Serum prohepcidin levels in premature newborns with oxygen radical diseases

This study aimed to investigate the prohepcidin levels in premature newborns with oxygen radical diseases such as bronchopulmonary dysplasia, retinopathy of prematurity and necrotizing enterocolitis and to compare these levels with those of healthy premature newborns. Eighty premature infants (25–34 weeks gestational age) were enrolled. The patient group was composed of 38 premature babies with oxygen radical diseases, and the control group consisted of 42 healthy premature newborns. Complete blood count, serum iron and ferritin concentrations, iron-binding capacity (IBC), transferrin and prohepcidin levels were measured. The mean ferritin and prohepcidin levels were higher in the patient group than in the control group (p?=?0.038 and p?=?0.022, respectively). No significant correlations were found between serum prohepcidin levels and iron parameters. We believe that this finding will contribute to a greater understanding of the etiopathogenesis of oxygen radical diseases. There is a need for future studies to explore the link between underlying inflammatory mechanisms and hepcidin in oxygen radical diseases.     

Plasma growth arrest-specific 6 levels in term and preterm newborns

Objective: Growth Arrest-Specific 6 (GAS6) is a vitamin K-dependent protein. Despite a similar structure to Protein S, it has no anticoagulant activity. An association between GAS6 and some diseases for adults has been reported. In the absence of prospective clinical studies of GAS6 in neonates, so far, the objective of this study is to obtain, for the first time, plasma GAS6 levels before and after vitamin K1 prophylaxis in full-term and pre-term newborns.

Methods: 80 newborns (40 term and 40 preterm) were recruited for this study. Cord blood samples and peripheral blood samples 48?h after vitamin K1 injection were collected into EDTA-tubes. GAS6 levels were measured in platelet-poor plasma by ELISA.

Results: Cord blood plasma GAS6 levels in preterm and term newborns were 9.07?±?5.30?ng/mL and 9.75?±?4.34?ng/mL, respectively. In response to vitamin K1 injection, GAS6 levels increased in preterm newborns (10.50?±?5.28?ng/mL) (p?p?>?.05).

Conclusion: This pilot study provided, to the best of our knowledge, the first report that GAS6 levels increased significantly after vitamin K1 prophylaxis in preterm newborns but not in term infants. This study may serve as a first step toward more extensive studies in neonates.     

Reference values of serum IgG and IgM levels in preterm and term newborns

Aim: Although, variations of normal immunoglobulin (Ig) levels in different gestational age and birth weight groups have been studied so far, data are still limited in newborns, especially in preterm infants. The aim of this study was to determine serum IgG and IgM levels in newborns in order to generate a reference standard for neonatal intensive care unit (NICU) and address the variations in preterm babies.

Methods: This study was conducted from June 2012 to June 2013 in a level III NICU. A total of 300 newborn infants hospitalized within first 72?h were included in the study. The quantification of serum IgG and IgM was performed by nephelometric method.

Results: Both serum IgG and IgM levels were increased in correlation with increased gestational age and birth weight.

Conclusion: The reference values of serum IgG and IgM levels should be further evaluated in larger series with the presented data in this article. In addition, preterm babies appear to have lower Ig levels thus carry the risk of relevant morbidity.     

Pain assessment and intervention for term newborns

A baseline assessment of pain should occur as part of a newborn's health assessment within the first few hours of life. Validation and assessment of pain in the term newborn is important for providing care because newborns may experience pain from a multitude of procedures, ranging from heel sticks to circumcisions. Current assessment tools evaluate both behavioral and physiologic parameters. In addition, providing individualized care requires a knowledge base of the interventions available to reduce or eliminate pain, such as breastfeeding, non-nutritive suck, skin-to-skin contact, and sucrose pacifiers. This article describes three newborn pain assessment tools, the use of valid assessment tools, and evidence-based interventions that are recommended to effectively manage newborn pain.     

