Levels of asymmetric dimethylarginine throughout normal pregnancy and in pregnancies complicated with preeclampsia or had a small for gestational age baby

Objective: The aim of this study was to investigate maternal asymmetric dimethylarginine (ADMA) concentrations at the three trimesters of pregnancy in uncomplicated pregnancies and in women who developed preeclampsia or had small for gestational age infants (SGA) without preeclampsia. Methods: ADMA concentrations were retrospectively determined in the first, second and third trimester of pregnancy in 41 uncomplicated pregnancies, 10 pregnancies complicated with preeclampsia and 14 pregnancies that delivered a SGA baby. ADMA was measured with an ELISA kit. Results: Mean (±SD) concentrations of ADMA (µmol/L) in uncomplicated l pregnancies were: 0.51?±?0.14; 0.52?±?0.13; 0.58?±?0.16 in the three trimesters, respectively. ADMA concentrations in SGA pregnancies were significantly lower in each trimester compared to uncomplicated pregnancies: (0.40?±?0.10, p?=?0.005 1st trim; 0.42?±?0.10, p?=?0.007 2nd trim; 0.45?±?0.10, p?=?0.007 3rd trim). Although pregnancies that developed preeclampsia had higher ADMA concentration in all trimesters compared to uncomplicated pregnancies (0.58?±?0.10; 0.63?±?0.14; 0.68?±?0.11), the difference was statistically significant only in the 2nd trimester (p?=?0.02). Conclusions: Maternal serum ADMA concentration tends to increase during normal pregnancy. Pregnancies with SGA infants had significantly lower ADMA levels in all trimesters of pregnancy. ADMA concentrations in the 2nd trimester was significantly elevated in pregnancies that later developed preeclampsia.     

Iqmik – A form of smokeless tobacco used by pregnant Alaska natives: Nicotine exposure in their neonates

Objective.?To determine the concentration of nicotine and cotinine in maternal blood and neonatal cord blood among pregnant Alaska Native women and to assess the neonates for neurobehavioral effects.

Methods.?In a nonrandomized, clinical observational pilot trial, 60 pregnant Alaska Native women were enrolled for assessment of Iqmik (a mixture of leaf tobacco and ash) and other tobacco use during pregnancy and at delivery. Neonatal cord blood, nicotine and cotinine concentrations were obtained, and neonatal neurobehavioral effects were assessed using the Lipsitz scale.

Results.?At delivery, there were 22 subjects who reported using only Iqmik, and 10 who used other tobacco products. Subjects who reported using only Iqmik prior to delivery had higher concentrations of cotinine (167?±?116 vs. 81?±?100) in maternal blood (rank sum test, p?=?0.036) and higher concentrations of nicotine (8.4?±?7.3 vs. 4.4?±?5.1, p?=?0.048) and cotinine (153?±?115 vs. 70?±?95, p?=?0.048) in cord blood compared to subjects who reported using other tobacco products. Neurobehavioral signs as assessed by the Lipsitz score were increased in neonates born to mothers using only Iqmik (3.7?±?1.8, p?=?0.011), or to mothers using other tobacco products (3.4?±?1.4, p?=?0.034) compared to neonates born to women who reported no tobacco use (1.8?±?1.4).

Conclusions.?Mothers who use Iqmik and their neonates have higher cotinine concentrations compared to mothers who use cigarettes and/or other forms of tobacco. Neurobehavioral signs occur in neonates born to women who use Iqmik but also in neonates born to mothers who use other forms of tobacco during pregnancy.     

The assessment of placental volume and mean gray value in preeclamptic placentas by using three-dimensional ultrasonography

Objectives: We aimed to evaluate the placental volume and placental mean gray value in preeclampsia and healthy placentas by using three-dimensional (3D) ultrasonography and Virtual Organ Computer-aided AnaLysis (VOCAL).

