was observed at high concentrations of HBsAg in mothers in labor with subsequent development of persisting HBs-antigenemia, and in half of the babies of chronic hepatitis. HBsAg was detected in the first days of life not only in the blood serum, but also in the liver tissue which may be explained by intrauterine infection. At low concentrations of HBsAg in mothers the babies were infected less frequently (26.1%) and half of them were shown to have anti-HBs in the umbilical blood and blood serum in the first days and months of life. Anti-HBc transmission from mothers was also demonstrated. In babies born to convalescents after HB in the absence of HBsAg, anti-HBs in combination with anti-HBc were determined.     

Quantitative analysis of HBV DNA level and HBeAg titer in hepatitis B surface antigen positive mothers and their babies: HBeAg passage through the placenta and the rate of decay in babies

It is well documented that perinatal transmission is the major cause of chronic HBV infection in China. However, the mechanisms of HBV perinatal transmission are not defined clearly. It is not known whether hepatitis B e antigen can cross the human placenta, and the rate of HBeAg decay in babies with and without HBV breakthrough has not been studied. In this study, HBV serological markers were investigated in 95 hepatitis B surface antigen positive pregnant women. These markers were also studied in the babies at birth and at the age of 6 months and 12 months. The data show that 7.4% (7/95) children were infected with HBV during the first year after birth despite receiving passive-active immunoprophylaxis with hepatitis B immune globulin and hepatitis B vaccine. The surface gene fragment of HBV DNA was cloned and sequenced following PCR amplification in 7 cases of HBsAg positive babies and their mothers. All babies had the same sequences as their mothers, although two babies also had sequences that would produce an amino acid substitution within the "a" determinant. Furthermore, we measured HBeAg titers and HBV DNA levels by using Abbott AxSYM system and LightCycler-based real-time fluorescence quantitative PCR in 54 mother-infant pairs. Thirty-three mothers were HBeAg positive, and 21 mothers were HBeAg negative. Seventy percent (23/33) of neonates from HBeAg-positive mothers were HBeAg positive at birth compared with 0% (0/21) of neonates from HBeAg negative mothers. HBeAg was present at higher titer in the birth sera of the babies with HBV breakthrough than in babies without breakthrough. HBeAg was cleared from the serum in all 19 babies without breakthrough. In 17 of these 19 babies, the HBeAg was cleared within 6 months, and in two babies clearance took 12 months. The mean serum HBV DNA level in the mothers of the 4 infants with HBV breakthrough was significantly higher than in the mothers of babies who did not become infected. In conclusion, this data suggests that HBeAg can cross the human placenta, and disappears from serum within 6 months in most babies. HBV DNA levels in hepatitis B carrier mothers are associated with the failure of HBIG and vaccine immunization, and the additional influence of transmitted HBeAg cannot be excluded.     

In vitro modulation of lymphocyte responses to phytohaemagglutinin by plasma in mother and baby at the time of birth. Increased lymphocyte responses in babies of mothers with lepromatous leprosy.

Peripheral blood lymphocytes from nineteen healthy mothers, mothers with borderline tuberculoid leprosy and fourteen mothers with borderline or polar lepromatous leprosy, and their newborn babies, were stimulated in vitro with phytohaemagglutinin (PHA). The responses in medium supplemented by serum from a pool of healthy non-pregnant individuals were compared with responses in medium supplemented by plasma from the mothers or from their babies, to assay for the presence of non-specific effects on T-cell responses. It was found that plasma from the mothers at the time of labour profoundly suppressed their own lymphocyte responses to PHA. However, the lymphocyte responses of healthy mothers were not significantly suppressed when cultivated in the presence of plasma from the babies, indicating that the suppressive factor(s) of normal pregnancy did not pass the placental barrier. Plasma from mothers with leprosy had a greater inhibitory effect on their babies' lymphocytes than plasma from healthy mothers. This raises the possibility that plasma from leprosy patients contains suppressive factors other than those associated with pregnancy. Babies of lepromatous leprosy mothers, who might have been exposed to mycobacterial antigens in utero, had higher PHA responses than the other babies, possibly due to a compensatory reaction to early stresses in the immune system.     

广西百色地区475例壮族正常胎儿身长顶臀长的测量分析

本文对百色地区11-38周的475例正常胎儿身长和顶臀长进行测量。数据经统计学处理。结果表明,胎儿身长和顶臀长均随胎龄增长而增大,但不同胎龄存在着生长速度上的差异。本组数据与合肥地区的数据比较,在5个月前明显偏小(P<0.01),6个月后(除第8个月外)基本相同(P>0.05)。     

The IgE and IgG subclass antibody response to foods in babies during the first year of life and their relationship to feeding regimen and the development of food allergy

