Clamp late and maintain perfusion (CLAMP) policy: delayed cord clamping in preterm infants

Objective: Randomized controlled trials have demonstrated that delayed umbilical cord clamping (DCC) in preterm infants results in improved neonatal outcomes, including increased hematocrit, and decreased rates of intraventricular hemorrhage (IVH) and packed red blood cell transfusions. We hypothesized that implementation of a DCC policy in preterm infants would result in similarly improved outcomes, despite initial clinician resistance.

Study design: A DCC policy (30–60?s) for singleton infants <35 weeks gestation was implemented in September 2011. We conducted a pre-test/post-test analysis of neonatal outcomes among singletons delivered between 24 0/7 weeks and 34 6/7 weeks gestation from 2009 to 2013 (2 years pre-implementation and 2 years post-implementation). The primary outcomes were rates of policy compliance and four neonatal outcomes.

Results: Despite multiple routes of policy dissemination, DCC was attempted in only 49% of the deliveries. In spite of this, infants delivered post-policy implementation (n?=?196) had a significant decrease in IVH, significant increase in initial hematocrits, and improved temperatures compared with infants delivered pre-implementation (n?=?204).

Conclusion: After implementation of a DCC policy, preterm singleton infants had improved temperatures, increased hematocrits and a decreased prevalence of IVH without significant differences in adverse outcomes, suggesting that the benefits of DCC outweighed the risks.     

The effect of initiating intravenous oxytocin infusion before uterine incision on the blood loss during elective cesarean section: a randomized clinical trial

Objective: This study compares the effect of starting intravenous oxytocin infusion early before uterine incision versus late after umbilical cord clamping on the blood loss during elective cesarean section (CS).

Methods: A single-blinded randomized clinical trial conducted on 200 pregnant women at term (>37 weeks) gestation scheduled for elective CS were assigned to either IV infusion of 30?IU of oxytocin started before uterine incision (Group I) or started immediately after clamping the umbilical cord (Group II). The primary outcome was the mean volume of blood loss during CS. The secondary outcomes included the mean volume of postoperative blood loss, the mean reduction in the hemoglobin and hematocrit levels, the need for additional uterotonics, blood transfusion and additional surgical procedures.

Results: The baseline characteristics of both groups are quiet similar. No statistical significant difference between both groups as regard to pre- and postpartum hemoglobin levels (p?=?.06 and 0.24 respectively) and hematocrit values (p?=?.12 and .51 respectively). There was a significant reduction in the intraoperative blood loss in group I compared with group II (432.7?±?90.6 versus 588.9?±?96.3?mL respectively, p?=?.001). The need for additional uterotonics was more frequent in the group II (19 women) than in group I (seven women) with statistical significance (p?=?.002). No differences between both groups regarding the need for blood transfusion or additional surgical procedures.

Conclusions: Initiating intravenous oxytocin infusion before uterine incision during elective CS could be associated with reduction in the intraoperative blood loss and the need for additional uterotonics.     

Second stage of labor and intraventricular hemorrhage in early preterm infants in the vertex presentation

Abstract

Objective: To investigate the association between exposure to second stage of labor and duration of second stage, and risk of intraventricular hemorrhage (IVH) among infants delivered <30 weeks of gestation.

Methods: We conducted a retrospective cohort study among 158 singleton vertex deliveries (97 vaginal and 61 cesarean). Multivariable logistic regression was used to evaluate the risk of IVH related to second stage.

Results: Infants exposed to second stage as compared to those not exposed to second stage irrespective of their mode of delivery had increased risk of mild IVH (odds ratio [OR] 2.69; 95% confidence interval [CI] 1.15, 6.29) but not of severe IVH (OR 1.14; 95% CI 0.33, 3.84). No relation with risk of mild (OR 0.98; 95% CI 0.95, 1.01) and severe (OR 1.00; 95% CI 0.95, 1.05) IVH was observed for each 1?min increase in duration of second stage. We also observed no significant association between quartiles of duration of second stage and risk of mild (p?=?0.20) and severe (p?=?0.29) IVH. We did not observe any significant interaction by gestational age, chorioamnionitis, birth weight or presenting complaint on admission.

