Fluid status changes during the transition in infants of diabetic mothers.

In animal and human neonates, expansion of the extracellular fluid volume is associated with "wet" lung and poor respiratory outcomes. To define fluid status changes during the transition from fetal to neonatal life in infants of diabetic mothers (IDM), we conducted a single-centre (Policlinico Abano Terme, Abano Terme, Italy) study of 66 IDM and a 1:2 matched control group from January 1 to September 30, 2020. Fluid status changes were assessed by computing Δ Hct from umbilical cord blood at birth and capillary heel Hct at 48 h, accounting for body weight decrease. IDM presented with significantly lower cord blood Hct levels in comparison to controls (47.33 ± 4.52 vs 50.03 ± 3.51%, p < 0.001), mainly if delivered by elective cesarean Sect. (45.01 ± 3.77 vs 48.43 ± 3.50%, p = 0.001). Hct levels at 48 h were comparable (55.18 ± 5.42 vs 54.62 ± 7.41%, p = 0.703), concurrently with similar body weight decrease (- 217.21 ± 113.34 vs - 217.51 ± 67.28 g, p = 0.614). This supports significantly higher ∆ Hct in IDM (5.13 ± 5.24 vs 7.29 ± 6.48, p < 0.01) and extra circulating fluid loss of 2-3%.Conclusion: Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung. What is Known: • In neonates, evidence suggests that expansion of the extracellular fluid volume prior to the postnatal diuresis is associated with poor respiratory outcomes. What is New: • Gestational diabetes is associated with an excess of circulating fluids during the transition from fetal to neonatal life, challenging the current assumption that is per se at risk of wet lung.

Pilot study of home phototherapy for neonatal jaundice monitored in maternity ward during the enforced Italy-wide COVID-19 national lockdown.

In Italy, where neonatal jaundice treatment is required, it is largely carried out in hospitals. However, it is possible to safely administer home phototherapy (HPT). We report our pilot center's experience of HPT and its potential benefits during the COVID-19-enforced national lockdown. This is an observational study performed at the Policlinic Abano Terme, a suburban hospital that covers a large catchment area near the Euganean Hills in Northeast Italy with around 1000 deliveries per year. HPT was started after regular nursery discharge, and the mothers brought the neonates back to the hospital maternity ward each day to check infants' bilirubin levels, weight, and general state of health, until it was deemed safe to stop. The efficacy of HPT in bilirubin reduction, hospital readmission rates, and parental satisfaction were evaluated. Thirty infants received HPT. In 4 of these infants, HPT was associated with total serum bilirubin (TSB) between 75 and 95th percentile (high-intermediate-risk zone) and in 26 infants HPT was associated with TSB > 95th percentile (high-risk zone) of the Bhutani nomogram. Among these 30 infants, 27 (90%) completed the HPT with a progressive decrease of TSB levels with 4 neonates requiring a second course and 3 infants requiring a third course of 24-h HPT. Three (10%) neonates failed HPT and were readmitted after one 24-h phototherapy course. No abnormalities of breastfeeding, body weight (defined as > 10% decrease), temperature, nor COVID infections were detected following HPT consultation in the neonatal ward. Home treatment efficacy with varying degrees of parental satisfaction occurred in all but 3 cases that involved difficulties with the equipment and inconsistent lamp manipulation practices. CONCLUSION: Our pilot study suggests that HPT for neonatal jaundice can be carried out effectively and with parental satisfaction as supported by daily back bilirubin monitoring in the maternity ward during the enforced COVID-19 national lockdown in Italy. WHAT IS KNOWN: • No high-quality evidence is currently available to support or refute the practice of phototherapy in patients' own homes. WHAT IS NEW: • Phototherapy can be delivered at home in a select group of infants and could be an ideal option if parents are able to return with their infants to the hospital maternity ward for daily follow-up. • It can be as effective as inpatient phototherapy and potentially helps in delivering family-centered care.

A Randomized Controlled Trial of Intact Cord Milking versus Immediate Cord Clamping in Term Infants Born by Elective Cesarean Section.

