Esad Koklu

Increased Aortic Intima-Media Thickness Is Related to Lipid Profile in Newborns with Intrauterine Growth Restriction

Background and Aim: Low birth-weight is known to be associated with an increase in cardiovascular risk similar to that seen with major environmental risk factors, such as cigarette smoking or hypertension. Much epidemiological evidence has linked low birth-weight with hypertriglyceridaemia. Method: We measured aortic wall thickness by ultrasonography and lipid profile in 40 newborn babies with intrauterine growth restriction and 40 controls. Results: Maximum and mean aortic intima-media thickness were significantly higher in the babies with intrauterine growth retardation (0.58 ± 0.06, 0.52 ± 0.03 mm, respectively) than in controls (0.44 ± 0.05, 0.40 ± 0.03 mm, p < 0.0001, p < 0.0001, respectively), more so after adjustment for birth-weight (maximum intima-media thickness: 0.23 ± 0.03 mm/kg vs. 0.12 ± 0.02 mm/kg, p < 0.0001; mean intima-media thickness: 0.21 ± 0.02 mm/kg vs. 0.11 ± 0.01 mm/kg, p < 0·0001). Serum triglyceride levels were significantly higher in the intrauterine growth retardation group (48.9 ± 14.8 mg/dl) compared with the control group (32.5 ± 9.8 mg/dl, p < 0.0001). The mean body mass index, prepregnancy weight, weight gain during pregnancy, maternal LDL cholesterol level and, height of the mothers were significantly lower in the intrauterine growth retardation group compared with the control group. For maximum aIMT, significant associations included the ponderal index (p = <0.01), length (p = 0.01) and serum triglyceride levels of infants (p = 0.02). Conclusion: Newborn babies with growth restriction have significant maximum aortic thickening with hypertriglyceridaemia, suggesting that prenatal events might predispose to later cardiovascular risk.

Oral nystatin prophylaxis to prevent invasive candidiasis in Neonatal Intensive Care Unit.

The use of oral nystatin to prevent fungal colonisation and infection in neonates in the Neonatal Intensive Care Unit (NICU) is still an open question and not yet recommended as a standard of care. To determine whether prophylactic oral nystatin results in a decreased incidence of invasive candidiasis in the newborn infants, a total of 3991 infants were divided randomly into two groups. Group A infants (n = 1995), only those neonates who were identified as yeast carriers (oral moniliasis) were treated with oral nystatin. Group B infants, all neonates who were admitted to the unit received oral nystatin, was routinely administered three times a day. Group A was divided into groups A1 and A2 (who were treated only if identified as yeast carriers). Urine and rectal cultures were taken on admission and then weekly thereafter. There were 215 (14.2%), 27 (5.6%) and 36 (1.8%) patients positive for invasive candidiasis in groups A1, A2 and B respectively. Oral nystatin prophylaxis significantly reduced the invasive candidiasis (P = 0.004) in extremely low‐birth weight (ELBW) and very low‐birth weight (VLBW) infants. Prophylactic administration of oral nystatine to the ELBW and VLBW infants results in a decreased risk of invasive candidiasis.

Aortic intima-media thickness, serum IGF-I, IGFBP-3, and leptin levels in intrauterine growth-restricted newborns of healthy mothers.

Neonates with intrauterine growth restriction (IUGR) are associated with reduced concentrations of IGF-I that might contribute to arterial wall thickening. Direct atherogenic effects of leptin have been described. We aimed to investigate the relationship among abdominal aortic intima-media thickness (aIMT), serum IGF-I, IGF binding protein-3, and leptin levels in neonates with IUGR. Abdominal aIMT was measured in 40 term neonates with IUGR and in 40 controls. Mean aIMT was significantly greater in neonates with IUGR (0.45 ± 0.03 mm) than in controls (0.39 ± 0.04 mm, p < 0.0001). Serum IGF-I and leptin levels were lower in neonates with IUGR than in controls. There was a significant positive correlation between aIMT and gestational age, whereas a significant negative correlation was determined between aIMT and IGF-I in the IUGR neonates. For aIMT, significant associations included serum IGF-I level (β = –0.406, p = 0.006) and gestational age (β = 0.331, p = 0.022) in a multiple stepwise linear regression analysis. In control neonates, serum IGF-I levels were negatively related to aIMT (β = –0.750, p < 0.001). Neonates with IUGR have significant aIMT with decreased IGF-I. IGF-I levels determine aIMT not only in neonates with IUGR but also in healthy controls.

