Risk of early onset neonatal septicemia in babies born to mothers with pre-eclampsia

The effects of maternal pre-eclampsia on fetal outcome has been a subject of concern for a long time. This prospective study aimed to find out the risk factors of early onset septicemia and its relation to neutropenia in the neonates of the pre-eclamptic mothers. Ninety newborn babies born to mothers with pre-eclampsia and 90 matched born to normal mothers were included. The results showed that the IPETMs and INMs groups demographic data were comparable [p >0.05]. Six neonates of IPEMs developed early onset sepsis versus 2 among INMs. The difference was not statistically significant [p<0.05]. Neutropenia was three-fold more frequent in IPETMs when maternal hypertension was severe

Conclusion: babies of pre-eclamptic mothers had relatively more risk of developing early onset septicemia than those of normal mothers. This risk was significantly more in neutropenic babies than non-neutropenic ones of pre-eclamptic mothers

What is the optimal gestational age for twin delivery

Optimal gestational age for twins remains unclear. The Objective of this study was to evaluate the timing of twin delivery associated with perinatal outcome in gestations of at least 36 weeks. The study was a retrospective analysis of infant and maternal hospital records for a consecutive series of twin deliveries at El-Shatby Hospital. The inclusion criteria were delivery after 36 weeks' gestation during a two-year period, without congenital anomalies or early fetal demise. Adverse perinatal outcome was significantly higher among the twin pregnancies that delivered before 38 weeks' gestation. Twin pregnancies that delivered between 36 and 37 weeks' gestation were 13 times more likely to require neonatal intensive care compared with those who delivered at or after 38 weeks' gestation [95% confidence interval 1.8 to 95.9, p < 0.001]

Conclusion : In uncomplicated twin gestations, delivery at between 36 and 37 weeks' gestation was not assonated with a reduction in neonatal complications compared with deliveries at or after 38 weeks' gestation

Value of first-day bilirubin in predicting the development of significant hyperbilirubinemia in healthy term newborns in Alexandria

The recognition, follow-up, and early treatment of neonataljaundice has become more difficult, since the earlier discharge of newborns from hospitals has become common practice. This prospective study was undertaken to identify the newborns at risk for developing significant hyperbilirubinemia later during the first days of life by measuring the serum bilirubin levels of the first 5 days of life to determine the critical predictive serum bilirubin value on the first day of life. A total of 498 healthy term newborns were followed with daily serum total bilirubin measurements for the first 5 days of life, and cases with serum bilirubin levels of >/= 17 mg/dL after 24 hours of life were defined to have significant hyperbilirubinemia. The results showed that no newborns had a serum total bilirubin level of >/= 17 mg/dL in the first 72 hours of life. Sixty of 498 cases [12.05%] had significant hyperbilirubinemia after 72 hours of life, and these cases had significantly higher bilirubin levels than those who did not develop significant hyperbilirubinemia on each of the first 5 days' measurements. Of the 206 newborns who had a serum bilirubin level of >/= 6 mg/dL in the first 24 hours, 54 [26.21%] developed significant hyperbilirubinemia, whereas only 6 of the 292 newborns [2.05%] who had a serum bilirubin level of <6 mg/dL on the first day developed significant hyperbilirubinemia. A mean serum bilirubin level of >/= 6mg/dL on the first day had the highestsensitivity [90%]. At this critical serum bilirubin value, the negative predictive value was very high [97.9%] and the positive predictive value was fairly low [26.2%]. Furthermore, because no cases with a serum bilirubin level of <6 mg/dL in the first 24 hours of life required a subsequent phototherapy treatment and because all of those infants requiring a phototherapy treatment with serum bilirubin levels of >/= 20 mg/dL were just among the cases whose first-day bilirubin levels were >/= 6 mg/dL, the critical bilirubin level of 6 mg/dL on the first day made it possible, with the highest [100%] sensitivity and negative predictive value, to definitely predict all of the infants who would have a bilirubin level of >20 mg/dL, requiring a phototherapy treatment later during the first days of life

