Serum zinc and copper levels in the maternal blood and cord blood of neonates

Estimation of serum zinc and copper in the maternal blood and cord blood of neonates was carried out to correlate the trace metals in the neonates and their mothers in relation to gestational age and birth weight. Sixty-five healthy neonates, both term and preterm and their mothers were selected. This cross sectional study was done at Azimpur Maternity Centre, Dhaka Medical College Hospital and Chemistry Division, Atomic Energy Centre, Dhaka, Bangladesh from July 1997 to June 1998. The estimation of trace metals was carried out by Atomic Absorption Spectrophotometry (AAS). The mean serum zinc levels in the maternal blood and cord blood were 0.47 ± 0.24 μg/ml and 0.85 ± 0.33 μg/ml respectively and the mean copper levels in the maternal blood and cord blood were 1.37 ± 0.62 μg/ml and 0.31 ± 0.32 μg/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels. There was no significant correlation between gestational age and serum zinc levels in the cord or maternal blood. But significant inverse correlation was found between gestational age and serum levels of copper in the maternal and cord blood.     

Maternal-neonatal serum vitamin A concentrations

Prevention of neonatal vitamin A deficiency is related to the adequacy of maternal vitamin A stores. In this study we investigated maternal and cord serum vitamin A and retinol-binding protein (RBP) values in an Indian population including, for the first time, clinically vitamin A-deficient mothers. Twenty-eight maternal-neonatal pairs were selected from maternal cohorts of high socioeconomic status without clinical evidence of vitamin A deficiency (group I) and low socioeconomic status with conjunctival xerosis and Bitot's spots (group II). Maternal education, caloric and vitamin A intakes, weight, height, hemoglobin, and birth weight were significantly lower in group II. Serum vitamin A levels were significantly higher in group I mothers and newborns as were RBP levels in group I mothers. However, a significant difference between groups I and II in cord blood RBP was not observed. Upon correlation of maternal vitamin A levels with cord blood vitamin A levels, a logarithmic relationship was revealed, suggesting saturable transplacental transport of vitamin A.     

Serum copper in newborns and their mothers

Serum copper levels in the cord blood of 100 newborns and the respective maternal serum copper at the time of delivery was estimated by atomic absorption spectrophotometer. The cases were classified into term AGA, term SGA, term LGA, preterm AGA and preterm SGA. The mean maternal serum copper level 152.42 ± 2.06 μg/Jdl) was significantly higher than the mean cord serum copper level (39.84 ±1.19 μg/dl). There was positive correlation between the maternal serum copper level and cord serum copper level. The mean serum copper level of term neonates was (44.42 ± 1.26 μgJdl) significantly higher (p < 0.001) than that of preterm neonates (30.30 ± 1.14 μg/dl). There was a positive correlation between cord serum cooper level and gestational age. The mean cord serum copper levels of term AGA, term SGA, preterm AGA and preterm SGA neonates was 45.42 ± 1.44 μg/dl, 39.22 ± 2.45 μg/dl, 31.00 ± 2.11 udJdl and 29.47 ± 2.08 μg/dl respectively. There was no statistically significant difference in the mean serum copper level, of AGA and SGA group of both term and preterm noenates. The difference amongst mean maternal serum copper level of various neonatal groups was not significant.     

A study of serum zinc levels in cord blood of neonates and their mothers

Serum zinc was estimated in the cord blood of 60 neonates of different gestational age and birth weight, and their mothers. Mean serum zinc levels in neonates FTGA, PTAGA and term SGA were 128.88±14.37, 94.32±17.79 and 111.8±9.2 ug/dl respectively. The maternal serum zinc levels in corresponding groups was 96.28±19.48, 115.44±15.41 and 93.8±7.62 ug/dl. Thus mean serum zinc level in cord blood of FT AGA newborns was significantly higher than that in PT AGA and FT SGA. Mean serum zinc level in mothers of FT AGA was significantly lower than that in mothers of PT AGA. However, there was no significant difference between the maternal serum zinc levels of FT AGA and FT SGAs. There was positive correlation between gestational age and serum zinc level in cord blood of AGAs while correlation was negative in case of their mothers. There was positive correlation between weight (keeping gestational age constant) and serum zinc level in case of neonates while corresponding maternal zinc levels did not vary. (FT AGA and FT SGA).     

