RESUMEN
BACKGROUND: Sustained systemic inflammatory response (SIR) was associated with poor postnatal growth in very preterm infants (VPI). We hypothesize that VPI with sustained SIR will exhibit linear growth retardation related to lower bone mass accrual mediated by GH/IGF-1 axis inhibition at term corrected age (CA). METHODS: C-reactive protein (CRP), procalcitonin (PCT), growth hormone (GH), insulin-like growth factor 1 (IGF-1), calcium, phosphorus, alkaline phosphatase, anthropometric, nutritional, neonatal and maternal data were collected prospectively in 23 infants <32 weeks gestational age. Body composition using dual-energy X-ray absorptiometry was performed at term CA. Analysis was undertaken with multiple linear regression models. RESULTS: At term CA 11 infants with sustained SIR compared with 12 infants without sustained SIR present significantly lower IGF-1, length z-score (LZS), bone mineral content (BMC) and lean mass (LM), and higher GH and fat mass (FM). LZS was associated significantly with PCT, BMC with IGF-1, FM and LM with CRP, GH with bronchopulmonary dysplasia and CRP, and IGF-1 with invasive mechanical ventilation, CRP and PCT. CONCLUSIONS: In addition to the known effect on linear growth failure, sustained SIR induces lower bone mass accrual related to higher GH and lower IGF-1 levels in VPI. IMPACT: Very preterm infants (VPI) with sustained systemic inflammatory response (SIR) compared with VPI without SIR present stunting, lower bone mass, higher GH and lower IGF-1 levels at term corrected age. SIR may help to explain the influence of non-nutritional factors on growth and body composition in VPI. SIR induces postnatal stunting related to lower bone mass accrual via GH/IGF-1 axis inhibition in VPI. VPI with SIR need special attention to minimize inflammatory stress, which could result in improved postnatal growth. Research on inflammatory-endocrine interactions involved in the pathophysiology of postnatal stunting is needed as a basis for new interventional approaches.
Asunto(s)
Hormona de Crecimiento Humana , Enfermedades del Prematuro , Lactante , Humanos , Recién Nacido , Factor I del Crecimiento Similar a la Insulina/metabolismo , Densidad Ósea/fisiología , Hormona del Crecimiento/farmacología , Recien Nacido Prematuro , Hormona de Crecimiento Humana/metabolismo , Trastornos del Crecimiento , Composición Corporal/fisiología , Inflamación , Síndrome de Respuesta Inflamatoria SistémicaRESUMEN
HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets) was described by Weinstein in 1982. It has a high maternal and perinatal morbi-mortality rate. We undertook this study to evaluate perinatal outcome in patients with HELLP syndrome. Patients with HELLP syndrome were identified in a retrospective study between March 1998 and March 2001 at the Hospital Privado de Córdoba. Maternal and neonatal variables were analyzed. Nine patients with HELLP syndrome were identified (incidence 2.3@1000). Mean maternal age was 24.5 (15-36) years. Five patients were nuliparous. The mean gestational age was 34.5 weeks (29-40). The main symptom was epigastric pain (77.7%). In seven women delivery was made by cesarean section. Three patients had postpartum HELLP syndrome. Three patients had difficult control hypertension; one had eclampsia and another one had disseminated intravascular coagulopathy with acute renal failure and died. Three women needed blood products transfusions. The average admission time was 4.4 days. There were six preterm infants (75%). Mean birth weight was 2030 g (736-3200). Four neonates had Apgar score < 7 at the first minute, all had > 7 at 5 minutes. Three neonates had alimentary disorders, one had hypoglucemia and another hyaline membrane disease, patent ductus arteriosus, sepsis and thrombocytopenia. The high maternal and perinatal morbi-mortality of HELLP syndrome requires management in a centre where intensive maternal and neonatal care are available.
Asunto(s)
Síndrome HELLP/diagnóstico , Preeclampsia/diagnóstico , Adolescente , Adulto , Peso al Nacer , Cesárea , Femenino , Edad Gestacional , Síndrome HELLP/terapia , Humanos , Recién Nacido , Preeclampsia/terapia , Embarazo , Resultado del Embarazo , Pronóstico , Estudios RetrospectivosRESUMEN
El síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia) descripto por Weinstein en 1982, se asocia a alta morbi mortalidad materna y perinatal. Se evaluaron retrospectivamente Ias pacientes que presentaron síndrome HELLP entre marzo 1998 y marzo 2001 en el Hospital Privado de Córdoba. Se identificaron nueve pacientes con Síndrome HELLP (incidencia 2.3%o). La edad media de Ias pacientes fue 24.5 anos (15 36) con una edad gestacional media de 34.5 semanas (29 40). Cinco pacientes fueron nulíparas. El síntoma principal fue epigastralgia (77.7%). El parto fue por cesárea en siete pacientes y tres tuvieron síndrome HELLP post parto. Tres pacientes resentaron hipertensión de difícil manejo, una eclampsia y otra coagulación intravascular diseminada, insuficiencia renal aguda y muerte. Tres requirieron transfusión de derivados sanguíneos y el promedio de internación fue 4.4 días. Seis (75%) neonatos fueron pretérmino. El peso medio de nacimiento fue 2030 gramos (736 3200). Cuatro recién nacidos tuvieron un score de Apgar menor de 7 ai minuto y todos mayor de 7 a los cinco minutos. Tres neonatos presentaron trastomos alimentarios, uno hipoglucemia y otro enfermedad de membrana hialina, ductus arterioso permeable, sepsis y plaquetopenia. Debido a Ia morbi mortalidad materna yperinatal el síndrome HELLP requiere atención en un centro de alta complejidad mediante un equipo multidisciplìnario.