Conclusion: The risk of mild IVH was increased in those exposed to a second stage of labor. However, no clear association was observed between duration of second stage and mild or severe IVH.     

Superior vena cava flow and intraventricular haemorrhage in extremely preterm infants

Objective: To evaluate the relationship between superior vena cava flow (SVCF) measurements within the first 24?h of life, and development of intraventricular haemorrhage (IVH) in extremely preterm infants.

Study design: Single centre retrospective cohort study of 108 preterm infants born less than 28 weeks’ gestation. Main outcome measure was degree of IVH at day 7 postnatal age.

Results: The mean GA of the study group was 25.4 weeks. Mean SVCF was lower (75?ml/kg/min) in infants later diagnosed with IVH (n?=?46) compared to infants, who did not develop IVH (87.7?ml/kg/min, p?=?0.055). PDA diameter was inversely associated with SVCF (p?=?0.024) and reversal of flow in the descending aorta (p?=?0.001). Sensitivity analysis did not confirm an independent association of SVCF with development of IVH [OR 0.990 (0.978–1.002), p?=?0.115].

Conclusion: Our study describes early SVCF in extremely preterm infants is associated with the extent of ductal shunting, but insensitive in predicting IVH.     

The effect of histological chorioamnionitis on the short-term outcome of preterm infants ≤32 weeks: a single-center study

Abstract

Background and objectives: Chorioamnionitis (CA) is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological CA on the short-term outcome of preterm infants.

Subjects and methods: The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus (PDA) requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (IVH; grade III–IV) were analyzed.

Results: Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological CA (n?=?145) and without histological CA (n?=?136). Mean gestational age was 28.8?±?2.6 weeks and 29.1?±?2.5 weeks, and mean birth weight was 1138?±?350?g and 1210?±?299?g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological CA was associated with early onset sepsis (p?=?0.007), PDA (p?=?0.003), IVH (p?=?0.03), and death (p?=?0.04).

Conclusion: Maternal histological CA is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, IVH, PDA and increased mortality.     

The comparison of intelligence levels of children born to kidney or liver transplant women with children of healthy mothers

Background: Pregnancy after transplantation is associated with high risk of complications and prenatal exposure to immunosuppressants. The purpose of the study was to evaluate the intellectual development of children born to women after organ transplantation.

Aims: A comparison of intelligence levels in 78 children of kidney or liver transplant women of 78 children born to healthy mothers. The assessment of intellectual level in children was conducted by psychologists and evaluated using age-adjusted intelligence tests (Psyche Cattell Infant Intelligence Scale, Terman–Merril Intelligence Scale or the Scales of Raven’s Progressive Matrices).

Results: No significant differences in the distribution of the quotient of intelligence between children born to kidney and liver transplant women were noted (Chi²?=?5.037; p?=?.284). Also no differences in the distribution of intelligence levels were noted between the children of transplanted and healthy mothers in infants and toddlers (Chi²?=?3.125; p?=?.537); preschool (Chi²?=?1.440; p?=?.692), and school age children (Chi²?=?4.079; p?=?.395).

Conclusions: The intellectual development of children of post-transplant women is similar to the general population. These results provide information on the low risk of intellectual disability in children of transplanted mothers and may improve counseling on the planning of pregnancy in this group of women.     

Five-dimensional long bones biometry for estimation of femur length and fetal weight at term compared to two-dimensional ultrasound: a pilot study

Background/objective: This study aimed to evaluate accuracy of five-dimensional long bones (5D LB) compared to two-dimensional ultrasound (2DUS) biometry to predict fetal weight among normal term women.

Methods: Fifty six normal term women were recruited at Ain Shams Maternity Hospital, Egypt from 14 May to 30 November 2015. Fetal weight was estimated by Hadlock’s IV formula using 2DUS and 5D LB. Estimated fetal weights (EFW) by 2DUS and 5D LB were compared with actual birth weights (ABW).

