Concentration of Twelve Plasma Proteins at Birth in Very Low Birthweight and in Term Infants

ABSTRACT. Plasma samples obtained at birth from 70 very low birth weight (VLBW) infants (gestational age 24 to 34 weeks) and from 20 term infants were analysed for concentrations of 12 different proteins. The plasma concentrations of albumin, transthyretin (TTR), retinol-binding protein (RBP), vitamin D-binding protein, apolipoprotein A I, fibronectin, orosomucoid and α₁-antichymotrypsin were significantly lower in the VLBW infants than in the term infants, whereas the values of α-fetoprotein (AFP) were significantly higher in the VLBW infants. No differences were found between the two groups for apolipoprotein A II, apolipoprotein B and transferrin. Birth asphyxia and sex had no influence on the measured plasma protein concentrations. The plasma concentrations of apolipoprotein A I and A II were significantly lower in small-forgestational age (SGA), VLBW infants compared with appropriate-for-gestational age (AGA), VLBW infants. Possible acute inflammation (defined as raised concentrations of orosomucoid or α₁-antichymotrypsin) was associated with significantly higher values of vitamin D-binding protein in both VLBW and term infants, suggesting that this protein may act as an acute phase protein in newborn infants.     

Children of Deviant Birthweight: the Influence of Genetic and Other Factors on Size at Seven Years

ABSTRACT. 138 small-for-gestational age (SGA), 138 average-for-gestational age (AGA) and 136 large-for-gestational age (LGA) children who had been followed up from birth were measured at the age of seven years. Parental measurements were also obtained. Significant differences for weight, height and head circumference of the children and their parents were found between the three groups. There were highly significant parent-child correlations for most somatic measures in all groups. Within each group the parental contribution to the variance in children's somatic measures was large; so also was the effect of sex on head circumference. Other biological and pathological factors made only a small contribution in any group.     

Attention Deficit Hyperactivity Disorders and Other Psychiatric Outcomes in Very Low Birthweight Children at 12 Years

One hundred and thirty-seven very low birthweight (VLBW) children were compared at 12 years with a sample of matched peers on a number of psychiatric symptoms including Attention Deficit/Hyperactivity Disorder, depression, anxiety, and antisocial behaviour using the Child and Adolescent Psychiatric Assessment parent interview and various parent and child questionnaires. The main psychiatric risk was Attention Deficit Hyperactivity (ADH) disorders, with 31/136 (23 %) VLBW children meeting clinical criteria, compared to 9/148 (6%) of peers. VLBW children were also more likely to have generalised anxiety and more symptoms of depression. More than one quarter of VLBW children (38/136; 28%) showed a psychiatric disorder of some type compared to 9% (14/148) of peers. VLBW children are at increased risk of psychiatric symptoms especially ADHD. This outcome is discussed in relation to neurological, demographic, and cumulative impairment factors.     

Histological Investigations Into the Relationship Between Low Birth Weight and Spontaneous Bowel Damage in the Neonatal Piglet

Experimental models for the study of neonatal necrotizing enterocolitis (NEC) using the small for gestational age (SGA), viable, term-delivered piglet have recently been described. A spontaneous model, especially of the early phases of NEC, has not been reported. Pig litters usually include one or two lethally or sublethally SGA “runted” piglets culled from the litters by breeders.

We have examined four groups of piglets: group A, SGA, lethally runted animals who died spontaneously before 12 h postpartum; group B, SGA, sublethally runted animals, showing some signs of vitality and left alive for 24 h before culling; group C, appropriate for gestation age (AGA) animals subjected to hypoxia and hyperviscosity known to induce NEC-like lesions; and group D, AGA control animals.

Acute, multiorgan pathology common to pre- and dysmature neonates was seen in groups A and B. Animals in group B also showed evidence of early postnatal complications such as urinary tract infection and diffuse pulmonary damage. All animals of groups A and B showed unequivocal early changes in the distal ileum, with mucosal and submucosal necrosis, suggestive of ischemic injury. One animal in group B had developed mural necrosis involving the whole of the submucosa. No similar changes were seen in control group D animals.

The very-SGA, lethally and sublethally runted, spontaneously term-delivered piglet offers sufficient spontaneous early NEC-like changes for studies of the early pathogenesis of this condition.     

Correlation between levels of plasma adenosine triphosphate and stress to the fetus at delivery

Adenosine triphosphate (ATP) and its metabolites are released from intracellular stores and levels of ATP in the plasma are affected by hypoxia and by exercise. We examined levels of plasma ATP in the fetus at the time of obstetrical delivery. The arterial (ACB), venous cord (VCB) and maternal venous blood (MVB) samples were collected immediately after clamping of the cord. ATP was determined by the bioluminescence method. The levels of plasma ATP were significantly higher in ACB than in VCB or in MVB. There were significant correlations between the levels of ATP in ACB and in VCB, between the levels in ACB and in MVB and between the levels in MVB and in VCB. In case of delivery by elective cesarean section, the levels of ATP in ACB were significantly higher than those in ACB of the fetus delivered vaginally. We found a significant correlation between the levels of plasma ATP in ACB and PO2 in VCB, though there was no significant correlation between the levels of ATP and pH and PCO2. These observations suggest that ATP in ACB may be of fetal origin, that the levels decrease concomitantly in response to stress during vaginal delivery and correlate with the oxygen supplied from the placenta.     

