Association of complex lipids containing gangliosides with cognitive development of 6-month-old infants

Background

Human breastmilk contains gangliosides which may play an important role in infant neurodevelopment.

Aim

A pilot study was conducted to assess the impact of infant formula supplemented with gangliosides from complex milk lipid on cognitive functions of normal healthy infants.

Study design

The study was a double-blind, randomized, controlled, parallel group clinical trial in which infants received the treatment or control product from 2 to 8 weeks of age until 24 weeks of age. The control group (n = 30) received standard infant formula and the treatment group (n = 29) received the same formula supplemented with complex milk lipid to increase the ganglioside content to approximately 11 to 12 μg/ml. A reference group (n = 32) consisted of normal healthy exclusively breast-fed infants.

Outcome measures

Cognitive development using the Griffith Scales and serum gangliosides was measured before (2–8 weeks of age) and after intervention (24 weeks of age).

Results

Ganglioside supplementation using complex milk lipids significantly increased ganglioside serum levels (control group vs treatment group, P = 0.002) and resulted in increased scores for Hand and Eye coordination IQ (P < 0.006), Performance IQ (P < 0.001) and General IQ (P = 0.041). Cognitive development scores and serum ganglioside levels for the treatment group did not differ from the reference group.

Conclusions

Supplementation of infant formula with complex milk lipid to enhance ganglioside content appears to have beneficial effects on cognitive development in healthy infants aged 0–6 months, which may be related to increased serum ganglioside levels.     

Hepatic aminotransferases of normal and IUGR fetuses in cord blood at birth

Background

The accepted standard for assessing the wellbeing of the newborn is the Apgar score and blood gas analysis. However, the prediction of neonatal morbidity or mortality is limited. In small-for-gestation (SGA) fetuses at 18–38 weeks of gestation, pO₂ is < 5th centile both in the umbilical artery and vein in 30%. In a previous study in singleton term neonates cardiac specific enzymes (B-type natriuretic peptide, BNP and cardiac troponin T, cTnT) are increased in growth-restricted fetuses compared with normals.

Aims

To test the hypothesis, that fetuses with intra uterine growth restriction (IUGR) have elevated AST (GOT) and ALT (GPT) aminotransferases as a result of hypoxic liver cell injury, and to establish references ranges.

Study design

Prospective cohort study, serum of umbilical artery (n = 156) and vein (n = 180), 599 normal singletons at 37^+ 0–42^+ 0 weeks, neonates with IUGR (n = 41), analysis for pH, birthweight and maternal weight, spontaneous vs cesarean section, vein vs artery and for the sex.

Outcome measures

Aspartate aminotransferase (AST, GOT) and Alanine aminotransferase (ALT, GPT) were measured in normals and IUGR neonates.

Results

Neonates with IUGR (n = 41) had AST values that were not different from the reference group, but had significantly lower ALT (− 1.49, 95% CI − 1.98 to − 1.00 vs 0.14, 95% CI − 0.42–0.13), (p < 0.001), (Fig. 3).

Conclusions

In neonates with IUGR, hypoxic hepatic injury markers in cord blood were not elevated. Rather, a substantially reduced ALT suggests a down-regulated hepatic activity.     

Maternal consumption of a DHA-containing functional food benefits infant sleep patterning: an early neurodevelopmental measure

Background

Docosahexaenoic acid (DHA; 22:6n − 3) is highly important during pregnancy for optimal development and functioning of fetal neural tissue. Infant ability to organize sleep and wake states following parturition is highly associated with later developmental outcomes. The impact of maternal DHA intake on sleep organization has not been previously investigated.

Aims

To examine the effect of a DHA-containing functional food consumed during pregnancy on early neurobehavioral development as assessed by infant sleep patterning in the first 48 postnatal hours.

Study design

A longitudinal, randomized, double-blinded, placebo-controlled design was used.

Subjects

Women (18–35 y) with no pregnancy complications consumed a cereal-based functional food (92 kcal) containing 300 mg DHA an average of 5 d/week or placebo bars (n = 27 DHA, n = 21 Placebo). The intervention began at 24 weeks gestation and continued until delivery (38–40 weeks).

