Heterogeneity of high-density lipoprotein in cord blood and its postnatal change.

BACKGROUND: Several subclasses of HDL are demonstrated to have different roles in atherosclerosis based on adult studies, but the significance of HDL heterogeneity in the fetus and neonate has not been clarified. It has been described that the cholesterol supply from apoE-rich HDL is essential for central nerve system neuron growth. METHODS: Sixty-five healthy, term, appropriate for gestational age neonates (38 males and 27 females) were included in the study. Serum lipoprotein analyses were performed by HPLC with gel permeation columns, which classified HDL into 5 subgroups (i.e., very large, large, medium, small, and very small) on the basis of particle size. Apolipoprotein A-I, B, and E were also determined by turbidimetric immunoassay. RESULTS: Cord blood has higher very large and very small HDL-cholesterol levels. Cord blood apolipoprotein E was not uniformly distributed in the HDL subclasses, with a strong association with very large HDL-cholesterol levels (males, r=0.548, p<0.001; females, r=0.631, p<0.01). However, the association disappeared by 1 month of age in males; in females, the association remained during the neonatal period. CONCLUSIONS: These results suggest that HDL may play the role of a dominant cholesterol carrier in the human fetus, and very large HDL-cholesterol have some contribution to the neurodevelopment in the fetus and neonates because of the close relationship with apolipoprotein E levels.

Effect of hemoglobin on transfusion and neonatal adaptation in extremely low-birthweight infants.

BACKGROUND: The aim of the present paper was to investigate the effect of initial hemoglobin level on red blood cell transfusion and neonatal adaptation in extremely low-birthweight (ELBW) infants. METHODS: Subjects consisted of 54 ELBW infants admitted to level III neonatal intensive care unit between 1995 and 2000, and divided into two groups based on hemoglobin level at birth. High hemoglobin was defined as hemoglobin > or =15.0 g/dL. RESULTS: There were no significant differences in gestational age and birthweight between the high hemoglobin group (n = 28) and low hemoglobin group (n = 26). The high hemoglobin group had decreased probability of requiring red blood cell transfusion (P < 0.05) and number of red blood cell transfusions (P < 0.05). Mortality rate in the low hemoglobin group was significantly higher compared with the high hemoglobin group (P = 0.03). In the high hemoglobin group, blood pressures during the first 24 h were significantly higher (P < 0.05) and the risk of intraventricular hemorrhage was significantly lower (P = 0.04) compared with the low hemoglobin group. The predictive variables, initial hemoglobin level (odds ratio 1.93 [decrease by 1 g/dL]) and intraventricular hemorrhage > or =III (odds ratio 21.76 [positive]) were found to be most predictive for death on logistic regression. CONCLUSION: High hemoglobin level at birth is associated with a significantly reduced requirement for red blood cell transfusion and might contribute to stabilization of blood pressure, and thus reduce mortality and the risk of severe intraventricular hemorrhage.

Optimal use of quick-acting insulin analogue in combination with basal insulin and its long-term effect in Japanese children and adolescents with type 1 diabetes.

The aim of the study was to examine the optimal use of quick-acting insulin analogue (Q) switching from regular insulin (R) in combination with basal insulin and its long-term effects in 40 Japanese children and adolescents with type 1 diabetes. Insulin regimens after administration of Q were increased to twice daily injections of basal insulin and modified use of Q or R as bolus insulin depending on the blood glucose profile and lifestyles. The mean dose of total insulin remained unchanged during treatment with using Q, but that of basal insulin increased 12 months after the use of Q (baseline: 25.8 +/- 12.2, after 12 months: 27.1 +/- 12.6 U/day). After switching to Q, the mean HbA1c value decreased in all patients (baseline: 7.6 +/- 1.0, after 12 months: 7.3 +/- 0.8%), which reflected improvement of HbA1c in patients with HbA1c > or = 8% at baseline. These results indicated that insulin regimens after switching from R to Q varied with increases of the number and the dosage of basal insulin. Use of Q seems to be useful to improve hyperglycemia in patients with a poor glucose profile under conventional insulin treatment with using R. The choice of insulin regimens with using Q in consideration of the blood glucose profile as well as lifestyles may lead to better glycemic control.