Results: Mean femur length (FL) was 7.07?±?0.73?cm and 6.74?±?0.67?cm by 2DUS and 5D LB (p?=?.02). EFW was 3309.86?±?463.06?g by 2DUS and 3205.46?±?447.85?g by 5D LB (p?=?.25). No statistical difference was observed between ABW and EFW by 2DUS (p?=?.7) or 5D LB (p?=?.45). Positive correlation was found between EFW by 2DUS, 5D LB, and ABW (r?=?0.67 and 0.7; p?p?=?.15).

Conclusions: 2DUS and 5D LB had same accuracy for fetal weight estimation at normal term pregnancy.     

High frequency jet ventilation in preterm infants: experience from Western Australia

Objective: To assess if high frequency jet ventilation (HFJV) is associated with reduced odds of death or discharge home on oxygen in preterm infants.

Methods: A case control study (1 February 2010 – 1 June 2014) comparing the primary outcome as “death or discharge home on oxygen” in preterm infants who needed HFJV (Cases) versus those who did not (Controls). Controls were matched to cases (1:1) on gestation, birthweight, gender, place of birth, growth status, antenatal glucocorticoids, and dexamethasone as treatment for severe bronchopulmonary dysplasia (BPD). Logistic regression analysis was used to control for confounders.

Results: Data on all preterm infants who needed HFJV (Cases: n?=?50) and 50 controls during the study period were analysed. Primary outcome was more frequent in cases versus controls, but not significant after adjusting for mean airway pressure and adjuvant therapy (e.g. diuretics) [aOR: 1.46 (0.23–9.14), p?=?.687]. Death before discharge [odds ratios (OR): 6.00 (1.34–55.2), p?=?.013] was more frequent in cases; discharge on home oxygen [OR: 0.88 (0.27–2.76), p?=?1.000] was comparable between groups. Duration of oxygen [adjusted hazard ratios (aHR): 1.23 (0.69–2.17), p?=?.475] and incidence of treatment warranting retinopathy of prematurity [aOR: 0.10 (0.01–1.96), p?=?.127] was not significant between cases versus controls.

Conclusions: HFJV was not associated with reduced odds of death or discharge home on oxygen in preterm infants in our study. Adequately powered randomized trials are required to assess the efficacy and safety of HFJV in preterm infants.     

The effect of zinc and vitamin E cosupplementation on metabolic status and its related gene expression in patients with gestational diabetes

Abstract

Objective: The aim of this study was to determine the effects of zinc and vitamin E cosupplementation on metabolic status and gene expression related to insulin and lipid metabolism in women with gestational diabetes mellitus (GDM).

Methods: Fifty-four women, in the age range of 18–40 years, diagnosed with GDM were recruited for this randomized, double-blinded, placebo-controlled trial. Subjects were randomly allocated into two intervention groups to either taking 233?mg/day Zinc Gluconate plus 400-IU/day vitamin E supplements or placebo (n?=?27 each group) for 6 weeks. Gene expression related to insulin and lipid metabolism was evaluated in peripheral blood mononuclear cells (PBMCs) of women with GDM using RT-PCR method.

Results: Participants who received zinc plus vitamin E supplements had significantly lower serum insulin levels (β?=??3.81; 95% CI, ?5.90, ?1.72; p?=?.001), homeostasis model of assessment-insulin resistance (β?=??0.96; 95% CI, ?1.54, ?0.38; p?=?.002), serum total-cholesterol (β?=??8.56; 95% CI, ?16.69, ?0.43; p?=?.03) and low density lipoprotein-cholesterol (LDL)-cholesterol (β?=??8.72; 95% CI, ?15.27, ?2.16; p?=?.01), and higher quantitative insulin sensitivity check index (β?=?0.01; 95% CI, 0.005, 0.02; p?=?.007) compared with the placebo. Moreover, zinc and vitamin E cosupplementation upregulated gene expression of peroxisome proliferator-activated receptor gamma (PPAR-γ; p?=?.03) and low-density lipoprotein receptor (LDLR; p?=?.04) compared with the placebo. Though, zinc and vitamin E combination did not affect other metabolic parameters.