Outcome measures

Infant sleep/wake states were measured on postnatal days 1 (D1) and 2 (D2) using a pressure sensitive mattress recording respiration and body movements.

Results

Using ANCOVA and controlling for ethnic variation, there were significant group differences in arousals in quiet sleep on D1 (P = 0.006) and D2 (P = 0.011) with fewer arousals in the DHA intervention group compared to the placebo group. Similarly, arousals in active sleep on D1 were significantly lower in the DHA-intervention group (P = 0.012) compared to the placebo group.

Conclusions

We conclude that increased prenatal supply of dietary DHA has a beneficial impact on infant sleep organization.     

The metabolic effects of two different lipid emulsions used in parenterally fed premature infants--a randomized comparative study

Objective

To compare the effects of two different lipid emulsions, based on soybean oil and olive oil respectively on plasma lipid concentrations and acylcarnitine profile of very low birth weight infants.

Design

Randomized comparative study.

Patients and methods

Forty very low birth weight infants, ≤ 32 weeks of gestational age and receiving at least 40% of the calorie taken by parenteral nutrition from lipid solution at 14th day of life were evaluated. Group I (n = 20) received soybean oil based lipid emulsion (Intralipid®) and Group II (n = 20) received olive oil based lipid emulsion (Clinoleic®).

Main outcome measures

Plasma lipid concentrations and acylcarnitine profile were assessed.

Results

Triglyceride, cholesterol, high and low density lipoprotein levels, liver function tests were similar between two groups whereas very low density lipoprotein level was statistically lower in Group I (p < 0.05). Free carnitine levels were 15.73 ± 10.67 in Group I and 34.25 ± 22.18 μM in Group II (p = 0.012) and hexanoyl carnitine levels 2.18 ± 2.10 in Group I and 0.38 ± 0.12 μM in Group II, respectively (p = 0.005). Plasma medium chain acylcarnitine levels were significantly higher in Group I.

Conclusions

Low levels of very low density lipoprotein in Group I may be a way of hemostasis to keep the serum triglyceride within normal levels. Lower free carnitine levels in soybean oil-based group is the result of carnitine need during the mitochondrial transport of long chain fatty acids. In Group I, due to the inefficient transport of medium chain fatty acids into the mitochondria, medium chain acylcarnitines accumulate in plasma. This may be the reason of lower carnitine levels in Group I. We suggest that higher levels of hexanoyl carnitine, reflecting defective mitochondrial transport of hexanoyl which leads immunsupression, may be the cause of higher sepsis risk in Group I.     

Low platelet count is associated with ductus arteriosus patency in preterm newborns

Background/aim

To determine whether there is an association between platelet counts and patent ductus arteriosus (PDA) incidence and/or closure in preterm newborns.

Study design and subjects

Premature infants with hemodynamically significant PDA (n = 154) and a control group without PDA (n = 207) who were hospitalized in the NICU were retrospectively evaluated. Platelet counts and other platelet indices including mean platelet volume (MPV) and platelet distribution width (PDW) of the infants in both groups during the first 3 days of life were recorded. Ibuprofen was started in infants with hemodynamically significant PDA and echocardiography was repeated 48 h thereafter to assess the closure of ductus.

Results

Median gestational age and birth weight of the infants with PDA were 28 (range 26–29) weeks and 1060 (range 892–1250) g respectively. Platelet counts were significantly lower in the patient group than in the control group (p < 0.001). Multivariate analysis including gestational age, presence of RDS, presence of thrombocytopenia and PDW showed that hemodynamically significant PDA was independently associated with platelet count < 150,000 (OR = 2.13, 95% CI 1.26–3.61; p = 0.005), high PDW (> 17) (OR = 2.68, 95% CI 1.41–5.09; p = 0.003) and the presence of RDS (OR = 2.25, 95% CI 1.41–3.59; p = 0.001). Baseline platelet counts of the infants in whom ductus closed or persisted after ibuprofen treatment were similar.

Conclusions

PDA was associated with low platelet count and high PDW but not with other platelet indices in preterm infants. We could not show an association between platelet counts and persistence or closure after medical treatment.     

