Assessment of proportional growth of very low birth weight infants fed banked human milk

Twenty appropriate (mean +/- S.D., gestational age (AGA): 29.9 +/- 1.5 weeks) and 15 small (GA: 34.6 +/- 2.4 weeks) for gestational age (SGA) very low birth weight infants fed banked mature human milk were studied until term for anthropometric parameters: midarm (MAC), chest (CC), head (HC) circumferences, triceps (TSKF) and subscapular (SSKF) skinfold thickness recorded at 15 and 60 s, dynamic skinfold (delta % SKF), muscle (AMA) and fat (AFA) areas, weight and length. In AGA infants, all the parameters at term were significantly lower in extrauterine (EUL) that in intrauterine life (IUL). At term the relative proportion of AFA to total arm area was increased in EUL compared to IUL both in AGA (25.87 +/- 3.8 vs. 23.26 +/- 1.27% respectively, P less than 0.01) and in SGA infants (21.89 +/- 4.63 vs. 18.81 +/- 3.9 respectively, P less than 0.05). SGA infants showed a similar growth in EUL compared to IUL, and a significantly lower AMA and AFA than in AGA infants in EUL. Although HC was in both infants below the 10th centile at term, the ratio weight/HC2 suggests a relative preservation of head growth in EUL compared to IUL (AGA: 20.72 less than 0.87 vs. 22.65 +/- 1.46 respectively, P less than 0.001; SGA; 20.82 +/- 1.16 vs. 21.62 +/- 1.86 respectively, NS). Delta %SKF were negatively correlated with post-conceptional age suggesting a loss of extracellular water in AGA (delta %TSKF: r = -0.287, P less than 0.02) and in SGA infants (delta %TSKF: r = -0.301, P less than 0.02; delta %SSKF: r = -0.316, P less than 0.02). An intrauterine model of discrimination between AGA and SGA infants does not apply to EUL. An equation was established in SGA infants with the best discriminant parameters giving a predictive post-conceptional age: post-conceptual age (PCA) (weeks) = 0.276 HC (cm) + 0.723 CC (cm) - 0.122 MAC (cm) + 0.5 TSKF (mm) + 10.173, (r = 0.867, P less than 0.001) allowing a clear discrimination between AGA and SGA infants. These results suggest that infants show quite different growth patterns between IUL and EUL both for AGA and SGA infants.     

Cardiac hypertrophy and altered hemodynamic adaptation in growth-restricted preterm infants

The objective was to elucidate hemodynamic adaptation in very low birth weight (<1500 g) infants after intrauterine growth retardation. 31 growth-retarded (SGA, birth weight <-2 SD) and 32 appropriate for gestational age (AGA, birth weight within +/- 1 SD range) infants were enrolled. In SGA infants, the diastolic diameters of the interventricular septum and the left ventricle were increased, and serum brain natriuretic peptide (BNP) was elevated. Left ventricular output (LVO) of the AGA infants increased from 150 +/- 28 to 283 +/- 82 mL/kg/min during the study (p < 0.01). The SGA infants had a higher initial LVO than the AGA infants (243 +/- 47 versus 150 +/- 28 mL/kg/min, p < 0.05), but did not show further LVO increase during the study period. Red cell (RCV) and blood (BV) volume were assessed by Hb subtype analysis, when packed donor red cells were transfused. RCV and BV did not differ between the groups initially, but RCV increased by 18% and BV by 29% in the AGA group during the first 3 d. On day 3, AGA infants had larger BV than the SGA infants (88 +/- 5 versus 73 +/- 12 mL/kg, p < 0.05). In conclusion, cardiac hypertrophy, elevated initial LVO and BNP of the SGA infants suggest increased cardiac workload after intrauterine growth retardation. Based on the BV and RCV data, blood volume regulation may also be impaired. The data suggest that SGA preterm infants may be exposed to an increased risk of circulatory failure during early adaptation.     

