Effect of intrauterine nutritional deprivation on neuromotor behaviour of the newborn.

The neurological maturation in 25 newborn babies born to severely undernourished mothers was studied by evaluating muscle tone and excitability status. These mothers had weight below the 25th percentile expected for height, haemoglobin less than 80.0 g/l and serum albumin less than 25.0 g/l. Twenty-three babies born to healthy mothers were studied as control. The babies of undernourished mothers demonstrated gross intrauterine growth retardation. There occurred parallel reduction in placental weight and its protein content. The neuromotor behaviour of these newborns showed significant alteration in the performance of most reflexes, resembling normal motor behaviour of preterm infants. As many as 72% newborns could be classified as hypotonic and 56% hypoexcitable. However, no newborn demonstrated hypertonia or hyperexcitability. The parameters of neuromotor assessment were found to have no correlation with the birth weight in both undernourished as well as control group. These observations suggest that muscle tone and excitability are better indices of maturation of central nervous system than the birth weight. It seems that the neurological evaluation becomes unreliable in babies who suffer from intrauterine nutritional deprivation.     

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 growth-promoting activity measured as [3H]thymidine incorporation into human activated lymphocytes and serum transferrin levels in newborns and mothers

Serum growth-promoting activity measured as [3H]thymidine incorporation into human activated lymphocytes and serum transferrin levels were measured during the perinatal period in newborns and mothers. Both thymidine activity (TA) and transferrin levels were significantly increased at the time of delivery in mothers compared to control women, and there was a progressive return to control levels in the first 5 postpartum days. A significant correlation was found between TA and placental weight. In the newborns, TA was low in cord blood after vaginal delivery but not in the cord blood from babies born by cesarean section. In premature newborns, TA was lower than in full term newborns. In all newborns during the first 24 postnatal hours, there was an increase in TA with levels rising above adult control values: levels in cord blood were positively correlated with birth weight but not with thymidine activity. These data afford complementary insights into the humoral controls of growth in newborn infants.     

Secular change in birthweight of Asian babies born in Birmingham.

We have studied changes in the birthweight of Asian babies born alive at this hospital between 1968 and 1978. In 1978 Pakistani babies were 139 g heavier but Indian babies only 25 g heavier than 10 years earlier. Contributing to these changes were significantly fewer short mothers and primiparae among Pakistanis, and non-significant increases in gestational age and intrauterine growth (that is, weight centile after allowing for gestational age, parity, and maternal height). Among Indians there were significant increases in maternal height and gestational age, but parity was reduced and intrauterine growth did not increase. In both groups there were fewer teenage mothers, but whereas among Pakinstanis birth intervals of less than one year were less common, there was no such reduction among Indian mothers. The secular change suggests that genetic factors are unlikely to be the major reason why Pakistani babies born in Birmingham are lighter than European babies, and that environmental factors play an important role. Efforts to increase birthweight need to consider both the mothers'' physical environment during pregnancy and prepregnancy factors influencing growth in childhood, age at first pregnancy, and birth interval. The study shows a need to describe an ''Asian'' population with details of their sub-ethnic structure. The sub-ethnic and secular differences further suggest that a single ''Asian'' standard for birthweight and intrauterine growth may be inappropriate; the use of international reference data with which all infants may be compared is preferable.     

Patterns of retarded fetal growth

The measurement of weight, length and head circumference at birth was used to document the size and shape of infants born at term in a population where mothers are relatively short and underweight. Different patterns of intrauterine growth are proposed to explain the variation in the infant's appearance at birth. Most of the small-for-gestational-age infants were proportionately stunted. This pattern of fetal growth is probably characteristic of infants born to undernourished mothers in economically developing communities, and reflects prolonged intrauterine growth retardation.     

Population-based case-control study of mebendazole in pregnant women for birth outcomes

The objectives of the study was to check the embryotoxic-teratogenic and fetotoxic effect of mebendazole (Vermox; Richter, Budapest, Hungary) treatment during pregnancy. Mebendazole use during pregnancy was evaluated in mothers of babies born with congenital abnormalities and in matched control mothers of babies born without congenital abnormalities in the population-based data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. Of 22,843 women who had newborns or fetuses with congenital abnormalities, 14 were found to have been treated with mebendazole for intestinal nematoda infections/diseases during pregnancy (crude POR: 1.8 with 95% CI: 0.7-4.2). Of 38,151 women who had newborns without any defects (controls), the same number (14) were found to have been treated with mebendazole during pregnancy. Six different congenital abnormality groups were evaluated and a higher prevalence of mebendazole use in these mothers throughout pregnancy was not found. Gestational age and birth weight were analyzed in control infants born to mothers with or without mebendazole treatment. The mean gestational age was somewhat longer and mean birth weight was larger in newborn infants born to mothers with mebendazole treatment. Thus, treatment with mebendazole during pregnancy did not indicate a teratogenic and fetotoxic risk to the embryo or fetus, though the numbers of treated cases and controls in this study were limited.     