Subcutaneous fat distribution in small for gestational age newborns

We assessed the anthropometric characteristics of symmetric (SGA-S) and asymmetric (SGA-A) term newborns and describe their subcutaneous fat differences. We assessed perinatal data, maternal characteristics and anthropometric variables (including skinfold thicknesses) in 139 small for gestational age (SGA) term infants, classified as symmetric and asymmetric according to their ponderal index (using the 10(th) percentile as the cut-off criterion). Despite an overall small body size and lower amounts of subcutaneous fat than the reference population, SGA-S term newborns showed a proportionate body fat distribution and SGA-A were thinner and had a lower percentage of central subcutaneous fat than SGA-S. These findings, resulting from intrauterine growth restriction, could be associated with different early and later postnatal outcomes among SGA groups.     

Urinary iodine concentrations in mothers and their term newborns in country with sufficient iodine supply

Objective: The main aim of the study was to evaluate maternal and newborn urinary iodine concentrations according to the usage of iodine supplementation during pregnancy.

Methods: Thirty-seven women with singleton uncomplicated pregnancies and their newborns were included in this study. Maternal urine samples were obtained at the time of delivery and on the third day after delivery. Newborn urine samples were obtained on the third day after delivery. Urinary iodine concentrations were determined by the alkaline ashing of urine specimens followed by the Sandell–Kolthoff reaction using brucine as a colorimetric marker.

Result: The overall rate of the usage of iodine supplementation during pregnancy was 54% (20/37). Women who used the iodine supplementation during the pregnancy did not have different urinary iodine concentrations neither at the time of delivery (p?=?0.23), nor on the third day after delivery (p?=?0.65) in comparison to women without extra iodine supplementation. Newborns from pregnancies with regular iodine supplementation had higher urine iodine concentrations on the third day after delivery (p?=?0.02). When women were split into several subgroups based on the daily dosage of iodine supplementation (200, 150, and 50?μg daily and without iodine supplementation), no differences were found in maternal urine iodine concentrations at the time of delivery (p?=?0.51) and on the third day after delivery (p?=?0.63). Different levels were found in newborn urine iodine concentrations among the subgroups of newborns from pregnancies with different daily doses of iodine supplementation and from pregnancies without iodine supplementation during pregnancy (p?=?0.05).

Conclusions: Iodine supplementation during pregnancy affects newborn urine concentrations but not maternal urine concentrations.     

Vitamin D levels in newborns and association with neonatal hypocalcemia

Objective: Vitamin D has many important functions in our body. Especially in intrauterine and early infancy periods, Vitamin D plays a major role in bone development, growth, and the maturation of tissues such as lung and brain. Fetus is dependent on the mother in terms of Vitamin D and maternal Vitamin D deficiency results in a Vitamin D deficient newborn. The purpose of this study was to determine the levels of Vitamin D in newborns and to investigate the association between Vitamin D status of the baby and neonatal hypocalcemia.

Method: Vitamin D, calcium, and parathyroid hormone levels of 750 infants, born between 1 January 2014 and 30 June 2015 and followed in Ondokuz May?s University Neonatal Intensive Care Unit were analyzed retrospectively. Blood levels of Vitamin D were checked within 3 days after birth. A 25(OH)D3 level of <10?ng/ml indicated severe, levels between 10 and 20?ng/ml, which indicated moderate and levels between 20 and 30?ng/ml indicated mild Vitamin D deficiency. Serum calcium levels below 8?mg/dl in term infants and below 7?mg/dl in preterm infants were accepted as hypocalcemia. Hypocalcemia that developed within the first week after birth was defined as early, while hypocalcemia after one week were defined as late hypocalcemia.