Metabolic consequences of intrauterine growth retardation in very low birthweight infants

By the combination of energy and macronutrient balances, continuous open circuit computerized indirect calorimetry, and anthropometry, we have compared small for gestational age (SGA) and appropriate for gestational age (AGA) very low birthweight infants with respect to metabolizable energy intake (mean +/- SE: 125.9 +/- 2.5 versus 130.4 +/- 3.5 kcal/kg X day), energy expenditure (67.4 +/- 1.3 versus 62.6 +/- 0.9 kcal/kg X day), storage of energy and macronutrients and growth. Fourteen studies in six SGA infants (gestational age, 33.1 +/- 0.3 weeks; birthweight, 1120 +/- 30 g) and 22 studies in 13 AGA infants (gestational age, 29.3 +/- 0.4 weeks; birthweight, 1155 +/- 40 g) were performed. The SGA infants had a lower absorption of fat (68.7 +/- 3.2 versus 79.7 +/- 1.7%) and protein (69.1 +/- 3.2 versus 83.4 +/- 1.5%) and hence increased (P less than 0.001) energy loss in excreta (29.9 +/- 2.8 versus 18.2 +/- 1.5 kcal/kg X day). The significant hypermetabolism of SGA infants by 4.8 kcal/kg X day was associated with an increased fat oxidation. Despite lower energy storage, SGA infants were gaining weight (19.4 +/- 0.9 g/kg X day), length (1.25 +/- 0.14 cm/week), and head circumference (1.16 +/- 0.9 cm/week) at higher rates than the AGA group. The energy storage per g weight gain was lower (P less than 0.001) in the SGA group (3.0 +/- 0.14 versus 4.26 +/- 0.26 kcal) reflecting higher water, lower fat (22.2 +/- 1.8 versus 33.8 +/- 2.5%; P less than 0.001) and lower protein (7.7 +/- 0.5 versus 12.5 +/- 0.8%; P less than 0.001) contents of weight gain in the SGA group.     

The premature small-for-gestational-age infant during the first year of life: comparison by birth weight and gestational age

To determine the effect of intrauterine growth retardation on the outcome of the premature infant, we compared a group of 35 premature, small-for-gestational-age (SGA) infants with two groups of premature, appropriate-for-gestational-age (AGA) infants: one with similar birth weight (AGA-BW group) and the other with similar gestational age (AGA-GA group). Groups were matched by year of birth, race, gender, and socioeconomic status. Infants were free of major congenital anomalies and intrauterine infection. They were evaluated at term, at 20 and 40 weeks, and at 1 year corrected age. The SGA infants had a lower mean developmental quotient than the two groups of AGA infants. The SGA infants had significantly smaller body dimensions at birth, more nursery complications, and a higher incidence of major neurologic problems than their AGA-GA matches but were comparable to the AGA-BW matches. Poor growth constitutes an additional risk factor to prematurity. The results highlight the importance of comparing premature SGA infants with premature AGA infants of similar gestational age rather than similar birth weight.     

Intrauterine growth restriction and postnatal steroid treatment effects on insulin sensitivity in preterm neonates

OBJECTIVES: To study whether intrauterine growth restriction (IUGR) is associated with decreased sensitivity to the main fetal growth factor, insulin, and the effect of glucocorticoid therapy on insulin sensitivity in preterm infants. STUDY DESIGN: Newborn infants with a birth weight (BW) of< 1500 g were classified as appropriate for gestational age ([AGA], BW within +/- 1 SD, n = 10), or small for gestational age ([SGA], BW <-2 SD, n = 13); 5 AGA infants and 8 SGA infants received systemic steroids. An abbreviated modified minimal model test was performed, consisting of sequential blood samples for glucose and insulin assays, and intravenous infusions of 0.3 g/kg glucose and 0.02 U/kg regular human insulin. The insulin sensitivity index (S(I)) was calculated using a computer program. RESULTS: The basal insulin/glucose ratio (I/G) and S(I) did not differ between the AGA and SGA groups. Steroids did not influence the I/G nor the S(I) of AGA infants (10.2 +/- 6.7 vs 8.2 +/- 2.3), but decreased the S(I) in the SGA group (12.2 +/- 5.1 vs 5.3 +/- 2.7, P <.05). CONCLUSIONS: Insulin sensitivity of neonates can be measured by the modified minimal model. IUGR is not associated with impaired fetal glucose tolerance. Early neonatal steroid treatment decreases insulin sensitivity in SGA infants, which may contribute to their risk of having hyperglycemia.     

