Granulocyte-colony stimulating factor levels in cord blood and neonatal peripheral blood

We measured the granulocyte-colony stimulating factor (G-CSF) levels in cord blood and peripheral blood obtained from full-term or pre-term infants during the first 3 days of birth. The mean G-CSF level among cord blood (17.2pg/mL) was similar to that of peripheral blood on day 0 (18.3 pg/mL) and day 1 (13.6 pg/mL), while that of peripheral blood on day 0 was significantly higher than on day 2 (10.9 pg/mL) and day 3 (8.8 pg/mL; both P < 0.05). There was no correlation between neutrophil counts and G-CSF levels. No difference was found in neutrophil counts or G-CSF levels between infants who weighed more or less than 2500 g at birth. These results suggest that the neonatal neutrophil count depends on regulatory factors other than G-CSF.     

缺氧缺血性心肌损伤新生儿血浆心肌营养素-1的变化及意义

目的 观察血浆心肌营养素-1(CT-1)在新生儿缺氧缺血性脑病(HIE)合并心肌损伤中的变化及临床意义.方法 选择HIE患儿45例(轻度15例、中度24例、重度6例)为观察组,根据有无心肌损伤分为心肌损伤组(19例)和无心肌损伤(26例)两个亚组.20例正常新生儿为对照组.采用双抗体夹心酶标免疫分析法检测血浆CT-1水平.同时检测血清肌酸激酶同工酶(CK-MB)和心肌肌钙蛋白I(CTnI)水平.结果 轻度、中/重度HIE组血浆 CT-1水平分别为169±20、287±44 pg/mL,均 高于对照组(30±8 pg/mL)(P<0.01),且中/重度HIE组高于轻度HIE组(P<0.01).HIE患儿急性期血浆CT-1水平与血清CK-MB、CTnI均呈显著正相关(r分别为0.565、0.621,均P<0.01).心肌损伤亚组血浆CT-1水平较非心肌损伤亚组升高(249±35 pg/mL vs 177±26 pg/mL;P<0.01).心肌损伤亚组急性期血浆CT-1水平(249±35 pg/mL)明显高于恢复期(157±19 pg/mL)(P<0.01).结论 检测HIE患儿血浆CT-1水平有助于HIE新生儿心肌损伤的诊断,且有助于判断HIE病情.     

Serum Vitamin B12 and Folate Concentrations and the Effect of the Mediterranean Diet on Vulnerable Populations

Low vitamin B12 and folate levels in expectant mothers may lead to low stores in babies. The aim of this study was to determine the frequencies of vitamin B12 and folate deficiencies in pregnant women and neonates, and to assess the effect of maternal vitamin status on babies’ vitamin levels in the Aegean region of Turkey, where the Mediterranean diet (mainly fresh fruits and vegetables) is adopted. We studied 72 pregnant women and their singleton-term babies. Venous blood samples of expectant mothers were collected 1 h before delivery and cord blood of babies were obtained at birth. The mean vitamin B12 in maternal and cord blood serum was 163.1 ± 72.0 pg/mL and 146.2 ± 102.5 pg/mL, and the mean folate, 9.8 ± 4.8 ng/mL and 15.8 ± 3.8 ng/mL, respectively. There were statistically significant correlation between maternal and cord blood serum vitamin B12 (r = 0.61, P = .04) and folate levels (r = 0.65, P < .001). 70.8% of the mothers and 83.9% of the babies were vitamin B12 deficient (<200 pg/mL). Neither group showed folate deficiency. The mean level of vitamin B12 in mothers significantly varied by the type of diet (241.6 (72.1) pg/mL versus 155.9 (68.2) pg/mL; P = .012). Vitamin B12 deficiency in pregnant women and neonates may be a public health problem in our community. The Mediterranean diet in these vulnerable groups may be an aggravating factor for vitamin B12 deficiency. Prenatal screening of all expectant mothers, prenatal supplementation of vitamin B12, and an increase in animal-source food intake may improve expectant mother's vitamin B12 level.     