Methods: This case–control prospective study consisted of 27 singleton pregnancies complicated by preeclampsia and 54 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm³) was analyzed using the VOCAL imaging program, and 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Preeclamptic and control group consisted of 27 (mean age: 28.90?±?5.95 years, mean gestation: 32.0?±?4.55 weeks) and 54 (mean age: 29.48?±?5.78 years, mean gestation: 32.61?±?4.23 weeks) singleton pregnancies, respectively. Placental volume was significantly smaller in preeclampsia (250.62?±?91.69 versus 370.98?±?167.82?cm³; p?=?0.001). Volumetric mean gray value of the placenta was significantly higher in preeclampsia (38.24?±?8.41 versus 33.50?±?8.90%; p?=?0.043). Placental volume was significantly correlated with the estimated fetal weight (r?=?0.319; p?=?0.003). There was negative significant relation between placental volume and umbilical artery pulsatility index, resistance index and systolic/diastolic ratio (r?=?–0.244, p?=?0.024; r?=?–0.283, p?=?0.005; r?=?–0.241, p?=?0.024, respectively).

Conclusions: Placental volume diminishes significantly in preeclampsia, whereas volumetric mean gray values increases. This may reflect the early alterations in preeclamptic placentas, which may help to understand the pathophysiology better.     

Umbilical blood gas analysis in preeclamptic versus healthy pregnancies with preterm birth

Objective: Comparing the value of umbilical cord arterial blood gas (UC-ABG) analysis in the prediction of neonatal mortality and morbidity in the preeclamptic versus healthy pregnancies with preterm birth.

Methods: Eight hundred sixteen preterm (born at?<37 gestational weeks) neonates with no other morbidities who were born by cesarean section were evaluated. Immediately after delivery, UC-ABG analysis was performed and the neonates were followed.

Results: Preeclamptic women had lower umbilical cord blood (UCB) pH (7.2 4?±?0.1 versus 7.2 7?±?0.08, p?=?0.008) and higher UCB base deficit (BD) (3.5?±?3.7 versus 2.2?±?3.4, p?=?0.005) compared with controls. In the preeclamptic group, UCB metabolic acidosis (pH?<?7.15 and B.D?>?8) was not independently associated with neonatal morbidity or mortality, while in the control group UCB metabolic acidosis was independently associated with low 10-min Apgar (OR, 4.9; 95%CI 1.37–18.03), respiratory distress syndrome (OR, 2.37; 95%CI 1.05–6.17), intraventricular hemorrhage (OR, 3.01; 95%CI 1.13–7.99), and neonatal mortality (OR, 17.33; 95%CI 4.51–66.53).

Conclusions: The preterm neonates born to preeclamptic mothers have lower UCB pH and higher BD. In these neonates, UCB acidosis is not independently associated with any adverse neonatal outcomes. In contrast, in the preterm neonates born to healthy mothers, UCB metabolic acidosis is independently associated with neonatal mortality and morbidity.     

Low-birth-weight,but not catch-up growth,correlates with insulin resistance and resistin level in SGA infants at 12 months

Objective: To investigate the insulin resistance status in SGA infants at 12 months and its relationship with auxological and metabolic parameters.

Methods: One group of 45 SGA and one of 50 appropriate for gestational age infants were followed from birth to the end of the first year of life. At 12 months, skinfold thickness, waist circumference, and blood levels of glucose, insulin, adiponectin, leptin, resistin, visfatin, retinol-binding protein 4, IGFs, lipids profile were determined, and the HOMA-IR index was calculated.

Results: The SGAs had increased insulin (5.2?±?2.7 versus 2.9?±?2.4 μIU/ml, p?=?0.012) and HOMA-IR (1.09?±?0.9 versus 0.59?±?0.55, p?=?0.016). In multiple regression, insulin resistance indices were independently correlated with low-birth-weight (β?=??2.92, p?=?0.015 for insulin, β?=??2.98, p?=?0.011 for HOMA-IR) but not with catch-up growth in either height or weight or any other metabolic parameter. Resistin was higher in the SGAs (5.1?±?2.1 versus 3.9?±?2.1?ng/ml, p?=?0.03) and independently correlated with low-birth-weight but not insulin resistance. Resistin was negatively correlated with total cholesterol (R?=??0.33, p?=?0.007) and positively with lipoprotein(a) (R?=?0.49, p?=?0.001).