This follow-up study of 191 babies investigated the development of food allergy in an unselected population and its relationship to total and antigen-specific IgE and IgG subclass levels. Sensitization to egg, as indicated by a positive skin test or RAST, was found in 5% of 1-year-old babies, but none of the babies in this series fulfilled the clinical criteria for immediate-type milk allergy. For both bovine casein (CAS) and egg albumin, the IgG response was largely restricted to IgG1 in contrast to the predominant IgG4 response to these antigens that is found in adults. The level of IgG4, but not IgG1, antibody to CAS and ovalbumin (OV) was lower in some of the babies compared with that of their mothers (N = 166; p less than 0.05, Student's paired t test). However, there was no difference in the total serum IgG subclass levels between mothers and babies. These results demonstrate that, in the population of babies studied, (1) type I hypersensitivity to egg occurred in 5% of 1-year-old babies, (2) the predominant IgG subclass of antibodies to CAS and OV in babies is IgG1, and (3) in the 22% of babies, there was substantially (greater than 1000-fold) less IgG4 antibody to CAS and OV than in their mothers, suggesting specific exclusion of some IgG4 antibodies.     

孕中晚期正常胎儿颈椎长度与胎龄关系的磁共振研究

目的　研究正常胎儿标本颈椎长度与孕周变化的关系,绘制正常胎儿脊柱长度生长曲线。 方法　本研究为前瞻性研究,利用3.0T MR扫描仪对65例16~42周自然流产及因母体或胎儿因素引产的胎儿标本行全脊柱3D-T2WI序列扫描,对所得图像进行三方位重建,在正中矢状位上测量颈椎长度及C4椎体的高度,建立相关线性回归方程。 结果　胎儿颈椎长度及C4椎体高度与孕周的线性回归方程分别为：颈椎长度（cm）=0.193＋0.117孕周,R2 =0.94 ,P<0.05;C4椎体高度（cm）=0.025+0.013孕周,R2 =0.94,P<0.05。颈段脊柱发育有着时间的不平衡性,在生长发育过程中有两个发育高峰,分别为23~26孕周及31~34孕周;同样在这两个高峰,椎体高度增长速度较快。 结论　孕中晚期,胎儿颈椎长度的增加与胎龄呈良好相关性,椎体的相关径线是评估胎儿脊椎发育的可靠指标。     

Maternal and fetal outcome of gestational diabetes mellitus in Mulago Hospital, Uganda

Objective

To determine the maternal and foetal outcomes in mothers with gestational diabetes mellitus attending antenatal clinics in Mulago Hospital Kampala Uganda.

Design

This was a cohort study.

Setting

Mulago Hospital antenatal clinics.

Participants

Ninety mothers with gestational ages between 24–32 weeks were recruited from April to September 2001.They were followed up to the time of delivery. The WHO criterion for the diagnosis of gestational diabetes was used. Thirty mothers with a 2 hrs post prandial capillary blood sugar more than 140 mg/dl were the exposed group and 60 mothers with less than 140 mg/dl were the unexposed group. Blood sugar was measured using a one touch glucometer.

Outcome variables

Socio demographic characteristics, maternal complications, mode of delivery and the foetal outcomes.

Results

The mean age of mothers in both groups was similar: 28.6 years vs 27.5 years. Both groups had similar body mass index more than 26. The mothers with gestational diabetes mellitus (GDM) were four times more likely to have hypertensive disease(p=0.04) and nine times more likely to have vaginal candidiasis(p=0.002).The modes of delivery were similar in both groups but genital injuries were more common among mothers with GDM. The indications of Caesarian section in mothers with GDM were two times more likely to be due to big babies and obstructed labour. The babies for mothers with GDM were more likely to be macrocosmic, still born, and have shoulder dystocia than those of normal mothers.

Conclusion

Gestational diabetes mellitus exists in Uganda and is associated with adverse maternal and foetal outcomes. There is need to routinely screen mothers for gestational diabetes in this environment.     

Risks of preterm delivery and association with maternal age, birth order, and fetal gender.

The risk of preterm delivery in a recent sample (1990-1994) of Italian liveborns was examined, taking into account child birth order, and maternal age and education in addition to the fetal gender. Univariate analyses showed that a higher risk was associated with male than female babies, with first- than second-born children, with older mothers, and with less educated mothers. The relative weights of the factors examined were evaluated through logistic regression analyses and the highest and the lowest risks were found to be associated with advanced maternal age and male fetal gender respectively. Our findings therefore suggest that biological factors associated more with advanced maternal age than with the male gender of the fetus may influence premature onset of labour.     