Granulocyte colony-stimulating factor receptor expression on neutrophils of term and preterm neonates with and without signs of infection

Neutrophils are an essential component of the human host defence system against infection. Recombinant human granulocyte colony-stimulating factor induces neutrophilia and enhances effector functions of mature neutrophils. Since the biological effects of granulocyte colony-stimulating factor (G-CSF) are mediated by its receptor, we investigated the expression of G-CSF receptor on the surface of neutrophils of term and preterm neonates (n = 22) with and without signs of infection and of healthy adults (n = 13) by flow cytometry. In healthy adults, the percentage of neutrophils expressing G-CSF receptor was higher compared to cord blood of term and preterm neonates (87% vs 53%, P < 0.05). Between 2 and 32 h of life, neonates with signs of infection showed lower values of G-CSF receptor expression compared to neonates without signs of infection (32% vs 54%, P < 0.05). No correlation was detectable between expression of G-CSF receptor and gestational age. Conclusion Expression of granulocyte colony-stimulating factor receptor on neutrophils is lower than in adults. This may adversely affect granulopoiesis and neutrophil function during the neonatal period. Moreover, granulocyte colony-stimulating factor receptor expression seems to be down-regulated during neonatal infection. Received: 8 June 1998 / Accepted in revised form: 13 October 1998     

Increased macrophage-colony stimulating factor levels in neonates with perinatal complications

Objective: To examine whether perinatal complications induce the production of macrophage-colony stimulating factor (M-CSF), we have compared M-CSF levels in the cord blood between normal neonates and neonates with complications. Methods: The M-CSF levels were determined by enzyme-linked immunosorbent assay (ELISA). Results: In 54 normal neonates, the M-CSF level was 1859±287 U/ml (mean±S.D.), being significantly higher than the serum M-CSF level in normal adults (697±132 U/ml). Compared with the M-CSF levels in normal neonates, significantly higher levels were evidenced in neonates with perinatal complications including premature rupture of the membranes, neonatal asphyxia, meconium staining of the amniotic fluid and maternal anemia. However, no difference in M-CSF concentrations was observed irrespective of complication types; furthermore, the M-CSF level was highly correlated with the leukocyte counts in the neonates with complications, but not in normal neonates. Incidentally, CRP levels were within normal limits in most of these neonates. Conclusion: M-CSF levels in the cord blood from neonates with premature rupture of the membranes, neonatal asphyxia, meconium staining of the amniotic fluid and maternal anemia were significantly higher than those in the cord blood sampled from normal neonates. The stress given to neonates may account for the higher M-CSF levels rather than infections.     

Plasma RANTES increase during the first month of life independently of the feeding mode

The chemokine RANTES (regulated upon activation, normal T cell expressed and secreted) plays a significant role in the innate immunity, which is particularly important in the neonatal period. In this study, we aimed to investigate the ability of the neonate to increase plasma levels of RANTES in the first month of life, and the possible impact of breast feeding on this ability. The study population consisted of 125 healthy term neonates that were exclusively breast-fed (n = 62) or formula-fed (n = 63) for at least 1 month after birth. Plasma RANTES concentrations (ELISA) as well as circulating leukocytes and platelets were measured on days 1 and 30 of life. Median RANTES concentrations of the total group showed a significant increase between day 1 [1000 (448–2100) pg/mL] and day 30 [3688 (1488–5400) pg/mL, p < 0.0001], as did median total lymphocyte, T-cell, B-cell, NK-cell and eosinophil counts (all p values <0.0001). Monocyte and platelet counts did not change significantly over the neonatal period. Further analysis according to the mode of feeding showed that RANTES levels as well as leukocyte populations and platelet counts did not differ significantly between breast-fed and formula-fed neonates on either day 1 or 30. Healthy term neonates are capable of increasing plasma RANTES levels during the 1st month after birth independently of the mode of feeding.     