Troponin-T levels in perinatally asphyxiated infants during the first 15 days of life

Aim: To measure serial cardiac troponin‐T, creatine kinase, creatine kinase‐MB, aspartate aminotransferase, alanine aminotransferase and lactate dehydrogenase levels in asphyxiated newborn infants during the first 15 d of life.

Macrosomic newborns of diabetic mothers are associated with increased aortic intima-media thickness and lipid concentrations

Background/Aims: Exposure to diabetes in utero has been established as a significantrisk factor for some of components of metabolic syndrome. A few studies have examined relationship between the metabolic syndrome and echocardiographic left ventricular (LV) mass. We aimed to investigate relationship between abdominal aortic intima-media thickness (aIMT), LV mass and lipid profile in macrosomic newborns. Methods: Abdominal aIMT was measured in 30 macrosomic neonates of diabetic mothers (group A), 30 macrosomic neonates of healthy mothers (group B) and 30 healthy neonates (group C). Lipid profile and LV mass were determined. Result: Mean aIMT was significantly higher in groups A and B (0.489 ± 0.015, 0.466 ± 0.019 mm, respectively) than in controls (0.375 ± 0.024 mm). Weight-adjusted aIMT in group A was significantly higher than in groups B and C. Macrosomia was associated with increased lipid concentrations. Both LV mass indexed for BSA (body surface area) and birth weight measurements were significantly increased in group A compared with control. Conclusions: Macrosomic neonates of diabetic mothers have significant aIMT and LV mass indexed for BSA and birth weight with lipid alterations. It might play a role in the pathogenesis of atherosclerosis in adult life.

The relationship between abdominal aortic intima-media thickness and lipid profile in neonates born to mothers with preeclampsia.

ABSTRACT Neonates born to mothers with preeclampsia are known to be associated with lipid alterations that might increase the risk for cardiovascular disease in adult life. The aim of this study was to investigate the effect of preeclampsia on lipid metabolism, aortic intima-media thickness (aIMT) and subsequent atherogenic risk in newborn infants. Aortic intima-media thickness was measured in 60 neonates of mothers with preeclampsia (group I; 30 neonates of mothers with preeclampsia and group II; 30 neonates of mothers with severe preeclampsia) and 30 healthy neonates (group III). Maternal and cord serum lipid profiles were determined in all groups. Mean abdominal aIMT measurements were higher in the neonates born to mothers with preeclampsia (group I; 0,36±0,03 mm and group II; 0,36±0,04 mm) compared with the control group (group III; 0,33±0,03 mm, p=0,006). Serum triglyceride levels were significantly higher in the neonates born to mothers with preeclampsia (group I; 39,2±42,0 mg/dl and group II; 39,5±56,5 mg/dl) compared with the control group (group III; 14,9±18,8 mg/dl, p = 0,039). Serum HDL cholesterol levels were significantly lower in the neonates born to mothers with preeclampsia (group I; 17,3±12,3 mg/dl and group II; 17,1±12,8 mg/dl) compared with the control group (group III; 27,6±13,0 mg/dl, p = 0,002). In conclusion; neonates of mothers with preeclampsia have significantly higher aIMT with lipid alterations. This may play a role in the pathogenesis of atherosclerosis in adult life.