Conclusion: Low-birth-weight, but not catch-up growth or adiposity tissue hormones, was correlated with insulin resistance at 12 months in non-obese SGA infants. The higher resistin in SGA infants and its correlation with total cholesterol and lipoprotein(a) need further clarification.     

Neopterin and hsCRP are not correlated in gestational diabetes mellitus

Objective: To determine serum neopterin and high sensitive C-reactive protein (hsCRP) levels in patients with and without gestational diabetes mellitus (GDM).

Methods: Neopterin and hsCRP levels were quantified in 28 women with GDM and 20 pregnant women with normal glucose tolerance (NGT). Postpartum neopterin and hsCRP levels were measured in a follow-up study.

Results: Neopterin levels were significantly higher in women with GDM than in women with NGT (15.89?±?8.19?nmol/L versus 10.4?±?3.8?nmol/L, p?p?p?=?0.9, respectively). In contrast, hsCRP levels decreased after delivery in patients with GDM (5.74?±?3.91 versus 3.78?±?2.78, p?r?=?0.3, p?=?0.02) and fasting glucose (r?=?0.4, p?=?0.004), postprandial glucose (r?=?0.3, p?=?0.01), HbA1c (r?=?0.3, p?=?0.02), whereas hsCRP levels were correlated with pre-pregnancy (r?=?0.3, p?=?0.04) and pregnancy body mass index (r?=?0.4, p?=?0.008). No correlation between serum neopterin and hsCRP levels was found (p?=?0.9).

Conclusion: Neopterin levels increased in patients with GDM; hence, it may be related to inflammation. However, the lack of correlation between neopterin and hsCRP suggests the role of different attitudes of these two parameters in the course of pregnancy and GDM.     

Evaluation of maternal serum progranulin levels in normotensive pregnancies,and pregnancies with early- and late-onset preeclampsia

Aims: To investigate the possible pathophysiological associations between progranulin (PGRN) and preeclampsia (PE), early-onset PE (EOPE) and late-onset PE (LOPE).

Study design: A cross-sectional study was designed to include consecutive patients with uncomplicated pregnancy (n?=?28), EOPE (n?=?30) and LOPE (n?=?22). Maternal levels of serum PGRN were measured with the use of an enzyme-linked immunosorbent assay kit.

Results: The mean serum PGRN level was significantly higher in women with PE compared to the control group (54.17?±?4.20?pg/ml versus 42.37?±?5.64?pg/ml, p?<?0.001), in the LOPE group compared to the control group (51.63?±?4.61?pg/ml versus 42.37?±?5.64?pg/ml, p?<?0.001) and also in women with EOPE compared to women with LOPE (56.03?±?2.68?pg/ml versus 51.63?±?4.61?pg/ml, p?<?0.001). Serum PGRN was negatively correlated with gestational age at birth (r?= ?0.669, p?=?0.001) and birth weight (r?= ?0.653, p?=?0.001); and positively correlated with systolic (r?=?0.653, p?=?0.001) and diastolic blood pressure (r?=?0.601, p?=?0.001), C-reactive protein (r?=?0.519, p?=?0.001), uterine artery pulsatility (r?=?0.441, p?=?0.001) and resistance indices (r?=?0.441, p?=?0.001).

Conclusions: Serum PGRN levels increase significantly in women with PE as an indirect sign of placental dysfunction. This increase is even more prominent in women with EOPE. The serum PGRN in the third trimester is positively correlated with gestational age at birth and birth weight.     

Prebiotics for the management of hyperbilirubinemia in preterm neonates

Objective: We evaluated if prebiotics have benefits for the management of hyperbilirubinemia in preterm neonates.

