In women with gestational diabetes mellitus factors influencing growth have a larger effect on placental weight than on birth weight.

BACKGROUND AND AIMS: Excessive fetal and placental growth are very common in diabetic pregnancy. We aimed to analyze in women with gestational diabetes mellitus (GDM) the association with birth weight (BW), placental weight (PW) and placental-to-birth weight (PWBW) ratio of acknowledged BW predictors. MATERIAL AND METHODS: We performed a retrospective analysis of a prospective cohort database from a tertiary hospital. Inclusion criteria were singleton pregnancy, diagnosis of GDM, delivery between 1982 and 2011 and gestational age at birth ≥23 weeks. Multiple regression analysis was performed using as dependent variables BW, PW and PWBW ratio and as independent ones maternal characteristics at baseline, metabolic characteristics (GDM diagnosis, treatment, control), pregnancy-induced hypertension, gestational age at delivery and fetal sex. Two sensitivity analyses were performed. RESULTS: We evaluated 2547 women, PW being available in 85.3%. BW was 3260g (2976, 3575), PW 620g (540, 720) and PWBW ratio 19.27 (17.20, 21.47). Among the 24 analyzed variables, there was an important overlap among those associated with BW, PW and PWBW ratio. For most characteristics associated with both BW and PW, the magnitude of the association was greater for the latter, both when promoting growth (i.e. prepregnancy body mass index, 3h plasma glucose at diagnosis) and when restricting it (insulin treatment). CONCLUSION: We conclude that in women with GDM and singleton pregnancies, variables associated with BW, PW and PWBW ratio overlap. The latter is the result of disproportionate associations with BW and PW, usually larger with PW.

Poorer perinatal outcome in male newborns of women with pregestational diabetes mellitus.

AIMS: To assess perinatal outcome in women with pregestational diabetes mellitus according to the sex of the fetus. METHODS: A retrospective review of all singleton pregnancies of women with pregestational diabetes progressing to a gestational age of 22 weeks or more who attended the diabetes and pregnancy clinic from 1981 to 2006 (n=455). We compared maternal characteristics and perinatal outcomes (perinatal mortality, major congenital malformations, small and large for gestational age newborns, preterm birth and a composite of the former) according to the sex of the fetus. A logistic regression analysis was performed using the composite perinatal outcome as the dependent variable and all maternal variables and sex of fetus as potential predictors. RESULTS: Maternal characteristics did not differ in mothers of male and female newborns. In the whole cohort, the composite perinatal outcome was significantly higher in male fetuses; adjusted OR 1.61 (95% CI 1.04-2.50). CONCLUSIONS: In women with pregestational diabetes, perinatal outcome was poorer in male newborns despite similar maternal characteristics.

[Interhospital transportation of the severe pediatric patient in Catalonia]. / Transporte interhospitalario del niño crítico en Cataluña.

OBJECTIVE: To describe the organization of the interhospital transport of the pediatric patients in Catalonia. DESIGN: Description of the different phases of organization, of the organizational structure, both of the bases and of the coordinating center, and of the evolution of the model. SCOPE: System of medical emergencies and hospital net of Catalonia. PERIOD: between 1996 and 2003. PATIENTS: Patients moved by the pediatric teams. INTERVENTIONS: Analysis of the documentation used in the transports realized by the system of medical emergencies. VARIABLES OF INTEREST: Clinical information, hours and times of transport, as well as the way used for the transport. RESULTS. A total of 6,110 pediatric transports were realized by an annual average of 777. The 94% of the movements carried out for ambulances and 6% with helicopter. The number of transport was growing to lengths of the years of study. CONCLUSIONS: The model followed in the last years in Catalonia bases on the specialization of the pediatric interhospital transport. The pediatric teams contribute a value added to the own transport.

Transporte interhospitalario del niño crítico en Cataluña / Interhospital transportation of the severe pediatric patient in Catalonia

Objetivo. Describir la organización del transporte interhospitalario del niño crítico en Cataluña. Diseño. Descripción de las diferentes fases de organización, de la estructura organizativa, tanto de las bases como del centro coordinador, y de la evolución del modelo. Ámbito. Sistema de emergencias médicas y red hospitalaria de Cataluña. Período entre 1996 y 2003. Pacientes. Pacientes trasladados por los equipos pediátricos. Intervenciones. Análisis de la documentación empleada en los traslados realizados por el sistema de emergencias médicas. Variables de interés. Datos clínicos, horas y tiempos de traslado, así como el modo empleado para el traslado. Resultados. Se realizaron 6.110 traslados pediátricos con un promedio anual de 777. El 94% de los traslados se realizaron por ambulancias terrestres y el 6% con medio aéreo. El número de transportes fue creciendo a lo largo de los años de estudio. Conclusiones. El modelo seguido en los últimos años en Cataluña se basa en la especialización del transporte pediátrico interhospitalario. Los equipos pediátricos aportan un valor añadido al propio transporte