Allergic disease in the first year of life is associated with differences in subsequent neurodevelopment and behaviour

Background

Recent trials suggest a link between neuropsychological function, atopy and allergic disease particularly in early childhood; however the nature of this association remains unclear.

Aims

To investigate the relationship between early allergic disease and sensitisation at 12 months of age and neurodevelopmental outcomes at 18 months.

Study design

Linear or binary logistic regression analysis was used to determine whether allergic diseases or sensitization at 12 months of age was a significant predictor of neurodevelopmental test scores at the 18 months.

Subjects

Infants with a maternal history of allergic disease (n = 324).

Outcome measures

Allergic outcomes at 12 months of age included allergen sensitisation, eczema, IgE-mediated and food allergy, and neurodevelopmental outcomes at 18 included the Bayley Scales of Infant Toddler Development III Edition, the Achenbach Child Behaviour Checklist and the Macarthur Scales of Infant Toddler Development.

Results

Children with any diagnosed allergic disease at 12 months had evidence of reduced motor scores (p = .016), and this was most apparent for a diagnosis of eczema (p = .007). Non-IgE mediated food allergy was significantly positively associated with problem Internalising Behaviours (p = .010), along with a trend for effects on the Social–Emotional composite score for IgE-Mediated food allergies (p = .052). Allergic sensitisation was not independently associated with any effects on neurodevelopmental outcomes.

Conclusion

This study provides evidence that an allergic phenotype in infancy is associated with effects on neurodevelopment. Further research is required to investigate the nature of this relationship.     

Outcomes of extremely low birth weight infants with bronchopulmonary dysplasia: impact of the physiologic definition

Aims

We compared neurodevelopmental outcomes of extremely low birth weight (ELBW) infants with and without bronchopulmonary dysplasia (BPD), using the physiologic definition.

Study design

ELBW (birth weights < 1000 g) infants admitted to the Neonatal Research Network centers and hospitalized at 36 weeks postmenstrual age (n = 1189) were classified using the physiologic definition of BPD. Infants underwent Bayley III assessment at 18–22 months corrected age. Multivariable logistic regression was used to determine the association between physiologic BPD and cognitive impairment (score < 70).

Results

BPD by the physiologic definition was diagnosed in 603 (52%) infants, 537 of whom were mechanically ventilated or on FiO₂ > 30% and 66 who failed the room air challenge. Infants on room air (n = 505) and those who passed the room air challenge (n = 51) were classified as “no BPD” (n = 556). At follow up, infants with BPD had significantly lower mean weight and head circumference. Moderate to severe cerebral palsy (7 vs. 2.1%) and spastic diplegia (7.8 vs. 4.1%) and quadriplegia (3.9 vs. 0.9%) phenotypes as well as cognitive (12.8 vs. 4.6%) and language scores < 70 (24.2 vs. 12.3%) were significantly more frequent in those with BPD compared to those without BPD. BPD was independently associated (adjusted OR 2.4; 95% CI 1.40–4.13) with cognitive impairment.

Conclusions

Rates of adverse neurodevelopmental outcomes in early childhood were significantly higher in those with BPD. BPD by the physiologic definition was independently associated with cognitive impairment using Bayley Scales III. These findings have implications for targeted post-discharge surveillance and early intervention.     

Is newborn melatonin production influenced by magnetic fields produced by incubators?

Background

During permanence in most incubators, newborns are very close to the electric engine, which represents a source of electromagnetic fields (EMF). Previous studies demonstrated a decrease in melatonin production in adults and animals exposed to EMF.

Aims

To assess melatonin production in a group of newborns exposed to EMF, and to evaluate whether removing the babies from the source of MF can affect melatonin production.

Study design and subjects

We have recruited 28 babies (study group), who had spent at least 48 h in incubator where we had previously assessed the presence of significant EMF. We have measured their mean 6-hydroxy-melatonin-sulfate (6OHMS) urine excretion at the end of their permanence in the incubators, and compared it with their mean 6OHMS excretion after having been put in cribs, where EMF are below the detectable limit (< 0.1 mG). We have also measured urine 6OHMS twice, with an interval of 48 h, in a control group of 27 babies who were not exposed to EMF during both samples.