Methods: Preterm neonates were entered into the study when enteral feeding volume met 30?mL/kg/day. They randomly received a mixture of short-chain galacto-oligosacarids/long-chain fructo-oligosacarids or distilled water (placebo) for 1 week. Total serum bilirubin level was measured by transcutaneous bilirubinometry. Stool frequency and meeting full enteral feeding during the study period were considered as secondary outcomes.

Results: Twenty-five neonates in each group completed the trial. Bilirubin level was decreased with the prebiotic (?1.3?± 1.8?mg/dL, p?=?0.004), but not placebo (?0.1?±?3.3?mg/dL, p?=?0.416). Peak bilirubin level was lower with the prebiotic than placebo (8.3?±?1.7 versus 10.1?±?2.2?mg/dL, p?=?0.003). Stool frequency was increased with the prebiotic (0.7?±?1.9 defecation/day, p?=?0.014), but not with placebo (0.6?± 1.5 defecation/day, p?=?0.133). Average stool frequency (2.4?± 0.4 versus 1.9?±?0.5 defecation/day, p?=?0.003) and frequently of meeting full enteral feeding (60% versus 16%, p?=?0.002) were higher with the prebiotic than placebo.

Conclusions: Prebiotic oligosaccharides increase stool frequency, improve feeding tolerance and reduce bilirubin level in preterm neonates and therefore can be efficacious for the management of neonatal hyperbilirubinemia.     

Glycemic control in twin pregnancies with gestational diabetes: are we improving or worsening outcomes?

Objective: To estimate the association between glycemic control and adverse outcomes in twin pregnancies with gestational diabetes (GDM).

Study design: A cohort of patients with twin pregnancies and GDM were identified from one maternal–fetal medicine practice from 2005 to 2014. Patients with prepregnancy diabetes were excluded. First, outcomes were compared between patients with GDMA1 and GDMA2 (gestational age at delivery, birthweight, small for gestational age (SGA, birthweight <10th percentile), preeclampsia, and cesarean delivery). Then, finger stick glucose logs were reviewed and correlated with the risk of SGA and preeclampsia. Abnormal finger stick values were defined as: fasting ≥90?mg/dL, 1-h postprandial ≥140?mg/dL, 2-h postprandial ≥120?mg/dL.

Results: Sixty-six patients with twin pregnancies and GDM were identified (incidence 9.1%). Comparing the 43 patients with GDMA1 to the 23 patients with GDMA2, outcomes were similar, aside from patients with GDMA1 having lower birthweight of the smaller twin (2184?±?519?g versus 2438?±?428?g, p?=?0.040). The risk of preeclampsia was not associated with glycemic control. Patients with SGA had lower mean fasting values (83.3?±?5.5 versus 87.2?±?7.7?mg/dL, p?=?0.033), and a lower percentage of abnormal fasting values (24.0% versus 36.9%, p?=?0.040), abnormal post-breakfast values (9.9% versus 27.1%, p?=?0.003), and total abnormal values (20.1% versus 27.7%, p?=?0.055).

Conclusion: In twin pregnancies with GDM, improved glycemic control is not associated with improved outcomes, and is associated with a higher risk of SGA. Prospective trials in twin pregnancies should be performed to establish goals for glycemic control in twin pregnancies.     

Type of anesthesia affects neonatal wellbeing and frequency of transient tachypnea in elective cesarean sections

Objective: We aimed to assess whether the type of anesthesia in cesarean section (C/S) (spinal anesthesia, SA versus general anesthesia, GA) has an effect or not on umblical vein blood gas analysis and APGAR scores of term neonates and development of transient tachypnea of the newborn (TTN).

Methods: The data of 172 procedure (85, GA versus 87, SA) were collected retrospectively. Results of umblical vein blood gas analysis, APGAR scores at first and fifth minutes and presence of TTN from in-hospital files’ of neonates were examined.