Results: A total of 44% of the infants in the study were girls, while 56% were boys; 38% were term and 62% were preterm. Average 25(OH)D3 level of all infants was 11.4?±?10.2 (0–153) ng/ml. Only 30 (4%) infants had normal (>30?ng/ml) 25(OH)D3 levels; 68 (9%) had mild, 234 (31%) had moderate and 418 (56%) had severe vitamin D deficiency. No correlation was found between Vitamin D levels and gender, mother’s age, gestational week or birth weight. In 79 (17.2%) preterms, neonatal hypocalcemia was observed. Vitamin D levels of the premature infants who had early neonatal hypocalcemia were statistically significantly lower when compared with those who did not have early neonatal hypocalcemia (p?=?.02). No significant difference was found between the Vitamin D levels of the term infants who had early neonatal hypocalcemia and those who did not (p=?.29). No significant difference was found between the Vitamin D levels of the infants who had late neonatal hypocalcemia and those who did not (in preterm p?=?.27; in term p?=?.29).

Conclusions: Although lack of Vitamin D is preventable and curable, it is an important health problem for newborns in Turkey. In our study, 56% of the infants were found to have severe lack of Vitamin D and lack of Vitamin D was found to be associated with early neonatal hypocalcemia in preterm newborns. However, long-term effects of lack of Vitamin D in infancy are not fully known. In order to be able to prevent neonatal Vitamin D deficiency, 1200?IU/day vitamin D was supplemented to mothers from the 12th gestational week to 6th month of the birth, which was put into effect by the Ministry of Health in 2011, and should be applied by all health workers.     

Total body water in small- and appropriate- for gestational age newborns

OBJECTIVES: To ascertain total body water in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns. METHODS: SGA and AGA babies were matched by gestational age and studied from birth to term age. Criteria for exclusions were genetic syndromes, malformations, and congenital infections. Bioelectrical impedance was performed at two days of life (term infants), or at seven days of life and term age (preterm infants). Weight and length were measured by trained interviewers, and Z-score, weight/length ratio and Rohrer ponderal index was calculated. RESULTS: Of the 54 infants evaluated, 28 were SGA (17 preterm) and 26 were AGA (15 preterm). Total body water was greater in SGA preterm babies at seven days of age (P=0.058) and at term age (P<0.0001). Weight/length ratio and Rohrer ponderal index increased towards term. Weight Z-score and anthropometric measures at term were significantly smaller in SGA babies. Being SGA and variation in Rohrer ponderal index influenced the variations in total body water. CONCLUSIONS: SGA babies had greater total body water, and both groups presented insufficient increase in body solid mass, stressing the importance of nutritional support during neonatal care.     

Serum unconjugated estriol levels in the third trimester and their relationship to gestational age.

Maternal unconjugated estriol levels were measured throughout the 28 to 41 week interval in two groups of accurately dated normal pregnancies. The first group consisted of randomly sampled pregnancies on which 285 unconjugated estriol determinations were performed. The logarithms of the mean values plotted into a positive sloping, relatively straight line which was disrupted by a plateau originating at 31 to 32 weeks and terminated at 35 weeks where there began a steep surge to a point at 36 weeks (surge point) that returned values to fit the previously established straight line. To investigate these findings in individual pregnancies, a second group of nine subjects was studied with serial unconjugated estriol determinations. In all nine of these subjects, the surge point could be identified statistically and occurred at a mean gestational age of 36.0 +/- 0.6 (1 S.D.) weeks. Data from the first group of randomly sampled pregnancies indicate that the surge point occurred around a mean gestational age of 36.0 weeks and was confirmed by data from the second group of serially sampled individual subjects showing the surge point as a statistically definable marker in normal pregnancies.     

Status of iron nutrition in term pregnant women and their newborns

Haemoglobin (Hb), free erythrocyte protoporphyrin (FEP), ratio of FEP and Hb (FEP/Hb), serum ferritin (SF) packed red cell volume (PCV), serum iron (SI), total iron binding capacity (TIBC), transferrin saturation (TS) were evaluated in 170 healthy pregnant women and their full-term babies. The pregnant women were devided into normal and iron deficient groups. The status of iron nutrition of babies of normal mothers and mothers with iron deficiency anemia (IDA) was compared. It showed that the decreased value of PCV in late pregnancy was mainly related to IDA. While the values of SF, FEP/Hb and Hb were more sensitive for detecting pregnancy associated IDA, the values of FEP, FEP/Hb and Hb in babies of IDA mothers were significantly higher than those in babies of normal mothers. Maternal iron status bore no significant correlation with the iron store of their babies. However, Hb less than 11 g/L, FEP/Hb greater than 4.5 micrograms/g, FEP greater than 0.92 mumol/L or SF less than 50 micrograms/L in early pregnancy were indications for iron supplementation.     

