Marina Gemelli

Incidence of meconium aspiration syndrome in term meconium-stained babies managed at birth with selective tracheal intubation

Abstract The delivery room management of infants born through meconium stained amniotic fluid (MSAF) remains controversial. The aim of this prospective study was to evaluate maternal and neonatal characteristics of MSAF infants and the incidence of meconium aspiration syndrome (MAS) in routine delivery room management which reserved selective intubation for depressed/asphyxiated babies. Between October 1993 and September 1997, a consecutive sample of 3745 full-term infants was analyzed. Of these, 361 were MSAF infants. No significant difference in maternal age, parity, gestational age, sex, low 1 and 5 minute Apgar scores, metabolic acidemia, or need for endotracheal intubation was found between MSAF and non-MSAF infants. Only one of the MSAF infants (0.28%), who needed intubation, developed MAS. Identification of postterm pregnancy and prenatal asphyxia is the best prevention of MAS.

Atrial Natriuretic Peptide and Renin‐Aldosterone Relationship in Healthy Newborn Infants

ABSTRACT. Plasma atrial natriuretic peptide (ANP) and aldosterone concentrations, and plasma renin activity (PRA) were measured by radioimmunoassay concurrently in 20 healthy full term infants, in cord blood, at 24 hours after birth and on the 4th day of life. ANP and aldosterone increased significantly at 24 hours and was persistently elevated on the 4th day of life. PRA remained unchanged during the first four days of life. In cord blood, ANP concentrations were correlated with aldosterone concentrations (r= 0.49, p<0.05) and hematocrit (r= 0.58, p<0.02). At the 24 hours of life, plasma ANP concentrations were correlated with weight loss observed on the 4th day of life (r= ‐0.70, p<0.005), while the percentage changes in plasma aldosterone concentrations were correlated with percentage changes in systolic blood pressure (BP) (r= 0.49, p<0.05). These findings suggest that during the early newborn period ANP and aldosterone act as an integrated system which has a role in regulation blood pressure and intravascular volume homeostasis.

Longitudinal study of blood pressure during the 1st year of life

Systolic and diastolic blood pressure (BP), heart rate and weight were measured in 260 boys and 254 girls, from birth to 12 months of age. Mean±SD values of parameters studied and percentile curves are reported. Systolic and diastolic BP increase significantly during the first 6 months of life and are poorly correlated with weight. In the 1st month of life the diastolic BP values are lower than those reported by others.

Serum levels of resistin and its correlation with adiponectin and insulin in healthy full term neonates

UNLABELLED Resistin and adiponectin are two adipokines involved in the regulation of insulin sensitivity, and have been suggested as mediators of adult metabolic syndrome. AIM The aim of this study was to investigate cord blood levels of resistin, and their postnatal changes in full-term appropriate for gestational age (AGA) neonates. Interrelations between resistin, adiponectin, and insulin, and between resistin and neonatal and maternal anthropometric parameters were also assessed. DESIGN Blood samples were obtained from 30 full term AGA neonates at birth and on the 4th day of life. Anthropometric variables studied included birth weight, length, body mass index (BMI), neonatal weight loss, and mothers BMI. Resistin and adiponectin were determined by ELISA, and insulin by radioimmunoassay method. Data were analyzed using Wilcoxon test and Spearmans correlation coefficient. RESULTS Resistin levels were high at birth and did not change on the 4th day of life. Resistin levels were not correlated to insulin, nor adiponectin levels, nor any anthropometric parameter of neonates or their mothers. Instead, adiponectin levels increased on the 4th day of life, and were correlated to insulin levels. CONCLUSION High levels of resistin in full-term AGA neonates suggest that this hormone may play a role in maintenance of metabolic neonatal homeostasis, but its physiological significance needs further investigation.

The validity of the Apgar scores in the assessment of asphyxia at birth

A prospective study was performed in 613 consecutively live born infants to investigate the validity of 1- and 5-min Apgar scores as an index for asphyxial assessment at birth. The independent and combined relationship between Apgar scores, metabolic acidemia, pulse oximeter (SaPO2) measurements and neonatal outcome were determined. In the term infants 1-min Apgar score was more influenced by the mode of delivery and by gestational age than by asphyxia. Instead, 5-min Apgar score had a high concordance with metabolic acidemia. Infants with low Apgar scores, metabolic acidemia and arterial desaturation have the highest incidence of neonatal intensive care unit admission and poor neonatal outcome. The study suggests that the 5-min Apgar score is useful for immediate clinical assessment and care of the neonate.

Effects of the mode of delivery on ANP and renin-aldosterone system in the fetus and the neonate.

Plasma ANP and aldosterone levels, plasma renin activity (PRA), haematocrit, systolic and diastolic blood pressure (BP), were evaluated in 15 full-term infants delivered by elective Caesarean section (CS group) and in 15 full-term infants delivered vaginally (vaginal group). The mode of delivery did not influence the cord blood levels of ANP and their increase at the 24th hour of life. Instead, PRA was lower and plasma aldosterone levels were higher in the CS group than in the vaginal group. Also haematocrit and BP were influenced by mode of delivery. The haematocrit values were lower in the CS group than in the vaginal group at birth as well at the 24th hour of life. The values of systolic and diastolic BP were the same in both groups, at birth, but at the 24th hour of life increases were observed only in the vaginal group. On the fourth day of life weight loss was the same in both groups. Our findings suggest that the mode of delivery has more influence on neonatal BP adaptation than on neonatal volume homeostasis.