A role of end-tidal CO(2) monitoring for assessment of tracheal intubations in very low birth weight infants during neonatal resuscitation at birth.

AIM: To investigate whether end-tidal CO(2) monitoring is useful for more rapid recognition of tracheal vs. esophageal intubation as compared to standard clinical evaluation in very low birth weight infants during neonatal resuscitation at birth. PATIENTS AND METHODS: Forty infants were prospectively identified. Tracheal tube placement was evaluated either using an end-tidal CO(2) monitor by an investigator not involved in the resuscitation, or by evaluation of clinical parameters by a resuscitation team unaware of the end-tidal CO(2) data. The time taken to detect accurate placement of the tube using capnometory vs. clinical determination of tracheal or esophageal tube placement was compared. RESULTS: A total of 54 intubations was analyzed from 40 neonates. End-tidal CO(2) monitoring correctly identified all 40 tracheal and all 11 esophageal intubations with 100% accuracy. On the other hand, clinical evaluation demonstrated discrepancies in three cases. The mean time in seconds for capnographic determination was significantly faster than clinical determination for both tracheal (7.5+/-1.3 vs. 17.0+/-3.4, P<0.01) and esophageal intubation (6.5+/-0.7 vs. 19.9+/-1.8, P<0.01). CONCLUSION: Exhaled CO(2) detection is a sensitive and accurate technique to confirm tracheal tube placement in very low birth weight infants during neonatal resuscitation.

Very low-density lipoprotein in the cord blood of preterm neonates.

Human fetuses have markedly low levels of serum lipids and a unique lipoprotein profile with respect to quality, with low-density lipoprotein (LDL)-like particle as the dominant cholesterol carrier. However, little is known about triglyceride (TG) distribution. In addition, lipid metabolism is important in lung development, with indications that TG from very low-density lipoprotein (VLDL) is essential for surfactant synthesis. We investigated TG distribution in preterm neonate cord blood and the relationship of VLDL-TG levels with respiratory distress syndrome (RDS). The study included 103 appropriate-for-gestational-age neonates (61 males). We performed serum lipoprotein analyses in cord blood by high-performance liquid chromatography with gel permeation columns. Term neonates had low cord blood TG concentrations distributed equally to the LDL and VLDL fractions. However, preterm neonates had even lower TG concentrations, with VLDL as the dominant carrier. The LDL-TG and high-density lipoprotein-TG concentrations in cord blood increased gradually with gestational age, but cord blood VLDL-TG concentrations increased dramatically from 32 to 34 weeks of gestational age. Neonates with RDS exhibited no RDS-specific lipoprotein profile; however, most were born before the timing of the dramatic VLDL-TG increase. Our results suggest that 34 weeks of gestation is a critical period for TG metabolism, indicating the need for evaluation of the lipid nutritional state in preterm neonates.

Impact of serum adiponectin concentration on birth size and early postnatal growth.

In term neonates, the adiponectin concentration is higher than it is in adults. To determine the relationship between adiponectin and early neonatal growth in a cohort study. Fifty-two neonates at term were studied. Serum adiponectin concentrations, body sizes, and skinfold thicknesses were measured at birth and at 1 mo of age. At birth, cord blood adiponectin concentration correlated positively with birth weight (r = 0.484, p = 0.0003), birth length (r = 0.524, p < 0.0001), and sum of the four skinfold thickness measurements (r = 0.378, p = 0.0057). In a stepwise regression, birth length was the only determinant of cord blood adiponectin concentration. However, at 1 mo of age, serum adiponectin concentration correlated with no anthropometric parameter at all. Between birth and 1 mo of age, the individual change in adiponectin concentration correlated negatively with birth weight. Thus, serum adiponectin concentrations in cord blood have a strong relationship to birth length rather than to body fatness, and this relationship is not demonstrated in 1-mo-old infants. These results imply that hormonal, substrate, or other mechanisms that regulate the relationship between body composition and growth in fetal life are different from those governing these relationships in early postnatal life.