Results

Mean 6OHMS/cr values were respectively 5.34 ± 4.6 and 7.68 ± 5.1 ng/mg (p = 0.026) when babies were exposed to EMF in incubators, and after having been put in the crib. In the control group, mean 6OHMS/cr values in the first and in the second sample were respectively 5.91 ± 5.41 vs 6.17 ± 3.94 ng/mg (p = 0.679).

Conclusions

The transitory increase in melatonin production soon after removing newborns from incubators demonstrates a possible influence of EMF on melatonin production in newborns. Further studies are needed to confirm these data.     

Altered placental development in pregnancies resulting in sudden infant death syndrome (SIDS)

Background

Sudden infant death syndrome (SIDS) is postulated to be a developmental disorder originating during fetal life in utero. Knowledge regarding the intrauterine environment in which SIDS infants develop is, however, inadequate and how the placenta develops prior to a SIDS event has not been studied.

Aim

To investigate the morphological development of the placenta obtained from full-term infants who subsequently succumbed to SIDS.

Study design

To estimate the percentage and total volumes of the chorionic villi and villous trophoblast membrane using stereological techniques.

Subjects

Placentas were obtained retrospectively from normal birthweight (SIDS-NBW n = 18) and small-for-gestational age (SIDS-SGA, n = 14) infants who had succumbed to SIDS, and compared to either control (n = 8) or SGA placentas (n = 7), respectively.

Results

SIDS-NBW placentas displayed evidence of augmented villous growth shown by significantly greater volumes of placental chorionic villi (gas-exchanging (GE) villi) in comparison to controls; this was not observed for SIDS-SGA placentas. However, both SIDS-NBW and SIDS-SGA placentas displayed significantly greater volumes of the cytotrophoblast (CT) (SIDS-NBW only), syncytiotrophoblast (SIDS-SGA only) and syncytial knots (SCT-K) and those displaying apoptotic syncytial nuclei (AP SCT-K). In contrast, SGA placentas displayed significantly reduced volumes of chorionic villi, GE villi and the villous trophoblast indicating a SIDS-specific effect associated with augmented placental growth.

Conclusions

Our findings provide initial evidence that placental abnormality, although not necessarily causative, may precede a subset of SIDS cases supporting the hypothesis that the origins of SIDS begin during fetal life in utero.     

Prevalence and predictors of idiopathic asymmetry in infants born preterm

Background

An idiopathic asymmetry in posture of the head is recognized as a risk factor to develop a deformational plagiocephaly (DP). In our neonatal follow-up clinic, an IA is often observed in infants born preterm at term-equivalent age (TEA).

Aims

To explore (1) the prevalence of an idiopathic asymmetry in 192 infants (gestational age ≤ 32.0 weeks) at TEA and 6 months corrected age (CA), (2) whether demographical, perinatal, and medical factors were predictors of the asymmetry, and (3) differences in motor maturation between infants with and without asymmetry.

Methods

In a retrospective study, frequencies of idiopathic asymmetry and DP, putative predictors, and Alberta Infant Motor Scale scores at 6 months CA were abstracted and analyzed with Chi², Mann–Whitney, logistic regression and T-test.

Results

The prevalence rate of a positional preference of the head at TEA was 44.8% (n = 86), 10.4% (20/192) had a DP at TEA and 13% (25/192) at 6 months CA. Positional preference, multiple birth and male gender predicted the presence of DP (p < .05, odds ratio 3.0, 3.2, and 3.1 respectively). Gross motor maturity at 6 months CA was less developed in infants with a positional preference at TEA compared to preterm norms (p = 0.01).

Conclusions

The high prevalence of a positional preference in infants born preterm at term equivalent age requires extra alertness to prevent the development of a deformational plagiocephaly, especially in boys and twins. Although, considering the lower prevalence of plagiocephaly at 6 months CA, therapists should be aware of over treating these infants.     

Dysmorphic features in 2-year-old IVF/ICSI offspring

Background

An increased risk of major congenital abnormalities after IVF and ICSI has been described, but underlying mechanisms are unclear. This study evaluates the effects of ovarian hyperstimulation, the in vitro procedure and time to pregnancy (TTP) – as proxy for the severity of subfertility – on the prevalence of dysmorphic features.

