Anastasia Varvarigou

Increased blood pressure in neonates and infants whose mothers smoked during pregnancy

OBJECTIVE To determine whether maternal smoking during pregnancy is associated with increased blood pressure (BP) in neonates. STUDY DESIGN We measured BP in the following groups: (1) 73 neonates of mothers who smoked during pregnancy, (2) 43 neonates of mothers who quit smoking early during pregnancy, (3) 83 neonates of passive smoking mothers, and (4) 170 neonates of nonsmoking parents. Three BP measurements were made at 1, 24, 48, and 72 hours of life. Some of the neonates were followed for 2 years. RESULTS We observed a significant positive correlation between the number of cigarettes smoked by the mothers during pregnancy and the BP of the neonates. From the first to the seventy-second hour of life the BP in the infants of the mothers who smoked 15 or more cigarettes per day was significantly higher than in the infants of the nonsmoking mothers, whereas the increase in BP was intermediate when the mothers smoked 7 to 15 cigarettes per day. The BP was similar to that of the control subjects when the mothers smoked 3 to 5 cigarettes per day, were passive smokers, or quit smoking during pregnancy. On reexamination between 4 and 9 months and at 12 months, in infants of mothers who smoked 15 or more cigarettes per day both the systolic and the diastolic BP were significantly higher than in the control subjects; at 12 months 5 of the infants of mothers who smoked cigarettes had BP greater than the 95th percentile for age and gender. At 24 months of life there was no significant difference in systolic or diastolic BP between infants of smoking and nonsmoking mothers. CONCLUSIONS Neonates and infants of mothers who smoked during pregnancy have an elevation of BP that is related to the number of cigarettes smoked per day. Smoking 15 or more cigarettes per day may cause BP elevation in infancy, but the BP returns to normal during the second year of life.

Cord blood leptin concentrations in relation to intrauterine growth

Leptin, a hormone that signals the amount of energy stores to the brain, has recently been shown to play a role in the regulation of several hypothalamic pituitary axes, including the growth hormone axis. To investigate a potential association between cord blood leptin concentrations and intrauterine growth we measured leptin concentrations in the cord blood of small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) healthy newborns.

Phagocytic ability of neutrophils and monocytes in neonates.

BackgroundInfections by a variety of pathogens are a significant cause of morbidity and mortality during perinatal period. The susceptibility of neonates to bacterial infections has been attributed to immaturity of innate immunity. It is considered that one of the impaired mechanisms is the phagocytic function of neutrophils and monocytes. The purpose of the present study was to investigate the phagocytic ability of neonates at birth.MethodsThe phagocytic ability of neutrophils and monocytes of 42 neonates was determined using the Phagotest flow cytometry method, that assesses the intake of E. Coli by phagocytes, in cord blood and in peripheral blood 3 days after birth. Fifteen healthy adults were included in the study as controls.ResultsThe phagocytic ability of neutrophils in the cord blood of neonates was significantly reduced compared to adults. The 3rd postnatal day the reduction of phagocytic ability of neutrophils was no longer significant compared to adults. The phagocytic ability of monocytes did not show any difference from that of adults either at birth or the 3rd postnatal day.ConclusionsOur findings indicate that the intake of E. Coli by phagocytes is impaired at birth in both preterm and full term neonates compared to adults. This defect is transient, with the phagocytic ability in neonates reaching that of the adults 3 days after birth.

Increased levels and positive correlation between erythropoietin and hemoglobin concentrations in newborn children of mothers who are smokers

The mean erythropoietin concentration in the cord blood of neonates whose mothers were smokers was greater than in neonates whose mothers were not smokers. There was a significant positive correlation between erythropoietin and hemoglobin concentrations. The findings suggest that approximately one of five fetuses who are exposed to tobacco smoke are in a state of chronic hypoxia.