Neurological examination in healthy term infants aged 3-10 weeks

OBJECTIVES: The neurodevelopmental progress of newborn term infants is checked routinely at around 6 weeks of postnatal age. The maturation of neurological signs in this age range however has not been systematically studied and normative data are not available. The aim of this study was to document any changes in posture, tone, reflexes, behaviour and movements in low-risk full-term infants between 3 and 10 weeks of postnatal age. STUDY DESIGN: We performed a structured neurological examination previously standardised in full-term newborns in the first 48 h after birth. In the current study, a total of 76 examinations were performed between 3 and 10 weeks of age in low-risk full-term infants. RESULTS: The results of the examinations were divided according to postnatal age. In most items, the scores changed with time, with a definite shift in their distribution occurring around 6 weeks. At this age, a reduction in flexor tone of the limbs was observed, together with an increase in active neck tone. Visual orientation in contrast had already improved by 3 weeks when all infants were able to follow a target in a full circle compared to newborns that are often only able to follow a target in an arc. CONCLUSIONS: Our results suggest that 6 weeks post-term birth is an important milestone for changes in neurological signs, particularly those related to muscle tone and posture, probably reflecting maturation of the nervous system. These findings provide important guidelines for the interpretation of the neurological examination performed at this age.     

Growth Pattern of Intrauterine Growth Retarded (IUGR) Babies in First Nine Months of Life

ABSTRACT. Forty-one full term intrauterine growth retarded (IUGR) babies of different maternal etiologies viz. maternal undernutrition (12), small maternal size (12), toxaemia of pregnancy (9) and idiopathic (8) were studied for growth pattern during first 9 months of life. Eighteen fullterm and 11 preterm who were appropriate for gestational age served as controls. These mothers were comparable for age, parity, socioeconomic status, weight and height (except in small size mothers), haemoglobin and plasma albumin (except in undernourished group). The various anthropometric parameters studied were weight, crown-heel length, head circumference, their velocities and ponderal index. The IUGR babies of undernourished mothers had lowest means for weight, crown-heel length and skull circumference. The babies of small sized mothers suffered most in crown-heel length followed by weight. The head growth was not affected in these babies. The IUGR babies of mothers with toxaemia of pregnancy demonstrated a catch up growth for all three parameters. The IUGR babies of idiopathic group showed a spurt in weight gain around 3 to 6 months and a similar spurt for crown heel length and head circumference was observed between 6 to 9 months of age. These babies were close to IUGR babies of mothers with toxaemia of pregnancy at 9 months. The preterm AGA babies also demonstrated a catch up growth for the weight, crown heel length and circumference.     

Growth pattern of intrauterine growth retarded (IUGR) babies in first nine months of life

Forty-one full term intrauterine growth retarded (IUGR) babies of different maternal etiologies viz. maternal undernutrition (12), small maternal size (12), toxaemia of pregnancy (9) and idiopathic (8) were studied for growth pattern during first 9 months of life. Eighteen fullterm and 11 preterm who were appropriate for gestational age served as controls. These mothers were comparable for age, parity, socioeconomic status, weight and height (except in small size mothers), haemoglobin and plasma albumin (except in undernourished group). The various anthropometric parameters studied were weight, crown-heel length, head circumference, their velocities and ponderal index. The IUGR babies of undernourished mothers had lowest means for weight, crown-heel length and skull circumference. The babies of small sized mothers suffered most in crown-heel length followed by weight. The head growth was not affected in these babies. The IUGR babies of mothers with toxaemia of pregnancy demonstrated a catch up growth for all three parameters. The IUGR babies of idiopathic group showed a spurt in weight gain around 3 to 6 months and a similar spurt for crown heel length and head circumference was observed between 6 to 9 months of age. These babies were close to IUGR babies of mothers with toxaemia of pregnancy at 9 months. The preterm AGA babies also demonstrated a catch up growth for the weight, crown heel length and circumference.     