Design/methods

Participants were singletons born following controlled ovarian hyperstimulation-IVF/ICSI (COH-IVF/ICSI; n = 66), or modified natural cycle-IVF/ICSI (MNC-IVF/ICSI; n = 56), or to subfertile couples who conceived naturally (Sub-NC; n = 86). Dysmorphic features were assessed according to the method of Merks et al., and are classified into ‘minor variants’ (minor anomalies or common variants) and ‘abnormalities’ (clinically relevant or irrelevant abnormalities). We focussed on minor anomalies as they indicate altered embryonic development and because they have the advantage of a higher prevalence.

Results

The prevalences of any of the outcome measures were similar in the three groups. One or more minor anomalies, our primary outcome measure, occurred in 50% of COH-IVF/ICSI, 54% of MNC-IVF/ICSI and 53% of Sub-NC children. TTP in years was significantly associated with abnormalities (adjustedOR = 1.20; 95%CI = 1.02–1.40), especially with clinically relevant abnormalities (adjustedOR = 1.22; 95%CI = 1.01–1.48).

Conclusions

The study indicates that ovarian hyperstimulation and the in vitro procedure are not associated with an increase in dysmorphic features. The positive association between TTP and clinically relevant abnormalities suggests a role of the underlying subfertility and its determinants in the genesis of dysmorphic features.     

Baseline serum magnesium concentrations and neurodevelopmental outcomes of extremely low birth weight premature infants

Aim

To test the hypothesis that, in ELBW infants who did not receive antenatal MgSO₄, lower baseline serum Mg is associated with poorer neurodevelopmental outcomes (NDO).

Study design

The study was conducted in two phases: Phase 1 — retrospective, and Phase 2 — prospective.

Subjects

Extremely low birth weight infants.

Outcome measures

Mortality and adverse NDO were assessed in relation to initial serum Mg measured in the first 12 hours of age.

Results

We studied 156 ELBW infants. In phase 1 (n = 102): initial serum Mg (median [IQ range]) was greater in the infants who died compared to those who survived (1.7 [1.5–2.2] mg/dL vs. 1.6 [1.4–1.7] mg/dL, p = 0.034). In phase 2 (n = 54): initial serum Mg was greater in infants who died or had adverse NDO at 9 months when compared to those who survived with better NDO (1.7 [1.55–2.1] mg/dL vs. 1.5 [1.4–1.68] mg/dL, p = 0.008). Using receiver operating characteristic (ROC) curve, increased Mg concentration in the first 12 hours > 1.6 mg/dL was associated with unfavorable outcomes with sensitivity of 73%, specificity of 67%, and odds ratio of 5.5 (CI = 1.2–24.8, p = 0.037).

Conclusions

In a cohort of preterm infants without antenatal exposure to MgSO₄, initial serum Mg concentrations associated positively with poor outcomes. Further studies are needed in ELBW infants with poor NDO to determine whether they have a dysfunctional transport system that prevents Mg from entering into cells, or they have an active process that excretes Mg extracellularly.     

Clinical and ultrasound features of placental maturation in pre-gestational diabetic pregnancy

Background

Pre-gestational diabetes (PGDM) is a significant cause of neonatal morbidity and mortality. Delayed villous maturation (DVM) is a placental diagnosis with increased risk of perinatal mortality.

Aims

This study aimed to prospectively look at the incidence of DVM in a PGDM population compared to non-diabetic controls. Additionally, we analysed antenatal ultrasound and clinical markers for DVM in the diabetic population.

Study design

This is a prospective study.

Subjects

Placentae of women with non-diabetic and PGDM pregnancies underwent detailed blinded histo-pathological examination.

Outcome measures

Clinical data, including birth weight, peri-natal outcome, and, in PGDM group, glycaemic control and ultrasound findings, were obtained.

Results

77 non-diabetic women and 74 PGDM women consented to the study. The incidence of DVM in the PGDM group was higher than in the non-diabetic group (21/74 (28.4%) vs. 11/77 (14.3%) p = 0.02; RR 1.98). In the PGDM group clinical and ultrasound markers were compared between the DVM group (n = 21) and the non‐DVM group (n = 53). There was no difference in perinatal outcome nor glycaemic control between these two groups.

