Long-term outcomes of extremely preterm infants and extremely low birth weight infants with low one-minute Apgar score / 中华围产医学杂志

Objective To investigate the relationships between low one-minute Apgar score and the prognosis of extremely preterm infants (EPI) and extremely low birth weight infants (ELBWI). Methods Altogether 50 EPI and ELBWI who had a low one-minute Apgar score ( ≤ 7) and were admitted to the Neonatal Intensive Care Unit (NICU) of Peking University Third Hospital from January 1,2010 to December 31, 2015 were enrolled in this study. All of them were divided into two groups according to their Apgar score: mild group (4-7) and severe group (0-3). Medical records of the subjects were reviewed and an at least 18 months follow up study was conducted. Conditions of all subjects during perinatal period and hospitalization were summarized. Outcomes and follow-up results were compared between the two groups by using Fisher exact test. Results (1) General information: Fifty infants were involved, among which 37 had a mild low Apgar score and 13 had a severe low Apgar score. The mean gestational age was (27.7±2.1) weeks and the mean birth weight was (884.4±174.3) grams. (2) Main complications (some infants with more than one complication): There were 42 cases of neonatal respiratory distress syndrome, 12 cases of pulmonary hemorrhage, 21 cases of bronchopulmonary dysplasia, 31 cases of patent ductus arteriosus, 36 cases of intraventricular hemorrhage, 22 cases of white matter damage and six cases of retinopathy of prematurity. (3) Outcomes: The survival rate was 48% (24/50) and the mortality rate was 52% (26/50). Among the 26 infants, five died despite treatment and 21 died within 72 hours after their parents giving up treatment. There were no significant differences in the survival rates, mortality rates and rates of abandon treatment between the two groups [43% (16/37) vs 8/13; 11%(4/37) vs 1/13; 46% (17/37) vs 4/13; Fisher exact test, all P>0.05]. (4) Follow-up results: Twenty-one infants were followed-up to at least 18 months of age, among which four were normal, 10 had growth retardation and recurrent respiratory tract infection and seven had motor development retardation. The incidence of motor development retardation in severe group was higher than that in mild group, and the difference between them was statistically significant (5/8 vs 2/13, Fisher exact test, P=0.046). Conclusions EPI or ELBWI with a low one-minute Apgar score have many nosocomial complications, resulting in high mortality and high incidence of motor development retardation.

Placental expression of CDKN1C imprinted gene and birth weight of appropriate and small for gestational age neonates / 中华围产医学杂志

Objective To investigate the relationship between the expression of imprinted gene CDKN1C in placenta and the birth weight of neonates.Methods Twenty-nine term small for gestational age (SGA) neonates admitted to Peking University Third Hospital from January 1,2014 to December 31,2014 were recruited,and 29 appropriate for gestational age (AGA) neonates with a difference of not more than one week in gestational age served as controls.Fresh placental tissue was collected and the expression of imprinted gene CDKN1C mRNA in the placenta were detected by real-time fluorescence quantitative-polymerase chain reaction,and its protein expression was estimated by Western-blot.Chi-square test,independent-sample t test,Pearson's correlation analysis were used for statistical analysis.Results The CDKN1C mRNA expression level in SGA was significantly higher than that in AGA (0.133± 0.059 vs 0.100±0.046,t=2.401,P=0.020),so was the CDKN1C protein expression (0.280±0.043 vs 0.190±0.041,t=8.410,P=0.000).The CDKN1C mRNA expression levels were negatively correlated with birth weight in both groups (SGA group,r=-0.587,P=0.001;AGA group,r=-0.569,P=0.001),and the correlation was slightly stronger in SGA (r2=0.344) than in AGA (r2=0.324).The CDKN1C protein expression levels of the two groups were negatively correlated with birth weight (SGA group,r=-0.579,P=0.001;AGA group,r=-0.497,P=0.006),the correlation being stronger in SGA group (r2=0.335) than in AGA group (r2=0.247).The CDKN1C mRNA and protein expression levels of the two groups were negatively correlated with birth weight for gender,especially in males [mRNA:r2=0.293(male)vs r2=0.185(female);protein:r2=0.730 (male) vs r2=0.601(female)].Neither CDKN1C mRNA nor protein expression level was correlated to the placenta weight (mRNA:SGA group,r=0.119,P=0.540;AGA group,r=-0.069,P=0.722;protein:SGA group,r=0.126,P=0.515;AGA group,r=-0.247,P=0.196).Conclusions The expressions of CDKN1C mRNA and protein may be related to birth weight of term SGA neonates,especially in male infants.