Early-life nutritional and environmental determinants of thymic size in infants born in rural Bangladesh

Aim:  The aim was to assess the impact of nutritional status and environmental exposures on infant thymic development in the rural Matlab region of Bangladesh.
Methods:  In a cohort of N_max 2094 infants born during a randomized study of combined interventions to improve maternal and infant health, thymic volume (thymic index, TI) was assessed by ultrasonography at birth and at 8, 24 and 52 weeks of age. Data on birth weight, infant anthropometry and feeding status were also collected.
Results:  At all ages, TI was positively associated with infant weight and strongly associated with the month of measurement. Longer duration of exclusive breastfeeding resulted in a larger TI at 52 weeks. TI at birth and at 8 weeks correlated positively with birth weight, but by 24 and 52 weeks and when adjusted for infant weight this effect was no longer present. Thymic size was not affected by pre-natal maternal supplementation or by socioeconomic status but was correlated to arsenic exposure during pregnancy.
Conclusion:  In this population of rural Bangladeshi infants, thymic development is influenced by both nutritional and environmental exposures early in life. The long-term functional implications of these findings warrant further investigation.     

Birth season and environmental influences on patterns of thymic growth in rural Gambian infants

AIM: In rural Gambia, birth season predicts infection-related adult mortality. Seasonal factors in early life may programme the immune system, possibly via an effect on thymic development. This study tested whether thymus size in rural Gambian infants is affected by birth season, defined as January-June (harvest, few infections) versus July-December (hungry, high infectious load). METHODS: Thymic volume (thymic index) was assessed sonographically at 1, 8, 24 and 52 wk in 138 singleton infants born over 14 consecutive months. Growth and morbidity were regularly assessed. RESULTS: Mean thymic index increased from 19.9 at 1 wk to 30.9 at 8 wk and 35.7 at 24 wk, then fell to 32.0 at 52 wk. Thymic index was associated with each preceding thymic index up to 24 wk. This tracking persisted after correcting for infant weight and month of measurement (p < 0.01). Thymic index at 1 wk was marginally but non-significantly lower in hungry season births (p = 0.06). Thymic index was lower in hungry season measurements; this effect persisted after adjusting for current weight and infection markers, and was strongest at 8 wk (p = 0.001). CONCLUSION: These results describe a pattern of thymic growth followed by diminution in size. An infant's thymic index tracks despite changes in body weight and season. Thymic index was lower in the hungry season. This appears not to be explained by infection or nutritional status. A possible influence of trophic factors in breast milk merits investigation.     

Effect of gestational age on cord blood plasma copper,zinc, magnesium and albumin

BACKGROUND: The transport of essential trace elements from mother to fetus varies throughout gestation, and the role of transport proteins in the neonate and the mother may change during pregnancy. Magnesium, often used as tocolytic agent, may reach the fetus and appear in cord blood at higher than normal concentrations. AIMS: To determine cord blood plasma zinc, copper and magnesium concentrations, as well as plasma albumin in premature and full-term newborns, and correlate these values with those of maternal blood plasma at birth. Also, to examine whether cord blood plasma concentration of these elements varies with gestational age. SUBJECTS: The 35 mother-infant pairs included: 11 in the 38-42-week gestational age (GA), 9 in the 34-37-week GA, 11 in the 29-33-week GA group and 4 in the 24-28-week GA. Magnesium for tocolysis was given to five of the mothers in the 29-33-week GA cohort and two of the women giving birth at 24-28-week GA. RESULTS: Trend analysis showed that while cord plasma zinc decreased with GA at birth, the reverse was observed for copper. There were no differences with GA either in maternal plasma zinc or copper. However, maternal ceruloplasmin tended to decrease with GA (P=0.0174). Maternal and cord blood plasma magnesium exhibited a strong correlation (r=0.942, P<0.001), as well as between cord plasma magnesium and zinc (r=0.448, P<0.01). CONCLUSIONS: While the vigorous mother-to-fetus uphill zinc transfer is clear throughout the last trimester, copper remains in cord blood plasma at much lower concentrations than in the mother, suggesting that prematurity may place the newborn infant at a greater risk than the term infant to copper deficiency. This situation, together with a reduced synthesis in the fetus of the transport protein ceruloplasmin, creates another potential challenge in the nutritional support of the premature infant.     

