Stavroula Gavrili

Enteral L-Arginine Supplementation for Prevention of Necrotizing Enterocolitis in Very Low Birth Weight Neonates A Double-Blind Randomized Pilot Study of Efficacy and Safety

BACKGROUND Necrotizing enterocolitis (NEC) is the most common acquired gastrointestinal disease in premature infants and has high mortality and morbidity. Endothelial nitric oxide is an important regulator of vascular perfusion and is synthetized from the amino acid L-arginine. Hypoargininemia is frequently observed in preterm neonates and may predispose them to NEC. Our objective was to determine the effect of enteral L-arginine supplementation on the incidence and severity of NEC in very low birth weight (VLBW) neonates. MATERIALS AND METHODS We conducted a parallel blind randomized pilot study, comprising VLBW neonates with birth weight ≤1500 g and gestational age ≤34 weeks. VLBW neonates were randomly assigned to receive enteral L-arginine supplementation (1.5 mmol/kg/d bid) between the 3rd and 28th day of life or placebo. Diagnosis and classification of NEC were done according to modified Bells criteria. RESULTS Eighty-three neonates were randomized to the arginine (n = 40) or placebo (n = 43) group. No adverse effects were observed in neonates receiving L-arginine supplementation. The incidence of NEC stage III was significantly lower in the arginine-supplemented group (2.5% vs 18.6%, P = .030). CONCLUSIONS Enteral L-arginine supplementation of 1.5 mmol/kg/d bid can be safely administered in VLBW neonates from the 3rd to the 28th day of life. Enteral L-arginine supplementation appears to reduce the incidence of stage III NEC in VLBW infants. Larger studies are needed to further evaluate the effect of L-arginine supplementation in preventing NEC in VLBW infants.

Maternal-neonatal 8-hydroxy-deoxyguanosine serum concentrations as an index of DNA oxidation in association with the mode of labour and delivery

Aim. To investigate the effect of the mode of labour and delivery on the total antioxidant status (TAS), and the biomarker of DNA oxidation, 8‐hydroxy‐deoxyguanosine (8‐OHdG) serum levels, in mothers and their newborns. Subjects and methods. Some 106 women with normal pregnancy and normal blood biochemical parameters were divided into 4 groups: Group A (n = 28) with normal labour and vaginal delivery (VG), Group B (n = 25) with scheduled cesarean section (CS), Group C (n = 26) with ‘emergency’ CS, and Group D (n = 27) with prolonged labour + VG. Blood was obtained from the mothers at the beginning of labour, and immediately after delivery (pre‐ and post‐delivery), as well as from the umbilical cord (CB). TAS, 8‐OHdG and creatine kinase (CK) were measured in the sera with appropriate methodology. Results. TAS levels were almost similar in all the groups pre‐delivery, and in CB irrespective of the mode of labour and delivery, and remarkably decreased in Groups C and D post‐delivery. 8‐OHdG levels in Group C (0.94±0.08 ng/ml) and Group D (0.98±0.08 ng/ml) were significantly higher than those in Group A (0.26±0.01 ng/ml, p<0.001) and Group B (0.28±0.07 ng/ml, p<0.001) post‐delivery. 8‐OHdG levels were low in CB, independent of the mode of labour. CK positively correlated with 8‐OHdG (r = 0.48, p<0.001), the latter negatively correlated with TAS (r = − 0.53, p<0.01). Conclusions. The lowest TAS and the highest 8‐OHdG levels were found in Groups C and D post‐delivery, probably due to the long‐term participation of the mothers’ skeletal and uterus muscles, whereas 8‐OHdG levels were low in CB irrespective of the mode of delivery, possibly as a consequence of the antioxidant action of the placenta and/or the low lipid levels in the serum of the umbilical cord.

Evaluation of glucose-6-phosphate dehydrogenase activity in two different ethnic groups using a kit employing the haemoglobin normalization procedure.

AIM Correct evaluation of Glucose-6-Phosphate Dehydrogenase (G-6-PD) activity of two ethnic groups using a fully quantitative kit with a simultaneous Hemoglobin Normalization (Hb Normalization) procedure. DESIGN AND METHODS Two groups of mothers and their healthy full term newborns of Greek (n = 1.166) and Albanian (n = 818) origin were tested for their G-6-PD activity employing a direct normalization protocol. RESULTS Greek mothers and newborns showed a higher prevalence for G-6-PD deficiency as compared to those of Albanian origin. Males of G-6-PD deficient mothers confirmed the efficacy of the method. CONCLUSION A fully quantitative G-6-PD kit employing Hb Normalization is essential for the correct classification of G-6-PD activity, both in male and female subjects.

The effect of nutritional habits on maternal- neonatal lipid and lipoprotein serum levels in three different ethnic groups