Results: Neonates in the SA group had significantly higher first and fifth minute APGAR scores (8, 7 versus 9, 2, p?p?=?0.017, respectively). The pH value of umblical vein samples were higher (7.30?±?0.05 versus 7.32?±?0.05, p?=?0.029) and pO₂ and SaO₂ levels were significantly lower in the SA group (34.8?±?13.8?mmHg versus 27.6?±?14.5?mmHg; p?=?0.001 and 56.6%?±?18.7 versus 49.8%?±?21.4; p?=?0.029, respectively) as compared to the GA group. Thirteen neonates in the GA group (15.3%) and five in the SA group (5.7%) were diagnosed as TTN (p?=?0.048).

Conclusion: In our study, considerable determinants of fetal wellbeing was stated to be higher in C/S performed under SA in comparison to GA. Furthermore, our findings favor SA for avoidance of TTN.     

Increased ADMA levels are associated with poor pulmonary outcome in preterm neonates

Background: Nitric oxide (NO), synthesized from the amino acid L-arginine by the action of NO synthases (NOS), is a pulmonary vasodilator. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of NOS. Preterm infants have higher plasma ADMA concentrations than term infants which could cause inhibition of NO synthesis and deterioration in pulmonary functions. We aimed to investigate the relationship between serum ADMA and L-arginine levels of preterm infants and respiratory distress syndrome (RDS), requirement of surfactant treatment, duration of mechanical ventilation, oxygen treatment, and development of bronchopulmonary dysplasia (BPD).

Methods: A prospective cohort study was conducted including 80 preterm infants born with gestational age (GA) ≤?32 weeks and birth weight (BW) ≤?1500?g. Blood samples were obtained from all infants immediately after birth, and at postnatal 28th day of age. The relationship of first-day serum ADMA and L-arginine levels and surfactant requirement, duration of mechanical ventilation, oxygen treatment was investigated. Serum ADMA and L-arginine levels at 1st and 28th days were compared at patients with and without BPD. The role of serum ADMA levels at postnatal 28th day of age to predict the requirement of oxygen at postmenstrual 36 weeks of age was also investigated.

Results: Eighty preterm infants (42 male, 38 female) were enrolled in the study. Mean BW and GA for the total cohort was 1144.81?±?220.44?g and 28.3?±?1.8 weeks, respectively. Sixty-one infants were diagnosed as RDS and 44 infants treated with surfactant. The first-day ADMA levels were significantly higher in infants with surfactant requirement (1.14?±?0.23 versus 0.86?±?0.37, p?p?>?0.05) but not significantly. Serum ADMA and L-arginine concentrations at first day were not different among infants with and without BPD (p?>?0.05). ADMA concentrations at 28th day was significantly higher in infants with BPD (1.00?±?0.25 versus 0.81?±?0.25, p?Conclus?on: Serum ADMA and L-arginine levels are related to pulmonary morbidities in newborn. The results of this study show that increased ADMA levels are associated with poor pulmonary outcomes in preterm infants.     

Three-dimensional ultrasonographic placental volume in gestational diabetes mellitus

Objectives: We aimed to evaluate the placental volume and placental mean gray value in gestational diabetes mellitus (GDM) and healthy placentas using three-dimensional (3D) ultrasound and Virtual Organ Computer-aided AnaLysis (VOCAL).

Methods: This case-control prospective study consisted of 39 singleton pregnancies complicated by GDM and 42 healthy singleton pregnancies matched for gestational age, maternal age and parity. Placental volume and placental volumetric mean gray values were evaluated. The placental volume (cm³) was analyzed using the VOCAL imaging analysis program and 3D histogram was used to calculate the volumetric mean gray value (%).

Results: Placental volume was significantly larger in GDM (411.59?±?170.82 versus 343.86?±?128.94?cm³; p?=?0.046). There was no significant difference in mean gray value between GDM and healthy placentas (36.65?±?7.02 versus 38.71?±?7.91, respectively; p?=?0.277). Placental volume was significantly correlated with gestational week (r?=?0.219, p?=?0.035) and parity (r?=?0.228, p?=?0.048). There was negative significant relation between placental volume and umbilical artery systolic/diastolic ratio, pulsatility index and resistance index (r?=??0.278, p?=?0.007; r?=??0.315, p?=?0.002; r?=??0.322, p?=?0.001, respectively).