Iron Stores in Low and Normal Birth Weight Infants at Birth and in Early Infancy

Serum ferritin levels of low birth weight (LBW; BW?<?2,500 g) and normal birth weight (NBW; BW?≥?2,500 g) infants were evaluated at birth and at 3 mo using electrochemiluminescence immunoassay. At birth, levels were 318.6 (31.0–829.5) ng/mL in LBW (n?=?217) and 366.2 (122.4–858.5) ng/mL in NBW infants (n?=?116; p?<?0.01), with 1.4 % of LBW and none of the NBW infants having levels <12 ng/mL (p?=?0.20). At follow up, levels were 66.9 (4.5–567.7) ng/mL in LBW (n?=?126) and 126.2 (6.8–553.7) ng/mL in NBW infants (n?=?76; p?=?0.27), with 11.9 % of LBW and 11.8 % of NBW infants having levels <12 ng/mL (p?=?0.80).     

新生儿窒息母儿血浆催乳素水平变化的研究(英文)

目的：目前发现催乳素(PRL)与缺氧缺血性脑病(HIE)的严重程度密切相关，PRL与新生儿窒息的关系较少报道，该文探讨窒息新生儿母儿血浆催乳素(PRL)水平变化与相关性及其意义。方法：采用放射免疫分析法对25例围产期窒息新生儿(窒息组，其中轻度窒息14例，重度窒息11例)及20例正 Ｐ律?对照组)母血、脐血及新生儿血浆PRL水平进行测定并进行动态观察。结果：窒息组母血、脐血及新生儿血浆PRL水平［(362.5±127.1)，(984.6±262.3)，(386.3±216.2)μg/L］均显著高于对照组［(96.4±26.2), (92.3±18.4), (68.7±7.27)μg/L］(P均0.05)。结论：围产期窒息时新生儿血浆、脐血及母血PRL水平显著增高，血浆PRL水平可作为判断新生儿窒息程度的一项参考指标。     

CDC Kerala 4: TDSC Items Based Developmental Therapy Package Among Low Birth Weight Babies – Outcome at 18 months Using DASII

Objective

To assess the effectiveness of Trivandrum Developmental Screening Chart (TDSC) items based intervention package developed at Child Development Centre, Kerala on the developmental outcome of children at 18 mo of age using Developmental Assessment Scale for Indian Infants (DASII) and compare the same in different birth weight groups.

Methods

Five hundred consecutive discharges from the Neonatal Intensive Care Unit (NICU), Sree Avittam Thirunal hospital, were recruited and followed up till 18 mo of age including 240 low birth weight (LBW;<2,500 g) babies and 260 normal birth weight babies. All 240 LBW babies were offered early intervention at monthly intervals till 12 mo of age, whereas the normal birth weight (NBW) group received only immunization service as per the routine of the hospital. The early intervention package for the low birth weight group was designed based on Trivandrum Developmental Screening Chart (TDSC 0–2 y) items delay. At 18 mo of age both the groups were offered developmental assessment using DASII by specially trained and experienced developmental therapists who were blind to the intervention status of the babies.