Aim: To investigate the effect of nutritional habits on lipid profiles in mothers of three different ethnic groups and in their newborns. Subjects and Methods: Lipids and lipoproteins were determined in 7-day dietetic diaries of 9,134 mothers (Greeks n = 3,118, Albanians n = 3,050, Muslim Asians n = 2,966), in their sera and in the cord blood of their newborns with routine methods. Results: Monounsaturated fat intake (35 ± 12 g/day) was similar among the groups. Total fat, saturated fat and cholesterol intakes were significantly lower in Asians than those in Albanians and Greeks. Significantly lower lipid and lipoprotein concentrations (cholesterol 5.09 ± 0.85 mmol/l, triglyceride, TG, 2.38 ± 0.58 mmol/l, low-density lipoprotein cholesterol, LDL-C, 2.90 ± 0.78 mmol/l, very-low-density lipoprotein cholesterol, VLDL-C, 0.32 ± 0.11 mmol/l) were measured in the Muslim Asian mothers and in their newborns (cholesterol 1.06 ± 0.26 mmol/l, TG 0.52 ± 0.16 mmol/l, LDL-C 0.49 ± 0.10 mmol/l and VLDL-C 0.10 ± 0.02 mmol/l; p < 0.001). Higher levels of the mentioned biochemical parameters were found in Greek mothers versus their newborns (cholesterol 5.20 ± 0.98 mmol/l, TG 2.37 ± 0.62 mmol/l, LDL-C 3.40 ± 0.85 mmol/l and VLDL-C 0.48 ± 0.13 mmol/l vs. cholesterol 1.55 ± 0.31 mmol/l, TG 0.56 ± 0.20 mmol/l, LDL-C 0.65 ± 0.15 mmol/l and VLDL-C 0.12 ± 0.01 mmol/l; p < 0.001) and Albanian mothers versus their newborns (cholesterol 7.1 ± 0.78 mmol/l, TG 2.55 ± 0.60 mmol/l, LDL-C 4.1 ± 0.88 mmol/l and VLDL-C 0.52 ± 0.13 mmol/l vs. cholesterol 1.6 ± 0.40 mmol/l, TG 0.59 ± 0.15 mmol/l, LDL-C 0.70 ± 0.21 mmol/l and VLDL-C 0.12 ± 0.01 mmol/l; p < 0.001). The highest HDL-C levels were observed in the Asian mothers (1.60 ± 0.31 mmol/l vs. 1.4 ± 0.39 mmol/l in Greeks and 1.31 ± 0.39 mmol/l in Albanians; p < 0.001). Conclusion: The normal lipid profile in Greeks, the high one in Albanians and the low profile in Muslim Asians may be due to their nutritional habits and their socioeconomic status affecting those of their newborns.

Association of C609T-Inborn Polymorphism of NAD(P)H: Quinone Oxidoreductase 1 with the Risk of Bronchopulmonary Dysplasia in Preterm Neonates

UNLABELLED Objectives In bronchopulmonary dysplasia (BPD), direct exposure to oxygen therapy can damage the pulmonary epithelium via oxidative stress. The NAD(P)H quinone oxidoreductase 1 (NQO1) enzyme detoxifies genotoxic products of oxidative stress. The corresponding gene is subject to an inactivating single-nucleotide polymorphism (C(609)T), which reduces detoxifying ability. The aim of this study was to investigate whether the C(609)T NQO1 inborn gene polymorphism is associated with an increased risk of BPD. Study Design Peripheral blood samples from 119 premature neonates ≤ 32 weeks of gestational age (42 BPD and 77 non-BPD) were used for DNA extraction. NQO1 genotyping was performed using the polymerase chain reaction-restriction fragment length polymorphism method. Results A significantly higher frequency of the NQO1 polymorphism was observed in BPD neonates compared with neonates without BPD. All neonates with ≤ 1,000 g birth weight who carried the mutant allele in heterozygous or homozygous state developed BPD. None of the BPD nonaffected group neonates with ≤ 1,000 g birth weight carried the NQO1 polymorphism. Conclusion The higher incidence of NQO1 mutants among BPD neonates as well as the presence of the mutant allele in all neonates with ≤ 1,000 g who developed BPD provided the first evidence for a possible pathogenetic role of the C(609)T polymorphism in BPD susceptibility due to the reduction or loss of NQO1 enzymatic activity.

Inhibitors of osteoblastogenesis in early human milk and maternal serum: evidence for protective properties of mother’s milk on bone

Abstract Objective: Lactation is associated with a dramatic increase of maternal bone turnover, leading to a reversible bone loss. Early life nutrition may influence later osteoporosis risk. Proteins synthesized by the group of wingless (Wnt) genes are key mediators of osteoblastogenesis and bone formation. We aimed to investigate maternal milk and serum concentrations of the inhibitors of the Wnt signaling pathway, Dickkopf-1 (DKK-1) and sclerostin. Material and methods: In 80 women, maternal milk and serum concentrations of DKK-1 and sclerostin were determined by ELISA on the 3rd–4th day postpartum. Concentrations were associated with various maternal, gestational and neonatal characteristics. Results: DKK-1 and sclerostin were detectable in early milk [mean ± SD: 817.17 ± 259.61 pg/mL, median (range) 258.04 (2452.40–53.17) pg/mL, respectively] at significantly lower concentrations than in maternal serum [mean ± SD: 3375.36 ± 416.75 pg/mL, median (range) 16 200.54 (58 832.00–3012.60) pg/mL, respectively], (p < .000). Maternal milk sclerostin concentrations positively correlated with respective serum ones (r = 0.599, p = .000). Maternal serum and milk sclerostin concentrations positively correlated with maternal body mass index (r = 0.37, p = .001 and r  =0.38, p = .000, respectively), while maternal serum sclerostin concentrations were higher in primiparas (p = .002). Conclusion: DKK-1 and sclerostin are present in early human milk at significantly lower concentrations, compared with maternal serum, probably contributing to the short- and long-term benefits of mother’s milk for bone health. Moreover, the large amounts of both substances in maternal serum may represent disruption of the Wnt cascade, contributing to the well-known lactation-associated bone loss, which seems to be greater in primiparas and obese mothers.