Analysis of very low birth weight infants with nosocomial infection within eleven years / 中华围产医学杂志

Objective To investigate the epidemiological and clinical characteristics, risk factors, outcome and prevention strategy of very low birth weight infant (VLBWI) with nosocomial infection in neonatal intensive care unit (NICU). Methods The VLBWIs whose birth weight were less than 1500 g and hospital stays were more than 48 hours in NICU of Peking University Third Hospital from January 1, 1998 to December 31, 2008 were selected in this study. They were divided into nosocomial infection group and non-infection group. The clinical features and outcomes of nosocomial infection were summarized and the risk factors of which were analyzed with Logistic regression. Results There were 158 VLBWIs who fit for the criteria of our study during the eleven years, the mean birth weight was (1263.8± 155.5) g and the mean gestational age was (30.4±2.1) weeks. There were 70 times and 56 cases suffered from nosocomial infections. The incidence of nosocomial infection was 35.4% and hospital stay-related incidence was 14.4‰. Among 70 times of infections, there were 40(57.1%) pneumonia, 22(31.4%) septicemia, 4(5.8%) thrush, 1(1.4%)conjunctivitis, 1 ( 1.4%) upper respiratory tract infection and 2 (2.9%) unknown site infections.Forty-one strains of bacteria were isolated from 121 specimens, among which gram-negative bacillus accounted for 56.1% and gram-positive cocci for 46.3%. The duration of hospital stay of VLBWIs with nosocomial infection was significantly longer than that without [(43.7±15.5) d vs (26.3±14.4) d] (t = -7.058, P＜0.01). The fatality rate of VLBWIs with and without nosocomial infection was 3.6% (2/56) and 3.9% (4/102), and there was no significant difference (x2 = 0.012,P＞0.05). Logistic regression showed that mechanical ventilation (OR = 3.388, 95% CI: 1.656-6.932, P=0.001) and parenteral nutrition (OR= 7.054, 95%CI: 2.005-24.813, P=0.002) were risk factors of nosocomial infection. Conclusions The incidence of nosocomial infection in VLBWIs in NICU is high. Mechanical ventilation and parenteral nutrition should be avoided and the duration of invasive operation and treatment should be shortened as much as possible to minimize the chances of nosocomial infection in VLBWIs.

Dynamic changes of insulin sensitivity in rats with fetal growth restriction / 中华围产医学杂志

Objective To investigate the regular pattern of dynamic changes of insulin sensitivity in fetal growth restriction (FGR) rats. Methods Twenty pregnant female rats were randomly divided into two groups as normal-protein group (NP) and low-protein group (LP), which respectively received normal protein diet (20% protein) and low protein diet (8% protein) during pregnancy. Weights of newborns were measured within 6 hours after birth, and the LP offspring whose birth weights were at least 2 standard deviations below the mean of NP offspring (≤2 standard deviations) were defined as FGR rats. At day 3, 7, 14, 30, 60 and 90 after birth, rats were fasted for 12 hours and then angular vein blood was collected to measure fasting plasma glucose (FPG) and fasting serum insulin (FINS) level. At 90 days of age, intraperitoneal glucose tolerance test (IPGTT)was performed; and blood triglyceride ( TG ), low-density lipoprotein cholesterol ( LDL-C ),high-density lipoprotein cholesterol (HDL-C) and glycosylated hemoglobin Alc (HbAlc) were measured. Insulin sensitivity was evaluated by FINS, insulin resistance index (HOMA-IR), insulin sensitivity index (ISI) and IPGTT. Results (1) Birth weights of LP offspring [(4. 92 ± 0. 36) g]were significantly lower than those of NP ones [(6. 43 ± 0. 59) g] (t = 14. 73, P＜0. 05). The incidence of FGR in LP was 88. 2% ; and for the male and female rats, the FGR rate was 94. 1% and 83. 1%, respectively. (2) FPG levels in the male FGR rats were significantly higher than in the NP from the age of 60 days [(9.38 ± 1.57) mmol/L vs (5. 58 ± 1.24) mmol/L] to 90 days [(8. 95 ±1.83) mmol/L vs (6. 21± 1.14) mmol/L] (t=-3. 291, P＜0. 05), while FPG levels in female FGR rats increased significantly only at 90 days of age [(9. 08±1.65) mmol/L vs (6.73±0. 67) mmol/L](t=-3. 226,P＜0. 05). FINS levels were significantly higher in FGR rats than in the NP from the age of 30 days (male FGR rats) or 60 days (female FGR rats) to 90 days (P＜0. 05, respectively).Similarly, HOMA-IR was significantly higher in FGR rats than in the NP at the age of 30 days (male FGR rats) or 60 days (female FGR rats) to 90 days (P＜0. 05, respectively). ISI in male FGR rats showed a reduction in comparison with the NP from the age of 30 to 90 days, while as to the female FGR rats it was significantly lower than in the NP only at 60 days of age and continued to 90 days (P＜0. 05, respectively). IPGTT showed that after injection of glucose, blood glucose at all four points (from 0 min to 120 min) in both male and female FGR rats were higher than that in the NP (P＜0. 05). (3) No significant difference was observed in TG, LDL-C and HDL-C at 90 days of age between the FGR rats and NP ones, while HbA1c in the male FGR rats was significantly higher than that in the NP [(7. 03±0. 54) % vs (4. 37±0. 64)%,t= -8. 028, P＜0. 05]. Conclusions FGR rats are able to maintain glucose balance and normal insulin levels during their earlier age, while insulin sensitivity decreased from adolescence to adulthood. The change of insulin sensitivity is different between male and female FGR rats, and male FGR rats are more likely to develop insulin resistance.