Conclusions: Overall, zinc and vitamin E cosupplementation for 6 weeks in women with GDM significantly improved insulin metabolism, lipid profile, and the gene expression levels of PPAR-γ and LDLR.     

Measurement of interleukin-6 (IL-6) and erythropoietin (EPO) in umbilical cords of preterm infants with intraventricular hemorrhage in two hospitals in Tehran

Background: Intraventricular hemorrhage (IVH) is an important cause of death in premature infants. This study aimed to assess the association of the umbilical cord plasma levels of interleukin-6 (IL-6) and erythropoietin (EPO) with the occurrence and severity of IVH in premature infants.

Methods: Fifty premature newborns of mothers with chorioamnionitis risk factor were selected via nonprobability sampling. The concentration of the cord plasma’s IL-6 and erythropoietin were measured by enzyme-linked immunosorbent assay (ELISA) for 3 days. Finally, all samples underwent sonography for the diagnosis of IVH. Results analyzed statistically.

Results: Among the samples, 68.98% of them were diagnosed with IVH grade 1. The most severe IVH cases were detected on the second day. The mean and standard deviation of IL-6 level was 74.71?±?50.53 in the case group and 24.10?±?46.10 in the control group. There was a correlation between IL-6 levels and IVH (p?=?0.0005). The mean and standard deviation of EPO level was 18.38?±?15.23 in the IVH group and 6.45?±?13.48 in samples without IVH. A correlation was detected between EPO level and IVH (p?=?0.005).

Conclusion: The concentration of IL-6 and EPO levels of the cord plasma was higher in the premature newborns with IVH.     

Platelet mass index in very preterm infants: can it be used as a parameter for neonatal morbidities?

Objective: Platelet mass index (PMI) is related to the platelet functionality. The aim of this study was to evaluate the correlation between PMI and the occurrence of various inflammation-related morbidities of prematurity, such as bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and sepsis in very low-birth weight (VLBW) infants.

Methods: This retrospective analysis of VLBW infants admitted to a level 3 neonatal intensive care unit from October 2012 and 2014, n?=?330. Platelet mass was calculated and recorded on the day of birth and between 3 and 7 days (second measure) for each patient. Statistical analysis included analysis of paired samples t test and independent samples t test.

Result: Among VLBW neonates, PMI values were lower in infants with ROP (p?=?0.016), BPD (p?=?0.002), IVH (p?=?0.018) and NEC (p?=?0.011) when compared with the control group in the second measurement.

Conclusions: In this study, we found that premature infants with BPD, NEC, ROP, IVH and sepsis had lower PMI levels in early postnatal life than infants without these diseases. This might be associated with the inflammatory process.     

Colostrum and mature breast milk analysis of serum irisin and sterol regulatory element-binding proteins-1c in gestational diabetes mellitus

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.

Methods: GDM positive women (n?=?33) and normal glucose tolerant women (NGT) (n?=?33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72?hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed by commercially available ELISA kits for all maternal samples.

Results: Lower levels of irisin were seen in serum, colostrum and mature breast milk of GDM females (p?r?=?0.439; p?r?=?0.403; p?=?.01), HbA1c (r?=??0.312; p?=?.011), Fasting blood glucose (r?=?0.992; p?=?.008), and baby weight at birth (r?=?0.486; p?r?=?0.325; p?=?.017; r?=?0.296; p?=?.022, respectively). Serum SREBP-1c at 6 weeks correlated with random blood glucose (r?=?0.318; p?=?.009), and HbA1c (r=??0.292; p?=?.011). All correlations were lost once we adjusted for maternal BMI.

Conclusions: Low irisin and SREBP1-c levels may favor development of GDM in pregnant subjects. Further, low mature breast milk levels may act as a continued stressor from fetal to infant life as long as breast-feeding is continued. Further studies are required to identify the mechanistic relationship between these biomarkers and GDM.     

