Bone gamma-carboxyglutamic acid containing protein in the perinatal period

We measured bone gamma-carboxyglutamic acid-containing protein (BGP), calcium (Ca), phosphorus (P), and alkaline phosphatase (Al-P) in paired maternal and cord sera, and urinary gamma-carboxyglutamic acid (gamma-Gla) in neonates. The circulating BGP was 41.21 +/- 2.47 ng/ml and 7.44 +/- 0.87 ng/ml in the cord (n = 15) and the maternal (n = 14) sera, respectively. The urinary gamma-Gla in the neonates was 147.68 +/- 10.75 mumol/g creatinine (n = 15). The cord serum BGP was significantly higher than the normal adult level. The maternal serum BGP was at the same level as in other adults. It is conceivable that the fetus may produce BGP during gestation, as the cord serum BGP level was significantly higher than the maternal level and there was no correlation between the cord and maternal serum BGP concentrations. The reason for the elevated circulating BGP level in the cord serum is not known, but increased bone turnover may be a factor. The cord serum BGP may include not only carboxylated but also non-gamma-carboxylated GP because of fetal vitamin K deficiency.     

新生儿血清瘦素水平与生长发育关系研究

目的：探讨新生儿血清瘦素与生长发育的关系。方法：采用放射免疫法检测80例新生儿静脉血和脐血瘦素水平,其中66例足月儿分为大于胎龄儿(LGA)组18例,适于胎龄儿(AGA)组32例,小于胎龄儿(SGA)组16例。采用Rohrer’s指数=出生体重(g)×100/身长(cm)~3估测新生儿营养状态。结果：早产儿血清瘦素水平明显低于足月儿[(0.66±1.03)ng/ml vs(3.59±2.16)ng/ml],P<0.01;足月儿中AGA血清瘦素水平[(3.06±0.96)ng/ml]明显低于LGA[(4.03±2.22)ng/ml],而高于SGA[(1.13±1.98)ng/ml];足月新生儿血清瘦素水平与Rohrer’s指数、新生儿体重、胎龄呈显著正相关(r=0.61,0.68,0.62,P均<0.01)。结论：新生儿体内瘦素是反映新生儿的发育和营养状态的有用指标。[中国当代儿科杂志,2003,5(1):29-30]     

脐血可溶性瘦素受体与胎儿生长发育关系探讨

目的：瘦素是肥胖基因的蛋白产物,除参与调节机体能量代谢外,与胎儿的生长发育密切相关,但其作用机制尚不清楚。本研究旨在探讨脐血可溶性瘦素受体与胎儿生长发育的关系及其可能机制。方法：67例足月新生儿根据出生体重分为小于胎龄儿(SGA)组23例,适于胎龄儿(AGA)组44例。采用ELISA法测定脐血和母血中瘦素及可溶性瘦素受体水平,并采用体脂含量估测新生儿营养状态。结果：①脐血可溶性瘦素受体水平与脐血瘦素水平及新生儿出生体重、体脂含量呈负相关(r分别为-0.405,-0.366,-0.356,P均0.05)。③SGA组脐血可溶性瘦素受体明显高于AGA组［(18.24±6.02) ng/ml vs (13.80±4.37) ng/ml］,P<0.01;而SGA组的瘦素含量低于AGA组［(6.79±4.59) ng/ml vs (16.30±11.62) ng/ml］,P<0.01。④脐血可溶性瘦素受体水平男性高于女性［(16.89±4.37) ng/ml vs (13.95±5.29) ng/ml］,P<0.05;而脐血瘦素水平则是男性低于女性［(10.28±8.28) ng/ml vs (15.70±12.11) ng/ml］,P<0.05。结论：可溶性瘦素受体可能通过对血清中游离瘦素水平的调节实现对胎儿生长发育的调控作用。同时测定瘦素和可溶性瘦素受体可能更有利于进一步了解瘦素的病理生理作用机制。     