Conclusions: Placental volume increases significantly in GDM, whereas mean gray values do not alter significantly. These data may reflect the placental changes in GDM placentas that may help to understand the pathophysiology better.     

Cigarette smoking,nicotine levels and increased risk for metabolic syndrome in women with polycystic ovary syndrome

Abstract

Women with polycystic ovary syndrome (PCOS) are at risk for metabolic syndrome, which may be exacerbated by smoking. We hypothesized that smoking worsens androgen levels and the metabolic profile in women with PCOS. PCOS smokers (n?=?47) and non-smokers (n?=?64) and control smokers (n?=?30) and non-smokers (n?=?28), aged 18–45 years, underwent anthropomorphic measurements, pelvic ultrasound and blood sampling. Smokers had higher cotinine (801?±?83 versus <11?nmol/L; smokers versus non-smokers, respectively; p?<?0.001) and nicotine levels (37?±?4 versus <12?µmol/L; p?<?0.001). Triglyceride levels were higher in women with PCOS who smoked compared to non-smokers (1.55?±?0.18 versus 0.95?±?0.08?mmol/L; p?<?0.001), even when adjusted for BMI. Metabolic syndrome was more common in smokers with PCOS compared to non-smokers with PCOS and smokers who were controls (28.6 versus 3.6%; p?=?0.02). There were no differences in reproductive parameters including androgen levels. Cotinine (r?=?0.3; p?<?0.001) and nicotine levels (r?=?0.2; p?=?0.005) correlated with triglycerides. Nicotine levels also correlated with pulse rate (r?=?0.2; p?=?0.02) and waist:hip ratio (WHR; r?=?0.2; p?=?0.02). Taken together, smoking may worsen the already high risk for metabolic syndrome in women with PCOS.     

In resource limited areas complete enteral feed in stable very low birth weight infants (1000–1500 g) started within 24 h of life can improve nutritional outcome

Objective: To evaluate feasibility of complete enteral feed (CEF) in stable very low birth weight neonates weighing 1000–1500?g.

Subjects and interventions: One hundred and three stable very low birth weight (vlbw) neonates (1000–1500?g) irrespective of gestational age (GA) were randomized to receive either CEF with expressed breast milk (EBM) (n?=?51) or minimal enteral feed (MEF) supplemented with intravenous fluid (IVF). (MEF) (n?=?52). Feed volume was increased progressively. Primary outcome measures were feed intolerance (FI) and necrotizing enterocolitis (NEC) in first 21 days of life or discharge from NICU, whichever was earlier. Secondary outcome measures were the time taken to reach calorie intake of 110?kcal/kg/D and regain of birthweight.

Results: FI was observed in n?=?12 (23.53%) in CEF group versus n?=?6 (11.53%) in MEF group (p?=?0.1264). NEC was observed in 4 (7.8%) in CEF group versus 1(1.9%) in MEF group (p?=?0.16) and results were comparable in both groups. Birthweight regain (10.6?±?1.6 days versus 11.8?±?1.6 days, p?=?0.038), NICU discharge (11.7?±?2.6 days versus 13.0?±?3.45 days, p?=?0.038) and time to reach 110?kcal/kg/day (9.571?±?1.458 days versus 10.833?±?1.655 days, p?=?0.001) were significantly earlier in CEF compared to MEF group.

Conclusion: Complete enteral feeds started within 24?h of life is feasible in vlbw neonates.     

Anthropometric measurements in infants conceived by assisted reproductive techniques versus spontaneous conception

Abstract

Objective: To compare body length and head circumference at birth of neonates conceived after in vitro fertilization/intracytoplasmic injection (IVF/ICSI), ovarian stimulation alone (OSa) or by natural conception (NC).

Methods: A retrospective, cohort study of all singleton neonates conceived after fertility treatment and born at 38–40 gestational weeks in 2011 in a tertiary, university-affiliated hospital. Pregnancy, delivery and neonatal data were obtained from the medical records. NC singleton neonates born at 38–40 weeks were selected to serve as controls.