A pioneering study: oral clarithromycin treatment for feeding intolerance in very low birth weight preterm infants

Purpose: To examine the prokinetic effect of clarithromycin in very low birth weight (VLBW) preterm infants.

Materials and methods: VLBW preterm infants who have not achieved half of the full enteral feeding in the second week of life were enrolled in the study. The infants enrolled in the study were randomized. Twenty infants received oral clarithromycin (7.5?mg/kg, twice a day) and 20 control infants did not receive any treatment.

Results: Full enteral feeding was attained earlier in the clarithromycin group than in the control group [7 (6–9) versus 9 (9–11) days, respectively; p?p?=?.013 and p?n?=?1 versus 3, p?=?.1) and length of hospital stay (50 versus 59 median days, p?=?.1) tend to be lower in the clarithromycin group without any statistical significance. We observed no adverse effect of clarithromycin therapy.

Conclusions: Clarithromycin treatment in VLBW preterm infants resulted in better toleration of enteral feeding. Larger randomized controlled trials are needed to establish routine use of clarithromycin in the treatment of feeding intolerance.     

Cord blood erythropoietin and interleukin-6 for prediction of intraventricular hemorrhage in the preterm neonate

Objective.?To evaluate cord blood erythropoietin (EPO) and interleukin-6 (IL-6) levels to predict preterm infants at risk of developing intraventricular hemorrhage (IVH).

Methods.?Levels of umbilical cord EPO, acid–base status and IL-6 were analyzed in 116 consecutive, preterm newborns (GA at delivery: 29 [23–34 ] weeks) born to mothers who had a clinically indicated amniocentesis to rule out infection. Early-onset neonatal sepsis (EONS) was diagnosed using symptoms, hematological criteria and blood cultures.

Results.?IVH was diagnosed by cranial ultrasounds. The prevalence of IVH in our population was 25% (29/116). There was a direct relationship between cord blood EPO and cord blood IL-6 concentration (r?=?0.225, p?=?0.014), independent of GA at birth. Elevated cord blood EPO levels (r?=?0.182, p?=?0.016) and GA at birth (r?=??0.236, p?=?0.004) remained significant independent factors associated with the risk of IVH, when evaluated with stepwise logistic regression analyses. Cord blood IL-6, pH, and EONS were not associated with IVH. These relationships remained following correction for GA at birth (p?=?0.027).

Conclusions.?Our results suggest that elevation in cord blood EPO may predict newborns at risk for IVH, independent of fetal inflammatory status. Further studies are warranted to confirm this association.     

Neurodevelopmental outcomes of premature infants with severe intraventricular hemorrhage

Objective: Our objective was to determine the neurodevelopmental outcome at 18–24 months’ of corrected age (CA) in preterm infants with severe intraventricular hemorrhage (IVH).

Methods: This was a retrospective cohort study of all preterm infants who were <37 weeks’ gestation, had Grade 3–4 IVH, were admitted between January 2009 and December 2010 and discharged. The cohort was divided into three groups. Group 1 was defined as infants born with a birth weight (BW) less than 1000?g, group 2 was defined as infants born with a BW between 1000 and 1500?g and group 3 was defined as infants born with a BW between 1501 and 2500?g. Severe IVH was defined as the presence of grade 3–4 IVH on cranial ultrasound. Cranial ultrasound was performed in the first week of life and subsequently at weekly intervals by a radiologist. A comprehensive assessment including hearing, vision, neurological and developmental evaluation with Bayley Scales of Infant Development, Second edition was performed by the experienced researchers at 18–24 months’ CA. Neurodevelopmental impairment (NDI) was defined as at the presence of one or more of the following: cerebral palsy; Mental Developmental Index score lower than 70; Psychomotor Developmental Index score lower than 70; bilateral hearing impairment; or bilateral blindness.