34 周以下适于胎龄及小于胎龄早产儿出生 2 周内 蛋白质、能量摄入及体质量变化

目的了解34周以下早产适于胎龄儿(AGA)和小于胎龄儿(SGA)生后蛋白质、能量摄入量以及体质量z评分的变化情况。方法回顾收集2012年1月至2014年12月入院的314例早产儿,比较268例AGA和46例SGA早产儿生后2周内蛋白质、能量摄入情况和体质量变化。结果 SGA组住院时间、肠外联合肠内营养时间、全肠内营养时间、达足量喂养时间均较AGA早产儿长,差异有统计学意义(P??0.05);SGA组生后第4、8、12天能量摄入量明显低于AGA组,SGA组生后第6、8天总蛋白质摄入量明显低于AGA组,差异均有统计学意义(P??0.05);SGA组日平均体质量增长量大于AGA组,差异有统计学意义(P??0.05);AGA组与SGA组生后2周内体质量z评分均逐渐远离中位水平,且SGA组2周时体质量z评分低于AGA组(P??0.05)。结论胎龄??34周的SGA早产儿恢复出生体质量后的生长速率快于AGA早产儿,存在一定的追赶生长;但SGA、AGA早产儿的生长均有待提高。     

Metabolic and energy balance in small- and appropriate-for-gestational-age, very low-birth-weight infants

This study compared nutrient utilization and postnatal weight gain composition in eight appropriate for gestational age (AGA: birth weight 1293 ± 107 g; gestational age 28.8 ± 1.4 weeks) and eight symmetrically growth-retarded (SGA: birth weight 1110 ± 230 g; gestational age 32.7 ± 1.9 weeks), very low-birth-weight (VLBW) infants. There was no significant difference in protein, mineral and energy intake between AGA and SGA infants. Nitrogen absorption (84 ± 3 and 83 ± 4%) and nitrogen retention (356 ± 48 and 352 ± 43 mg/kg/day) were similar in both groups. Fat absorption tended to be lower in AGA (78 ± 15%) than in SGA (87 ± 4%) infants. Calcium, phosphorus and magnesium absorptions were similar in AGA and SGA infants. Metabolizable energy utilization was similar in both groups; about 55% was expended and 45% stored in new tissues. Energy expenditure was 58 ± 4 kcal/kg/day in SGA infants and 61 ± 9 kcal/kg/day in AGA infants. Weight gain and its composition were similar in both groups. We conclude that nutrient and energy utilization are similar in AGA and symmetrically growth-retarded, VLBW infants.     

ENERGY REQUIREMENTS AND UTILIZATION OF THE LOW BIRTHWEIGHT INFANT

Brooke, O.G. (Department of Child Health, St. George's Hospital, London, U.K.). Energy requirements and utilization of the low birthweight infant. Acta Paediatr Scand, Suppl. 296:67, 1982.—Energy balance data have been obtained on 24 well grown immature (AGA) infants (mean BW 1554 g) and 16 small-for-gestational age (SGA) infants (mean BW 1210 g) using bomb calorimetry on milk and excreta over 7–10 days periods. Simultaneous measurements of energy expenditure were made, using a Kipp diaferometer. The main findings were: At any particular gestational age, digestible energy (the proportion of dietary energy absorbed) was similar in AGA and SGA infants. Energy digestibility improved with maturation in all infants. Retained (metabolisable) energy was also similar in AGA and SGA infants, and averaged 65 % of the intake at 30 weeks, 78% at 32 weeks, and 85% at 40 weeks post-conceptional age. Weight gain was linearly correlated with metabolisable energy in AGA infants, an energy cost of 24 kJ/g (5.7 kcal). Maintenance energy requirement at zero weight gain in AGA infants was 270 kJ/kg/d (64 kcal/kg/d). Resting energy expenditure was significantly higher in SGA than in AGA infants, but postprandial metabolism was less. In spite of these differences, rates of weight gain were similar in the two groups of infants. Energy expended in activity was probably less than 20 % of the total energy turnover in both groups of infants. Energy balance was profoundly impaired by acidosis in all infants.     