Influence of Mode of Delivery on Fetal Pituitary-Thyroid Axis

We measured the cord serum levels of thyroid-stimulating hormone (TSH), thyroxine (T4) and triiodothyronine (T3) in 922 neonates delivered by mothers who had no thyroid disorders. The T4 and T3 levels increased progressively from the 27th to the 40th week of gestation. However, the TSH levels varied widely and had no correlation with gestational age, because they were affected by the mode of delivery. The mean cord serum TSH level in neonates delivered by vacuum extraction was 16.3 ±10.0 µUml (n = 30), which was significantly higher than the level following normal vaginal delivery (9.5 ± 6.0 µ U/ml, n = 622) (p < 0.005). The mean cord serum TSH level following elective caesarean section was 6.5 ± 3.1 µ U/ml (n = 79), and this was significantly lower than after normal vaginal delivery (p< 0.005). TSH levels in high-risk neonates were significantly higher than in neonates without risk factors. A significant positive correlation was found between the duration of the second stage of labor and the cord serum TSH level (r = 0.45, n = 412, p<0.01). However, there was no correlation between the cord serum TSH level and the congenital hypothyroidism screening TSH level (r = 0.01, n = 468). We conclude that the cord serum TSH level reflects delivery stress and that an elevated level does not influence the congenital hypothyroidism screening TSH test in which blood is obtained at five days of life.     

Serum level of digoxin-like immunoreactive substances in newborn infants in the first two weeks of life, in umbilical cord blood and in pregnant patients at the time of labor

A digoxin-like immunoreactivity (DLIS) was measured by two routinely used clinical digoxin-immunoassays (radio- and enzymeimmunoassay) in cord blood of 255 newborns, in sera of their mothers at birth and in sera of 211 newborns during the first two postpartal weeks. The highest DLIS levels were found in serum of neonates at the first day of life (median: 0.23 ng/ml, 25% and 75% percentile: 0.19 and 0.28 ng/ml) and in cord blood (median: 0.21 ng/ml, 25% and 75% percentile: 0.19 and 0.24 ng/ml); maternal serum was shown to have three times less DLIS (median: 0.08 ng/ml, 25% and 75% percentile: 0.05 and 0.10 ng/ml). There was no significant correlation between DLIS concentrations in serum of newborns, cord blood or pregnants. The DLIS serum levels of preterms with birthweight less than 2500 g and gestational age less than 37 weeks were significantly lower than those of normal neonates at term (p less than 0.01); concomitantly the lowest DLIS levels were found in maternal serum of preterms (p less than 0.01). These observations strongly suggest rather a DLIS origin in the newborn than in the mother. During the first two postpartal weeks the DLIS concentration of a vast majority of the 211 newborns (91%) decreased continuously to one half of the starting value. Within the second postpartal week preterms were found to have a significantly delayed decrease in the DLIS serum levels (p less than 0.01). Small for date newborns showed no difference in their postpartal DLIS time course compared to normal neonates.(ABSTRACT TRUNCATED AT 250 WORDS)     

Serum zinc and copper levels in the maternal blood and cord blood of neonates

Estimation of serum zinc and copper in the maternal blood and cord blood of neonates was carried out to correlate the trace metals in the neonates and their mothers in relation to gestational age and birth weight. Sixty-five healthy neonates, both term and preterm and their mothers were selected. This cross sectional study was done at Azimpur Maternity Centre, Dhaka Medical College Hospital and Chemistry Division, Atomic Energy Centre, Dhaka, Bangladesh from July 1997 to June 1998. The estimation of trace metals was carried out by Atomic Absorption Spectrophotometry (AAS). The mean serum zinc levels in the maternal blood and cord blood were 0.47 ± 0.24 μg/ml and 0.85 ± 0.33 μg/ml respectively and the mean copper levels in the maternal blood and cord blood were 1.37 ± 0.62 μg/ml and 0.31 ± 0.32 μg/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels. There was no significant correlation between gestational age and serum zinc levels in the cord or maternal blood. But significant inverse correlation was found between gestational age and serum levels of copper in the maternal and cord blood.     