Prognosis of neonates in pregnant women with systemic lupus erythematosus

PURPOSE: The effects of maternal systemic lupus erythematosus (SLE) on neonatal prognosis were examined by comparing clinical features of full-term babies born to lupus mothers and age- and parity-matched controls. PATIENTS AND METHODS: From January 2000 to December 2005, 39 singletons were born to 37 SLE women. Excluding 11 cases of prematurity and preeclampsia, 28 full-term neonates formed the lupus group. The control group included 66 full-term babies. The retrospective study examined medical records and compared gestational age, birth weight, days of hospital stay, small for gestational age (SGA) frequency, Apgar scores < 7, and parity. Lupus neonates were tested for anti-nuclear antibody (ANA) and platelet count, and electrocardiogram was performed. RESULTS: Average gestational age (38 vs. 39 weeks, p < 0.05) and birth weight (2,775 vs. 3,263g, p < 0.05) were significantly different between the SLE and control groups. SGA frequency was higher in the SLE group (25% vs. 4.5%, p < 0.05). No significant difference was observed in Apgar score, birth weight, gestational age, SGA frequency, and platelet count between lupus subgroups formed based on anti-dsDNA antibody levels and antiphospholipid antibody status. CONCLUSION: The association of maternal ANAs, antiphospholipid antibodies, and drug history with neonatal prognosis could not be elucidated. However, even in uncomplicated pregnancies, maternal lupus is disadvantageous for gestational age, birth weight, and SGA frequency.     

Usefulness of tissue transglutaminase type 2 antibodies in early pregnancy

Celiac disease (CD), an autoimmune disease triggered by dietary gluten, is a multi-systemic disorder that primarily results in mucosal damage of the small intestine. Reproductive disorders and pregnancy complications have been associated with CD. Conflicting results have been published concerning CD and the risk of impaired fetal growth with reduced birthweight. The aim of our multicentric, perspective, case–control study was to determine the prevalence of undiagnosed CD in mothers of small for gestational age (SGA) newborns in two regions of Italy. The study included 480 mothers: group A consisted of 284 SGA newborns’ mothers and group B consisted of 196 appropriate for gestational age (AGA) newborns’ mothers. Tissue transglutaminase type 2 antibodies (TG2) IgA and IgG were measured in blood samples. We diagnosed two new cases of CD in asymptomatic mothers. It may be appropriate to include the TG2 to the panel of prenatal blood test.     

Oral zinc therapy in diabetic neuropathy

The present double blind randomized study was conducted on 50 subjects; 20 age and sex matched healthy controls (Group--I); 15 patients of diabetes mellitus with neuropathy who received placebo for 6 weeks (Group--IIA); and 15 patients of diabetes mellitus with neuropathy who were given supplemental zinc sulphate (660 mg) for 6 weeks (Group--IIB). Serum zinc level, fasting blood sugar (FBS) and post prandial blood sugar (PPBS) levels and motor nerve conduction velocity (MNCV) were estimated on day 0 and after 6 weeks in all subjects. Serum zinc levels were significantly low (p < 0.001) in group IIA and IIB as compared to healthy controls (Group--I) at baseline. After 6 weeks the change in pre and post therapy values of FBS, PPBS and MNCV (median and common peroneal nerve) were highly significant (P = < 0.001) for group IIB alone with insignificant change (P = > 0.05) in group IIA. No improvement (P = > 0.05) in autonomic dysfunction was observed in either groups. Therefore, oral zinc supplementation helps in achieving better glycemic control and improvement in severity of peripheral neuropathy as assessed by MNCV.     

Oxygen consumption in normally grown, small-for-dates and large-for-dates new-born infants

1. Serial measurements of minimal oxygen consumption (V(O2)) have been obtained from nineteen healthy new-born infants in order to find out how body weight, gestational age and age after birth affected V(O2). The first measurement of V(O2) was done within 12 hr of birth, and further measurements were made at intervals until the baby left hospital.2. The majority of the infants (seventeen) weighed less than 2.5 kg at birth, and were ;premature' according to international definition. Gestational age, calculated from the mother's last menstrual period, was corroborated by clinical data and obstetrical history. The babies were divided into four groups according to birth weight and gestational age combined (see Table 1). Babies in the first two groups were the appropriate weight for dates (i.e. normally grown), babies in the other two groups were either small-for-dates or large-for-dates.3. At birth minimal V(O2) was closely correlated with birth weight in all babies and appeared to be directly proportional to it. The value for V(O2)/kg was similar in all groups. V(O2) was not related to gestational age per se. However, in the two normally grown groups V(O2) was roughly related to gestational age because birth weight was related to gestational age.4. In all babies minimal V(O2) rose progressively with increasing age after birth; a marked increase in V(O2) occured in the first week of life, despite a small decline in body weight.5. At a given age after birth differences in V(O2)/kg between the four groups were mostly less than 10%, and in general the differences were not statistically significant.Values for minimal V(O2) in all four groups were roughly:5 ml. O(2)/kg.min at < 12 hr of age.7 ml. O(2)/kg.min at 7-14 days of age.9 ml. O(3)/kg.min at about 2 months of age.6. It is concluded that:(a) At birth minimal V(O2) is largely determined by birth weight. V(O2)/kg is little affected by either rate of growth in utero or gestational age.(b) Minimal V(O2) is a function of age after birth as well as of body weight, and the value for V(O2)/kg increases as the baby gets older.