The influence of gestational age, size for dates, and prenatal steroids on cord transferrin levels in newborn infants

Serum transferrin levels assess protein status in older children and adults. To generate standards for its use in newborn infants, we measured umbilical cord serum transferrin levels in 161 appropriate (AGA), 25 large (LGA) and 16 small (SGA) for gestational age infants between 25 and 43 weeks' gestation. We also assessed the effects of intrauterine growth, exposure to prenatal steroids, and presence of pulmonary maturity on neonatal transferrin levels. Cord transferrin levels in AGA infants were significantly correlated with increasing gestational age (r = 0.60; p less than 0.001). Infants born before 37 weeks' gestation had significantly lower transferrin levels, when compared with those born at term (p less than 0.001). LGA infants had significantly higher levels than age-matched AGA infants (253 +/- 75 vs. 214 +/- 53 mg/dl; p less than 0.025). Despite significantly lower mean birth weights (p less than 0.001), SGA infants also had significantly higher levels than gestational age-matched AGA controls (227 +/- 63 vs. 167 +/- 40 mg/dl; p less than 0.005). For infants less than 35 weeks' gestation, neither the 20 preterm infants with exposure to prenatal steroids (maternal betamethasone), nor the 26 infants with pulmonary maturity had significantly elevated transferrin levels, when compared with gestational age-matched control infants. Newborn transferrin levels correlate well with gestational age and are significantly affected by size for dates, but not by a brief course of prenatal steroids or by pulmonary maturity.     

早产小于胎龄儿生长代谢的临床研究

目的 探讨早产小于胎龄儿（SGA）与适于胎龄儿（AGA）在住院期间生长代谢的差异,为临床对早产SGA进行营养干预提供依据。方法 1 370例早产儿纳入研究,根据胎龄与出生体重的关系分为SGA组（675例）与AGA组（695例）,比较两组早产儿住院期间的一般情况、体格增长及血生化指标等情况。结果 SGA组住院天数长于AGA组（P < 0.05）。与AGA组相比,SGA组出院体重、出院体重Z评分及出院身长均较低,宫外生长迟缓发生率较高（P < 0.05）,头围增长速率大于AGA组。与AGA组相比,SGA组达全肠内喂养时间及需肠外营养时间均较长（P < 0.05）。SGA组入院时白蛋白、前白蛋白、血清磷、出院前总胆汁酸高于AGA组,白蛋白低于AGA组（P < 0.05）。SGA组窒息、新生儿呼吸窘迫综合征、心肌损伤、喂养不耐受、肺炎、败血症、低血糖、低甲状腺素血症的发生率高于AGA组（P < 0.05）。结论 早产SGA住院期间体格发育明显落后于AGA,宫外生长迟缓发生率较高,更易出现并发症。     

Influence of gestational age and intrauterine growth on leptin concentrations in venous cord blood of human newborns

BACKGROUND: The ob gene product leptin is involved in the regulation of body weight and energy expenditure, suggesting a potential role of leptin in embryonal and fetal development and progression of pregnancy. In term infants, leptin concentrations showed a positive correlation with birth weight. We aimed at comparing leptin cord blood levels in AGA (appropriate for gestational age) to SGA (small for gestational age) preterm and term newborns. PATIENTS AND METHODS: Ninety-seven human newborns, 47 females and 50 males, 33 born at term and 64 born before 36 weeks of gestation, were studied prospectively. Leptin concentrations in venous cord blood were determined using a specific RIA (radioimmunoassay). RESULTS: In term newborns, mean gestational age (GA) was 39 weeks (wk) (+/- 0.7 wk) and mean birth weight (BW) was 3316 g (+/- 473 g); in preterm newborns (n = 64), mean GA was 30 wk (+/- 5.0 wk) and mean BW was 1398 g (+/- 505 g). Mean standard deviation score of birth weight (BW SDS) was calculated as - 0.47. Mean leptin concentrations in term newborns differed significantly from those in preterm newborns (9.21 +/- 2.63 ng/ml vs. 1.58 +/- 0.88 ng/ml; p < 0.0001). In preterm and term infants, leptin concentrations showed a linear correlation with BW (r = 0.46; p < 0.0001) and GA (r = 0.48; p < 0.0001), respectively. Leptin levels were best predicted by an exponential regression model with GA (Leptin = exp(- 4.41 + 0.14 x GA); r = 0.61; p < 0.0001). Using multivariate regression analysis (r = 0.57; p < 0.0001), we found significant influences of GA (p < 0.00001) and BW SDS (p < 0.05) on leptin levels. No difference was observed between leptin values in AGA versus SGA preterm infants. CONCLUSION: These data suggest fetal leptin levels to be primarily determined by GA and additionally modulated by growth restriction in term newborns. We found a dramatic increase at weeks 33 to 35 of gestation and no modulation by BW SDS in very preterm infants.     