肌钙蛋白Ⅰ在新生儿胎粪吸入综合征并心肌损伤诊断中的意义

目的　探讨心肌肌钙蛋白Ⅰ (CTn Ⅰ )在新生儿胎粪吸入综合征 (MAS)并心肌损伤诊断中的意义。方法　用化学发光免疫法及酶法分别测定 35例合并心肌损伤的MAS患儿、30例无心肌损伤的MAS患儿及 15例正常对照组血清CTn Ⅰ及CK MB的水平。结果　心肌损伤组生后 2～ 3dCTn Ⅰ浓度为 (0 .6 7± 0 .13)ng/ml,较MAS对照组 [(0 .0 7± 0 .0 5 )ng/ml]和正常对照组 [(0 .0 7± 0 .0 3)ng/ml]明显升高 ,差异有显著性意义 (P <0 .0 5 )。结论　CTn Ⅰ是诊断新生儿MAS并心肌损伤的特异性指标之一。     

Breast milk β-glucuronidase and prolonged jaundice in the neonate

Breast milk samples from mothers of breast-fed, healthy, term newborns with unexplained prolonged jaundice were analyzed for β-glucuronidase activity. Mean enzyme activity was 75.7 ± 34.5 modified Sigma units/ml in the breast milk samples ingested by the study group of jaundiced babies ( n = 25) and 82.2 ± 40.1 modified Sigma units/ml in the samples ingested by the control group of non-jaundiced babies ( n = 20) ( p > 0.05). Enzyme activities at 2, 3 and 4 postnatal weeks were 101.0 ±39.9, 66.0 ± 20.7 and 57.0 ± 22.4 modified Sigma units/ml in the study group and 87.9 ±36.1, 58.5 ± 15.0 and 88.3 ±49.1 modified Sigma units/ml in the controls. The differences were not statistically significant ( p > 0.05). We conclude that breast milk β-glucuronidase activity may be a contributory factor, in the presence of other variables, in hyperbilirubinemia but it is neither the main nor the only cause of prolonged jaundice in neonates.     

肌钙蛋白Ⅰ在新生儿胎粪吸入综合征并心肌损伤诊断中的意义

目的 探讨心肌肌钙蛋白Ⅰ(CTn-Ⅰ)在新生儿胎粪吸入综合征(MAS)并心肌损伤诊断中的意义。方法：用化学发光免疫法及酶法分别测定35例合并心肌损伤的MAS患儿、30例无心肌损伤的MAS患儿及15例正常对照组血清CTn-Ⅰ及CK-MB的水平。结果：心肌损伤组生后2～3 d CTn-Ⅰ浓度为(0.67±0.13) ng/ml,较MAS对照组［(0.07±0.05) ng/ml］和正常对照组［(0.07±0.03) ng/ml］明显升高,差异有显著性意义(P<0.05)。结论：CTn-Ⅰ是诊断新生儿MAS并心肌损伤的特异性指标之一。     

Inter-relationship between serum concentrations of glucose, glucagon and insulin during the first two days of life in healthy newborns

The relationship between serum concentrations of glucose, insulin and glucagon during the first two days of life was studied in healthy newborns. The first capillary blood sample was obtained at 3–15 h of age (median 6h; day 0) and a second sample approximately 24 h later (day 1). Serum glucose concentrations in the first sample averaged 2.1 ± 0.07mmol/l (mean ± SEM; n = 60) and were positively correlated with postnatal age ( p < 0.01). Serum glucagon concentrations in the first sample averaged 570 ± 32pg/ml and were inversely correlated with glucose concentrations ( p < 0.0001). At the second sampling, serum glucose concentrations had increased to 2.9 ± 0.07mmol/l ( p < 0.001; n = 57) and serum glucagon concentrations had decreased to 403 ± 22pg/ml ( p < 0.001). Serum insulin concentrations were 11.7 f 0.3 μU/ml and 10.2 ± 0.3 μU/ml at the two samplings and did not correlate with serum glucose concentrations. The relationship of serum glucose and hormone concentrations to maternal and infant characteristics was studied by stepwise regression analysis. Serum glucose concentration on day 0 was positively correlated with postnatal age ( p < 0.01) and birth weight ( p 0.05) but inversely correlated with duration of labour ( p < 0.05). Serum glucose concentration on day 1 was positively correlated with birth weight ( p < 0.0001) and inversely correlated with maternal prep-pregnancy weight ( p < 0.05). Similar analyses of serum hormone concentrations did not demonstrate any relationships with maternal or infant characteristics. It is suggested that glucagon secretion is part of the counter-regulation against hypoglycaemia in healthy newborns and that neonatal energy stores, as indicated by birth weight, influence the ability to increase circulating glucose concentrations in response to counter-regulatory hormones.     