Transient electrocardiographic changes suggesting myocardial ischaemia in newborn infants following tocolysis with beta-sympathomimetics.

Serial electrocardiograms (ECGs) were studied prospectively in 80 apparently healthy newborn infants; 30 infants exposed in utero to prolonged tocolytic therapy (21 to ritodrine and 9 to isoxsuprine) and 50 infants non-exposed in utero to drugs (control group) matched for gestational age, Apgar score, and birth weight. Duration of exposure to tocolysis was at least 30 days (30–180 days) with an oral dosage of 10 mg 3 times daily. ECGs were graded for changes suggestive of ischaemia using the arbitrary grading system described by Jedeikin et al. [12]. In all infants with ECG features of myocardial ischaemia, serum creatine-phosphokinase iso-enzyme (CK-MB) activity was measured. Six out of 21 infants to ritodrine and six out of nine infants exposed to isoxsuprine showed a degree of ECG ischaemia which persisted for several weeks. No control infant presented grade 2 or 3 ECG changes after the 5th day of life. The results of this study seem to show that prolonged tocolytic therapy with β-sympathomimetics has side-effects on the fetal myocardium and suggest that this treatment be reserved only for selective cases and/or for short periods of time.

Serum alpha-fetoprotein (AFP) levels in breastfed infants with prolonged indirect hyperbilirubinemia

UNLABELLED The aim of this prospective study was to verify normal serum AFP (alpha-fetoprotein) levels in jaundiced breastfed infants with indirect hyperbilirubinemia. METHODS The study was conducted in clinically jaundiced breastfed infants, 20, or more, days old, referred to our outpatient ambulatory. Inclusion criteria were: birth at term after a physiologic pregnancy, with an Apgar score >7 at 1 and 5 min, no evidence of congenital anomalies or diseases, direct bilirubin <1 mg/dl, normal values of alpha-1-antitrypsin, glucose-6-phosphate dehydrogenase, thyroid stimulating hormone, triiodothyronine, tyroxine, and normal growth. 30 non-jaundiced breastfed infants age-weight-matched, were used as control group. RESULTS 98 jaundiced breastfed infants satisfied inclusion criteria. Their mean serum concentration of AFP was significantly higher than control infants (3548 vs 1095 ng/ml, p<0.001). Serum AFP levels of jaundiced infants were directly associated with serum indirect bilirubin and gamma-glutamyltranspeptidase concentrations. CONCLUSIONS The most probable explanation of elevated AFP in jaundiced breastfed infants may be the presence in human milk of one or more factors which affect hepatocyte growth and/or function. Based on our finding we demonstrated that in jaundiced breastfed infants normal range of serum AFP levels are higher than previously published data for healthy infants. Our data can be useful for a right interpretation of AFP levels in breastfed infants with prolonged jaundiced and may be used to avoid unnecessary investigations.

Circadian blood pressure pattern in full-term newborn infants

A fully automatic noninvasive device (Dinamap) was used for monitoring blood pressure (BP) and heart rate repetitively over 48 h in 21 full-term newborn infants (9 males and 12 females), aged 4 days in order to clarify the occurrence of a circadian rhythm (CR). The data collected were analyzed by computer statistical analysis. Mean values and standard error of BP and heart rate measured at hourly intervals in males and females were computed and plotted as chronograms. However, each newborn infant was analyzed for a CR of BP and heart rate by the single cosinor fit of a 24-hour cosine curve. The analysis of the chronograms revealed that the values of systolic and diastolic BP show an hour-by-hour significant fluctuation in male infants, but not in female infants. CR development of BP is present only in a minority of newborn infants and reveals sex and interindividual differences. CR of heart rate is absent in all infants. The physiological significance of these findings was discussed, and the importance of knowing the physiological variances of BP in infants in order to obtain a correct clinical evaluation was stressed.

Correlation between plasma levels of ACTH and β-endorphin in the first seven days of postnatal life

Plasma adrenocorticotropic hormone (ACTH) and β-endorphin (β-EP) concentrations were measured by radioimmunoassay in 122 newborns, born vaginally after spontaneous labor between the 38th and the 41 st week of pregnancy. Blood samples were taken from umbilical cord in 10 newborns and from antecubital vein in the remaining 112 newborns, divided into 8 groups aged from 12 h to 7 days. The mean (± SE) ACTH concentrations in cord plasma were 81.87 ±10.16 pg/ml and decreased significantly (p < 0.01) at the 24th h of life (49.09 ± 6.93 pg/ml). Afterwards mean ACTH plasma concentrations fluctuated around the latter values. The mean (± SE) B-EP concentrations in cord plasma were 21.96 ± 3.12 pmol/l and decreased significantly at the 24th h of life (13.43 ± 2.08 pmol/l; p < 0.01). From the 24th h to the 7th day the mean plasma concentrations of β-EP were not significantly different. ACTH and β-EP plasma levels were positively correlated (p < 0.001) at delivery and during the first seven days of life.