Variation in size at birth in infants born small for gestational age in Lithuania

The aim of this study was to describe the heterogeneity in body proportions of infants born small for gestational age (SGA), defined by birthweight, and to study the relationship of placental size with neonatal anthropometric measurements. Anthropometry was evaluated in 107 symmetrically and asymmetrically growth-retarded infants born SGA (birthweight <-2 SD) and compared with 181 appropriate-for-gestational age infants (AGA; birthweight and length +/- 2 SD). Study children were born at Kaunas University Hospital during the period from 1 January 1998 to 25 August 2000. Two-thirds of SGA children were light (SGA(W)) and one-third was both light and short (SGA(WL)) for gestational age. Infants in both SGA groups were significantly leaner than AGA children. SGA(WL) infants had significantly larger heads in relation to their length compared with SGA(W) and even AGA children, probably indicating a brain-sparing effect. SGA(WL) children had the lowest mean placental weight, but the highest placental weight to birthweight (PW/BW) ratio. The PW/BW ratio was inversely correlated with most infant measurements; the strongest negative relationship was observed with birthlength and lower leg length. CONCLUSION: There is heterogeneity in children born SGA, defined by birthweight. It is suggested that the two SGA groups represent the continuum of intrauterine growth retardation, with an initial reduction in trophic growth and a subsequent retardation of linear growth. The PW/BW ratio is a strong indicator for impaired prenatal linear growth.     

Energy expenditure in premature newborns with bronchopulmonary dysplasia.

Five premature newborns (birth weight, mean +/- SD, 960 +/- 145 g; gestational age 28 +/- 1 weeks) with bronchopulmonary dysplasia (BPD) according to the criteria of Bancalari, and 6 controls (birth weight 1,320 +/- 210 g; gestational age 30 +/- 2 weeks) were studied for energy expenditure (EE) by indirect calorimetry. The measurement of total EE was performed when the intake of the infants in both groups was the same and when the respiratory condition had stabilized (control group: postnatal age 31 +/- 6 days, 1,950 +/- 200 g; BPD group: postnatal age 105 +/- 45, postnatal weight 2,440 +/- 380). The BPD group had a higher VO2 (11.15 vs. 8.04 ml/kg/min, p less than 0.01), VCO2 (9.13 vs. 7.74 ml/kg/min, p less than 0.02) and total EE (76 vs. 61 kcal/kg/day, p less than 0.02). The highest values were encountered in the 3 more severely ill infants: mean VO2 11.03 ml/kg/min, mean EE 82 kcal/kg/min. In these cases, administration of medium chain triglycerides limits the increase in VCO2 and lowers the respiratory quotient (0.87 vs. 0.96 in controls.     

Total energy expenditure in small for gestational age infants.

OBJECTIVE: To measure total energy expenditure and body composition in small for gestational age (SGA) infants, to investigate hypermetabolism. METHODS: A cross-sectional study was performed in 52 small for gestational age (SGA) measured at 5 weeks of age, using existing data from appropriate for gestational age (AGA) infants as controls. The doubly-labelled water technique was used to assess both total energy expenditure and body composition in both cohorts of infants. RESULTS: Multiple regression analysis revealed that expressing energy expenditure per kg fat free mass adjusts for body composition in infants of this age. Regression analysis also showed that the relation between total energy expenditure and fat free mass differed between the two groups. CONCLUSION: These data indicate that for a given fat free mass, the total energy expenditure of SGA infants is greater than that of AGA infants. Such data should be taken into account when energy requirements for SGA infants are being considered.     