Serum YKL-40 levels in gestational diabetes mellitus

Objective: Serum YKL-40 levels are elevated in patients with type 1 and 2 diabetes. However, the correlation between YKL-40 and gestational diabetes mellitus (GDM) remains unknown. The present study compared serum YKL-40 levels in pregnant women with GDM and those with normal glucose tolerance and evaluated the relationship between YKL-40 and insulin-resistant syndrome.

Methods: Thirty-five patients with GDM and 43 age-matched healthy pregnant women at 24–28 weeks of gestation were studied. In addition to anthropometric assessments, serum glucose, insulin, YKL-40, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein and glycated hemoglobin were measured in all subjects. All subjects underwent a 2-h 75-g oral glucose tolerance test (OGTT). Body mass index (BMI) and the homeostasis model assessment of insulin resistance (HOMA-IR) were calculated.

Results: Fasting and 2?h serum YKL-40 levels were significantly higher in pregnant women with GDM compared with controls (77.3?±?29.3 versus 50.9?±?16.7 ng/mL, p?<?0.001, fasting concentrations; 63.5?±?20.1 versus 40.6?±?10.7 ng/mL, p?=?0.009, 2?h concentrations). OGTT had no effect on YKL-40 levels in either group (p?>?0.05). There were significant correlations between YKL-40 and glycated hemoglobin (β?=?0.37, p?=?0.006), fasting insulin (β?=?0.49, p?=?0.001) and HOMA-IR (β?=?0.18, p?=?0.015) in the GDM group.

Conclusions: Serum YKL-40 levels are elevated in patients with GDM but are unaffected by OGTT. YKL-40 levels are related to glycated hemoglobin, fasting insulin and HOMA-IR. These results suggest that YKL-40 may be a major contributor to GDM.     

Birth weight and gestational age of newborns from Wielkopolski and Lubuski regions

OBJECTIVES: The correlation between the gestational age and the birth body weight are among others the basis of the estimation of newborn's maturity. Because of the acceleration of development and the decrease in the gestational age and birth body weight regarded as a limitation to newborn's survivalship there is a necessity of bringing up to date the existing reference systems. DESIGN: The main goal of this work is to modernize the reference system of birth body weight in relation to gestational age. MATERIALS AND METHODS: The data of the birth body weight of 48,443 (25,225 boys and 23,218 girls) newborn, singleton children with a gestational age of 24-43 weeks were examined. Data was collected in 2001 and 2002 in Wielkopolski and Lubuski region. Values of the 3rd, 10th, 25th, 50th, 75th, 90th and 97th percentile were calculated. The analysis was carried out separately for both sexes. Additionally, because of lack of dimorphic differences until the 33rd week of gestation, percentile values were calculated for both sexes together in the partition of 24 to 33 weeks of gestation. CONCLUSIONS: In comparison to previous reference systems, the obtained results showed a tendency for the birth body weight to increase.     