Serum copper in newborns and their mothers

Serum copper levels in the cord blood of 100 newborns and the respective maternal serum copper at the time of delivery was estimated by atomic absorption spectrophotometer. The cases were classified into term AGA, term SGA, term LGA, preterm AGA and preterm SGA. The mean maternal serum copper level 152.42 ± 2.06 μg/Jdl) was significantly higher than the mean cord serum copper level (39.84 ±1.19 μg/dl). There was positive correlation between the maternal serum copper level and cord serum copper level. The mean serum copper level of term neonates was (44.42 ± 1.26 μgJdl) significantly higher (p < 0.001) than that of preterm neonates (30.30 ± 1.14 μg/dl). There was a positive correlation between cord serum cooper level and gestational age. The mean cord serum copper levels of term AGA, term SGA, preterm AGA and preterm SGA neonates was 45.42 ± 1.44 μg/dl, 39.22 ± 2.45 μg/dl, 31.00 ± 2.11 udJdl and 29.47 ± 2.08 μg/dl respectively. There was no statistically significant difference in the mean serum copper level, of AGA and SGA group of both term and preterm noenates. The difference amongst mean maternal serum copper level of various neonatal groups was not significant.     

A study of serum zinc levels in cord blood of neonates and their mothers

Serum zinc was estimated in the cord blood of 60 neonates of different gestational age and birth weight, and their mothers. Mean serum zinc levels in neonates FTGA, PTAGA and term SGA were 128.88±14.37, 94.32±17.79 and 111.8±9.2 ug/dl respectively. The maternal serum zinc levels in corresponding groups was 96.28±19.48, 115.44±15.41 and 93.8±7.62 ug/dl. Thus mean serum zinc level in cord blood of FT AGA newborns was significantly higher than that in PT AGA and FT SGA. Mean serum zinc level in mothers of FT AGA was significantly lower than that in mothers of PT AGA. However, there was no significant difference between the maternal serum zinc levels of FT AGA and FT SGAs. There was positive correlation between gestational age and serum zinc level in cord blood of AGAs while correlation was negative in case of their mothers. There was positive correlation between weight (keeping gestational age constant) and serum zinc level in case of neonates while corresponding maternal zinc levels did not vary. (FT AGA and FT SGA).     

GROWTH HORMONE AND SOMATOMEDIN A IN GIRLS WITH ADOLESCENT IDIOPATHIC SCOLIOSIS

Abstract. Girls with adolescent idiopathic scoliosis are taller than nonscoliotic girls of the same age. This observation may be related to factors regulating longitudinal growth. Plasma growth hormone was determined in a group of scoliotic girls by double antibody radioimmunoassay under the following conditions: 1) Insulin induced hypoglycemia, 2) glucose tolerance test, 3) exercise. Somatomedin A was determined by a method based on the ability of serum to stimulate the incorporation of radioactive sulphate in embryonic chick cartilage. The results were compared with those obtained in a control group of healthy nonscoliotic girls of comparable age. After overnight fasting and after at least one hour's rest the basal growth hormone level was 9.8 ± 11.1 (±S.D.) ng/ml in the scoliotic girls ( n =48) and 2.2 ± 1.1 ng/ml in the controls ( n =15). This difference is significant. In the hypoglycemia test the peak growth hormone level tended to be higher in the scoliotic girls but the difference is not significant. In the exercise test the maximal value was reached at different times in the two groups: at 20 min after start of the exercise in the scoliotic girls ( n =14, 17.3±11.8 ng/ml) and at 40 min in the controls (n=9, 16.0±6.6 ng/ml). In the glucose tolerance test the growth hormone level was suppressed in both groups but the mean values tended to be higher during the first 120 min in the scoliotic girls. The serum somatomedin levels were higher in the group of scoliotic girls ( n =19, 1.13±0.17 U/ml) than in the controls ( n =14, 0.88±0.16 U/ml) and the difference is significant. The results obtained are difficult to interpret but suggest that growth hormone secretion is higher in girls with adolescent idiopathic scoliosis than in healthy girls of comparable age.     