Results: From January 2009 to December 2010, a total of 138 infants were diagnosed as severe IVH (grade 3–4). Of them, 74 (71.1%) infants (group 1?=?31, group 2?=?29 and group 3?=?14 infants) completed the follow-up visit and evaluated at 18–24 months’ CA. Median Apgar score (p?p?p?p?p?p?p?=?0.014, respectively). The duration of hospitalization and mortality rates consistent with the degree of prematurity were significantly higher in group 1 compared to groups 2 and 3 (p?=?0.03 and p?=?0.01). Among the long-term outcomes, the rates of CP and NDI did not differ between the groups (p?=?0.68 and p?=?0.068).

Conclusion: Our results demonstrated that long-term outcomes of preterm infants did not differ between the groups classified according to the BW at two years of age. This has leaded to the conclusion that severe IVH is alone represents a significant risk factor for poor neurodevelopmental outcome in this already high-risk population.     

Umbilical cord blood and maternal visfatin (PBEF/NAMPT) concentrations in preterm birth with and without preterm premature rupture of membranes

Objectives: The aim of the study is to investigate differences in visfatin concentrations between mothers with term and preterm birth (PTB) and between mothers who delivered within seven days and after more than seven days following admission for PTB/preterm premature rupture of membranes (PPROMs).

Methods: Maternal peripheral blood and cord blood were collected from 56 mothers with PTB (31 with PPROM) and 71 mothers with term delivery (three with PPROM).

Results: Maternal visfatin concentration was significantly higher for given gestational age in PTBs compared to term deliveries (p?=?.021) and also in mothers who delivered within seven days after admission for PTB or PPROM, compared to those who delivered after more than seven days (p?=?.027; p?=?.039). Cord blood visfatin concentration was found to be decreased in preterm compared to term infants (p?=?.007).

Conclusions: Visfatin in both maternal and fetal circulation may play an important role in the pathogenesis of PTB/PPROM and could be used to distinguish between women who will deliver in a short period of time after clinical presentation of PTB/PPROM and those who deliver later. Nevertheless, additional research is necessary in order to identify its direct involvement in PTB/PPROM.     

Is there a role for kisspeptin in pathogenesis of polycystic ovary syndrome?

Aim: To investigate association of kisspeptin levels in infertile women with different ovarian reserve patterns.

Materials and methods: In this prospective cross-sectional study, 157 participants were recruited. The women were divided into three groups: (i) adequate ovarian reserve (AOR) (n?=?57), (ii) high ovarian reserve (PCOS) (n?=?60), (iii) diminished ovarian reserve (DOR) (n?=?40). Weight, height, waist circumference (WC), hip circumference (HC), body mass index (BMI), waist/hip ratio (WHR) were measured. The blood samples were analyzed for estradiol (E2), follicle-stimulating hormone (FSH), luteinizing hormone (LH), total testosterone (TT), 17-hydroxy progesterone (17OHP), dehydroepiandrosterone sulfate (DHEAS), antimullerian hormone (AMH), kisspeptin measurements.

Results: FSH concentration was higher and AMH concentration was lower in DOR group (p?p?p?=?.001, p?p?=?.003, respectively). The 17OHP level did not differ among the groups (p?=?.15). Women with PCOS possessed the highest kisspeptin level (p?=?.01). The kisspeptin level was negatively correlated with FSH level (r?=??0.18, p?=?.02) and positively correlated with TT and DHEAS levels (r?=?0.17, p?=?.02 and r?=?0.23, p?=?.003, respectively).

Conclusions: Women with PCOS had increased serum kisspeptin levels. Kisspeptin concentrations were negatively correlated with serum FSH and positively correlated with serum TT and DHEAS levels.     

Late umbilical cord clamping does not increase rates of jaundice and the need for phototherapy in pregnancies at normal risk

Objective: To verify the relationship between the time of clamping of the umbilical cord and the development of neonatal jaundice, the dosage of bilirubin and the need for phototherapy.