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adolescente , Adulto , Síndrome HELLP/diagnóstico , Preeclampsia , Complicaciones del Embarazo , Peso al Nacer , Cesárea , Edad Gestacional , Síndrome HELLP/mortalidad , Preeclampsia , Complicaciones del Embarazo , Resultado del Embarazo , Pronóstico , Estudios RetrospectivosRESUMEN
El síndrome HELLP (hemólisis, enzimas hepáticas elevadas y plaquetopenia) descripto por Weinstein en 1982, se asocia a alta morbi mortalidad materna y perinatal. Se evaluaron retrospectivamente Ias pacientes que presentaron síndrome HELLP entre marzo 1998 y marzo 2001 en el Hospital Privado de Córdoba. Se identificaron nueve pacientes con Síndrome HELLP (incidencia 2.3%o). La edad media de Ias pacientes fue 24.5 anos (15 36) con una edad gestacional media de 34.5 semanas (29 40). Cinco pacientes fueron nulíparas. El síntoma principal fue epigastralgia (77.7%). El parto fue por cesárea en siete pacientes y tres tuvieron síndrome HELLP post parto. Tres pacientes resentaron hipertensión de difícil manejo, una eclampsia y otra coagulación intravascular diseminada, insuficiencia renal aguda y muerte. Tres requirieron transfusión de derivados sanguíneos y el promedio de internación fue 4.4 días. Seis (75%) neonatos fueron pretérmino. El peso medio de nacimiento fue 2030 gramos (736 3200). Cuatro recién nacidos tuvieron un score de Apgar menor de 7 ai minuto y todos mayor de 7 a los cinco minutos. Tres neonatos presentaron trastomos alimentarios, uno hipoglucemia y otro enfermedad de membrana hialina, ductus arterioso permeable, sepsis y plaquetopenia. Debido a Ia morbi mortalidad materna yperinatal el síndrome HELLP requiere atención en un centro de alta complejidad mediante un equipo multidisciplýnario.(AU)
Asunto(s)
Humanos , Femenino , Embarazo , Recién Nacido , Adolescente , Adulto , Síndrome HELLP/diagnóstico , Preeclampsia/diagnóstico , Complicaciones del Embarazo , Síndrome HELLP/mortalidad , Resultado del Embarazo , Edad Gestacional , Peso al Nacer , Estudios Retrospectivos , Preeclampsia/mortalidad , Complicaciones del Embarazo/mortalidad , Cesárea , PronósticoRESUMEN
HELLP syndrome (Hemolysis, Elevated Liver Enzymes and Low Platelets) was described by Weinstein in 1982. It has a high maternal and perinatal morbi-mortality rate. We undertook this study to evaluate perinatal outcome in patients with HELLP syndrome. Patients with HELLP syndrome were identified in a retrospective study between March 1998 and March 2001 at the Hospital Privado de Córdoba. Maternal and neonatal variables were analyzed. Nine patients with HELLP syndrome were identified (incidence 2.3@1000). Mean maternal age was 24.5 (15-36) years. Five patients were nuliparous. The mean gestational age was 34.5 weeks (29-40). The main symptom was epigastric pain (77.7
). In seven women delivery was made by cesarean section. Three patients had postpartum HELLP syndrome. Three patients had difficult control hypertension; one had eclampsia and another one had disseminated intravascular coagulopathy with acute renal failure and died. Three women needed blood products transfusions. The average admission time was 4.4 days. There were six preterm infants (75
). Mean birth weight was 2030 g (736-3200). Four neonates had Apgar score < 7 at the first minute, all had > 7 at 5 minutes. Three neonates had alimentary disorders, one had hypoglucemia and another hyaline membrane disease, patent ductus arteriosus, sepsis and thrombocytopenia. The high maternal and perinatal morbi-mortality of HELLP syndrome requires management in a centre where intensive maternal and neonatal care are available.
