[Outcome of pregnancy for immigrant women: a retrospective study]. / L'outcome della gravidanza nella donna immigrata: studio retrospettivo.

AIM: Italy is experiencing a continuous increase in female immigration and, as a consequence, the number of births by immigrant mothers. The objective of our study was therefore to compare indices for maternal-foetal wellbeing as regards immigrant as opposed to autochthonous pregnant women. METHODS: An analysis was made of CEDAP data from 2001 to 2008 concerning parturients at Udine Obstetric and Gynaecological Clinic, DRG clinical data for 2008 and clinical records for 2008 of foreign parturients: the focus was on which geographical area they came from, hypertensive and metabolic symptoms during pregnancy, maternal serology, gestational period up to childbirth, weight at birth, Apgar index, duration of hospitalisation for the mother and infant. RESULTS: The study covered 13,352 women of whom 2,139 were foreigners, while 363 of the latter gave birth in 2008. In terms of geographical area the largest group of immigrants came from Eastern Europe, followed by sub-Saharan African and Arab countries. The worst outcome of pregnancy was found in African women, who showed the highest incidence of chronic hypertension, pregnancy-induced hypertension and pre-eclampsia and they also developed gestational diabetes more frequently, although a high incidence was also seen for Eastern European and Arab women. Furthermore, African women were found to be HIV-seropositive more frequently, showed a greater tendency to preterm or severely preterm birth, with a significantly lower weight and Apgar at birth compared to all other immigrant women. As a result, African women and infants remained in hospital for a longer period. CONCLUSION: Monitoring, both pre-conceptional and during pregnancy, needs to be intensified, especially among African mothers, in order to reduce the maternal-foetal disadvantage when compared to other women.

Iron supplementation enhances response to high doses of recombinant human erythropoietin in preterm infants.

AIMS: To determine whether iron supplementation would enhance erythropoiesis in preterm infants treated with high doses of human recombinant erythropoietin (r-HuEPO). METHODS: Sixty three preterm infants were randomly allocated at birth to one of three groups to receive: r-HuEPO alone, 1200 IU/kg/week (EPO); or r-HuEPO and iron, 1200 IU/kg/week of r-HuEPO plus 20 mg/kg/week of intravenous iron (EPO + iron); or to serve as controls. All three groups received blood transfusions according to uniform guidelines. RESULTS: Infants in the EPO + iron group needed fewer transfusions than controls--mean (95% CI) 1.0 (0.28-1.18) vs 2.9 (1.84-3.88) and received lower volumes of blood--mean (95% CI) 16.7 (4.9-28.6) vs 44.4 (29.0-59.7) ml/kg. The EPO group also needed lower volumes of blood than the controls--mean (95% CI) 20.1 (6.2-34.2) vs 44.4 (29.0-59.7) ml/kg, but the same number of transfusions, 1.3 (0.54-2.06) vs 2.9 (1.84-3.88). Reticulocyte and haematocrit values from postnatal weeks 5 to 8 were higher in the EPO + iron than in the EPO group, and both groups had higher values than the controls. Mean (SEM) plasma ferritin was lower in the EPO group-65 (55) micrograms/l than in the EPO + iron group 780 (182) micrograms/l, and 561 (228) micrograms/l in the control infants. CONCLUSIONS: Early administration of high doses of r-HuEPO with iron supplements significantly reduced the need for blood transfusion. Intravenous iron (20 mg/kg/week in conjunction with r-HuEPO yielded a higher reticulocyte count and haematocrit concentration after the forth week of life than r-HuEPO alone. Infants treated with r-HuEPO alone showed signs of reduced iron stores.

The bronze baby syndrome: evidence of increased tissue concentration of copper porphyrins.

A case regarding a newborn infant with severe Rh haemolytic disease, who presented with the bronze baby syndrome and eventually died, is reported. The postmortem examination showed marked extramedullary haematopoiesis in the liver and spleen, heavy hepatic haemosiderosis and mild intralobular cholestasis. The porphyrin content, which was assayed in different tissues, was very high in the liver, suggesting that the increased erythropoiesis seen in Rh haemolytic disease leads to an increased synthesis of porphyrins as by-products of haem synthesis. Phototherapy causes photodestruction, sensitized by bilirubin, of porphyrins (mainly copper porphyrins), yielding brown photoproducts.

