Umbilical markers of perinatal hypoxia.

OBJECTIVES: The aim of the study was to evaluate activin A and NGAL levels as potential early markers of perinatal hypoxia. MATERIAL AND METHODS: We prospectively studied 58 full-term newborns: 24 with perinatal hypoxia (study group) and 34 healthy controls. Umbilical cord blood samples were obtained from all subjects immediately after delivery for the measurement of activin A and NGAL levels. Both biomarkers were correlated with biochemical indicators od hypoxia and neonatal complications. RESULTS: Activin A levels were significantly higher in hypoxic as compared to non-hypoxic newborns (0.51 vs. 0.22pg/mL; p<0.01). NGAL levels were also higher in asphyxiated babies as compared to controls (99.1 vs. 22.3ng/mL; p<0.001). A correlation between NGAL and activin A levels was detected (R=0.54; p<0.01). NGAL concentration was also correlated with Apgar score at 5 min. and pH value, HCO3, based deficit and lactate levels. ROC curve analysis demonstrated the cutoff value of >33.9ng/ml for NGAL in prediction of perinatal asphyxia in neonates, with a sensitivity of 100% and specificity 78.3%, whereas the cutoff value for activin A was 0.208ng/ml had, with a sensitivity of 93.1% and only 26.7% specificity. CONCLUSIONS: Asphyxiated neonates demonstrate elevated NGAL and activin A levels as compared to controls. The correlation of NGAL with clinical and biochemical signs of neonatal hypoxia, as well as higher sensitivity and specificity for NGAL measurements, have led us to believe that NGAL could be a better marker of perinatal hypoxia than activin A.

Can neonates born at 34 weeks be classified as late preterm?

OBJECTIVES: In recent years, much attention has been given to infants born prematurely, at 34 0/7 to 36 6/7 weeks of gestation (WG), which have been classified as 'late preterm'. Neonates from that subgroup are less physiologically and metabolically mature than term infants. The aim of the study was to determine whether infants born at 34WG can be classified as 'late preterm' or 'preterm' newborns. MATERIAL AND METHODS: A total of 141 newborns were included in the study: 25 born ≤ 33WG, 53 late-preterm newborns, and 63 term infants. Cord-blood neutrophil gelatinase-associated lipocalin (NGAL) and creatinine concentrations were measured in all newborns. Also, the incidence of clinical complications in the early adaptive period during hospitalization was evaluated. RESULTS: Higher NGAL concentration was noted among preterm newborns as compared to late-preterm neonates (p < 0.05), and term newborns (p < 0.05), especially in children born at 34WG as compared to 35WG (p < 0.001). However, no differences in NGAL concentration were found between neonates born at 35WG and 36WG, as well as children born at 36WG and term infants. A relationship between umbilical NGAL levels and gestational age was observed. Additionally, a statistically significant difference was found in the incidence of respiratory distress syndrome (p < 0.05) and infections (p < 0.05) among neonates born at 34WG as compared to 35WG. CONCLUSIONS: Late preterm neonates should be defined as 'preterm' between 35 0/7 and 36 6/7 WG. Infants born at 34WG should be included in the preterm group.

Evaluation of selected ultrasonography parameters in the second stage of labor in prediction mode of delivery.

OBJECTIVES: The aim of the study is to determine the usefulness of ultrasound parameters in the second stage of labor in prediction of the method of delivery and to evaluate the benefits to be derived from this study. MATERIAL AND METHODS: Ultrasound scan was performed with Convex transabdominal probe on 68 pregnant women in labor at term with fetuses in cephalic presentation at the beginning of the second stage of labor and parameters such as angle of progression, head progression distance, head-symphysis distance and head-perineum distance were measured. The parameters were observed in two scans: a midline scan visualizing the pubic symphysis with the head of the fetus and a transverse scan approximately 1-2 cm below the pubic symphysis visualizing the head of the fetus. RESULTS: The ultrasound parameters measured at the beginning of the second stage of labor, differed in the group in which women have delivered vaginally and in the group, in which caesarean section was performed: angle of progression and head progression distance were greater in group of women who delivered naturally and head-perineum distance and head-symphysis distance were smaller in this group. Some relations between each measured parameter and time left to delivery were observed as well as strong relations among parameters were also observed. CONCLUSIONS: Intrapartum sonography is a useful and objective tool to assess the progress of labor. Transperineal ultra-sound scans performed in the second stage of labor may play a role in making the decision about the mode of delivery.

Assessment of the diet components of pregnant women as predictors of risk of preterm birth and born baby with low birth weight.

OBJECTIVE: The diet of pregnant women is an important factor in the development of the fetus. In our study we wanted to determine the diet of women who gave birth to healthy children at term (AGA), preterm (PTB) and small for gestational age neonates (SGA). Based on the analysis of dietary components we wanted predict the likelihood of giving birth AGA, PTB and SGA. METHODS: The content of components in the women's diets were estimated based on the dietary questionnaire. The large number of variables analyzed in the diet was reduced using factor analysis. Next, the prediction of pre-maturity and SGA based on previously selected factors was analyzed. For this purpose, two independent methods were used: discriminant function analysis and ROC analysis. RESULTS: Factor analysis resulted in nine factors containing at least one variable of the factor load being greater than 0.7. Analysis of variance only showed differences between the AGA and preterm groups. The study of discriminant function showed that three factors significantly affect the discriminative power to classify cases into AGA and preterm groups. ROC analysis confirmed diagnostic usefulness factor 1 (fatty acids) in classifying cases into AGA and preterm groups. CONCLUSION: Based on the analysis of dietary components of women one can predict the likelihood of giving birth to a healthy child at term and prematurely For AGA the predicting factor is a higher content of short and medium chain fatty acids in a woman's diet.

Pregnant women's diet composition and transitional milk fatty acids: factor analysis.

INTRODUCTION: The variation in the nutrients contained in the milk is the result of changes to the breast metabolism, placenta metabolism and the diet of pregnant women. Various factors influence fatty acid composition which are one of the major components of woman's breast milk. In our research, we wanted to determine the relationship between the components of the diet of and the transitional milk fatty acid composition mothers who delivered healthy full-term babies, preterm and small for gestational age neonates. MATERIALS AND METHODS: The study group comprised of 95 healthy women who were divided into three sub-groups: mothers of appropriate for gestational age (AGA) neonates (group A); mothers of preterm neonates (group B); and mothers who gave birth to small for gestational age (SGA) babies (Group C). The women's elements diet and the content of biochemical components were estimated based on the dietary questionnaire. The FAs in the mother's milk were analyzed using GCMS chromatography. The results of the studies of the dietary components and fatty acids of the milk underwent factor analysis. RESULTS: In group A, 10 correlations (5 positive and 5 negative) were found between the components of the mother's diet and the FAs in the milk (correlation varying from 0.285-0.366). In group B, only negative correlations were observed and these had higher absolute correlation values (0.354-0.500). The most correlations between dietary components and FAs in the milk were found in group C (0.537-0.800). CONCLUSION: Nature of the correlations between the variables examined in groups A, B and C are different.