Total energy expenditure in small for gestational age infants.

AIM: To measure total energy expenditure and body composition in small for gestational age (SGA) infants in order to investigate proposed hypermetabolism in such babies. METHODS: A cross sectional study of 52 SGA infants measured at 5 weeks of age was made, using existing data from appropriate for gestational age (AGA) infants as controls. The double labelled water technique was used to assess both total energy expenditure and body composition. RESULTS: Multiple regression analysis showed that expressing energy expenditure per kg fat free mass adjusts for body composition in infants of this age. The relation between total energy expenditure and fat free mass differed between the two groups. CONCLUSION: These data indicate that for a given fat free mass the total energy expenditure of SGA infants is greater than that of AGA infants. Such data should be taken into account when energy requirements for SGA infants are being considered.     

小于胎龄儿青春前期女孩硫化脱氢表雄酮和胰岛素水平的研究

目的探讨小于胎龄儿(SGA)青春前期女孩肾上腺机能初现及是否具有肾上腺机能早现、高肾上腺雄激素血症、高胰岛素血症和胰岛素抵抗现象。方法以符合纳入标准的SGA 39例为研究对象,年龄(7.4±1.7)岁,42例适于胎龄儿(AGA)为对照组,年龄(7.4±1.7)岁。在隔夜空腹12 h后,行身体检查,并抽血检测空腹血糖、胰岛素、硫化脱氢表雄酮(DHEAS)、皮质醇和雌二醇。胰岛素敏感性用空腹血糖与胰岛素乘积的倒数再取自然对数来评价。结果两组中未发现肾上腺机能早现的临床表现,两组间孕母孕龄、年龄、体重指数、空腹血糖、皮质醇、雌二醇和胰岛素敏感性指数差异无统计学意义。SGA组出生体重、研究时的身高和体重均低于AGA组,SGA血清胰岛素和DHEAS水平均高于AGA组(对数转换值:1.076±0.041vs.1.050±0.051,P<0.05;2.637±0.271vs.2.514±0.250,P<0.05)。AGA组DHEAS值在7岁以后出现明显增加,SGA组DHEAS值出现增加的趋势与AGA组比较有所提前。结论AGA女孩肾上腺机能初现的年龄约为7岁,而SGA女孩肾上腺机能初现有始动提前的趋势,青春前期SGA女孩有高肾上腺雄激素血症和胰岛素水平升高的现象,但以胰岛素敏感性指数来评价,尚未发现胰岛素抵抗现象。     

适于胎龄儿和小于胎龄儿小脑发育的对比研究

目的 探讨适于胎龄儿（AGA）和小于胎龄儿（SGA）的小脑发育是否存在差异。方法 选取165例胎龄25~40⁺⁶周的AGA和105例相应胎龄的SGA纳入研究。于新生儿出生24~48 h内采用超声测量小脑横径、小脑蚓部高度、小脑蚓部面积、小脑蚓部周长、小脑横径切面小脑面积、小脑横径切面小脑周长。采用Pearson相关分析法进行各测量值与胎龄关系的分析。结果 不论AGA还是SGA,小脑各测量值和胎龄均呈正相关（r=0.50~0.81,P < 0.05）。AGA和SGA各测量值在胎龄25~27⁺⁶周、28~30⁺⁶周、31~33⁺⁶周亚组中的比较差异无统计学意义（P > 0.05）,但在胎龄34~36⁺⁶周、37~40⁺⁶周亚组中,SGA的各测量值均明显低于AGA（P < 0.05）。结论 胎龄 < 34周SGA的宫内小脑发育与同胎龄的AGA类似,而≥34周SGA的宫内小脑发育落后于AGA。     

Circulating insulin-like growth factor I levels in newborn premature and full-term infants followed longitudinally

