Rosa Manganaro

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.

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.

Influence of recombinant erythropoietin on the production of endothelin-1 from human umbilical artery.

Prof. Michele Buemi, MD, Via Oddo delle Colonne 16, I-98100 Messina (Italy) Dear Sir, Induced hypertension due to treatments with recombinant erythropoietin (rHuEPO) is with no doubt the most frequent and important side effect of this hormone therapy, capable of conditioning the therapeutic success in subjects affected by anemia from renal failure. Although different factors, among which the increase in hematic viscosity, are recognized as possibly responsible for the pressure rise which often goes along with rHuEPO treatment, up to now a reliable explanation of the pathogenetic mechanisms of hypertension induced by erythropoietin [1] is still missing. In previous investigations, through the evaluation of the changes brought about by the intravenous administration of rHuEPO on the pretibial flux by means of the Xenon 133 clearance, we showed the existence of a direct vasoconstric-tive action exerted by erythropoietin on the compliance vasa [2]. The presence of endothe-lial receptors for the erythropoietin could give account of such action [3]. Furthermore, in our previous investigations as well as in other investigations [4], it was shown how the intravenous chronic treatment was able to change the plasma levels of endothel·in-1, a substance produced by the endothelium, able to induce a high vasoconstriction. Yet, the plasma dosage of endothelin does not seem to correspond to the real activity of the vasal endothelium. Therefore, we wanted to use an experimental model based on the umbilical arteries, where the receptors for endothelin are to be found [5]. The arteries were quickly Fig. 1. Production of immunoreactive endothelin-1 (ir ET-1) in the umbilical artery: electrolytic solution (I); rHuEPO solvent (II); 30 U of rHuEPO (III). 20 μl of solvent. Then, the 3 umbilical artery segments were kept for 10 min at 37 °C, were weighed and the corresponding supernatant frozen at -30 °C, the endothelin-1 was dosed with the RIA method (Amersham, UK). The results obtained from 25 umbilical arteries showed the presence of a significant increase in the concentration of endothelin-1 from the medium to

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.

Endothelin-1 concentrations in cord blood of neonates with meconium-stained amniotic fluid

Abstract Background: The effects of meconium-stained amniotic fluid (MSAF) on cord blood endothelin-1 (ET-1) concentrations have not been explored. Objective: The aim of this study was to verify whether MSAF influences ET-1 cord blood concentrations in healthy term neonates. Methods: Using an enzyme-linked immunosorbent assay, plasma ET-1 concentrations were determined in 30 healthy term neonates with MSAF, and in 15 healthy term neonates without MSAF. The two groups were of the same gestational age, weight, Apgar score, cord blood pH, base excess, and hematocrit values, as well as systolic and diastolic blood pressures. Results: ET-1 plasma concentrations were not significantly different between the two groups and did not correlate with cord blood pH or base excess values. Conclusion: Our data demonstrate that meconium passage does not induce ET-1 secretion.