Methods: Cross-sectional, retrospective study with 398 parturients at normal risk (single term gestation, no complications during gestation or delivery, birth weight between 2500 and 4499?g). The population was divided into three groups regarding the time of cord clamping: <1?min(117, 29.4%), between 1 and 3?min(228, 57.3%) and >3?min(53, 13.3%). Sociodemographic, clinical and obstetric characteristics, birth and delivery data, and maternal and perinatal outcomes were evaluated. Pearson’s chi-square test, Fisher’s exact test and the Kruskal–Wallis test were used for comparison between the groups. Statistical significance was considered p?Results: The groups were similar in the development of jaundice (p?=?.370), bilirubin dosage (p?=?.342) and need for phototherapy (p?=?.515). Late clamping was more prevalent in vaginal deliveries when compared to cesarean sections (1–3?min: 64 versus 21.4%, >3?min: 16.6 versus 1%) (p?Conclusion: The clamping time of the umbilical cord showed no association with jaundice, bilirubin dosage, or phototherapy needs in neonates at normal risk. The adoption of late clamping was more prevalent in vaginal deliveries.     

First-trimester irisin and fetuin-A concentration in predicting macrosomia

Objective: We investigated the diagnostic value of first-trimester adipokines and placental markers in predicting macrosomia.

Methods: Out of 328 women recruited during the prenatal diagnosis between 11th and 13th week of pregnancy and subjected to follow up until delivery, we selected 26 women who gave birth to macrosomic babies and 34 women who gave birth to normal weight neonates for the evaluation of first trimester serum levels of pregnancy associated plasma protein-A, free β-human chorionic gonadotropin, placental growth factor (PIGF), and selected adipokines.

Results: The mothers of macrosomic infants had higher PIGF (p?=?.049) and irisin concentrations (p?=?.00003), and lower fetuin-A levels (p?=?.0002) than had the mothers of normal weight babies. Newborn’s weight correlated positively with maternal irisin (R?=?0.454, p?=?.0003) and negatively with fetuin-A concentrations (R?=??0.497, p?=?.00005). Multiple regression analysis showed that only serum irisin concentration was a significant predictor of birth weight (β?=?0.329, p?=?.03), explaining 14% of its variability. The sensitivity and the specificity of irisin concentration in predicting macrosomia were 0.769 and 0.794, respectively (AUC?=?0.818 [95%CI: 0.708–0.928], p?=?.00001) with a proposed cut-off value of 1725.4?ng/ml.

Conclusions: Our results suggest that mother’s irisin may be an early biomarker of macrosomia.     

Evaluation of serum ischemia-modified albumin levels in anemia of prematurity

Purpose: Ischemia-modified albumin (IMA) is used to determine tissue hypoxia. We aimed to evaluate the serum IMA levels in preterm infants requiring transfusion due to anemia of prematurity, a clinical condition to cause tissue hypoxia.

Materials and methods: This prospective study was performed in Etlik Zubeyde Hanim Hospital, Turkey. Preterm infants with birth weight less than 1500?g and born between 25 and 32 weeks were included during assessment for anemia of prematurity. The transfused infants with anemia of prematurity formed the “transfusion group”, the control group consisted of gender, gestational and postnatal age-matched infants without transfusion requirement. Serum samples of control group and pre-transfusion and post-transfusion samples of transfusion group were analyzed for IMA (ABS unit). Serum IMA levels were compared between control group and pre-transfusion samples of transfusion group and were also evaluated for the significance of change after transfusion.

Results: Sixty-two infants were included (transfusion group: 31, control group: 31). The pretransfusion serum IMA levels were higher than that of infants in the control group [ABS unit; transfusion group; pre-transfusion: 1.00 (0.76–1.09) and control group: 0.81 (0.52?1.04); p?=?.03]. Serum IMA levels decreased significantly to 0.79 (0.59–0.95) after transfusion; p?=?.007. Infants with hematocrit higher than 30% had lower IMA levels [0.69 (0.54?0.96)] than infants with lower hematocrit [0.96 (0.75?1.05)]; p?=?.002.

Conclusions: Clinicians may bear in mind that serum IMA levels could be utilized as a marker in deciding on erythrocyte transfusion in premature anemia.