Conclusion

DVM, a placental finding with an increased risk of perinatal mortality, is increased in PGDM population compared to non-diabetic controls. No association was found with maternal glycaemic control. The presence of placental DVM was not associated with antenatal ultrasound parameters nor clinical perinatal outcome.     

Resistin and leptin in breast milk and infants in early life

Background

The role of adipokines in early life is considered an emerging topic issue in nutritional researches.

Aims

To evaluate serum resistin and leptin concentrations and their relations in infants and in breast milk.

Study design

We enrolled 41 term, AGA, healthy infants, of which 23 exclusively breast-fed (BF) and 18 formula-fed (FF), aged less than 6 months. Breast milk (BM) samples were collected from 23 breastfeeding mothers of the infants enrolled. Resistin concentration in serum and BM was determined by ELISA test (Human-Resistin-ELISA, Mediagnost, Reutlingen, Germany). Leptin concentration was determined by Radioimmunoassay method (LEP-R40, Mediagnost, Reutlingen, Germany). Infants weight, length and body mass index were measured. We used Mann–Whitney test. Spearman correlation was applied. Statistical significance was set at p < 0.05. Data are reported as median and interquartile range (IR).

Results

Infants serum resistin concentration was 9.30 (5.02) ng/ml. Breast milk resistin concentration (n = 23) was 0.18 (0.44) ng/ml. Leptin concentration was 3.04 (3.68) ng/ml in infants serum and in BM was 2.34 (5.73) ng/ml. Serum resistin concentrations in BF infants correlated positively with BM resistin (r = 0.636, p = 0.035). We have shown a positive correlation between resistin and leptin in total group of infants (r = 0.44, p = 0.05), confirmed in breastfed subjects (r = 0.65, p = 0.02). No correlations were found between serum hormones and anthropometric parameters of infants.

Conclusion

Our findings show interestingly a positive correlation between resistin concentrations in BF infants serum and in BM and between resistin and leptin in infants.     

Fetal habituation in assisted conception

Background

Neurodevelopment outcomes of children conceived by Assisted Reproductive Technology (ART)have been the subject of much recent attention. To date there are no reports of neurodevelopmental performance before birth in this group.

Aims

To compare habituation (a measure of brain function) in fetuses conceived by assisted reproduction techniques (ART) with naturally conceived (NC) fetuses.

Study design

Case control study.

Subjects

Women with singleton pregnancies matched for maternal age, parity and smoking were recruited in 2 groups: ART (n = 20) and NC (n = 20).

Outcome measures

Sound stimuli (250 Hz, 110 dB) at 10 second intervals lasting 2 s were administered to the fetus. The end point was habituation (cessation of movement for five consecutive stimuli) or a maximum of 30 stimuli. Responses of the fetus were observed with ultrasound at 28, 32 and 36 weeks' gestation, video-recorded and anonymised for analysis.

Results

At 28 weeks' gestation significantly more ART fetuses responded to sound of 250 Hz, 110 dB (p = 0.02) but this difference did not persist at 32 and 36 weeks'. There was a significant increase in nonresponders as gestation advanced in the ART group. There was no difference in habituation or mean number of trials to habituate at all three gestations.

Conclusions

ART fetuses demonstrated no differences in habituation suggesting that there is no neurodevelopment delay. However, a decrease in response to sound as gestation advances might be a harbinger for poor perinatal outcomes and needs exploration.     

Neonatal side effects of maternal labetalol treatment in severe preeclampsia

Objective

Labetalol is often used in severe preeclampsia (PE). Hypotension, bradycardia and hypoglycemia are feared neonatal side effects, but may also occur in (preterm) infants regardless of labetalol exposure. We analyzed the possible association between intrauterine labetalol exposure and such side effects.

Study design

From 1 January 2003 through 31 March 2008, all infants from mothers suffering severe PE admitted to one tertiary care center were included. Severe PE was defined according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) criteria. Infants exposed to labetalol in utero (labetalol infants) were compared with infants, who were not exposed to labetalol (controls). Neonatal records were reviewed for hypotension (RR < mean gestational age in weeks), bradycardia (heartrate < 100/min) and hypoglycaemia (glucose < 2.7 mmol/L) in the first 48 postnatal hours.