Relationship of maternal serum ferritin with foetal serum ferritin, birth weight and gestation

Haemoglobin and ferritin estimations employing the micro-ELISA technique were done in 308 random selected mothers in labour and their newborns. The values of haemoglobin and serum ferritin as well as birth weight and gestation of babies born to iron depleted, and mildly and moderately anaemic mothers were no different from those of newborns of non-anaemic women. However, the values of serum ferritin per se in all these newborns were much lower than what are generally reported from the western countries. Babies born to severely anaemic women, on the other hand, showed elevated levels of haemoglobin and serum ferritin, and lower birth weights and gestation. Thus, mild to moderate iron deficiency in the mother does contribute to lower iron reserves in the foetus, if not frank iron depletion, and severe iron deficiency anaemia to lower birth weight and gestation.     

INVESTIGATION OF 89 CHILDREN BORN BY DRUG-DEPENDENT MOTHERS I

ABSTRACT. Among 89 infants born by opiate- and methadone-addicted mothers 20% were preterm and 31% were light for gestational age. Mean gestational age. Mean gestational age and birth weight were lower in infants of mothers who had taken mainly opiates compared with infants of mothers who had taken mainly methadone. Preterm labor was more frequent among women who had been acutely withdrawn on methadone within the last month before birth than among women who were maintained on methadone at birth. 85% of the newborns had withdrawal symptoms and 12% had convulsions the severity of which was not correlated with the type of drug abuse. The duration of withdrawal, however, correlated with the amount of methadone taken by the mother at birth. 20% had signs of perinatal asphyxia and had an increased frequency of neonatal convulsions. These babies represent a special high-risk group of newborns. Prevention, therapy and care demand extraordinary combined efforts by politicians, social welfare personnel, midwives, doctors and nurses.     

Cord and maternal serum IgM in IUGR babies

Due to constraints in conducting specific tests for diagnosis of perinatal infection, the present study was carried out to find out the value of cord serum IgM levels as a screening procedure for intrauterine infection in full term intrauterine growth retarded (IUGR) babies. Thirty five consecutively born full term IUGR singleton babies and their mothers (having weight greater than 40 kg, height greater than 145 cm, Hb 8 g/dl and normal blood pressure) formed the study group. Ten full term singleton babies weighing greater than or equal to 3000 g and their mothers served as controls. In the study population both mean cord serum IgM (26.8 mg/dl) and mean maternal serum IgM (142.42 mg/dl) were raised as compared to the mean cord serum IgM (13.76 mg/dl) and mean maternal serum IgM (100.16 mg/dl) of the control group. However, statistically the rise was significant only between the maternal cord serum IgM levels. But all the same, cord serum IgM levels exceeding 20 mg/dl and 30 mg/dl were found in 51.43 and 22.8% of full term IUGR neonates, respectively whereas among the control neonates only 20.0% had levels exceeding 20 mg/dl and none had levels above 30 mg/dl suggesting possible intrauterine antigenic challenge to perinatal infection in higher proportion of IUGR babies. Cord serum IgM levels were also seen to increase with increase in birth weight. Idiopathic IUGR babies having cord serum IgM levels greater than 30 mg/dl should undergo specific immunological tests and follow up.     

Effects of obstetrical complications on the clinical features,morbidity and mortality of the newborn

Summary The present work summarises the effects of obstetric complications on the newborns. The neonate is adversely affected by toxaemia of pregnancy leading to a high incidence of low birth weight and preterm babies, high morbidity rate, increased incidence of asphyxia, sclerema and prematurity leading to high perinatal loss. Antepartum haemorrhage in the mother was associated with increased frequency of low birth weight, preterm babies, high morbidity rate and increased proneness to asphyxia and respiratory distress syndrome causing: high perinatal mortality. The neonates born of mothers having abnormal presentation, such as, breech, also had a greater predisposition to asphyxia and intracranial injury leading to high perinatal loss. Hydramnios in the mother gave rise to a high incidence of congenitally malformed, preterm babies associated with increased perinatal mortality. It is obvious that many factors which affect the newborn adversely can be prevented and if treated adequately in time, may improve the outcome of the foetus and reduce the perinatal loss appreciably. From the Department of Paediatrics, S.M.S. Medical College & Hospital, Jaipur.     

Loose stools in the early neonatal period.