Transcutaneous Bilirubin Nomogram for Prediction of Significant Neonatal Hyperbilirubinemia

OBJECTIVE: The goal was to develop a predictive nomogram, based on transcutaneous bilirubin (TcB) measurements, for assessment of the risk of significant hyperbilirubinemia in healthy term and near-term neonates. METHODS: A total of 10382 TcB measurements were performed with 2039 healthy neonates (gestational age of ≥35 weeks and birth weight of ≥2000 g), with a BiliCheck bilirubinometer (SpectRx, Norcross, GA), at designated time points between 12 and 120 hours of life. According to their severity, these TcB measurements were selectively cross-checked with a direct spectrophotometric device, and significant hyperbilirubinemia was defined on the basis of the hour-specific threshold values for phototherapy proposed by the American Academy of Pediatrics. With the use of likelihood ratios (LRs), the high- and low-risk demarcators for each designated time were calculated and presented on an hour-specific nomogram. RESULTS: Significant hyperbilirubinemia was documented for 122 neonates (6%). At 24 hours of life, the high-risk zone of the nomogram had 73.9% sensitivity and a positive LR of 12.1 in predicting significant hyperbilirubinemia, whereas the low-risk zone had 97.7% sensitivity and a negative LR of 0.04. At 48 hours, the high-risk zone had 90% sensitivity and a positive LR of 12.1, whereas the low-risk zone had 98.8% sensitivity and a negative LR of 0.02. In our study population, the probability of significant hyperbilirubinemia would be >35% for values in the high-risk zone and <0.5% for values in the low-risk zone of the nomogram. CONCLUSIONS: We provide a predictive TcB tool that could allow for a noninvasive, risk-based approach to neonatal hyperbilirubinemia.

Transcutaneous Bilirubin Levels for the First 120 Postnatal Hours in Healthy Neonates

OBJECTIVE: The objective of this study was to provide data on transcutaneous bilirubin (TcB) levels for the first 120 postnatal hours and to develop an hour-specific TcB nomogram for healthy term and near-term neonates. METHODS: From September 2005 to August 2008, we obtained 14864 TcB measurements from 2818 healthy neonates (gestational age ≥ 35 weeks and birth weight ≥ 2000 g). All measurements were performed with the BiliCheck bilirubinometer, at designated times from 12 to 120 postnatal hours. TcB percentiles for each designated time were calculated and used for the development of an hour-specific nomogram. TcB percentiles for neonates who required phototherapy are also presented. RESULTS: The developed TcB nomogram reflects the natural history of TcB levels in healthy neonates up to the fifth postnatal day. A different pattern of TcB increasing rate was noted in neonates who did and did not require phototherapy but with substantial overlap of TcB values between the 2 groups. CONCLUSIONS: We provide data on TcB levels for the first 120 postnatal hours from a large population of white, healthy, term and near-term neonates. We also present a percentile-based TcB nomogram designated for noninvasive and hour-specific evaluation of neonatal hyperbilirubinemia.

Vascular retinal abnormalities in neonates of mothers who smoked during pregnancy

OBJECTIVE To investigate whether maternal smoking during pregnancy causes retinal abnormalities in the newborn. STUDY DESIGN One hundred sixty-two neonates of smoking mothers and 162 matched neonates of nonsmoking mothers (112 appropriate for gestational age [AGA], 30 small for gestational age [SGA], 20 large for gestational age [LGA] in each group) were studied. RESULTS Retinal arterial narrowing and straightening (RANS) was observed in 52 and 10 eyes of the newborns of smoking and nonsmoking mothers, respectively (P <. 000001) in association with elevated blood pressure in the neonates. The frequency of RANS was more than 3-fold greater in the SGA neonates than in the AGA and LGA neonates of the smoking mothers. Retinal venous dilatation and tortuosity (RVDT) was found in 100 and 36 eyes of neonates of smoking and nonsmoking mothers, respectively (P <.000001). The frequency of RVDT in the SGA neonates of the smoking mothers was 2.5-fold and 4.2-fold greater than in the AGA infants and the LGA infants, respectively. Also, intraretinal hemorrhages were found in 61 and 31 eyes of neonates of smoking and nonsmoking mothers, respectively (P =.0007) in association with elevated hematocrit and RVDT, whereas no intraretinal hemorrhages were found when RANS was present. All retinal abnormalities resolved by 6 months in infants of smoking mothers and by 2 months in infants of nonsmoking mothers. CONCLUSIONS Maternal smoking during pregnancy causes increased frequency of RANS, RVDT, and intraretinal hemorrhages; but these retinal abnormalities resolve by 6 months of age.