Results

It was observed that the LBW (<2,500 g) group, who received intervention had a DASII mental age of 18.31 as against 18.16 in the NBW (≥2,500 g) group and mental DQ 101.84 (LBW group) and 98.65 (NBW group) and the observed differences were not statistically significant. Similarly, the LBW, who received intervention group had a DASII motor age of 18.68 as against 18.47 in the NBW group and motor DQ 139.40 (LBW group) and 135.39 (NBW group) and the observed differences were not statistically significant.

Conclusions

The results of this TDSC based intervention package among low birth weight babies showed that at 18 mo of age there was no statistically significant difference in the developmental outcome using DASII, between low birth weight babies on intervention and the normal birth weight babies without any intervention.

     

The effect of maternal, umbilical cord and placental malaria parasitaemia on the birthweight of newborns from South-western Cameroon

Aim: The impact of maternal, umbilical cord and placental malaria parasitaemia on the incidence of low birthweight was investigated in pregnant women reporting for delivery at the Mutengene Maternity Centre, Fako Division, South West Province, Cameroon. Methods: The malaria parasitaemia status of 770 umbilical cords, parturient women and placental impression smears were determined by light microscopy using blood samples collected between June 1999 and September 2001. The birthweights (BW) of the newborns were recorded soon after delivery. Results: The results show that malaria parasites were present in the blood samples of 57 out of 730 (7.8%), 233/711 (32.8%) and 248/735 (33.7%) cord, maternal and placental biopsies respectively. Low birthweight (LBW) was recorded in 72 (9.6%) newborns, and the incidence was higher in primiparae. Newborns of mothers who had malaria parasites in their peripheral blood (12.4%) had a higher incidence (p=0.014) of LBW when compared with malaria parasite-free mothers (6.8%). Similarly, neonates born from malaria-positive placentas (13.5%) had a significantly higher incidence of LBW (p=0.006) than those from parasite-negative placentas (6.8%). Furthermore, newborns of malaria parasite-positive mothers, umbilical cords, placentas and primiparae had lower mean birthweight than malaria-negative mothers, placentas, umbilical cords and multiparae.

Conclusion: We suggest that parity and maternal and placental malaria parasitaemia at delivery have an important negative impact on birthweight, especially in first pregnancies. This observation emphasizes the need for appropriate aggressive intervention strategies such as the use of insecticide-treated bed nets or intermittent preventive treatment to control malaria in pregnancy in the study area.     

CORD BLOOD HAEMOGLOBIN, IRON AND FERRITIN STATUS IN MATERNAL ANAEMIA

ABSTRACT. Maternal and cord blood haemoglobin, serum iron, transferrin saturation and ferritin were studied in sets of 30 anaemic (haemoglobin <110 g/l) and 21 nonanaemic (haemoglobin ≧110 g/l) mothers. The cord serum iron, transferrin saturation and ferritin concentrations had significant correlation with maternal haemoglobin. The significant low levels of these parameters suggested that maternal anaemia adversely affected the iron status including iron stores of the newborns. The cord serum iron of 15.2±4.35 μmol/l and ferritin of 29.7±10.93 ng/ml seem to be effective to maintain cord haemoglobin levels. Thus, anaemic mothers with reasonably maintained ferritin and trasferrin saturation levels provide sufficient iron for maintenance of cord haemoglobin, although foetal iron stores are likely to be depleted.     

The vitamin status of low birth weight infants and their mothers

The levels of vitamins A, E, B1, B2, folate, and B12 were measured in maternal blood, cord blood, and in 5-day neonate capillary blood samples. Twenty-six infants and their mothers served as controls and were compared with 32 low birth weight (LBW) infants. LBW infants showed significantly lower levels of vitamins A, E, B2, and folate than the controls. The folate status of mothers of LBW infants was significantly lower (7 +/- 1.8 ng/ml) than that of control mothers (21 +/- 0.8 ng/ml).     