Longitudinal circulating levels of insulin-like growth factor I (IGF-I) were measured by radioimmunoassay after acid/ethanol extraction of serum or plasma in 44 appropriate-for-gestational age (AGA) premature infants, 7 small-for-gestational age (SGA) premature infants and 9 AGA full-term infants. The subjects were divided into cohorts with gestational age at birth 26-29 weeks, 30-33 weeks, 34-37 weeks and 38-42 weeks (full-term). The premature infants in this study exhibited diminished growth as compared with normal intrauterine growth. In all but the earliest premature infant cohort there was an immediate fall from the mean fetal IGF-I level, as reflected by the cord value, to a basal postnatal circulating level of IGF-I. The basal level of circulating IGF-I in premature infants was related only to gestational age. It increased slowly from 25 weeks gestation until four weeks after full-term equivalent and was independent of time of birth. Full-term infants were distinguished from early premature infants by the occurrence of a prominent postnatal surge in circulating IGF-I levels that was characterised by a significant (P less than 0.02) increase between day 1 and days 10-15. The SGA and AGA infants in the 34-37 week cohort showed similar profiles of circulating IGF-I with no significant difference in cord values between the two groups.     

Brainstem auditory evoked responses in term small for gestational age newborn infants born to undernourished mothers.

Our aim was to assess the effect of intrauterine growth retardation on neurosensory development by evaluating brainstem auditory evoked responses (BAER) in term small for gestational age (SGA) newborn infants born to undernourished mothers. This prospective clinical study included 25 singleton healthy SGA newborn infants born between 38 and 41 weeks to undernourished mothers (weight <45kg, height <145cm, haemoglobin <8g/dl, and serum albumin <2.5g/dl). An equal number of age- and sex-matched appropriate for gestational age newborn infants born to healthy mothers served as controls. Mothers with other risk factors and newborns with complications during delivery or immediate newborn period were excluded. BAER was recorded within first 3 days of life. Interpeak latency (IPL), absolute peak latency (APL) and amplitudes of various waveforms were determined and compared between the groups.No statistically significant differences were observed for the mean interpeak and absolute latencies between term SGA and AGA infants (p>0.05). The absolute peak latency (wave V) and central conduction time (I-V interval) were borderline prolonged in the study group compared with controls (p=0.051 and 0.088 respectively). Using multiple regression analysis, maternal haemoglobin was identified to be the only parameter having a negative correlation with both IPL (waves I-V) (F[1,46]=4.12, p=0.048) and APL (wave V) (F[1,46]=5.80, p=0.02). Maternal undernourishment may have a minor effect on intrauterine development of the auditory brainstem. Maternal haemoglobin is the only factor significantly associated with these changes.     

Serum adiponectin concentrations in newborn infants in early postnatal life

Serum adiponectin levels were investigated in 28 small-for-gestational-age (SGA) and 34 appropriate-for-gestational-age (AGA) term neonates to examine how fetal growth correlates with adiponectin levels. A blood sample for determination of adiponectin was obtained during the first 24 h of life. The levels of serum adiponectin were significantly higher in all newborn infants than in healthy children (28.7 +/- 17.0 versus 9.3 +/- 6.1 microg/mL; p < 0.01). There was a significant difference in adiponectin levels between SGA and AGA infants (23.2 +/- 14.8 versus 33.2 +/- 17.5 microg/mL; p=0.02). For all of the newborn groups, serum adiponectin levels correlated positively with birth weight (r=0.27, p <0.05) and head circumference (r=0.30, p <0.05). There was no relationship between serum adiponectin levels and gestational age, birth length, blood glucose levels, or blood sampling time after birth. There was no gender difference in adiponectin levels in the entire newborn group (30.0 +/- 19.7 versus 28.0 +/- 15.5 microg/mL, in male and female infants). Our results suggest that hyperadiponectinemia and a positive relationship between the serum levels of adiponectin and birth weight in newborns cannot be explained by the low percentage of body fat alone. Lower adiponectin levels in SGA infants than in AGA infants are unlikely to suggest insulin resistance in intrauterine growth-retarded infants in early postnatal life but may be a predisposing factor in the future development of insulin resistance or type 2 diabetes.