OBJECTIVE: We evaluated whether intact umbilical cord milking (UCM) is more effective than immediate cord clamping (ICC) in enhancing placental transfusion after elective cesarean delivery. STUDY DESIGN: In a randomized trial, volume of placental transfusion was assessed by Δ hematocrit (Hct) between neonatal cord blood and capillary heel blood at 48 hours of age, corrected for the change in body weight. RESULTS: There were no significant differences in cord blood mean Hct values at birth (UCM, 44.5 ± 4.8 vs. ICC, 44.9 ± 4.2%, p = 0.74). Conversely, at 48 hours of age, the UCM group had significantly higher capillary heel Hct values (UCM, 53.7 ± 5.9 vs. ICC, 49.8 ± 4.6%, p < 0.001), supporting a higher placental transfusion volume (Δ Hct, UCM 9.2 ± 5.2 vs. ICC 4.8 ± 4.7, p < 0.001), despite comparable neonatal body weight decrease (UCM, -7.3 vs. ICC, -6.8%, p = 0.77). CONCLUSION: Higher Δ Hct between cord blood at birth and capillary heel blood at 48 hours of age, corrected for the change in body weight, suggests that intact UCM is an efficacious and safe procedure to enhance placental transfusion among neonates born via elective cesarean delivery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, www.clinicaltrials.gov, NCT03668782.

Gestational weight gain and eating-related disorders.

This prospective cohort study took place at the Division of Perinatal Medicine of Policlinico Abano Terme, Italy, from January to November 2018. In the second day postpartum, 463 healthy at term puerperae, 122 (26.35%) with inadequate gestational weight gain (GWG), 210 (45.46%) with adequate GWG, and 131 (28.29%) with excessive GWG, were studied by EAT-26, through distinguishing three factors: 'Dieting', 'Bulimia and food preoccupation', and 'Oral control'. EAT-26 Global score increased from inadequate, to adequate, and excessive GWG puerperae, resulting significantly higher in excessive GWG group (p = .0029, Anova's). In addition, among EAT-26 subscales 'Dieting' scores significantly increased from inadequate, to adequate, and to excessive GWG category women, resulting significantly higher in excessive GWG group (p = .006, Anova's). It was found that excessive GWG is a warning indicator of unhealthy eating and 'Dieting' disorders. This relationship highlights the potential for interventions directed towards psychosocial support to have salutary effects upon GWG.Excessive gestational weight gain across an uncomplicated pregnancy is a warning indicator of unhealthy eating and dieting disorders.IMPACT STATEMENTWhat is already known on this subject? Pregnancy represents a time of rapid trimester-specific changes in body weight and size.What do the results of this study add? Excessive gestational weight gain is a warning indicator of unhealthy eating and dieting disorders.What are the implications of these findings for clinical practice and/or further research? This relationship highlights the potential for interventions directed towards psychosocial support to have salutary effects upon gestational weight gain.

Determinants and effects of fluid status changes in caesarean delivered neonates.

AIM: Evidence suggests that caesarean section is associated with a reduced placental transfusion and poor iron-related haematological indices, both in cord and peripheral blood, compared with vaginal delivery. We assessed determinants and effects of fluid status changes on placental transfusion in neonates delivered by elective (ElCD) and emergency (EmCD) caesarean section. METHODS: Placental transfusion was estimated by ∆ haematocrit (Hct) increase from birth to 48 hours of life, accounting for contemporaneous ∆ body weight decrease, in 143 women/infant pairs, 62 who underwent ElCD and 81 EmCD, respectively. RESULTS: Cord blood Hct levels at birth of ElCS neonates were significantly lower than those of EmCD neonates (44.58 + 4.87vs 49.93 + 4.29, P = .01). At 48 hours of life, capillary heel Hct levels of ElCD and of EmCD neonates were comparable. ElCD had a higher ∆ body weight decrease (ElCD -7.25 ± 1.74% vs EmCD -6.31 ± 2.34% [P: .011]) and ∆ Hct increase ([ElCD + 5.93 ± 4.92 vs EmCD + 3.59 ± 5.29, [P: .011]). In a linear regression model analysis, gestational age in ElCD neonates had a significant effect on the differences in arterial cord blood Hct, body weight at birth and body weight decrease at 48 hours after birth. CONCLUSION: Early-term surgical delivery is a determinant of transient dilutional anaemia in ElCD neonates, lacking neuroendocrine response of labour and delivery.

Pain and stress after vaginal delivery: characteristics at hospital discharge and associations with parity.