2000年至2009年足月单胎活产新生儿出生体重与剖宫产率的关系

目的 了解首都医科大学燕京医学院附属密云医院妇产科10年间分娩的足月单胎活产新生儿出生体重,分析其变化趋势及与剖宫产率的关系,为加强孕期营养指导、降低剖宫产率提供依据。 方法选取2000年1月1日至2009年12月31日在首都医科大学燕京医学院附属密云医院妇产科分娩的足月单胎活产新生儿,对其出生体重、巨大儿发生率及剖宫产率变化趋势进行分析。结果 (1)10年间共分娩足月单胎活产新生儿14 716人,男婴7642人,女婴7074人,男女比例为1.08.：1。10年间分娩巨大儿共1773人,构成比12.0％,低出生体重儿180人,构成比1.2％。(2)10年间足月单胎活产新生儿出生体重范围1200～5850 g,平均出生体重(3422±447)g,年度间平均出生体重呈上升趋势,差异有统计学意义(F= 15.337,P＜0.01)。(3)年度间巨大儿构成比呈上升趋势,差异有统计学意义（x2=125.285,P＜0.01）。(4)年度间剖宫产率呈逐年上升趋势,自2000年的49.9％上升至2009年的57.1％,差异有统计学意义(x2=180.883,P＜0.01)。(5)10年间随足月单胎活产新生儿平均出生体重上升,剖宫产率自＜2500 g的52.2％上升至4500 g～的85.4％,差异有统计学意义（x2=518.519,P＜0.01）。 结论 足月新生儿出生体重与剖宫产率有密切关系,应重视加强围产保健和孕期营养指导。     

Growth discordancy in appropriate for gestational age, term twins

We compared 14 term (37 weeks or more), discordant (15% or more birth weight difference), but not growth-retarded (2500 g or larger) twin pairs with 28 randomly selected term and appropriate for gestational age twin pairs without discordancy. The comparison of the two subgroups showed no significant difference in maternal age, parity, gestational age, incidence of maternal hypertension, or perinatal outcome. It is suggested that discordancy is not a risk factor when the twin pair has reached term and the lighter twin weighs at least 2500 g.     

Plasma adrenomedullin levels in pregnancies with appropriate for gestational age and small for gestational age infants.

AIMS: To evaluate whether maternal and fetal plasma adrenomedullin levels in pregnancies with small for gestational age (SGA) infants are different from those in pregnancies with appropriate for gestational age (AGA) infants. METHODS: Maternal and fetal circulating adrenomedullin levels were compared between 62 pregnancies with AGA (43 delivered vaginally and 19 delivered by elective cesarean section) and 28 pregnancies with SGA (20 delivered vaginally and 8 delivered by elective cesarean section) at birth. Plasma adrenomedullin levels were measured from maternal and cord venous blood samples using a radioimmunoassay. Umbilical artery blood pH was also measured. RESULTS: There were no significant differences for maternal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. There were also no significant differences for fetal total adrenomedullin levels, mature adrenomedullin levels, and its ratio among the groups. In the AGA group delivered vaginally, fetal mature/total adrenomedullin ratio (mean +/- standard error, 16.6 +/- 0.7%) was significantly higher than the maternal ratio (13.8 +/- 0.6%) (p < 0.05). In the SGA group delivered vaginally, fetal mature/total adrenomedullin ratio (18.5 +/- 1.0%) was also significantly higher than the maternal ratio (14.5 +/- 0.6%) (p < 0.05). There was no significant difference in umbilical artery blood pH among the groups. CONCLUSIONS: These results suggest that maternal and fetal plasma circulating adrenomedullin levels may play a role in maternal and fetal cardiovascular adaptation during delivery in pregnancies with both AGA and SGA infants.     

The effects of gestational age and maternal hypoxia on the placental renin angiotensin system in the mouse

IntroductionThe renin angiotensin system (RAS) is an important mediator of placental development. However, a comprehensive expression profile for 8 key components of the placental RAS throughout murine gestation has not been performed. Furthermore, maternal hypoxia induces dysregulation of RAS expression in fetal tissues but the effects on the murine placental RAS are less well known.MethodsPlacentas were collected from male and female CD1 mouse fetuses at seven gestational ages for qPCR analysis of Agt, Ren1, Atp6ap2, Ace, Ace2, Agtr1a, Agtr2 and Mas1. mRNA localisation of Agtr1 and Mas1 and protein localisation of ACE and ACE2 was determined at E18.5. To determine the effects of maternal hypoxia on the placental RAS, mice were housed in 12% oxygen from E14.5–E18.5 and placentas examined at E18.5.ResultsAll RAS genes were expressed in the placenta throughout pregnancy and expression varied with fetal sex and age. Agtr1 was expressed within the labyrinth while Mas1 was expressed within the intraplacental yolk sac. ACE and ACE2 were localised to both labyrinth and junctional zones. In response to maternal hypoxia the expression of Agt, Ace and Ace2 was decreased but expression of Agtr1a was increased. Ace and Agtr1a mRNA levels were affected to a greater extent in females compared to males.DiscussionCollectively, the location within the placenta as well as the expression profiles identified, support a role for the placental RAS in labyrinth development. The placental RAS is disturbed by maternal hypoxia in a sexually dimorphic manner and may contribute to impairment of placental vascular development.     