Antioxidant status of neonates exposed in utero to tobacco smoke

To investigate the influence of maternal smoke exposure on neonatal and maternal antioxidant status, 39 mothers who were active smokers, 14 mothers exposed to environmental tobacco smoke (ETS), 17 controls, and their newborns were included in a prospective, controlled study. Plasma total antioxidant capacity, measured as total radical-trapping antioxidant parameter (TRAP) and ferric reducing antioxidant power (FRAP), and concentrations of specific antioxidants were measured in cord and in maternal blood. A similar, significant increase in ceruloplasmin concentration was observed in neonates born to actively smoking mothers and in those born to ETS exposed mothers. Uric acid and TRAP concentrations were significantly increased in ETS-exposed newborns and their mothers, compared to newborns and mothers from the active smoking and no-exposure groups with a trend towards increased uric acid, TRAP and FRAP concentrations being observed in the active smokers group. Neonatal and maternal antioxidant concentrations correlated significantly, except for ceruloplasmin. Cord blood vitamin A, E and C concentrations were unaffected by smoke exposure. These results show that maternal active smoking as well as ETS exposure significantly affect neonatal and maternal antioxidant status.     

Antioxidant levels in cord blood of low birth weight newborns

We evaluated the antioxidant status of 82 healthy term low birth weight (LBW) newborns and equal number of gestation and sex matched controls weighing <2500 g by measuring vitamin A and E, superoxide dismutase, catalase and glutathione peroxidase in cord serum. Levels of vitamin A and E, superoxide dismutase and catalase were significantly lower and glutathione peroxidase significantly higher in LBW babies compared to controls, with the lowest levels found in babies showing more severe growth restriction (<2000 g). We conclude that LBW newborns are deficient in several important antioxidants which may predispose them to higher oxidative stress.     

Value of homocysteine levels,troponin I,and score for neonatal acute physiology and perinatal extension II as early predictors of morbidity

Background: Although the effects of cardiac troponin I (cTnI) have been documented in infants, the associations among the value of maternal and cord blood total homocysteine (Hcy) levels, cord blood cTnI and the score for neonatal acute physiology and perinatal extension II (SNAPPE‐II) values in infants have not been documented. The aim of this study was to determine the value of maternal total Hcy (mtHcy) and cord blood total Hcy (ctHcy) levels, cTnI and SNAPPE‐II as predictive factors of morbidity in newborns. Methods: Maternal and cord blood samples were routinely collected for analysis from all prospective participating volunteers. In this case–control study, both hospitalized (n= 71) and non‐hospitalized (n= 148) newborns were identified and followed until discharge. Results: Regression analysis revealed that pre‐eclampsia, gestational age, mtHcy and SNAPPE‐II values were significantly and independently associated with morbidity. Cord blood pH, ctHcy levels, SNAPPE‐II values, and pre‐eclampsia were associated with mtHcy levels. A similar association was found among cTnI, cord blood pH, mtHcy levels and ctHcy levels. The specificity and sensitivity values of mtHcy in predicting newborn morbidity were 62% and 78%, respectively, while the specificity and sensitivity values of SNAPPE‐II in predicting newborn morbidity were 96% and 97%, respectively. Conclusions: Elevated mtHcy levels were associated with cTnI, SNAPPE‐II values, cord blood gas, and neonatal morbidities. These results suggest that SNAPPE‐II may be an early predictor of morbidity after delivery and that elevated mtHcy levels may be an early prenatal biomarker of morbidity in newborns.     