Relation of serum leptin to birth weight and insulin in preterm and term neonates / 中华围产医学杂志

Objective To investigation the relation of leptin to birth weight and insulin in preterm and term neonates and to explore whether a functional “adipoinsular axis” might exist in preterm and term neonates. Methods A total of 264 preterm and term newborns were recruited and categorised according to gestation length. Anthropometric measurements were performed at birth. Leptin, fasting glucose and insulin were measured at 3 days of life. Results Serum leptin was significantly higher in term than in preterm. The relation between serum leptin and gestation followed a non-linear pattern; The slope of the curve began to increase after 34 weeks gestation. Serum leptin was associated with birth weight and insulin in newborn more than 32 weeks gestation(r=0.240, 0.227, P

Study of the intrauterine environment's effect on neonatal insulin gensitivity / 中华围产医学杂志

Objective To Discuss the influence of intrauterine environment to neonatal insulin sensitivity. Methods Two hundred and eight new borns were selected into our study and divided into 4 groups, they are full term adequate for gestational age(AGA) group(133 cases), full term small for gestational age(SGA) group(30 cases), preterm AGA group(87 cases) and preterm SGA group(30 cases). In the morning of the 3rd day after birth their serum glucose, insulin and lipid concentration were examined before milk, and the ratio of insulin to glucose were calculated. Statistical analysis was performed with the SPSS 9.0 software. Results The mean ratio of insulin to glucose are 1.243?0.703 in full term SGA group and 0.259?0.837 in full term AGA group, while in preterm SGA group and preterm AGA group the mean ratio of insulin to glucose are 1.190?0.683 and 0.497? 0.080, it shows that each SGA group has significantly higher insulin to glucose ratio than the AGA group( P

Effect of the family history of cardiovascular disease and diabetes on birth weight and insulin sensitivity in neonates / 中华围产医学杂志

Objective Examining the potential for genetic influences on the association of fetal growth restriction (FGR) with increased occurrence of coronary heart disease, hypertension and diabetes in later life. Methods The study group consisted of 75 neonates of small-for gestation age (SGA) and 244 neonates of adequate for gestational age (AGA), whose mothers did not have diabetes mellitus. Anthropometric measurements were performed at birth. Fasting glucose and insulin levels were measured on the 3rd day after birth. The history of cardiovascular disease and diabetes mellitus was recorded in their parents and grandparents. Results The prevalence of coronary heart disease, hypertension and diabetes mellitus was significantly higher in parents and grandparents of SGA group than that of AGA group (20.0%, 30.7%, 12.0% vs 9.3%, 14.7%, 3.5%,P0.05). Conclusions Genetic factor may promote both FGR and susceptibility to occurrence of coronary heart disease, hypertension and diabetes.