The objective of this study was to characterise pre-discharge maternal pain and stress severity after vaginal delivery and associations with parity. This is a descriptive analysis with 148 women in the early post-partum period (84 primiparae and 64 secondiparae) after vaginal delivery. Pain and stress were measured by McGill Pain Questionnaire (MGPQ) and by the Psychological Stress Measure (PSM). Vaginal delivery in primiparae women was associated with MGPQ, significantly higher pain scores. Sensorial, affective and mixed pain descriptive categories were also significantly higher. Pain location involved lower abdomen, vagina and perianal area. In addition, their PSM showed a significantly higher 'Sense of effort and confusion' subscale scores. In conclusion, this study provides important information on the quality of care implications of hospital-to-home discharge practices in puerperae after vaginal delivery, a critical time characterised by qualitatively and quantitatively high pain and stress in primiparae.Impact statementWhat is already known on this subject? Pain and fatigue are the most common problems reported by women in the early postpartum period.What the results of this study add? Primiparae who delivered vaginally presented at the time of hospital-to-home discharge significantly higher pain and stress, as compared to secondiparae. Pain involved lower abdomen, vagina and perianal area, whereas the stress was quantitatively higher in the 'sense of effort and confusion'.What the implications are of these findings for clinical practice and/or further research? Awareness of problematic pain and stress associations with parity may offer the opportunity to better support puerperae to develop maternal orientation and adjust to motherhood.

A temperature gradient may support mother-infant thermal identification and communication in the breast crawl from birth to breastfeeding.

AIM: The human female's nipple-areolar complex (NAC) is the point of arrival of a natural progression from birth to breastfeeding, linked to functional, chemical and biophysical cues that promote the breast crawl soon after birth. We investigated the thermal gradient generated by the lips of the neonate and warmth of the NAC, which may drive the infant directly to the nipple. METHODS: We prospectively studied 41 full-term singleton infants and their mothers at the Policlinico Abano Terme, Italy, between January 1, 2015, and February 28, 2015. NAC and breast quadrant temperatures were assessed 6 ± 2 hours prepartum and one and two days postpartum, together with the neonates' lip temperature. RESULTS: The temperature of the neonates' lips was significantly lower than the forehead temperature on days one and two postpartum (delta = -1.24°C, p < 0.001 and delta = -1.02°C, p < 0.001, respectively). Thus, the thermal gradient between the NAC and the neonates' lips was -1.66 ± 1.07°C on day one (p < 0.001) and -1.68 ± 0.63°C (p < 0.001) on day two postpartum. CONCLUSION: These findings demonstrate, for the first time, that a temperature gradient may support mother-infant thermal identification and communication in the breast crawl and in the natural progression of the continuum from birth to breastfeeding.

Timing of delivery and neonatal outcomes for small-for-gestational-age fetuses.

OBJECTIVES: To investigate whether antenatal recognition of small-for-gestational-age (SGA) fetuses with normal maternal and fetal Doppler values delivered after 34 weeks' gestation is associated with changes in the risk of adverse maternal and neonatal outcomes. METHODS: In this retrospective study, we included 313 singleton SGA fetuses and 313 appropriate-for-gestational-age control fetuses born between 34 and 42 weeks' gestation from 2009 to 2012. Small-for-gestational-age fetuses identified before delivery (n = 124), for whom antenatal surveillance was performed until delivery (estimated fetal weight twice weekly and Doppler evaluation of the fetal compartment once weekly), were compared to those not identified at delivery (n = 189). The latter group did not undergo antenatal surveillance for several reasons (women for whom a sonographic evaluation or gynecologic consultation was not performed in the third trimester and incorrect sonographic biometric evaluation in the third trimester). Main outcome measures were mode of delivery, perinatal complications, and neonatal intensive care unit admission. The risk of serious fetal complications was assessed by cross-tabulation analysis adjusted for gestational age and degree of SGA. RESULTS: Prenatally recognized SGA fetuses were smaller and delivered earlier than unrecognized SGA fetuses (P< .05). Fetal acidemia (pH <7.10) was significantly more common in unrecognized SGA fetuses (3.7% versus 0%). Small-for-gestational-age fetuses at or below the 3rd percentile were more commonly recognized prenatally and hospitalized in the neonatal intensive care unit. Unrecognized SGA fetuses also had worse fetal outcomes compared to controls (P< .05). Recognized and unrecognized SGA fetuses were born significantly more frequently by cesarean delivery (P < .05). No significant differences in perinatal outcomes were found between recognized SGA deliveries with or without medical induction. CONCLUSIONS: Antenatal recognition of SGA fetuses delivered after 34 weeks' gestation might improve perinatal outcomes. Medical induction of labor did not modify neonatal outcomes among prenatally recognized SGA fetuses.

Body image and breastfeeding practices in obese mothers.