The Relationship between Birth Weight Leptin and Bone Mineral Status in Newborn Infants

Background: The positive relationship between fat mass, bone mass and leptin has been shown in fetal mouse cartilage/bone. It has been shown that umbilical venous leptin predicts both the size of the neonatal skeleton and its estimated volumetric mineral density. Aims: This study investigates how birth weight and bone mineralization correlate with leptin levels. In addition, we aimed to determine the predictive value of anthropometrics measurements and gender on variability in bone mineral status. Methods: Umbilical cord venous blood samples were obtained at the delivery from 100 term newborn infants. Forty of the newborn infants had birth weights appropriate for gestational age (AGA), 30 were small for gestational age (SGA) and 30 were large for gestational age (LGA). Data were acquired using the whole body dual energy X-ray obsorptiometry scanner in the first 24 h after birth. Results: Leptin concentrations were higher in LGA (36.6 ±12.0 ng/ml; p < 0.0001), but lower in SGA (11.7 ± 5.6 ng/ml; p < 0.001) than in AGA infants (20.3 ± 7.6 ng/ml). Whole body bone mineral density and whole body bone mineral content were higher in LGA babies (0.442 ± 0.025 g/cm2, 71.6 ± 9.0 g, p < 0.01, p < 0.001, respectively) but lower in SGA (0.381 ± 0.027 g/cm2, 29.1 ± 9.1 g, p < 0.001, p < 0.001, respectively) than in AGA babies (0.426 ± 0.022 g/cm2, 53.7 ± 9.6 g, respectively). The percentage of whole body bone mineral content was lower in SGA (1.3 ± 0.3) than in AGA (1.6 ± 0.2, p < 0.001) and LGA (1.7 ± 0.2, p < 0.001). In stepwise linear regression analyses models; leptin is not found related to the bone indices. Conclusion: Our study does not provide support for the hypothesis that leptin may play a major role in the regulation of bone metabolism in the developing skeleton.

Brucellosis with pulmonary involvement in a premature infant.

Abstract Congenital brucellosis is rare. A premature infant with transplacentally acquired congenital brucellosis and pulmonary involvement is described.

Severe vitamin D deficiency among pregnant women and their newborns in Turkey.

Abstract Objectives: Vitamin D deficiency is an important health problem in pregnant women and their infants in sunny countries. Low socio-economic status (LSES), covered dressing style, pregnancies in winter season and having dark skin are the major risk factors for vitamin D deficiency. The present study evaluated serum 25-hydroxyvitamin D3 [25(OH)D3] concentrations in pregnant women and in their newborns and determined the risk factors in LSES cities in Turkey. Methods: Ninety-seven pregnant women and their newborns were included in the study between December 2012 and February 2013. All of the pregnant women had irregular follow-up or had received no antenatal care, were pregnant during summer, had presented to the hospital after 37 weeks of gestation (WG) and had received no vitamin D supplementation. A detailed history was obtained, which included mothers’ age, number of births and dressing sytle. Maternal and cord blood samples were taken to measure 25(OH)D3 levels. Results: All of the pregnant women were predominantly LSES, had covered dressing style and none of them had received vit D3 supplementation during pregnancy. The mean serum 25(OH)D3 level and mean cord blood level of of 97 mothers were 4.97 ± 3.27 ng/ml and 4.29 ± 2.44 ng/ml, respectively. There was a strong positive correlation between maternal serum and umbilical cord 25(OH)D3 levels (r: 0.735, p < 0.05). Ninety-five mothers had serum 25(OH)D3 below 20 ng/ml and all cord blood serum 25(OH)D3 levels were below 20 ng/ml. Level of 25(OH)D3 was not correlated with mother age, WG or newborn weight. Serum 25(OH)D3 concentrations in primigravida and multigravida were 3.71 ± 1.88 and 5.2 ± 3.4 ng/ml, respectively, with a significant difference between them (p < 0.05). Conclusion: Severe vitamin D deficiency is common in reproductive women and their newborns in LSES cities of Turkey. Covered dressing style, not receiving any vitamin D supplementation and primigravida women are at greatest risk. Vitamin D supplementation campaigns which should cover pregnant women and the newborn to prevent maternal and perinatal vitamin D deficiency should be implemented especially in risk areas.

The relationship between birth weight, oxidative stress and bone mineral status in newborn infants

Background:  It was shown that oxygen‐derived free radicals, and particularly the superoxide anion, are intermediaries in the formation and activation of osteoclasts. Many antioxidant defence systems depend on micronutrients or are micronutrients themselves. Oxidative stress might be related to bone indices in newborn infants.