Plasma vascular endothelial growth factor level is a predictor of the severity of postoperative capillary leak syndrome in neonates undergoing cardiopulmonary bypass

 Capillary leak syndrome (CLS), characterized by extravascular fluid accumulation and significant organ dysfunction, is a serious complication in children undergoing cardiopulmonary bypass (CPB). We examined the relationship between plasma vascular endothelial growth factor (VEGF) levels and severity of CLS. The kinetics of VEGF in the plasma of 11 neonates and 7 older children undergoing CPB were investigated, correlating plasma VEGF levels and CLS clinical presentation. The degree of postoperative CLS was quantified by measuring parameters of extracellular volume and end-organ dysfunction. A chest-wall soft-tissue-width index (CSTWI) was designed in order to standardize the extracellular fluid accumulation. Most CLS parameters were significantly more prominent in the neonatal patients. Low plasma VEFG levels (>35 pg/ml) were found in 3 neonatal control patients and all but, sample from the older group patient. The neonates had significantly higher preoperative VEGF plasma levels (684.4 ± 559.1 pg/ml, P = 0.02), which decreased during the operation to levels below 35 pg/ml and increased again 24 h postoperatively to levels significantly higher than in the older patients (484 ± 270.3 pg/ml, P = 0.001). Multilinear regression analysis found preoperative VEGF levels to independently correlate with CLS as represented by CSTWI (P < 0.01, r = 0.726). Both the occurrence of post-CPB CLS and plasma VEGF levels pre- and postoperatively were thus higher in neonates than in children. Plasma VEGF level is a predictor of the severity of postoperative CLS. Accepted: 1 March 2000     

Color of Meconium and Interleukin-6

Objective

To test the hypothesis that the color of meconial fluid is associated with inflammatory biomarkers, by determining C-reactive protein (CRP) and Interleukin-6 (IL-6) in serum from the umbilical cord.

Methods

In this prospective study, the authors selected 30 newborns with meconium-stained amniotic fluid (MSAF): 14 with green/brown 656 R color and 16 with brown/cinnamon 654 R color, and 20 newborns which showed clear amniotic fluid without MSAF (non-MSAF); all newborns were from mothers without risk factors for neonatal sepsis.

Results

IL-6 concentration from umbilical cord blood, [median of 12.9?pg/mL (interquartile range {IQR} 8.7?C31.0)] of MSAF-green/brown 656 R increased significantly (p?<?0.05) when compared with IL-6 concentration, [median of 9.2?pg/mL (IQR 7.2?C12.2)] of newborns with clear amniotic fluid and without meconium. CRP from MSAF-green/brown 656 R was median of 0.5?mg/mL (IQR 0.0?C2.7), and median of 1.0?mg/mL (IQR 0.0?C5.5) from clear amniotic fluid, without meconium.

Conclusions

Significant association was found between MSAF-green/brown 656 R and increase in IL-6, with normal CRP values.     

Cord blood thyroid stimulating hormone level — interpretation in light of perinatal factors

Objectives

To study the influence of perinatal factors on cord blood TSH (CB TSH) levels.

Design

Cross-sectional study.

Setting

Tertiary care private hospital.

Methods

CB TSH levels were measured in 952 live-born infants using electrochemiluminescence immunoassay. The effect of perinatal factors on the CB TSH levels was analyzed statistically.

Results

The median CB-TSH was 8.75 microIU/mL (IQR = 6.475–12.82) with 11.5% neonates having values more than 20. CB TSH was significantly raised in first order neonates (P <0.01) and in babies delivered by assisted vaginal delivery and normal delivery (P <0.01). Neonates who had fetal distress or nonprogress of labour had significantly higher CB TSH than those who were delivered by elective caesarean section. Requirement of resuscitation beyond the initial steps and low Apgar scores at 1 minute also resulted in significantly raised CB TSH (both P <0.01). Maternal hypothyroidism, maternal hypertension and neonates’ weight appropriateness for gestation, gestational age and birth weight did not have significant effect.

Conclusions

The incidence of high cord blood TSH (>20 microU/mL) is 11.45%. On multivariate analysis, requirement of resuscitation, mode of delivery and fetal distress as indication for LSCS were significant factors affecting CB TSH values. Hence, these values need to be interpreted in light of perinatal factors.     

Do neonates with high serum cholesterol levels have a different high density lipoprotein composition?