Thrombopoietin levels of thrombocytopenic term and preterm newborns with infection

We measured Thrombopoietin (Tpo) levels in thrombocytopenic term and preterm babies with infection to investigate the relationship between thrombopietin levels and platelet counts. Sixteen preterm (27-34 weeks' gestational age) and 5 term neonates (38-41 weeks' gestational age) with the diagnosis of neonatal infection and thrombocytopenia (platelets <150 x 10(9)/L) but, without the evidence of disseminated intravascular coagulation, were prospectively enrolled in the study. Fifteen preterm (27-34 weeks' gestational age) and 9 term (38-40 weeks' gestational age) age-matched healthy neonates were enrolled in the study as control. Blood samples were obtained from each subject at the time when infection and thrombocytopenia were detected and stored until assay. Bacterial infection was confirmed by blood cultures in five patients and by tracheal cultures in five. Median Tpo levels of term controls were lower than those of preterm controls (62 pg/mL vs. 87 pg/mL) (p <0.05). Median Tpo levels of thrombocyopenic preterm patients were higher than the levels of healthy preterms (258 pg/mL vs. 87 pg/mL) (p <0.05). Similarly, median Tpo levels of sick terms were significantly higher than those of healthy term controls (209 pg/mL vs. 62 pg/mL) (p <0.001). There was not significant difference between the median Tpo levels of term and preterm babies with infection (258 pg/mL vs. 209 pg/mL) (p >0.05). There was no correlation between platelet counts and Tpo levels in both term and preterm groups. The results of our study show that healthy term and preterm babies have detectable levels of Tpo and preterm babies have higher Tpo levels than term infants. Although thrombocytopenic babies with infection have increased levels of Tpo, these levels are still lower than the levels of thrombocytopenic children/adult patients and there seems to be no correlation between platelet counts and thrombopoietin levels. So our observation of increased Tpo levels may still be inadequate for normal platelet production in this period. and this group of babies may also be candidates for the administration of recombinant human Tpo.     

血清内脏脂肪素浓度与妊娠期糖尿病的关系

目的 观察不同程度糖代谢异常孕妇血清内脏脂肪素(visfatin,VF)浓度的变化并探讨其与胰岛素抵抗(insulin resistance,IR)、代谢参数及新生儿出生体重(birth weight,BW)的关系. 方法 根据50g糖筛查(glucose challenge test,GCT)及75g口服葡萄糖耐量试验(oral glucose tolerance teat,OGTT)结果将120名孕妇(妊娠36～40周)分为三组:妊娠期糖尿病葡萄组(n=45)、50g GET(+)组(n=20)、正常糖耐量(normal goucose tolerance,NGT)组(n=55),检测血清VF浓度、空腹血糖,空腹胰岛索、总胆固醇、甘油三酯水平及记录新生儿出生体重. 结果 GDM组血清VF浓度明显高于NGT组[(374.9±23.1)ng/ml和(308.9±16.8)ng/ml,P＜0.05],但GCT(+)组血清VF浓度[346.5±23.1)ng/ml]与GDM组及NGT组差异无统计学意义.血清VF浓度与空腹血糖、胰岛素、总胆固醇、甘油三酯水平、IR及新生儿出牛体重无关(P均＞0.05). 结论 GDM孕妇血VF水平是升高的,与GDM有密切联系,但其与IR、代谢参数及新生儿出生体重无关.