Cord Blood Lipid Profile In Preterm And Term Newborns: A Hospital Based Comparative Study From North Kanara Region Of India

Introduction: Background: Cardiovascular diseases are common cause of moertality in developed countries and also are rising trend in developing countries. It has its roots in adverse fetal environment; which lead to adult diseases like Coronary artery diseases in later life. The objective of this study was to compare & contrast the lipid profiles inAim: term and preterm neonates. a case-control study was conducted in departments of PediatricsMaterials and Methods: & Obstetrics of Karwar Institute of Medical Sciences, Karwar, Karnataka of India over a period of 10 months. 500 deliveries were recruited randomly which met the inclusion criteria after informed written consent; babies were divided into Comparison group 1 (Preterm gestation of <37weeks gestational age)& comparison group 2 (term gestation of >37 weeks gestational age). Cord blood lipd-profiles of these babies were compared & studied. Out of 500 babiesResults: studied, there were 197 preterm (<37weeks gestational age) & 409 term babies (>37 weeks gestational age) babies. The Mean gestational age was 39.55±1.11 weeks for term babies & 34.50 ± 2.77 weeks for preterm babies. The mean TC level (73.76±27.98 mg/dL) was higher in comparison group 1(preterms) compared to comparison group 2(term)babies(62.60 ± 34.20mg/dL) and this difference was statistically very significant(P=0.003). The mean low density lipoprotein(LDL) level (35.54 ± 20.96mg/dL) was more higher in comparison group 1(preterms) compared to comparison group 2(term)babies (27.89 ± 15.62 mg/dL) and this difference was statistically very significant(P=0.001). The mean very low density lipoprotein(VLDL) level (11.12 ± 5.13mg/dL) was more higher in comparison group 1(preterms) compared to comparison group 2(term)babies (8.68 ± 7.55 mg/dL) and this difference was statistically very significant(P=0.003).The mean Triglycerides(TGs) levels of comparison group 1(preterms) & comparison group 2(term)babies were comparable with no statistical significance(42.63 ± 25.80mg/dL of preterm babies ; 42.43 ± 28.10mg/dL of term babies; P=0.948). The mean High density lipoprotein(HDL) levels of comparison group 1(preterms comparison) & comparison group 2(term)babies were comparable with low statistical significance(26.37 ± 13.65mg/dLof reterm babies ; 24.78 ± 10.76mg/dL of term babies;P=0.218). Levels of most lipidConclusion: components were observed to be higher in preterm babies compared to term babies

Detection of fetal malnutrition and its associated maternal factors in a rural setting

Background: The objectives of study were to analyse and compare the methods for detection of fetal malnutrition and to study the maternal factors associated with fetal malnutrition in babies born in rural hospitals.Methods: Periodic prospective cross-sectional case-control questionnaire-based study. Nursing home and Hospital based in rural population from January 2017-March 2018. There were 350 term newborns born in Shrinivasa Nursing Home, and Crawford General Hospital, Sakleshpur, were selected consecutively. Inclusion criteria: live, singleton term neonates. Exclusion criteria: Preterms, post-terms, those with congenital malformation, multiple gestations, cephalhematoma, subgaleal bleed. Anthropometry, fetal malnutrition assessed using clinical assessment of nutrition (CAN) score, Ponderal and Kanawati indices between 24–48 hours of birth. Newborns with fetal malnutrition (cases), and well-nourished babies (controls) assessed for maternal risk factors using standardised questionnaire from mothers.Results: CAN score identified 185 (52.9%) as malnourished and 165 (47.1%) as normal; Ponderal index classified 170(48.6%) as malnourished and 180 (51.4%) normal. Kanawati index grouped 151 (43.1%) as malnourished. Maternal factors:  age (91.7% among <20 yr mothers-malnourished, 25% among >35 yrs), socioeconomic status (status 3, 4 had 57.2%, 66.7% malnourishment), improper antenatal care(80.7% irregulars; 38.5% among regulars), primiparity (60%;against  38.3% among multipara), pre-eclampsia (78.7%; 41.3% in normotensives), anemia (55.4%), weight gain (83.2% in <10 kg; 33.33% in >10 kg), stature (73.5% in <145 cm; 39.7% in >145 cm), medical illness (55.81%).Conclusions: CAN score is simple, systematic, clinical method of identifying malnutrition; statistically superior as screening tool. Maternal factors: improper antenatal checkups, primiparity, pre-eclampsia, medical illness, inadequate weight gain, short stature had significant association with fetal malnutrition. Maternal age, socioeconomic status, anemia not statistically significant.