SERUM GAMMA-GLUTAMYL TRANSPEPTIDASE ACTIVITY AND URINARY D-GLUCARIC ACID EXCRETION IN NEWBORNS IN THE FIRST WEEK OF LIFE; Effects of phenobarbital and nicethamide combination

ABSTRACT. High serum γ-glutamyl transpeptidase activity was found in cord blood of newborn boys. This activity decreased to lower values on the 4th and 7th days. In newborns treated for 3 days following the birth with a combination of Phenobarbital and nicethamide an increase of γ-glutamyl transpeptidase activity occurred from the 4th to the 7th days. The 7th day levels were significantly higher when compared with the controls. Simultaneous determination of urinary glucaric acid excretion confirmed the induction of hepatic microsomal enzymes in glucuronic acid pathway. This could also be demonstrated by a pronounced decrease of serum bilirubin levels in groups receiving the enzyme inducers whether phenobarbital was administered intramuscularly or orally as sodium salt solution.     

Interleukin-1 receptor antagonist in the fetomaternal compartment

Interleukin-1 (IL-1) is a major mediator in infections and inflammation. Interleukin-1 receptor antagonist (IL-1ra) opposes the actions of IL-1. IL-1ra is present in exceptionally high concentrations in third trimester amniotic fluid. We studied IL-1ra in amniotic fluid, fetal serum and newborn urine. The concentrations of IL-1ra in amniotic fluid at mid-trimester and at 25-41 gestational weeks were 6.6 ± 0.5ng/ml ( n = 30) and 100 ± 4ng/ml ( n = 202), respectively. At mid-trimester, amniotic fluid IL-1ra was not dependent on fetal gender, whereas during the third trimester IL-1ra was higher in female- than in male-bearing gestations. Urine of normal term newborns during the first day of life contained a very high concentration of IL-1ra (125 ± 16ng/ml, n = 50). Urinary concentration in female newborns was significantly higher than that in male newborns (202 ± 19ng/ml, n = 25 versus 49 ± 14ng/ml, n = 25). IL-1ra concentration in fetal serum at 22-36 gestational weeks was 0.50 ± 0.07ng/ml ( n = 31) and at term 1.5 ± 0.3ng/ml ( n = 17). Serum concentrations were not gender-dependent. The gender differences in IL-1ra concentrations may in part explain the lower susceptibility of female fetuses to infection.     

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.     

Pulmonary surfactant protein A in sera for assessing neonatal lung maturation

To examine whether surfactant protein A (SP-A) in postnatal serum can predict the development of respiratory distress syndrome (RDS), we analyzed the relationship between serum concentrations of SP-A and the risk of RDS using sera from neonates within 24 h after birth. A total of 104 blood samples including 23 samples from newborn infants with RDS were obtained. SP-A content in sera was measured with an enzyme-linked immunosorbent assay system consisting of a standard of native SP-A and two monoclonal antibodies against human SP-A. The level of serum SP-A increased with advancing gestation. Since the mean level of serum SP-A in patients with RDS (3.8 ng/ml) was significantly lower than those without RDS (12.0 ng/ml) (P<0.001), we calculated the diagnostic index values at various cutoff points and chose cutoff values to predict the risk of RDS. Maximum diagnostic value of 85% was obtained at a cutoff point of 3.8 ng/ml (sensitivity 57% and specificity 93%). We also chose a cutoff value of 2.1 ng/ml for definitive diagnosis of RDS, and 8.3 ng/ml for exclusive diagnosis of RDS. The adjusted odds ratios of RDS was significantly elevated when SP-A concentration in serum was under the cutoff values. The presence of SP-A in cord blood serum was also confirmed by immunoblotting analysis. We emphasize the value of SP-A examination in cord blood or postnatal serum from infants who exhibited respiratory difficulties at birth. We believe that our results are consistent with the hypothesis that SP-A is a useful serum marker in predicting the development of RDS.     