Birth weight and maternal characteristics at the Maternity of Campinas along 25 years

OBJECTIVE: To study the secular trends of birthweight and maternal characteristics at the Maternity of Campinas, S?o Paulo, Brazil, from 1971 to 1995. METHODS: The authors studied 18,262 newborns in the Maternity of Campinas. Birthweight and maternal characteristics were analyzed comparing changes occurred every 5 years. The data were analyzed by chi-square test, analysis of variance, multivariate logistic regression, and population attributable risk. RESULTS: The results showed a positive trend for birthweight only in the period between 1976 and 1980 (P<0.05). The frequency of low birthweight was constant, remaining around 8.0%, but towards the end of the studied period, it started to be predominantly seen among preterm newborns. The frequency of favorable weight was below 70.0%. The authors observed an increase in the number of pregnant adolescents, pregnant women working outside home, unmarried mothers, cesarean sections, frequency of preterms, and decrease of parity (P<0.05). The maternal characteristics associated with low birthweight were: unmarried status, maternal age of 17 years old or less, maternal age of 35 years or more, public medical-hospital assistance, nonwhite skin color, primiparity, multiparity, and female newborns. In the 90s, 44.3% of low birthweight was attributed to preterm newborns. CONCLUSIONS: Even with a positive development of the general conditions considered important to improve population s health, birthweight has not increased, probably as a reflex of other changes that held back this advance.     

Indications for Plasma Exchange and Other Immunosuppressive Theraphy at the Onset of IDDM

Several facts indicate that immunological mechanisms are involved in the etiology of insulin dependent diabetes mellitus. As there usually is an important residual beta cell function at the time of diagnosis, the destructive process should be stopped. Different kinds of immunosuppressive therapy have been tried. A review is made concluding that especially Cyclosporin A-treatment has given promising preliminary short-term results. However, the side effects cannot be neglected and the follow-up is short. It is therefore recommended that the results of ongoing studies are reported before new studies are started. Plasmapheresis has also given some positive results. Both the removal of plasma from the patients and supply of plasma from healthy donors may contribute to the effect. Further studies are needed before any recommendations for clinical use can be given.     

Birth weight and cognitive function at age 11 years: the Scottish Mental Survey 1932

AIMS—To examine the relation between birth weight and cognitive function at age 11 years, and to examine whether this relation is independent of social class.
METHODS—Retrospective cohort study based on birth records from 1921 and cognitive function measured while at school at age 11 in 1932.Subjects were 985 live singletons born in the Edinburgh Royal Maternity and Simpson Memorial Hospital in 1921. Moray House Test scores from the Scottish Mental Survey 1932 were traced on 449of these children.
RESULTS—Mean score on Moray House Test increased from 30.6 at a birth weight of <2500 g to 44.7 at 4001-4500 g, after correcting for gestational age, maternal age, parity, social class, and legitimacy of birth. Multiple regression showed that 15.6% of the variance in Moray House Test score is contributed by a combination of social class (6.6%), birth weight (3.8%), child''s exact age (2.4%), maternal parity (2.0%), and illegitimacy (1.5%). Structural equation modelling confirmed the independent contribution from each of these variables in predicting cognitive ability. A model in which birth weight acted as a mediator of social class had poor fit statistics.
CONCLUSION—In this 1921 birth cohort, social class and birth weight have independent effects on cognitive function at age 11. Future research will relate these childhood data to health and cognition in old age.

     

Effect of Human Growth Hormone Treatment for 1 to 7 Years on Growth of 100 Children,with Growth Hormone Deficiency,Low Birthweight,Inherited Smallness,Turner's Syndrome,and Other Complaints