Detection and comparison of fetal malnutrition by CANSCORE and other methods.

Background: Objective of current study was clinical assessment of nutritional status of neonate using CANSCORE and comparison with other methods of determining fetal malnutrition. Design: Cross sectional study. Setting: Tertiary care hospital. Study subjects: 384 live born singleton neonates with known gestational age and no major congenital malformation. Methods: Birth weight, length, midarm circumference and head circumference recorded in new-borns. Ponderal index and mid arm to head circumference ratio was calculated. Clinical assessment of nutritional status was done on the basis of CANSCORE and compared with other methods. Results: CANSCORE <25 separated 67.71% of the babies as well-nourished and 32.29% as malnourished. Weight for age and MAC/HC classified nearly 70% of babies as well-nourished and 30% as malnourished. Also Ponderal index classified 75.52% the babies as well-nourished and 24.48% as malnourished. Conclusion: CANSCORE may be a simple clinical index for identifying fetal malnutrition and for prediction of neonatal morbidity associated with it, without the aid of any sophisticated equipments.

Detection of Fetal Malnutrition by CAN Score at Birth and its Comparison with other Methods of Determining Intrauterine Growth.

Background: Fetal malnutrition (FM) and the terms ‘small for gestational age’ (SGA) and ‘intrauterine growth retardation’ (IUGR) are not synonymous, one may occur without the other. FM can be clinically assessed by using the Clinical Assessment of Nutritional Status (CAN) score. CAN score can assess the prevalence of FM among term newborns and is comparable to anthropometric criteria used to assess fetal growth. Methodology: A prospective cohort study was carried out at a tertiary referral hospital affiliated to a medical college, consisting of 200 singleton full-term neonates over a period of two months. In all neonates complete anthropometric assessment as per standard procedures and determination of weight for gestation was done. On the basis of Alexander and Associates intrauterine growth curves, newborns were classified into SGA and appropriate for gestational age (AGA). FM was assessed using CAN score as a standard and compared with weight for gestation age and Ponderal index (PI) Results: CAN score identified 17.5% (n = 35) malnourished neonates and 82.5% (n = 165) of babies as well-nourished by keeping the cut-off value of <25. Eight percent of AGA babies and 76.8% of SGA babies were found to be well-nourished on comparing weight for gestation age with CAN score. Sixteen (8%) babies were found to have FM using PI but by applying CAN score only 10 babies were found to have FM. The sensitivity and specificity of weight for gestational age were found to 82.85% and 41.81%, respectively and that of PI 28.57% and 96.36%, respectively, when CAN score was taken as standard. Conclusion: This implies that CAN score can identify fetal malnourishment in those neonates, which are missed by other methods.

Does the maternal micronutrient deficiency (copper or zinc or vitamin e) modulate the expression of placental 11 βhydroxysteroid dehydrogenase-2 per se predispose offspring to insulin resistance and hypertension in later life.

The relevance of maternal macronutrient deficiency on developmental origin of health and adult disorders has been well studied but not that of micronutrients. We hypothesized that chronic maternal dietary mineral (copper or zinc) or vitamin E restriction modulates the expression of placental 11 β hydroxysteroid dehydrogenase-2 (11 β HSD-2) per se predisposing the offspring to insulin resistance (IR) and hypertension in later life. Female weaning Swiss albino mice received a control or a 50% of Vitamin-E or Zn or Cu restricted diet and mated with control males. Pups born to the dams on the restricted diet had significantly (P<0.001) reduced body weight and crown rump length. These offsprings were weaned on to the restricted diet till postnatal day 180. Glucose intolerance in association with hyperinsulinemeia (IR), hyperlipidemeia and increased systolic blood pressure were recorded in all the offsprings of micronutrient restricted groups. Placental 11 β HSD-2 expression was attenuated, while activities of glucocorticoid -insensitive enzymes were unchanged in all the restricted groups. Thus, the present study reiterates the importance of micronutrients during pregnancy because chronic maternal micronutrient deficiency may alter placental 11 β HSD-2 expression and predispose the offspring to IR and hypertension in later life.