SERUM GAMMA-GLUTAMYL TRANSPEPTIDASE ACTIVITY AND URINARY D-GLUCARIC ACID EXCRETION IN NEWBORNS IN THE FIRST WEEK OF LIFE Effects of phenobarbital and nicethamide combination

Abstract. High serum γ-glutamyl transpeptidase activity was found in cord blood of newborn boys. This activity decreased to lower values on the 4th and 7th days. In newborns treated for 3 days following the birth with a combination of phenobarbital and nicethamide an increase of γ-glutamyl transpeptidase activity occurred from the 4th to the 7th days. The 7th day levels were significantly higher when compared with the controls. Simultaneous determination of urinary glucaric acid excretion confirmed the induction of hepatic microsomal enzymes in glucuronic acid pathway. This could also be demonstrated by a pronounced decrease of serum bilirubin levels in groups receiving the enzyme inducers whether phenobarbital was administered intramuscularly or orally as sodium salt solution.     

Relationship between cord blood levels of IGF-I and ferritin in healthy term neonates

OBJECTIVE: We hypothesize that the balance of maternal and fetal insulin-like growth factor-I (IGF-I) concentrations contributes to the regulation of substrate distribution between mother and fetus, and may thus mediate the maintenance of blood ferritin concentration in the fetus. Therefore, the relationship between cord blood IGF-I to ferritin concentration was investigated. INFANTS AND METHODS: Twenty-six term neonates were recruited. Anthropometric measures were recorded and umbilical cord blood samples were collected at birth. We studied serum concentrations of IGF-I in relation to blood ferritin and anthropometric data in term neonates. To assess the importance of the correlation of ferritin with both IGF-I and all other parameters, multiple linear regression analysis was carried out, with ferritin as the dependent variable and IGF-I and anthropometric parameters as independent variables. RESULTS: The mean concentrations of cord blood IGF-I and ferritin levels were 45.2 +/- 36.8 ng/ml and 225.5 +/- 124.2 ng/ml, respectively, at birth. A positive correlation was observed between IGF-I and ferritin concentrations of term neonates (r = 0.53, p = 0.005). IGF-I emerged as a significant predictor of ferritin concentration (beta = 1.79, p = 0.005) contributing to 28% of its variability. CONCLUSIONS: We showed a relationship between cord blood IGF-I and ferritin levels in term neonates, suggesting that even within an unremarkable population, fetal ferritin level may be influenced by IGF-I. Moreover, we speculated that IGF-I might also be important in the regulation of placental transport of ferritin.     

CORD BLOOD HAEMOGLOBIN, IRON AND FERRITIN STATUS IN MATERNAL ANAEMIA

ABSTRACT. Maternal and cord blood haemoglobin, serum iron, transferrin saturation and ferritin were studied in sets of 30 anaemic (haemoglobin <110 g/l) and 21 nonanaemic (haemoglobin ≧110 g/l) mothers. The cord serum iron, transferrin saturation and ferritin concentrations had significant correlation with maternal haemoglobin. The significant low levels of these parameters suggested that maternal anaemia adversely affected the iron status including iron stores of the newborns. The cord serum iron of 15.2±4.35 μmol/l and ferritin of 29.7±10.93 ng/ml seem to be effective to maintain cord haemoglobin levels. Thus, anaemic mothers with reasonably maintained ferritin and trasferrin saturation levels provide sufficient iron for maintenance of cord haemoglobin, although foetal iron stores are likely to be depleted.