During a two-year period, the various factors associated with loose stools in the early neonatal period were studied among hospital born babies. Low birth weight babies had a lower incidence of non-infective loose stools when compared to neonates with a birth weight of more than 2500 g (p < 0.001). Newborns delivered by Cesarean section (p < 0.001) and those born to women with more than two children (p < 0.02) had a greater frequency of loose stools. Initiation of supplementary feeding and administration of antibiotics were important factors in causing loose stools. Bacterial etiology could be found only in 9.3% of newborns having loose stools. A later onset of loose stools was noted in those, whose stool culture grew bacterial organisms. Only nine newborns with loose stools required antibiotic therapy. Although loose stools were less common among low birth weight babies, they often required treatment with antimicrobials. None of them developed any complications. Since majority of them are non-bacterial and non-infective, great caution must be exercised before administering antibiotics to newborns with loose stools.     

A study on the health status of twin babies

A study on twin births was conducted from May 1993 to April 1994 at S.A.T. Hospital, Thiruvananthapuram. The twinning rate in this period was found as 17.33 per 1000 births. 79.6% babies in the twin pairs were of like sex and 20.4% were of unlike sex. The incidence of low birth weight twin babies in this study was 68.9%. There was no significant difference in the physical parameters (birth weight, body length and head circumference) of twin babies in relation to sex. The incidence of twin birth was higher among primipara mothers and in the mothers of age group 21 to 25 years. The first born baby (twin A) was found to be heavier than the second born baby (twin B) in 44.78% twin pairs and their mean birth weight difference was 438 g, while the second born baby (twin B) was found to be heavier than the first born (twin A) in 38.31% twin pairs and their mean birth weight difference was 291 g. Statistical analysis showed that the difference between the mean birth weight difference in the case of twin A>B was significantly greater when compared to that of twin A<B.     

Neonatal infections: I—Maternal and cord serum IgG levels in relation to gestation and intrauterine growth

Fifty low birth weight babies (both preterms and intrauterine growth retarded) and their mothers were the subjects of the study. Ten fullterm babies weighing more than 3.0 kg and their mothers served as controls. The cord serum IgG levels were significantly lower in preterm babies compared to fullterm appropriate for gestational age (FT-AGA) and fullterm intrauterine growth retarded (FT-IUGR) babies. The cord serum IgG levels were not significantly different between FT-AGA and FT-IUGR babies. The maternal serum IgG levels were significantly higher than the cord serum IgG levels in preterm group whereas in fullterm AGA and IUGR groups cord serum IgG levels were significantly higher then the maternal serum IgG levels. There was no correlation between maternal and cord serum IgG levels. The cord serum IgG levels were significantly correlated with gestation even after controlling birth weight. The correlation between cord serum IgG levels and birth weight disappeared once qestation was controlled.     

Fetal growth: relationship with maternal dietary intakes

One hundred urban and 85 rural pregnant women in third trimester were subjected for the studies of dietary intakes and the body size (weight for height ratio index). The intrauterine growth of newborn infants was assessed at birth by weight, crown-heel length and head circumference. The fetal growth improved significantly with increasing maternal caloric and protein intakes. The mean values of weight, crown-heel length and head circumference of newborn infants were significantly higher in mothers receiving more than 2000 kcals and 75g of proteins as compared to the mean values observed for newborns of mothers with dietary caloric and protein intakes less than 1500 kcals and 45.0g respectively in both urban and rural subjects. No significant difference was observed in the growth parameters of newborn infants with further increase in the maternal caloric intake above 2000 kcals. Further the total protein intake influenced the newborn's weight significantly irrespective of the animal protein content.     

微粒体基因16SrRNA在宫内感染诊断中的意义探讨

目的：探讨微粒体基因与宫内感染的关系。方法：单胎早产出生者30例为病例组,按照早产原因分为胎膜早破（PROM）组16例（早破膜时间均＞18 h）,自发性早产(SPL)组6例,有指征的医源性早产（包括母亲或胎儿原因）8例,另选取10例单胎足月出生者作为对照组。分别留取部分胎盘、胎膜、羊水、脐血、气管分泌物、胃液及新生儿静脉血等,观察各种原因早产胎盘、胎膜病理改变;用PCR方法分别测定微粒体基因16SrRNA及解脲脲原体(UU)基因在胎盘及胎膜等各类标本中的表达。结果：病例组中21例（70%）诊断为绒毛膜羊膜炎,主要病理改变为胎膜、胎盘组织中性粒细胞浸润,胎膜改变尤为明显,主要见于胎龄＜32周或出生体重＜1 500 g者。病例组30例患儿中,16SrRNA基因阳性12例,UU基因阳性10例,对照组10例患儿均未检测到16SrRNA及UU基因。PROM组早产儿生后感染发生率高于其他原因早产患儿,但差异无统计学意义。结论：绒毛膜羊膜炎是导致胎膜早破及胎儿早产的主要原因,检测微粒体基因可间接反映是否有宫内感染存在。［中国当代儿科杂志,2010,12（9）：726-729］     