Cord blood leptin levels: relationship to body weight, body mass index, sex and insulin and cortisol levels of maternal-newborn pairs at delivery

To investigate leptin and to which factors it is related during the perinatal period, we measured serum leptin levels of 46 mothers at delivery, umbilical cord blood and infants on the third day of life. Maternal leptin was higher than in cord (p < 0.001), and did not correlate with maternal age, body weight, body mass index, weight gain during pregnancy, serum glucose, cholesterol, triglycerides, CPE, cortisol or HbA1c levels, nor any biochemical values or anthropometric data of the newborns (p > 0.05). In cord blood, leptin was significantly higher than in 3 day-old infants (p < 0.05), and correlated only with maternal insulin and glucose (r = 0.5, p < 0.01 and r = 0.4, p < 0.05, respectively). In 3 day-old infants, leptin did not correlate with any clinical data (p > 0.05). Leptin was not different in the two sexes (p > 0.05). Serum leptin levels were not related to adiposity of the mother-infant pairs or neonatal growth, and were not different in the two sexes during the perinatal period.     

The usefulness of measuring fructosamine in the cord blood of the newborn infants of diabetic mothers

The aim of our study was to evaluate the usefulness of fructosamine measurement (Fram) in cord blood as an index of glucose metabolism in the last week of pregnancy in infants of diabetic mothers. In newborns and their respective mothers Fram values were surprisingly greater in N than in IDM and IGDM and neonatal and maternal values appeared to be strictly related. While intrauterine growth was associated with metabolic control indexes of 2nd and 3rd trimester gestation. Fram value appeared positively correlated to cord insulin. In conclusion Fram level appears as a good index of glucose metabolic control of the last week of pregnancy and it is associated to cord insulin level and to neonatal hypoglycemia.     

Free fatty acids and triglycerides in normoglycemic low birth weight newborns in early neonatal period

Free fatty acids, triglycerides and blood sugar were estimated in 45 lowbirth weight which included 24 preterm and 21 small for gestational age term babies, in the cord blood, in the fasting state at 6±1 h of age, and after initiation of sugar water feeds at 24±2 h of age. Thirty six appropriate for gestational age, term newborns were taken as controls. None of the newborns were born to diabetic mothers or had hypoglycemia. Mean cord blood sugar levels in all the groups were similar ranging between 69.55 to 73.7 mg/dl. followed by a fall in all at 6±1 h and subsequent rise at 24±2h. levels were significantly lower in LBW newborns compared to controls. Means FFA levels were lowest in babies with agestation of 28–32 weeks (0.27 m Mol/L), being almost similar to controls (0.35 mMol/L) in preterm 33–36 weeks (0.32 mMol/L) and higher than controls in SGA (0.48 mMol/L). An inverse relationship with blood sugar level was seen in serial estimations. SGA neonates continued to show higher and preterm (28–32 weeks) lowest levels throughout the study period. Triglycerides in cord blood were 36.72 mg/dl, 38.33 mg/dl, 56.23 mg/dl and 40.11 mg per cent in preterm 28–32 weeks, 33–36 weeks, SGA term and controls respectively. Levels showed a steady rise during the study period.     

Adrenocorticotrophic hormone during the first day of life

The plasma concentration of ACTH (by radioimmunoassay) was measured in 56 healthy parturients and their newborns. Umbilical cord and maternal venous blood were collected immediately after delivery. In addition one venous blood sample was taken from 50 newborns at the age of 15, 30, 60 min, 2, 6, 12, or 24 h.The maternal and cord plasma ACTH levels were higher than the levels in healthy nonpregnant women. There are no differences between the mean maternal (226±146 pg/ml) and cord (226±147 pg/ml) values of ACTH.The high ACTH levels of cord plasma remain unchanged for 30 min, decrease significantly during the 1–6 h after birth, because of the elimination process of the circulated foetal ACTH, and increase over the next 12–24 h and slightly thereafter indicating an initiation of neonatal pituitary ACTH secretion.The plasma ACTH level in the mothers with membranes ruptured for 1–5 h was significantly (P<0.05) higher compared with that in the mothers with membranes ruptured for less than 1 h. However, the duration of ruptured membranes appeared to have no effect on the cord blood ACTH level.