Results: The sample included 81 IVF/ICSI neonates, 102 OSa neonates and 91 neonates after NC. Mean gestational age (GA) was 38.8 weeks. Gravidity and parity were significantly higher in the NC group. Mean neonatal length was 50.0?±?2.1 cm in the IVF/ICSI group, 49.7?±?2.6?cm in the OSa group and 50.3?±?2?cm in the NC group (p?=?0.123). Corresponding mean head circumference was 34.4?±?1.5, 34.2?±?1.8 and 34.5?±?1.2?cm (p?=?0.287). Neither of these parameters was significantly different even after adjustment for GA at delivery and sex.

Conclusions: Our study showed no significant difference in body length or head circumference at birth related to the mode of conception. Previously reported differences in anthropometric parameters in childhood may be related to other factors.     

Endometrial injury in the menstrual cycle prior to assisted reproduction techniques to improve reproductive outcomes

Abstract

Objective: Oral contraceptive pills (OCP) are widely used for treating women with polycystic ovary syndrome (PCOS). Metformin has beneficial effects on insulin resistance and endothelial functions. The aim of this study was to investigate the effects of treatment with drospirenone/ethinyl estradiol (EE) alone or in combination with metformin on the flow-mediated vasodilatation (FMD) and carotid intima media thickness (CIMT) in women with PCOS.

Methods: Fifty women with PCOS (mean age 23?±?5) were randomized to oral treatment of OCP alone (n?=?25) or an OCP combination with metformin (n?=?25) for 6 months. FMD from the brachial artery and CIMT were calculated. The hormonal profile, HOMA-IR score, basal insulin and glucose levels were studied in both groups. Before and after 6 months' treatment, echocardiographic measurements and laboratory tests were also obtained.

Results: After 6 months' treatment we observed a small decrease in FMD in the OCP group (14.9?±?9.4 versus 14.4?±?9.9, p?=?0.801) and a slight increase in the combination group (14.5?±?9.1 versus 15.0?±?8.0, p?=?0.715) but neither of them reached significance. CIMT increased in the OCP group (0.048?±?0.011 to 0.050?±?0.010?cm, p?=?0.433) and decreased slightly in the combination group (0.049?±?0.012, 0.048?±?0.011?cm, p?=?0.833).

Conclusion: We demonstrated that adding metformin to OCP treatment may have beneficial effect on FMD and CIMT that represent vascular function in patients with PCOS. These results suggest that adding metformin to OCP treatment for PCOS could preserve the cardiovascular system and improve it.     

First trimester fetal heart rate as a predictor of newborn sex

Objective: To predict the sex of newborns using first trimester fetal heart rate (FHR).

Methods: This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student’s t-tests while categorical variables were compared using Chi-square test.

Results: We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0?±?9.1?bpm and for male fetuses 167.3?±?10.1?bpm (p?=?0.62). There was no significant difference in crown rump length between female and male fetuses (4.01?±?1.7 versus 3.98?±?1.7?cm; p?=?0.78) or in gestational age at birth (38.01?±?2.1 versus 38.08?±?2.1 weeks; p?=?0.67). The males were significantly heavier than females (3305.3?±?568.3 versus 3127.5?±?579.8?g; p?<?0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants.

Conclusions: We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns.     

Risk factor profile of massive pulmonary haemorrhage in neonates: the impact on survival studied in a tertiary care centre

Objective: Pulmonary haemorrhage (PH) in neonates is a fatal event leading to hazardous complications and even death. The aim of this study was to elucidate influential factors of the ultimate disease course that affect death or survival.

Methods: Infants treated for PH in our institution from March 2009 to December 2013 were retrospectively reviewed. Infants transferred from other hospitals were excluded. Infants were grouped into two categories, deceased or survived at neonatal intensive care unit discharge. Information regarding perinatal history, initial management and laboratory results were obtained and analysed for each group.