Results

Of 109 infants, 55 had been exposed to labetalol, whereas 54 were not (controls). Gestational age at delivery and birthweight were similar in both groups (31.8 vs. 32.8 weeks (p = 0.06) and 1510 vs. 1639 grams (p = 0.25), respectively for the labetalol vs. control group). Hypotension occurred significantly more in conjunction with labetalol exposure (16, (29.1%) vs. 4 (7.4%); p = 0.003), irrespective of the route of administration. Patent ductus arteriosus (PDA) was present in 9 (56%) of hypotensive labetalol infants compared to 1 (24%) infant in the hypotensive control group (NS). In a multivariate regression model, labetalol exposure, the need for intubation and PDA appeared independently associated with hypotension (P < 0.001). Hypoglycemia occurred in 26 (47.3%) of labetalol infants and in 23 (42.6%) of control infants (p = 0.62). Bradycardia occurred in 4 (7.3%) of labetalol infants and in 1 (1.9%) of control infants (p = 0.18). Hypoglycemia was more common in premature infants (n = 45 (48,9%) vs. n = 4 (23.5%), p = 0.05) in both labetalol and control infants.

Conclusion

Hypotension is more common after maternal labetalol exposure, regardless of the dosage and route of administration. The need for intubation and the presence of a PDA also play a role. Hypoglycemia is a very common finding in this population and is merely related to prematurity and independent of labetalol exposure as was the incidental occurrence of bradycardia. These findings on the neonatal side effects of maternal labetalol treatment in preeclampsia underline the importance of frequent blood glucose and blood pressure measurements in the first days of life, especially in intubated preterm infants with a PDA.     

Impact of maternal probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration: a prospective, randomized, placebo-controlled study

Background

The breast milk bioactive substances such as adiponectin, have a presumably long-term impact upon the health and well-being of a child.

Aim

To determine the impact of probiotic-supplemented dietary counseling during pregnancy on colostrum adiponectin concentration.

Study design and subjects

Altogether 256 pregnant women were randomized into three study groups: dietary intervention with probiotics (diet/probiotics) or with placebo (diet/placebo) and a control group (control/placebo). The intervention group received dietary counseling provided by a nutritionist, the main focus being the amount and the type of dietary fat. The probiotics used were Lactobacillus rhamnosus GG and Bifidobacterium lactis in combination. Dietary intake was evaluated by food records at every trimester of pregnancy. Breast milk samples were collected after birth (colostrum) for adiponectin concentration analysis (n = 181).

Results

The dietary intervention increased the colostrum adiponectin concentration (ng/mL, geometric mean [95% CI]), the difference being significant when comparing to the control group; 12.7 [10.6–29.7] vs. 10.2 [9.9–13.2], P = 0.024. Maternal weight gain during pregnancy (kg) correlated inversely with colostrum adiponectin concentration; β (SE) = − 1.7 (0.1), P = 0.020, and gestational diabetes mellitus was associated with the likelihood of adiponectin concentration falling into the lowest quartile; OR 2.36, 95% CI 1.1–3.2, P = 0.028.

Conclusions

In showing that the colostrum adiponectin concentration is markedly dependent on maternal diet and nutritional status during pregnancy, and considering that colostrum adiponectin has potential effects on metabolism, nutrition, and immune function in the neonates, the results of this study underscore the importance of the metabolic homeostasis of the mother for the child's initial nutritional environment.     

The use of oxygen for delivery room resuscitation of newborn infants in non-Western countries

Background

Using pure oxygen (PO) in neonatal resuscitation increases oxidative stress and mortality in full-term hypoxic infants. International neonatal resuscitation guidelines recommend air or blended oxygen for resuscitation regardless of gestational age but this requires education and equipment that may not be globally available.

Objective

To determine current neonatal resuscitation practices and availability of oxygen blending equipment in non-Western hospitals.