In order to ascertain whether the high density lipoprotein (HDL) composition of neonates with high serum cholesterol levels (≥2.59 mmol/l or ≥100 mg/dl) differs from that of neonates with normal serum cholesterol levels (<2.59 mmol/l), 548 cord blood samples were examined from full-term newborns of the Toledo Study (Spain) of whom no perinatal factors were known which could alter cord blood lipid levels. Newborns were selected according to the following criteria: single and eutocic delivery with cephalic presentation, gestational age between the beginning of the 37th week and the end of the 41st week, body weight between 2.5 kg and 3.999 kg and an Apgar score of ≥7 and ≥9 at l min and 5 min, respectively. The prevalence of high serum total cholesterol (TC) level was greater (P < 0.02) in females than in males. Newborns with high TC levels had higher triglyceride (P < 0.01), HDL-cholesterol (P < 0.001) and apoprotein (Apo) A-I (P < 0.001) levels, and a higher TC/HDL-cholesterol ratio (P < 0.05), but a lower HDL-cholesterol/Apo A-I ratio (P < 0.05). ANOVA two-way analysis showed a significant effect of gender and serum cholesterol level and a statistical interaction of these two factors upon triglycerides, Apo A-I, and the HDL-cholesterol/Apo A-I ratio. However, HDL-cholesterol and the TC/HDL-cholesterol ratio were higher in neonates (males plus females) with high serum TC but they were not affected by sex. The larger HDL particles in males with high TC levels (HM) should be associated with the higher triglyceride level found in those individuals. Conclusion The composition of high density lipoproteins in newborns is influenced by the serum cholesterol level and by gender. Neonates with high total cholesterol have larger average high density lipoprotein (HDL) particles. If total cholesterol is elevated, HDL from males carries more cholesterol than HDL from females. Received: 26 November 1996 / Accepted: 7 January 1997     

Cord blood thyroid‐stimulating hormone and free T4 levels in Turkish neonates: Is iodine deficiency still a continuing problem?

Background: The objectives of this study were to determine the cord blood thyroid‐stimulating hormone (TSH) and free T₄ (FT₄) levels in Turkish neonates and to determine whether these variables reveal iodine deficiency. Methods: We collected 818 cords from healthy mothers at parturition and measured levels of FT₄ and TSH. We also measured cord blood FT₄ and TSH levels in different stages of gestation and gender. We grouped the neonates according to cord serum TSH levels, either being less (Group A) or greater (Group B) than 10 mIU/L. Group A included 589 neonates (300 girls [51%] and 289 boys [49%]) and Group B included 229 neonates (105 girls [45%] and 124 boys [55%]). Results: The percentage of subjects with cord blood TSH < 10 mIU/L and >10 mIU/L was 72% and 28%, respectively. Although cord TSH levels in Group B were greater than those in Group A (P < 0.001), cord blood FT₄ levels in Group B were lower than those in Group A (P < 0.05). There was no difference between both sex in terms of birthweight and maternal age. TSH and FT₄ levels did not vary according to neonate sex during gestation, except for from week 37 to 41. TSH levels of male neonates at the 41st week of gestation were higher than those of female neonates (P < 0.05). There were no effects of birthweight on TSH and FT₄ levels if the neonate was lighter than 2500 g at birth. TSH levels of male neonates were higher than those of female neonates when their birthweights were <2500 g (P < 0.05). There was no significant difference in TSH levels according to birthweights in male neonates. Conclusion: Our data provide the normative data for cord blood TSH and FT₄ levels in Turkish neonates and show that iodine deficiency is a still a public health problem in Turkey. These measurements can be useful for detection and verification of hypothyroidism in a screening program for congenital hypothyroidism as well as evaluation of the success of the iodination program.     