Results: Seventy infants fulfilled the inclusion criteria, 41 infants in the deceased group and 29 infants in the survived group. Overall, the infants in the deceased group displayed lower gestational age (27 and 1/7?±?3.610 versus 29 and 3/7?±?3.530 weeks, p?=?0.009) and lower one-minute (2.342?±?1.493 versus 4.035?±?2.079, p?<?0.001) and five-minute Apgar scores (2.342?±?1.493 versus 4.035?±?2.079, p?<?0.001) and required aggressive resuscitation (p?=?0.003) and a greater number of inotropes (2.195?±?1.346 versus 1.069?±?0.704, p?<?0.001). Deceased infants were administered increased amounts of fluid during the first 24?h after birth (117.783?±?32.325 versus 99.379?±?17.728?mL/kg, p?=?0.004). A relatively short prothrombin time impacted survival (p?=?0.01), whereas platelet count was the only factor that significantly affected the time length from the onset of PH to death (p?=?0.01).

Conclusion: Infants with a lower gestational age in a compromised state are prone to die once PH develops. The initial management of fluid intake not to exceed the adequate limit is especially important in order to prevent PH-related deaths when correcting hypoalbuminemia and coagulopathy.     

Total energy intake accounts for postnatal anthropometric growth in moderately/late preterm infants

Objective: Moderately preterm (MP) (32–33 weeks) and late preterm (LP) (34–36 weeks) infants have higher risks of mortality and growth and developmental problems. We, herein present a new concept of nutritional assessment, total energy intake (TEI), which is the sum total of kilocalories administered in all nutrient forms.

Methods: Fifty-two preterm infants were classified as MP (n?=?12), LP/appropriate for gestational age (LP/AGA) (n?=?33), or LP/small for gestational age (LP/SGA) (n?=?7). All groups received nutrient therapy by the same protocol. The sum of the daily energy intake at 14 and 28 days after birth was determined.

Results: TEI was 2822.1?±?162.1?kcal/kg/28 days in the MP group, 3187.2?±?265.0?kcal/kg/28 days in the LP/AGA group and 3424.6?±?210.4?kcal/kg/28 days in the LP/SGA group. In all groups, TEI for 28 days was significantly correlated with body weight gain (r?=?0.465, p?=?0.006). TEI for 14 days after birth was inversely correlated with the body weight loss rate after birth (r?=??0.491, p?=?0.0002).

Conclusion: TEI was well correlated with anthropometric changes after birth. TEI may be used to effectively assess preterm infants’ nutritional needs.     

Urinary NGAL and hematic ADMA levels: an early sign of cardio-renal syndrome in young adults born preterm?

Abstract

Background: Prematurity at birth is a known risk factor for the development of an early chronic renal disease. Urinary neutrophil gelatinase-associated lipocalin (NGAL) is a well established biomarker of kidney injury, while high blood levels of asymmetric dimethylarginine (ADMA) are associated with the future development of adverse cardiovascular events and cardiac death.

Aims: (1) to verify the presence of statistically significant differences between urinary NGAL and hematic ADMA levels in young adults born preterm at extremely low birth weight (<1000?g; ex-ELBW) and those of a control group of healthy adults born at term (C) (2) to seek correlations between NGAL and ADMA levels, which would indicate the presence of an early cardio-renal involvement in ex-ELBW.

Methods: Twelve ex-ELBW subjects (six males and six female, mean age: 23.9?±?3.2 years) were compared with 12 C (six males and six female). Urinary NGAL and hematic ADMA levels were assessed.

Results: Urinary NGAL levels were higher in ex- ELBW subjects compared to C (p?<?0.05), as well as hematic ADMA concentrations (p?<?0.05). A statistically significant correlation was found between urinary NGAL and ADMA (r?=??0.60, p?<?0.04).

Conclusions: Our preliminary findings support the hypothesis that in ex-ELBW subjects the development of an early chronic kidney disease contributes towards inducing an increase in the atherosclerotic process and in the risk of future adverse cardiovascular events.