Design

196 email addresses were obtained through perinatal societies representing 45 hospitals in 14 countries in Asia, Africa and the Middle East.

Results

68 (34.6%) responses were received from all 14 countries. The majority (90%, n = 61) of respondents were aware of recent guideline changes but continued to resuscitate with PO because of the lack of equipment and uncertainty about international guidelines (61%, n = 41 for term, 44%, n = 30 for preterm). Most (81%, n = 55) believed that PO caused adverse effects in term neonates. The availability of oxygen blending equipment correlated significantly with the country's gross domestic product.

Conclusion

The majority of the practitioners we surveyed in non-Western countries are aware of the most recent recommendations regarding oxygen use in neonatal resuscitation. However, lack of oxygen blending equipment remains a hindrance to the use of blended gas at resuscitation in low resource, non-western countries. Global guidelines from developed countries must take into account the resource limitations and implementation difficulties faced by countries with restricted resources, where the majority of the high-risk infants are born.     

Maternal use of selective serotonin reuptake inhibitors during pregnancy and neonatal bone density

Background

Selective serotonin reuptake inhibitors (SSRI) are commonly used to treat depression in pregnant women. Several adverse effects of prenatal SSRI exposure on the offspring have been described, including decreased growth. SSRI use by adults decreases bone mineral density, but this effect had not been examined in infants.

Aim

To examine growth parameters and bone mineral density of infants born to mothers using SSRIs during pregnancy.

Study design

Anthropometric variables and bone density were compared between 40 newborns exposed to SSRIs in utero, and 40 gestational-age matched control infants. Tibial bone speed of sound, a marker of bone density and strength, was measured using quantitative ultrasound. The difference in bone speed of sound between the two groups was compared using linear models, adjusting for relevant confounders.

Results

Infants in the SSRI-exposed group were shorter, with a marginal statistical significance (49.3 ± 2.1 vs. 50.1 ± 1.3 cm, p = 0.07), while mean birth weight did not differ substantially between study groups. Head circumference was significantly smaller in the SSRI group (33.8 ± 1.2 vs 34.4 ± 1.1 cm, p = 0.005), remaining so even after adjustment for several confounders. No considerable difference was found in the bone speed of sound between SSRI-exposed infants and controls (3011 ± 116 vs. 3029 ± 129 m/s).

Conclusions

We found no evidence that prenatal SSRI exposure hindered neonatal bone quality, yet a marginally shorter length and a smaller head circumference raise the possibility of an effect on bone growth. We conclude that the effect of SSRIs on fetal bone density seems minimal or absent.     

Fetal myocardial tissue Doppler indices before birth physiologically change in proportion to body size adjusted for gestational age in low-risk term pregnancies

Background

Few studies have investigated the relationship between myocardial tissue Doppler parameters and fetal size adjusted for gestational age and its trend has been controversial.

Aims

To investigate fetal cardiac function before birth using tissue Doppler imaging (TDI: indicated by the prime symbol (′)) in low-risk term pregnancies by comparing the TDI parameters with gestational age-specific birth weight percentiles and z scores.Study design and measurementsInterventricular septum, left and right ventricular myocardial peak early diastolic (E′), late diastolic (A′) and systolic (S′) velocities, E′/A′ ratios, myocardial performance index (MPI′) and umbilical artery pulsatility index were measured within three days before birth in 76 low-risk term pregnancies, including appropriate for gestational age (AGA, n = 50), small for gestational age (SGA, n = 10), and large for gestational age (LGA, n = 16) subjects.

Results

Myocardial peak velocities showed higher in the LGA and lower in the SGA compared with the AGA group, and All S′ positively correlated with birth weight (r = 0.51–0.57). All z scores of S′ demonstrated a positive correlation with birth weight z score (Spearman r = 0.45–0.53). MPI′ was significantly higher in the SGA and lower in the LGA compared with the AGA group. All MPI′ negatively correlated with birth weight (r = − 0.55 to − 0.65). All z scores of MPI′ showed a negative correlation with birth weight z score (Spearman r = − 0.40 to − 0.56).

Conclusions

Fetal myocardial peak velocities and MPI′ physiologically changed in proportion to body size adjusted for gestational age in low-risk term pregnancies.