PURPOSE: This study analyzed body image perceptions and breastfeeding practices in obese mothers. METHODS: Prospective, case-control study on 25 obese (BMI >30 kg/m(2)) and 25 normal-weight puerperae, matched for parity and delivery route. The participants completed the Body Uneasiness Test, a two-part, self-report questionnaire, investigating body image perception before they were discharged from hospital and participated in telephone interviews concerning breastfeeding practices. RESULTS: Obese women demonstrated body image dissatisfaction related to their obesity. On average, they reported significantly higher scores on Global Severity Index (p < 0.0001) and on all of the BUT-A subscales: Weight Phobia (p < 0.02), Body Image Concerns (p < 0.0001), Avoidance (p < 0.0001), Compulsive Self-Monitoring (p < 0.01), and Depersonalization (p = 0.002) than did normal-weight puerperae. Moreover, they also had higher BUT-B scores and the Positive Symptom Total was significantly higher (p < 0.002). Finally, while breastfeeding practices at discharge were similar in the two groups, the obese mothers were more likely to maintain full breastfeeding at 6 months (p < 0.04). CONCLUSIONS: Obese mothers have negative body image perceptions but they maintain full breastfeeding longer.

Aortic wall thickness and amniotic fluid albuminuria in growth-restricted twin fetuses.

BACKGROUND AND OBJECTIVE: Intrauterine growth restriction (IUGR) may be associated with significantly higher aortic intima-media thickening (aIMT) values. It is unknown if fetal aIMT is associated with glomerulosclerosis and amniotic albuminuria in utero. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS: Fetal abdominal aIMT and amniotic albumin/creatinine ratio (ACR) were measured in 126 individual twin fetuses, recruited by the Obstetrics and Gynaecology Clinics of the University of Padua (Italy) Medical Center. The IUGR twin fetuses were classified into two groups: Group A were those fetuses whose estimated fetal weight (EFW) was <10th percentile with pulsatility index >2 SD and Group B were those fetuses whose EFW was <10th percentile and had no velocimetry abnormalities. RESULTS: The median fetal aIMT was significantly different in the three groups (Group A = 0.9 mm; Group B = 0.7 mm; and appropriate for gestational age (AGA) = 0.5 mm; p < .0001). It was significantly higher in Group A than in the AGA group (p < .0001) and than in the Group B fetuses (p = .003), respectively. In addition, ACR was different in the three groups (Group A = 183,500 mg/g; Group B = 6,4720 mg/g; and AGA = 8,2750 mg/g; p = .0002). It was significantly higher in Group A than in the AGA group (p = .03) and than in Group B (p = .02), respectively. CONCLUSIONS: Growth-restricted twin fetuses with velocimetry abnormalities present are associated with aIMT and higher ACR levels in amniotic fluid, which could be possible markers in utero of preclinical atherosclerosis, and early glomerulosclerosis.

'Two-step' head-to-body delivery activates foetal gluconeogenesis.

AIM: The 'two-step' head-to-body delivery method, which involves waiting for the next contraction to deliver the shoulders, causes a decrease in umbilical artery pH. The aim of this study was to assess whether foetal acidemia activates gluconeogenesis. METHODS: We tested umbilical artery cord blood glucose concentration and pH after 341 spontaneous and 25 vacuum extractor 'two-step' vaginal deliveries (VD) and after 85 elective and 49 emergency caesarean sections (CS). RESULTS: Cord blood glucose concentration was significantly higher (95.5 ± 21.4 mg/dL vs 75.6 ± 16.4, p < 0.001), and pH values significantly lower (7.31 ± 0.09 vs 7.33 ± 0.06, p = 0.003) in 'two-step' VD neonates than in CS delivered neonates. In addition, cord blood glucose concentration was significantly higher (101.4 ± 30.6 mg/dL, p = 0.004), and pH values were significantly lower (7.26 ± 0.10, p < 0.001) in VD by vacuum extractor than in all other groups. The cord blood glucose concentration is significantly and negatively correlated with pH in the study population (r = -0.094, p = 0.036) and strongly significantly and negatively correlated in VD by vacuum extractor (r = -0.594, p = 0.007). CONCLUSION: Cord blood glucose concentrations are significantly higher and pH values significantly lower in 'two-step' VD neonates, indicating activated foetal gluconeogenesis.

Developmental programming of cardiovascular risk in intrauterine growth-restricted twin fetuses according to aortic intima thickness.