Objective. To describe the organization of the interhospital transport of the pediatric patients in Catalonia. Design. Description of the different phases of organization, of the organizational structure, both of the bases and of the coordinating center, and of the evolution of the model. Scope. System of medical emergencies and hospital net of Catalonia. Period: between 1996 and 2003. Patients. Patients moved by the pediatric teams. Interventions. Analysis of the documentation used in the transports realized by the system of medical emergencies. Variables of interest. Clinical information, hours and times of transport, as well as the way used for the transport. Results. A total of 6,110 pediatric transports were realized by an annual average of 777. The 94% of the movements carried out for ambulances and 6% with helicopter. The number of transport was growing to lengths of the years of study. Conclusions. The model followed in the last years in Catalonia bases on the specialization of the pediatric interhospital transport. The pediatric teams contribute a value added to the own transport

In human gestational diabetes mellitus congenital malformations are related to pre-pregnancy body mass index and to severity of diabetes.

AIMS/HYPOTHESIS: This study analysed the relationship between congenital malformations (CM) and severity of gestational diabetes mellitus. METHODS: A cohort of 2060 infants of mothers with gestational diabetes was studied. Universal screening and 3(rd) Workshop-Conference criteria were used to diagnose gestational diabetes. The severity of diabetes was assessed on the basis of previous hyperglycaemia, blood glucose values in diagnostic OGTT, area under the glucose curve, gestational age and HbA(1)c at diagnosis, insulin requirements during pregnancy, and OGTT after delivery. Potentially confounding variables (age, pre-pregnancy BMI, smoking) were considered. The relationship of potential predictors with CM was analysed with several multivariate logistic regression analyses. RESULTS: The rate of CM was 6% for minor and 3.8% for major malformations (1.4% heart, 0.8% renal/urinary, 0.7% skeletal, 0.3% hypospadias, 0.2% central nervous system, 0.2% cleft lip/palate, 0.1% digestive tract, 0.3% other). In the final models, forward logistic regression analysis identified pre-pregnancy BMI as the predictor of CM (area under receiver operating characteristic curve 0.616); in the backward analysis additional predictors were 1-h blood glucose in diagnostic OGTT and gestational age at diagnosis (area under receiver operating characteristic curve 0.646). Both BMI and severity of gestational diabetes were predictors of heart and minor CM, whereas BMI predicted renal/urinary CM and severity of diabetes predicted skeletal CM. CONCLUSIONS/INTERPRETATION: In these infants of mothers with gestational diabetes, severity of diabetes and pre-pregnancy BMI were predictors of CM, in accordance with the well-documented pathogenic role of BMI (in the general population) and hyperglycaemia (in diabetic pregnancy). BMI was the main predictor of more prevalent CM.

[Interest in the study of genetic variants of the promoter region of the UGT1A1 gene in neonatal jaundice]. / Interés del estudio de las variantes genéticas del promotor del gen UGT1A1 en la ictericia neonatal.

BACKGROUND: A relationship between polymorphism in the promoter region of the UGT1A1 gene (associated with Gilbert's syndrome) and the development of jaundice has recently been demonstrated. This polymorphism is due to (TA)7 instead of wild-type (TA)6. OBJECTIVE: To investigate the relationship between Gilbert's syndrome and neonatal jaundice by evaluating the distribution of (TA)7 in a population of newborns. METHODS: A total of 136 newborns were studied: 21 had neonatal jaundice, 69 were healthy and the remaining newborns had various diseases. DNA from each patient was used to amplify, by polymerase chain reaction, the promoter region of the UGT1A1 gene, which flanks the TATA box where the polymorphism is located. RESULTS: In the group without jaundice, 53 % of the newborns were normal (6/6 genotype), 40 % were 6/7 and 7 % were 7/7. In the group with jaundice, 33 % of the newborns were normal, 53 % were heterozygous (6/7) and 14 % were homozygous (7/7). Comparison of the groups revealed that the prevalence of UGTA1A polymorphism tended to be greater among jaundiced newborns (p 0.09). CONCLUSION: The results of this study suggest that there is a relationship between neonatal jaundice and Gilbert's syndrome among the Spanish population. These results, together with those of other authors, suggest that genetic screening for Gilbert's syndrome should be included in the investigation of neonatal jaundice in our population. Further studies with a greater number of subjects would determine the exact relationship between marked neonatal jaundice and IGTA1A polymorphism. Key words:

Interés del estudio de las variantes genéticas del promotor del gen en la ictericia neonatal / Interest in the study of genetic variants of the promoter region of the ugt1a1 gene in neonatal jaundice

Antecedentes: Recientemente se ha mostrado la asociación entre un polimorfismo en el promotor del gen UGT1A1 (asociado con el síndrome de Gilbert) y la presencia de ictericia. Este polimorfismo consiste en la existencia de siete repeticiones TA (TA)7, en lugar de seis (TA)6. Objetivo: Analizar la distribución del genotipo (TA)7 en una población de recién nacidos para determinar la posible relación entre el síndrome de Gilbert y la ictericia neonatal. Métodos: Se estudiaron 136 recién nacidos: 21 presentaron ictericia del resto de recién nacidos, 69 eran sanos y el resto mostró diferentes procesos, incluyendo 7 prematuros. El ADN de cada paciente fue utilizado para amplificar, mediante la reacción en cadena de la polimerasa, la región del promotor del gen de la UGT-1 que flanquea la caja TATA donde se encuentra el polimorfismo. Resultados: Grupo sin ictericia: 53% normales (genotipo 6/6); 40 % genotipo 6/7, y 7%, 7/7. Grupo con ictericia: 33% normales, 53% heterozigotos (6/7) y 14% homozigotos (7/7). Al comparar entre los grupos, los recién nacidos con ictericia tenían una tendencia a tener una mayor prevalencia del polimorfismo para el gen de la UGT-1 (p = 0,09). Conclusión: Este estudio sugiere una relación en la población española entre la ictericia neonatal y el síndrome de Gilbert. Estos datos y otros similares obtenidos por varios autores indican la idoneidad de incluir el escrutinio molecular para el síndrome de Gilbert en el protocolo diagnóstico de la ictericia neonatal. Evidentemente, estudios más amplios permitirán definir cuál es el grado exacto de relación entre la presencia de una ictericia neonatal marcada y la presencia de este polimorfismo (AU)

Early administration of the second dose of surfactant (beractant) in the treatment of severe hyaline membrane disease.

UNLABELLED: The aim of this study was to demonstrate that administration of the second dose of beractant 2 h after the first one is more effective than 6 h after the initial dose. The inclusion criteria for the recruitment of newborn infants were: age < or = 8 h, birthweight 600-2000 g, gestational age 23-36 wk, need for mechanical ventilation with inspiratory oxygen fraction (FiO2) > or = 0.4 and mean airway pressure (MAP) > or = 7 cmH2O to obtain arterial oxygen tension (PaO2) values between 70 and 80 mmHg, and thoracic X-ray compatible with hyaline membrane disease (HMD). Newborns with major congenital malformations, hydrops fetalis or severe pulmonary hypoplasia, or being treated with high-frequency oscillatory ventilation were excluded. In total, 57 premature newborns were studied, 20 of them below 1000 g, who received 100 mg kg-1 of beractant in 2 aliquots and showed an inadequate response, i.e. after 2 h of the first dose the newborn still needed a FiO2 > or = 0.4 and a MAP > or = 7 cmH2O to achieve a PaO2 > 70 mmHg. The second dose was randomly administered 2 or 6 h from the first one. CONCLUSION: The 2 study groups were comparable except for a higher need of dopamine and seroalbumin in 2-h group. Evolution and complications were similar. Twelve hours after the first dose, the percentage improvement in the arteriolar/alveolar ratio (a/ADO2) in the 2-h group was similar to that in the 6-h group. However, in newborns below 1000 g, 12 h after the first dose the a/ADO2 percentage improvement in the 2-h group was greater than in 6-h group (median of 103.6% vs 16.3%; p = 0.035). In premature infants below 1000 g, it seems reasonable to advance the second dose of beractant if needed.

Late hemorrhagic disease of the newborn as a cause of intracerebral bleeding.

We report a case of a 4-week-old female who presented with late hemorrhagic disease of the newborn (HDN). The newborn was previously healthy, and she received 1 mg of intramuscular vitamin K at birth. She was exclusively breast-fed. At 4 weeks she began bleeding at the umbilicus and 4 days after she suffered an intracranial hemorrhage. Coagulation studies showed a deficiency of vitamin K-dependent coagulation factors, and the normalization of all clotting studies after administration of vitamin K confirmed the diagnosis of HDN. Our conclusions are that physicians must be alert to mild bleeding in newborns and that prophylaxis with 1 mg of intramuscular vitamin K at birth may be insufficient to prevent late HDN.