(1) Human growth hormone (HGH) has been given for one whole year or longer to 100 patients, aged 1·5 to 19 years, participating in the Medical Research Council Clinical Trial of HGH. Each patient was measured 3-monthly for a control year before treatment, and the majority for a control year after the first treatment year. All measurements were made by one anthropometrist. Radiographic measurements of widths of bone, muscle, and fat in calf and upper arm were made. Methods and standards for assessing the significance of a given height acceleration are presented.(2) The characteristics at diagnosis are given of 35 patients with isolated GH deficiency or hyposomatotrophism (HS), 18 with craniopharyngiomas and other CNS lesions, 3 with multiple trophic hormone deficiency, 18 with low birthweight short stature, 4 with hereditary smallness and/or delay in growth, 4 with psychosocial short stature, 1 with high resting HGH and low somatomedin, 6 with Turner''s syndrome, and 11 with other diagnoses.(3) 29 of the 35 HS patients were boys and 13 had an abnormally small penis and ill-developed scrotum. Only 2 were sibs. Parents averaged 40th centile for height. 4 children developed growth-suppressing antibodies, and had to cease treatment. The mean standard deviation score (SDS) for height at diagnosis was -4·7, range -2·6 to -7·3. Bone age SDS averaged -3·2, range -0·8 to -5·7. Skinfold SDS averaged +0·91. Limb muscle width SDS averaged about -3·0. GH peak in insulin hypoglycaemia averaged 4·7 ± 0·7 μU/ml, range 1 to 13.(4) A category of partial growth hormone deficiency is defined as patients with GH peaks of 7-20 μU/ml inclusive and height velocity SDS in the year before treatment between -1 and -2. Total HS patients have GH peaks of 1 to 6 μU/ml inclusive and height velocity SDS of < -2. Partial HS patients are accelerated by HGH and should be treated; but their average acceleration is below that of total HS patients.(5) There was a highly significant relation (r = -0·64) between blood GH peak level and pretreatment height velocity in the HS patients.(6) The LBW patients were 10 boys and 7 girls; all the boys had normal genitalia. The average height SDS at diagnosis was -3·7; parents'' height centile averaged 50th, bone age SDS -1·8, skinfold SDS -0·9. GH peaks were all above 30     

Right Pulmonary Artery Measurements in Term and Preterm Neonates during the Early Newborn Period: Hemodynamic Correlation and Clinical Significance

Right pulmonary artery (rPa) diameter was measured during the first hour of life, then during the next 23 hours, at 72 hours and at 120 hours in 62 normal term and 14 normal preterm neonates by M-mode echocardiography via the suprasternal notch. Left atrium (LA) and aortic (Ao) diameters were likewise determined from the standard parasternal view. Comparison was also made with rPA values of 34 patients with patent ductus arteriosus (26), persistent fetal circulation (6) and cyanotic congenital heart disease (2). In normal term babies, the mean rPA size changed significantly during the 4 periods of examination with diameters of 4.6 mm, 5.5mm, 5.2mm and 4.7 mm respectively. Among preterm babies, mean rPA diameter at 24 hours was 3.8 mm, at 72 hours, 3.8 mm, and at 120 hours, 3.3 mm. unlike those in term babies, the changes in preterm babies were not significant. LA dimensions and LA/Ao ratio were more variable. Furthermore, rPA measurements reliably differentiated clinical conditions with increased or decreased pulmonary blood flow. Thus, our data confirm the significance of rPA measurement as it closely correlates with the hemodynamic changes in the early neonatal period in normal and abnormal term and preterm babies.     

Rhizomelic Chondrodysplasia Punctata: Report of a Case with Review of the Literature and Correlation with Other Peroxisomal Disorders

A 3-year-old girl rhizomelic chondrodysplasia punctata (RCDP) had serve micrencephaly but a normal gyral pattern, neuronal density, and cortical cytoarchitecture. The white matter was diffusely decreased in mass but normally myelinated. There was optic atrophy and cerebellar degeneration. Leukodystrophy in peroxisomal disorders is caused by elevated very long chain fatty acids. The absence of a fatty acid abnormality in RCDP explains the normal myleination. Cerebellar and retinal degeneration and possible stunted dendritogenesis may be due to plasmalogen deficiency, which is the most severe biochemical abnormality in RCDP.     

Birth weight and cognitive function at age 11 years: the Scottish Mental Survey 1932.

AIMS: To examine the relation between birth weight and cognitive function at age 11 years, and to examine whether this relation is independent of social class. METHODS: Retrospective cohort study based on birth records from 1921 and cognitive function measured while at school at age 11 in 1932. Subjects were 985 live singletons born in the Edinburgh Royal Maternity and Simpson Memorial Hospital in 1921. Moray House Test scores from the Scottish Mental Survey 1932 were traced on 449 of these children. RESULTS: Mean score on Moray House Test increased from 30.6 at a birth weight of <2500 g to 44.7 at 4001-4500 g, after correcting for gestational age, maternal age, parity, social class, and legitimacy of birth. Multiple regression showed that 15.6% of the variance in Moray House Test score is contributed by a combination of social class (6.6%), birth weight (3.8%), child's exact age (2.4%), maternal parity (2.0%), and illegitimacy (1.5%). Structural equation modelling confirmed the independent contribution from each of these variables in predicting cognitive ability. A model in which birth weight acted as a mediator of social class had poor fit statistics. CONCLUSION: In this 1921 birth cohort, social class and birth weight have independent effects on cognitive function at age 11. Future research will relate these childhood data to health and cognition in old age.