Effect of high doses of human recombinant erythropoietin on the need for blood transfusions in preterm infants.

To determine whether prophylactic treatment with recombinant human erythropoietin (rHuEPO) and iron would reduce the need for blood transfusions, we randomly assigned 22 premature infants with gestational ages less than or equal to 32 weeks and birth weights less than or equal to 1.75 kg to receive rHuEPO, 400 IU/kg three times a week, plus iron, 20 mg/wk intravenously, from the second day of life (11 infants), or no rHuEPO and no iron (11 infants). The two groups had similar birth weights and clinical variables. The treated infants required fewer blood transfusions (0.8 +/- 1.5 vs 3.1 +/- 2.1; p = 0.01) and less volume of packed erythrocytes (14.2 +/- 25.9 vs 48.4 +/- 34.0 ml/kg; p = 0.02). The amounts of blood sampled were not different (19.5 +/- 21.1 vs 27.8 +/- 19.1 ml/kg; p = 0.35). Reticulocyte and hematocrit values were higher in the treated group (4.46% +/- 0.8% vs 1.49% +/- 1.1% (p = 0.0001) and 48.1% +/- 7.3% vs 43.8% +/- 4.7% (p = 0.004), respectively). No side effects of either rHuEPO or intravenously administered iron were noted. These data indicate that rHuEPO, in combination with iron supplementation, is effective in reducing the need for blood transfusions in the premature infant. More information is needed on dosage, timing, and iron and vitamin supplementation.

Renal function in preterm twins with birthweight discordance.

To evaluate the development of renal function in fetal malnutrition conditions, we tested glomerular filtration rate and fractional sodium excretion (FENa) of premature twins at birth (less than or equal to 35 weeks gestational age) with birthweight discordance, divided according to birthweight (less than or equal to 10% group A; higher birthweight group B). Groups A and B of twins are comparable in fluid intake, biochemical serum tests (glucose, sodium, potassium, albumin, total protein, osmolality and hematocrit) and also in percent weight decrease at 24 h of life. Moreover, both creatinine clearance (CrCl) and FENa result respectively correlated directly (r = +0.63) and indirectly (r = -0.46) with gestational age of twins. Consequently, CrCl (8.3 +/- 4.3 vs 8.3 +/- 4.5 ml/min/1.73 m2) and FENa (3 +/- 2.8 vs. 2.7 +/- 2.8%) do not result different in relation to birthweight discordance of premature twins. In conclusion, at birth, gestational age is the main determinant of kidney function in premature twins with birthweight discordance.

Urinary beta-2-microglobulin excretion in prematures with respiratory distress syndrome.

Urinary concentrations of beta 2-microglobulin (beta 2M) were studied in 25 prematures (less than or equal to 35 weeks) with respiratory distress syndrome (RDS), divided into two groups (group 1: ventilation greater than or equal to 2 days; group 2: oxygenotherapy less than or equal to 4 days), to assess the value of beta 2M in the detection of tubular damage in relation to the severity and management of the respiratory disease. The data were compared with those obtained from 10 healthy controls, matched for birth weight and gestational age. Measurements of beta 2M were made on urine collected on days 1, 3, and 5 until the recovery phase of RDS was reached. Urinary beta 2M values for infants with RDS were increased on days 1 and 3, with respect to the controls, and significantly increased in the ventilated group (8,814 +/- 4,768 vs. 2,594 +/- 3,231 micrograms/l, p less than 0.005 and 7,624 +/- 6,264 vs. 2,762 +/- 2,316 micrograms/l, p less than 0.05, respectively). Serum sodium and creatinine, creatinine clearance, fractional tubular sodium excretion and renal function index on day 1 were similar in prematures with or without RDS. However, the ventilated newborns presented higher urinary sodium excretions. On the 5th day, no significant differences in urinary beta 2M were found among the groups. The elevated levels of urinary beta 2M in the acute phase of RDS and in the more severe lung disease indicate the existence of subclinical tubular dysfunction, probably secondary to hypoxic stress and to negative hemodynamic effects of ventilatory management.