The relation between delivery type and tau protein levels in cord blood

Background: The perinatal morbidity risk is higher in operative deliveries than normal vaginal deliveries. ‘Tau protein’ is a cytoskeletal component that is predominantly expressed in axons of neurons. The aim of this study was to investigate whether delivery type, particularly the forceps application, had any effect on cord blood tau levels. Methods: Ninety babies born in the Division of Maternal‐Fetal Medicine of Ankara Etlik Maternity and Women's Health Teaching Hospital, Ankara, Turkey were involved in the study. The babies were divided into three groups according to delivery type: Group 1: normal vaginal delivery (NVD); Group 2: caesarean section; Group 3: forceps application. Cord blood samples were drawn from umbilical veins of the babies soon after the birth. Results: The cord blood tau protein levels in the caesarean section group (79 pg/mL [45–223]) were found to be significantly lower than those of NVD (135 pg/mL [44–627]) and forceps (175 pg/mL [17–418]) groups (P= 0.001 and P < 0.001, respectively). Conclusion: We have shown that forceps applications uncomplicated with perinatal asphyxia did not affect the cord blood tau protein level significantly. Tau levels in caesarean section group were significantly lower than the other two groups. Caesarean section in this manner might be considered especially in conditions of risk of perinatal asphyxia to avoid hypoxia.     

Effects of APOA5 S19W polymorphism on growth,insulin sensitivity and lipoproteins in normoweight neonates

Apolipoprotein (Apo) A5 is a protein involved in the activation of lipoprotein lipase (LPL) and the metabolism of triglyceride (TG)-rich lipoproteins. LPL plays a major role in the metabolism of TG-rich lipoproteins, and placental LPL activity is known to correlate positively with foetal fat deposition and size. We examine the association between the common APOA5 S19W polymorphism and neonatal anthropometrical measurements, lipoprotein and hormone concentrations, and insulin sensitivity in 58 normal weight Caucasian newborns from the Mérida cohort. Neonates with the W allele displayed lower BMI (P < 0.001), ponderal index (P < 0.001), birth weight (P < 0.01), insulin levels (P < 0.05), the insulin/cortisol ratio (P < 0.05), HOMA-R (P < 0.05) and Apo B values (P < 0.01), but higher oxidised LDL (LDLox) values and a higher LDLox/low-density lipoprotein (LDL) ratio (both P < 0.05) than S-homozygous newborns. The APOA5 S19W polymorphism was associated with foetal growth as well as with glucose and lipoprotein metabolism in the neonates. Concurrence of the S19W polymorphism in neonates and their mothers did not affect neonatal lipid and lipoprotein concentrations but was associated with impaired foetal growth. Specifically, W allele carriers displayed a higher degree of LDL oxidation and lower body weight, plasma insulin values, insulin/cortisol ratio and Apo B concentrations than homozygotes for the common S allele. In conclusion, these findings suggest that the W allele carriers received a less optimal nutrition during gestation and that their lipoprotein antioxidant status was inferior to that of their homozygous S allele counterparts.     

母婴因素对脐血CD34+造血干/祖细胞的影响

目的 比较不同母婴因素与脐血有核细胞总数及CD34⁺造血干/祖细胞数量的关系,为脐血库合理选择脐血提供参考。方法 前瞻性收集130例2019年6月至2020年1月期间于大连市妇女儿童医疗中心分娩的新生儿脐血标本,男女比例为1：1。收集围生期相关信息：孕母年龄及血型,有/无妊娠糖尿病、妊娠高血压,妊娠方式、分娩方式、单胎/双胎,新生儿体重、性别、生后Apgar评分,以及胎盘、羊水、脐带情况。结果 根据孕母血型、妊娠糖尿病、妊娠高血压、妊娠方式、分娩方式、单胎/双胎,新生儿性别、生后Apgar评分,胎盘形态、羊水胎粪污染、脐带绕颈等情况进行分组,组间比较脐血有核细胞总数及CD34⁺细胞计数差异均无统计学意义（P > 0.05）。孕母年龄、新生儿体重与脐血有核细胞总数无相关性（P > 0.05）,新生儿体重与CD34⁺细胞计数无相关性（P > 0.05）,孕母年龄与CD34⁺细胞计数呈正相关（P < 0.05）。结论 脐血中CD34⁺细胞数量随孕母年龄增大而增多,故脐血库在筛选脐血时,同等条件下可以选择年龄偏大的孕妇。     

Association of development of chronic lung disease of newborns with neonatal colonization of Ureaplasma and cord blood interleukin‐8 level