Increased cortisol concentrations in the cord blood of newborns whose mothers smoked during pregnancy.

Abstract Aim: To investigate the effect of tobacco smoke on cord blood cortisol concentrations. Methods: Cortisol concentrations were measured in cord blood from 211 term newborns of smoking and 211 term newborns of nonsmoking mothers; 48 and 36 newborns were delivered by cesarean section, respectively. In 16 cases, in addition to cord blood, maternal venous blood was obtained at delivery. Results: The median cord blood cortisol concentration in neonates of the smoking and the nonsmoking mothers was 23 and 13 μg/dL, respectively (P<0.0001). Cortisol concentrations were greater in the newborns whose mothers smoked, when compared to corresponding controls, whether they were delivered vaginally or by cesarean section. In the newborns delivered by cesarean section, there was a positive correlation between number of cigarettes smoked/day and cortisol concentrations, as well as a negative correlation between cortisol concentrations and neonatal length. There was no significant correlation between cortisol concentrations and birth weight or head circumference. Cortisol concentrations in the cord blood of neonates whose mothers were smokers and nonsmokers were by 29% and 45% lower from those measured in their mothers, respectively. Conclusions: Although a causal relationship between maternal smoking and high cortisol concentrations in cord blood was not established, the findings are in accordance with previous reports indicating elevated stress-hormones in newborns whose mothers smoked during pregnancy.

Cord blood α-fetoprotein concentrations in term newborns of smoking mothers

Abstract To investigate the toxic effect of tobacco smoke on the fetus, we measured in cord blood the concentrations of α-fetoprotein (AFP), the principal serum protein in early ontogenic development, and erythropoietin (EPO), as an index of chronic fetal hypoxia. A total of 103 consecutively enrolled term newborns of smoking mothers and 103 term infants of nonsmoking parents were studied. The mean ± SD AFP concentrations in the newborns of the mothers who smoked 1–50, 5–50, and 10–50 cigarettes/day were 86.4 ± 88.9, 96.3 ± 91.9 and 118.7 ± 103.7 ng/ml, respectively. The difference of all three groups from the control neonates (57.7 ± 37.2) was significant. The EPO concentrations in the newborns of the mothers who smoked 1–50 (53.9 ± 64.6 mU/ml) and 5–50 (56.3 ± 68.5) cigarettes/day were significantly greater than in the control neonates (29.5 ± 16.1). In the newborns of the smoking mothers there was a significant positive correlation between AFP concentrations and number of cigarettes smoked per day, and a negative correlation between AFP and birth weight or length. There was no correlation between AFP and EPO concentrations, as well as between EPO and birth weight, length or number of cigarettes smoked per day. Conclusion The absence of a correlation between erythropoietin and birth weight or length and the negative correlations between α-fetoprotein and these anthropometric parameters suggest that the intra-uterine growth retardation caused by maternal smoking is not due to tissue hypoxia, but that both growth retardation and elevated α-fetoprotein result from the direct or indirect toxic effect of a factor(s) present in tobacco smoke.

Growth Hormone, Insulin-Like Growth Factor-l and Prolactin in Small for Gestational Age Neonates

Growth hormone (hGH), insulin-like growth factor-I (IGF-I) and prolactin (PRL) were measured in the cord and venous blood of small for gestational age (SGA) neonates in order to evaluate their endocri