Do preterm infants with Bronchopulmonary dysplasia have a unique postnatal weight gain pattern?

OBJECTIVES: To investigate the weight gain pattern of preterm infants with bronchopulmonary dysplasia (BPD) during the hospital stay using weekly weight assessment methods. METHODS: This single-center, retrospective, cohort study was carried out in Zekai Tahir Burak Maternal Health Education and Research Hospital between 2014 and 2018. One hundred fifty-one preterm infants <32 weeks of gestation and <1500 g of birth weight with BPD were compared to 251 babies without BPD in terms of weekly weight gain, standard deviation score (SDS), and fall in weight SDS till discharge. RESULTS: Mean body weight was significantly lower in babies with BPD in all weeks except postnatal week (PW) 8. The groups had similar daily weight gain between birth and discharge (p = .78). Infants with BPD had lower weight SDS on postnatal day (PD) 14 and 21, and discharge, however similar on PD 28. The fall in SDS between PW 4 and discharge was significantly higher in the BPD group. Infants with BPD had higher fall in weight SDS between birth and discharge (p = .022). Discharge weight SDS was associated with gestational age and weight SDS on PW 4 in the whole cohort. CONCLUSION: Infants with BPD showed a unique and unsteady pattern of growth compromise during the NICU course, most explicitly in early postnatal life and between PD 28-discharge. Future studies should consider not only the early postnatal life but also the period after four weeks of life till discharge to design an optimal nutrition strategy and decent growth for preterm infants with BPD.

Evaluation of Breast Milk Macronutrient Content in Preeclamptic Mothers.

Background: Preeclampsia remains among the leading causes of maternal and perinatal morbidity and mortality worldwide. This study aimed to evaluate the macronutrient content of colostrum in mothers with preeclampsia. Materials and Methods: Women who delivered by cesarean section at ≤37 weeks of gestation were included in the study. Fresh colostrum samples were collected by manual expression on postpartum days 2 and 4 and were analyzed using a mid-infrared human milk analyzer. Demographic characteristics of the patients were recorded. The protein, fat, carbohydrate, and energy composition of the milk samples were compared between mothers with and without preeclampsia. Results: A total of 58 colostrum samples (25 preeclampsia, 33 nonpreeclampsia) were analyzed. The median gestational age of the infants was similar in both groups (32 versus 33 weeks; p > 0.05). There were also no differences between the groups in terms of maternal age, maternal body mass index, maternal weight gain during pregnancy, and infant gender. Median protein, fat, and carbohydrate levels in the colostrum of the preeclamptic mothers were 2.2, 2.1, and 6.3 g/dL, respectively, compared with 1.8, 2.4, and 6.2 g/dL in the nonpreeclamptic mothers, respectively. Although the colostrum of preeclamptic mothers had higher protein content and lower fat content, the difference was not statistically significant. Carbohydrate and energy contents were similar in both groups. Conclusions: The presence of preeclampsia does not cause a significant change in the macronutrient composition of mother's milk. Analyses of micronutrients at different lactation stages in larger samples are needed.

Macronutrient Composition of Colostrum in Mothers with Gestational Diabetes Mellitus.

Background: Infants fed breast milk are known to have lower rates of childhood obesity. However, there is evidence suggesting an increased risk of obesity in infants who receive milk from a diabetic mother. The aim of this study was to investigate the calorie and macronutrient content of colostrum in mothers with gestational diabetes mellitus (GDM). Methods: This prospective, controlled study included mothers who had diagnosis of GDM and a control group of mothers without GDM who delivered at term. Colostrum samples were analyzed for macronutrients (fat, protein, and carbohydrate) and calorie content using a human milk analyzer (Miris, Uppsala, Sweden). Results: A total of 92 colostrum samples were analyzed, 31 in the GDM group and 61 in the non-GDM group. The carbohydrate content of colostrum in the GDM group was higher compared with the non-GDM group (p = 0.004). The calorie, fat, and protein contents of colostrum were similar between the groups (p > 0.05). Multiple regression analysis indicated that having GDM was significantly related to carbohydrate content. Conclusion: The colostrum of GDM mothers had higher carbohydrate content. This might be one of the factors explaining the relationship between diabetic breast milk and infantile obesity.

Nucleated red blood cell levels in the diagnosis of patients with indirect hyperbilirubinemia.

BACKGROUND: Nucleated red blood cells (NRBCs) are progenitores of red blood cells that are physiologically seen in the peripheral blood of the fetus and newborn at birth. The increased numbers of NRBCs in the circulation is associated with pathologic conditions such as prematurity, hemolytic diseases and bleeding, intrauterine growth restriction. We aimed to evaluate the relationship between NRBCs and the demographic and clinical characteristics of the patients with indirect hyperbilirubinemia who were followed up in the neonatal intensive care unit. METHODS: In this retrospective study we evaluated 134 patients with indirect hyperbilirubinemia between January 2017 and December 2018. Patients were divided into two groups as those with ABO and/or Rh incompatibility and those without. Groups were compared in terms of demographic, clinical characteristics and for the hematological parameters. RESULTS: A total of 134 infants were evaluated in the study, including 68 (50%) infants with ABO incompatibility, 12 (8.9%) with Rh incompatibility and 3 (2.2%) with ABO and Rh incompatibility. Coombs test results were positive for 34 patients. There were no differences between ABO and/or Rh incompatibility group and non incompatibility group with regards to birth weight, gestational age and gender. In terms of hematologic parameters, there were no differences between the hemoglobin, hematocrit and mean platelet volumes of the patients at the time of hospitalization, while red cell distribution width, NRBCs per 100 white blood cells (NRBCs/100 WBCs) and absolute NRBC count were statistically higher in patients with ABO and/or Rh incompatibility. It was found that NRBCs/100 WBC and absolute NRBC count were statistically higher in patients with positive direct coombs test than patients with negative coombs test (p <0.05). CONCLUSIONS: Early diagnosis of indirect hyperbilirubinemia is essential, as it can prevent to occur serious neurological sequelas. Elevated levels of NRBCs in infants with blood group incompatibilities could alert clinicians about the severity of jaundice and should increase awareness in terms of hemolysis.

Successful management of twin anemia/polycythemia sequence by syngeneic partial exchange transfusion.

Twin anemia/polycythemia sequence (TAPS) is characterized by large intertwin hemoglobin (Hb) differences without signs of twin oligopolyhydramnios. The spontaneous form complicates approximately 3-5% of monochorionic twin pregnancies. TAPS placentas are characterized by the presence of only very few and small unidirectional arteriovenous anastomoses, which allow a slow transfusion of blood from the donor to the recipient, gradually leading to highly discordant Hb levels. Neonatal morbidity in TAPS appears to be mainly limited to hematological problems at birth. Donor twins may be severely anemic and require blood transfusions, whereas recipient twins may be severely polycythemic and require partial exchange transfusion (PET). We herein report monochorionic twins with TAPS: the anemic twin was transfused with the blood concomitantly obtained from the polycythemic co-twin during PET. To our knowledge this is the first therapeutic approach using a recipient twin's whole blood as a donor source instead of a foreign blood donor. In this case, we have approached this recently (un)known form of chronic fetofetal transfusion from a different aspect. In our opinion, this will lead to new postnatal therapeutic approaches for optimal TAPS management.