Muscle power development during the first year of life predicts neuromotor behaviour at 7 years in preterm born high-risk infants

The aim of the study was to find if neurological function during the first year of life could predict neuromotor behaviour at 7 years of age in children born preterm with a high risk. A follow-up study of neuromotor behaviour in 52 children at a mean age of 3, 6, 12 months (corrected age) and 7 years was performed. All children were born with a gestational age less than 32 weeks and/or a birthweight under 1500 g and the infants were categorised according to their medical history in the three highest categories of the 'Neonatal Medical Index' (NMI, from category I to V, from few to serious complications). In addition, neonatal cerebral ultrasound abnormalities were used to divide the infants further into the different NMI categories. At 3 and 6 months, the relationship between active and passive muscle power was measured in shoulders, trunk and legs and (a)symmetry between right and left was noted. The results at 3 and 6 months were ranged from 1 for optimal to 5 for poor muscle power regulation. At 12 months of age, a neurological examination was done with special emphasis on the assessment of postural control, spontaneous motility, hand function and elicited infantile reactions with special attention to (a)symmetry. Outcome at 12 months was expressed as percentage of the optimal score on each subcategory. At 7 years, the motor behaviour study based on Touwen's examination for minor neurological dysfunction was performed. This investigation focuses on different functions, such as hand function, quality of walking, posture, passive muscle tone, coordination and diadochokinesis. The outcome was expressed as percentage of the optimal score on the combined subcategories. The best prediction of neuromotor behaviour at 7 years was assessed with stepwise linear multiple regression, using as potential predictors perinatal factors and outcome of motor behaviour at the corrected age of 3, 6 and 12 months. At 7 years none of the children scored 100% on the combined subcategories, 15 children (29%) scored between 75% and 99%, whereas 15 children scored less than 50%. Neuromotor behaviour at 7 years could be predicted by the NMI categorisation and gender with a sensitivity of 92% (specificity 47%; positive and negative predictive value 81% and 70%). No direct relation was found between neuromotor behaviour and cerebral ultrasound classification only, days on the ventilator and/or continuous positive airway pressure, birthweight, gestational age and dysmaturity. The best predictor of neuromotor behaviour at 7 years was the combination of outcome of muscle power in shoulders and legs at 3 months and postural control at 12 months, taking into account the gender of the child (sensitivity 95%; specificity 40%; positive predictive value 80%; negative predictive value 75%).     

SERUM CONCENTRATIONS OF THYROXINE-BINDING GLOBULIN, PREALBUMIN AND ALBUMIN IN HEALTHY FULLTERM, SMALL-FOR-GESTATIONAL AGE AND PRETERM NEWBORN INFANTS

Abstract. Jacobsen, B. B., Peitersen, B., Andersen, H. J. and Hummer, L. (The University Clinic of Paediatrics, Children's Hospital Fuglebakken and the Departments of Nuclear Medicine, Rigshospitalet, Copenhagen, Denmark). Serum concentrations of thyroxine-binding globulin, prealbumin and albumin in healthy fullterm, small-for-gestational age and preterm newborn infants. Acta Paediatr Scand, 68: 49, 1979.—Simultaneous serum concentrations of thyroxine-binding globulin (TBG), prealbumin (TBPA) and albumin (Alb) were measured in 130 fullterm, 32 small-for-gestational age and 25 preterm infants during their first six days of life. In all infants serum concentrations of TBG were higher and serum TBPA and Alb were lower than in male adults. Even higher serum TBG levels wer found in the mothers. There was no correlation between serum concentrations in paired maternal and cord sera. In infants with birth weights appropriate for gestation serum TBG, TBPA, and Alb concentrations increased progressively with gestational age. In small-for-gestational age infants born at term serum concentrations of TBG and Alb were lower than those in full-term, but higher than those in premature newborns. Serum TBPA in small-for-gestational age babies was evne lower than seen in prematures. A positive correlation was found between thyroid hormones and TBG concentrations, not between serum TBPA and thyroid hormones. The ratios between serum concentration of thyroid hormones and proteins might indicate that more thyroid hormonebinding sites are occupied in fullterm than in low birth-weight newborns. However, the main reason for the different serum levels of thyroid hormones in fullterm, small-for-gestational age and preterm babies is probably the various serum TBG concentrations demonstrated in these infants.