OBJECTIVES: We aimed to test the hypothesis that aortic intima thickness is greater in intrauterine growth-restricted (IUGR) twin fetuses compared to normally developing twins, thus defining an increased cardiovascular risk that reflects genetic factors in fetuses sharing the same womb. METHODS: We conducted a prospective study performed on twins from January 2009 to July 2011. Twins were classified into 3 groups: IUGR fetuses with an estimated fetal weight below the 10th percentile and an umbilical artery pulsatility index of greater than 2 SDs (group A), fetuses with an estimated fetal weight below the 10th percentile and normal Doppler findings (group B), and fetuses with an estimated fetal weight appropriate for gestational age (group C). Aortic intima thickness was measured at a median gestational age of 32 weeks. Values were compared among groups and between each twin and cotwin, also considering sex and chorionicity. RESULTS: Twenty-five fetuses were classified as group A, 36 as group B, and 95 as group C. The median aortic intima thickness values were 0.9 mm in group A, 0.7 mm in group B, and 0.6 mm in group C (P < .0001). There was a statistically significant difference between the aortic intima thickness of the twins and cotwins in groups A and B (P < .0001). Sex and chorionicity did not correlate with aortic intima thickness. CONCLUSIONS: In this study, IUGR fetuses with Doppler abnormalities had greater aortic intima thickness, and IUGR twins with normal Doppler findings had intermediate thickness, supporting a genetic predisposition to cardiovascular risk independent of sex and chorionicity.

Trajectory of serum bilirubin in offspring of women with gestational diabetes mellitus.

AIMS: To investigate the trajectory of bilirubin from birth to the first 48 h of life in neonates of women with gestational diabetes. METHODS: In a cohort of 69 neonates of women with gestational diabetes, delivered at Policlinic Abano, Abano Terme, Italy, from October 2021 to May 2022, we conducted a case-control study (1:2 ratio) on total serum bilirubin (TSB) trajectory over the first 48 h after birth. An ancillary analysis was conducted on arterial cord blood gas analysis at birth and on concurrent hemoglobin, hematocrit, lactate, glycemia, and bilirubin levels. RESULTS: The neonates of women with gestational diabetes showed a significantly higher mean percent variation of TSB from birth to the first 48 h of life (p = 0.01), a finding supported by a higher, although not significant, TSB levels at 48 h of life in comparison to controls (8.05 ± 4.8 vs 8.05 ± 4 mg%, p = 0.082), and by a significantly lower cord TSB levels (2.3 ± 0.9 vs 2.6 ± 0.9 mg%, p = 0.010). CONCLUSIONS: The findings suggest that future primary studies on hyperbilirubinemia risk in neonates of women with gestational diabetes should consider the trajectory of TSB beyond the first 48 h, adjusting for a more complete set of pre-pregnancy and gestational prognostic risk factors.

Mood and anxiety spectrum disorders detected by neuropsychiatric interviews in young adults born preterm: A prospective cohort study.

BACKGROUND: Psychopathology has not yet been studied beyond pediatric age for all degrees of prematurity, including late-preterm, particularly in those who grew up with no apparent neurodevelopmental sequelae. This study aimed to examine psychopathological outcome following preterm birth and admission to neonatal intensive care in young adults without major neurodevelopmental and psychopathological problems that emerged during childhood. METHODS: An Italian single-center prospective cohort study. Eighty-nine young adults (40 admitted to neonatal intensive care unit with less than 37 weeks of gestation and no medical history of other neurological or psychiatric conditions in childhood and 49 healthy peers born at term, matched by age, sex, and education) underwent neuropsychiatric interviews at the age of 20 ± 1 years; MINI International Neuropsychiatric Interview, Beck Depression Inventory and Barratt Impulsive Scale, results were correlated to individual neonatal data and cognitive measures. RESULTS: We found a significantly higher prevalence of psychopathology at MINI score (22.5% vs. 4.2%; χ2 = 6.7; p = 0,010) and prevalence of previous stressful life events in the preterm compared to at-term group. B.D.I. (testing depression) and BIS-11(testing impulsivity) did not highlight a statistically significant difference between the groups. All patients had average I.Q., a statistically significant difference (p < 0.001) was observed between groups with a better performance in controls than cases. CONCLUSIONS: Preterm infants attaining young adult age with otherwise typical development during childhood are at risk of psychopathology and lower resilience to stressful life events. The MINI interview could be a useful tool to highlight the psychopathology of preterm infants attaining adult age.