Conclusion: A serum bilirubin measurement and the use of the critical bilirubin level of 6 mg/dL in the first 24 hours of life will predict nearly all of the term newborns who will have significant hyperbilirubinemia and will determine all those who will require a phototherapy treatment later during the first days of life

Study of leptin levels in pregnant women and newborn infants in Alexandria

Little is known about variation in leptin levels during pregnancy or the level or function of leptin in the growing fetus and infants. The aim of the present study was to examine plasma concentration of leptin in pregnant women and their newborn infants during the first 3 months of life, and to relate plasma leptin concentration to body weight and gender during this period. One hundred and eighty [180] healthy nullior primipara women were selected to study leptin. The study was randomized and double blinded, and the participants received either cod liver or corn oil. Blood samples were taken from the mothers during pregnancy in weeks 18 and 35, and from the umbilical cord and from 4-and 14-week-old infants. The mothers' BMI was calculated. Results proved that leptin concentration in maternal plasma increased during pregnancy from 15.5 +/- 9.0 mg/L [n = 175] in week 18 to 17.7 +/- 10.7 mg/L [n = 166] in week 35. Mothers, pregnant with female fetuses [n = 77], had a significant increase in plasma leptin concentration, from 15.5 +/- 8.8mg/L [n=83] at 18 weeks to 18.5 +/- 10.9 mg/L [n = 80] at 35 weeks of pregnancy, whereas in mothers pregnant with male fetuses, the increase was not significant [15.4 +/- 9.3 mg/L [n = 92] to 17.0 +/- 10.5 mg/L [n = 86]. BMI increased during the same time period, from 24.2 +/- 3.3 kg/m2 to 27.8 +/- 3.8 kg/m2 [n = 174]. There was a significant correlation between BMI and plasma leptin concentration at 18 weeks [r= 0.54, n = 169] and at 35 weeks [r= 0.45, n = 160], but we found no change in the relative leptin concentration [plasma leptin concentration/BMI] from week 18 to week 35. Conclusion: The leptin levels of the mothers increased during pregnancy and correlated to BMI, but the relative leptin concentration did not change. Our findings demonstrate that gender differences in plasma leptin concentrations already are present at birth. Together with the recent observation that leptin mRNA is expressed in placenta, our present results indicate that placenta may contribute to the high level of leptin found in umbilical cord plasma and suggest a role for leptin in intrauterine growth and development

Study of the effect of low-dose aspirin in pregnancy on maternal and neonatal aspirin concentrations

The objective of this study is to evaluate maternal and neonatal plasma concentrations of acetylsalicylic acid and salicylic acid and the neonatal endogenous prostanoid formation during Iow-dose aspirin prophylaxis [LDA; 75 mg daily] in pregnant women. Concentrations of acetylsalicylic acid and salicylic acid in maternal plasma after at least 4 weeks of LDA [n = 14] and in umbilical cord plasma of newborns after maternal LDA [n = 7] were determined by gas chromatography-mass spectrometry. Platelet and renal formation of thromboxane A2 and the formation of prostaglandin E2 and prostacyclin were evaluated in vivo by quantification of index metabolites in plasma and urine by gas chromatographymass spectrometry in neonates after maternal LDA [n = 14] and in a control group. The results proved that in the pregnant women, acetylsalicylic acid and salicylic acid concentrations rapidly increased after ingestion of LDA. Acetylsalicylic acid was completely eliminated within 4 hours, whereas salicylic acid was detected with low concentrations at 18 and 21 hours after dosing. In the neonates, acetylsalicylic acid was not detected. Salicylic acid was detected in 1 infant only. Platelet thromboxane A2 formation in the newborn infants was significantly suppressed but recovered within 2 to 3 days after discontinuation of LDA. Renal thromboxane A2 formation and the formation of prostaglandin E2 and prostacyclin were not affected by LDA

Conclusion: In pregnant women who are treated with LDA, acetylsalicylic acid is not completely inactivated in the portal circulation but reaches the uteroplacental circulation and exerts antiplatelet effects in the fetus and newborn