Background: The aim of the present study was to investigate the association of chronic lung disease (CLD), neonatal Ureaplasma colonization, and interleukin‐8 (IL‐8) level of cord blood in preterm infants. Methods: In 77 infants of <32 weeks gestation, the relationship between IL‐8 level of cord blood, neonatal colonization of Ureaplasma, histological chorioamnionitis (CAM), and development of CLD was studied. Results: Five infants died and 29 infants developed CLD. The CLD group had significantly lower gestation (mean ± SD: 26.6 ± 1.8 weeks) compared with the infants without CLD (28.9 ± 1.9 weeks, P < 0.0001). Logistic analysis showed that the development of CLD was associated with gestational age (odds ratio [OR], 0.5; 95% confidence interval (CI): 0.4–0.8) and Ureaplasma colonization (OR, 4.1; 95%CI: 1.2–14.4). Ureaplasma colonization was also associated with CAM (OR, 6.5; 95%CI: 1.8–23.5), absence of respiratory distress syndrome (OR, 6.2; 95%CI: 1.3–30.5), and development of CLD (OR, 4.0; 95%CI: 1.1–15.3). Elevated cord blood IL‐8 ≥100 pg/mL was associated with female sex and the isolation of microorganisms (OR, 49.4; 95%CI: 4.6–525). Conclusion: The development of CLD defined by oxygen requirement at 36 weeks was associated with neonatal Ureaplasma colonization but not with IL‐8 level of cord blood. Elevated cord blood IL‐8 was associated with neonatal microorganisms isolation.     

Neonatal hyperbilirubinemia and its association with thyroid hormone levels and urinary iodine excretion

Objective : To investigate, if, urinary iodine contents as a marker of iodine deficiency and hypothyroidism are associated with the incidence of neonatal hyperbilirubinemia.Methods : One hundred neonates with total serum bilirubin ≥15 mg/dl and with no known cause of jaundice were included in the study as a jaundice group. An equal number (n=100) of non-jaundiced neonates (bilirubin ≤14.9 mg/dl) with matching for age, gestation period and weight were enrolled in the study as a control group.Results : Thirteen neonates (13%) in the study group had urinary iodine levels < 100 mg/dl as against only 2 (2%) in the control group (p<0.05). Thirty-four (34/200-17%) neonates i.e. 17 each in the study and control groups had serum TSH> 5 mU/ml and hence an indirect indicator of iodine deficiency in the study population. The mean serum levels of total T3, T4 and TSH in the study neonates were 1.52 ±1.23 ng/ml, 15.8±12.0 μg/dl & 3.13 ±3.0 mU/ml respectively and did not differ significantly from the mean levels in the control group. Only one neonate in the study group had serum TSH > 20 mU/ml which was suggestive of hypothyroidism, but had normal T3 & T4. Seven neonates in the study group and 8 in the control group had low T4. There was no significant correlation between the maternal and neonatal urine iodine levels, thyroid functions and the bilirubin levels (p>0.01).Conclusion : The jaundiced babies had lower urine oidine levels than the control population. Since, there was no significant difference in the levels of the thyroid hormones, no cause and effect relationship could be inferred between iodine deficiency and jaundice.     

Risk factors for perinatal stroke in term infants: A case–control study in Australia

Aim

The aetiology of perinatal stroke is poorly understood. This study aimed to prospectively confirm the risk factors and identify any previously unknown variables.

Methods

A prospective case–control study was conducted in Australia. Univariate odds ratios (ORs), associated 95% confidence intervals (CIs) and multivariable logistic regression models fitted with backwards stepwise variable selection were used.

Results

Sixty perinatal stroke cases reported between 2017 and 2019 included 95% (57/60) with multiple risk factors. Univariate analysis identified emergency caesarean section rather than NVD (P < 0.01), low Apgar score (<7) at 1, 5 and 10 min of age (P < 0.01), resuscitation at birth (P < 0.01), abnormal cord blood gas (P < 0.01), neonatal infection/sepsis (P < 0.01), congenital heart disease (P < 0.01) and hypoglycaemia (P < 0.01) as significant risk factors. Multivariate analysis found smoking during pregnancy (OR: 1.48; 95% CI: 1.09–1.99), 1-min Apgar score < 7 (OR: 1.54; 95% CI: 1.15–2.08), 10-min Apgar score < 7 (OR: 1.26; 95% CI: 1.02–1.54) and hypoglycaemia (OR: 1.49; 95% CI: 1.07–2.06).

Conclusions

Perinatal stroke is associated with multiple risk factors. Exposure to smoking, 10-min Apgar score < 7, neonatal infection and hypoglycaemia were independent risk factors. Emergency caesarean section, resuscitation at birth and abnormal cord blood gas were additional risk factors.     

B‐type natriuretic peptide levels at birth predict cardiac dysfunction in neonates

Background: Although the B‐type natriuretic peptide (BNP) levels in the umbilical cord blood (UCB‐BNP) and amniotic fluid (AF‐BNP) of neonates may be clinically useful for identifying newborns with cardiac dysfunction, the effects of various clinical factors, such as gestational age at birth, small for gestational age (SGA), and neonatal asphyxia, on the UCB‐BNP and AF‐BNP levels have not been studied extensively. Methods: The present study sought to determine whether the UCB‐BNP and AF‐BNP levels can predict cardiac dysfunction and hypotension in preterm infants soon after birth and to evaluate the association between BNP and various clinical factors. The UCB‐BNP and AF‐BNP levels at birth were determined in 320 and 195 neonates, respectively, born to mothers with singleton pregnancies. Results: The UCB‐BNP and AF‐BNP levels in infants treated with dopamine were significantly higher than those in infants without dopamine administration (230.1 vs 33.1 pg/mL and 74.4 vs 18.1 pg/mL, respectively). Stepwise multiple regression analyses indicated that gestational age, SGA, asphyxia, and chorioamnionitis were significant independent determinants of the UCB‐BNP level. Cut‐off values of >90 pg/mL for UCB‐BNP and >36 pg/mL for AF‐BNP yielded sensitivities of 68% and 93%, respectively, and specificities of 84% and 81%, respectively, for detecting neonates who required dopamine administration after birth. Conclusion: High UCB‐BNP and AF‐BNP levels predict neonatal cardiac dysfunction soon after birth.     

Influence of plasma glucagon levels on glycemic control in children with type 1 diabetes

Objective: The aim of this study was to investigate the association between plasma glucose (PG), HbA1c and plasma glucagons levels in children with type 1 diabetes to determine the influence of plasma glucagon on their glycemic control. Methods: The study was conducted in 60 Japanese children, aged 13.3 ± 4.6 years, with type 1 diabetes for at least 3 years of diabetes. Most of the subjects had absent pancreatic β‐cell function. We compared the glucagon levels among patient groups stratified according to the 2‐hour postprandial levels (<50, 50–99, 100–199, 200–299, and ≥300 mg/dL), and the HbA1c levels (<7.0, 7.0–7.9, 8.0–8.9, and ≥9%). Results: The mean 2‐hour postprandial PG, HbA1c and plasma glucagon levels were 174 ± 97 mg/dL, 7.7 ± 1.3% and 84.0 ± 32.6 pg/mL, respectively. The glucagon levels were highly correlated with the PG levels (r = 0.553, P < 0.0001) and mildly correlated with the HbA1c levels (r = 0.301, P = 0.0192). Patients with high PG levels had significantly higher levels of glucagon as compared with those with lower PG levels (139.4 ± 47.2, 78.4 ± 17.3, 82.4 ± 21.0, 98.3 ± 29.2 and 93.8 ± 18.3 pg/mL, P = 0.0009). On the other hand, there were no significant differences in plasma glucagon levels among patient groups stratified according to HbA1c levels (P = 0.1566), however, patients with HbA1c levels ≥ 9% had significantly higher levels of glucagon than those with HbA1c levels < 7% (113.3 ± 53.4 vs 80.8 ± 18.4 pg/mL, P = 0.0291). Conclusion: These results suggest that patients with high PG are likely to have high concentrations of plasma glucagon, which may aggravate glycemic control progressively, leading to elevation of HbA1c levels.