[Clinical monitoring of myocardial injury in neonates with intrauterine distress].

OBJECTIVE: To investigate whether no asphyxia neonates with intrauterine distress are complicated with myocardial injury and determine the sensitive biochemical diagnostic parameters. METHODS: A total of 89 neonates born in the First Affiliated Hospital of Sun Yat-sen University from July 2009 to December 2009 were enrolled. Fifty-three fetal distress cases with Apgar score > 7 at 1 and 5 minutes were enrolled in the study group; while the rest 36 healthy neonates, whose Apgar score = 10 at 1 and 5 minutes, were the control group. Umbilical artery blood samples of all cases were collected for blood gas analysis and biochemical measurement. RESULTS: (1) pH (7.23 ± 0.07) and BE [(-4.8 ± 3.0) mmol/L] in the study group were significantly lower than pH (7.31 ± 0.03) and BE [(-2.1 ± 1.5) mmol/L ] in the control group(P < 0.05). The lactic acid of study group [(5.2 ± 2.3) mmol/L] was higher than that of the control group [(2.3 ± 1.1) mmol/L], and the difference was significant (P < 0.01). However, there was no significant difference between the two groups in PaO2 [(16.2 ± 7.9) mm Hg (1 mm Hg = 0.133 kPa) vs. (17.5 ± 6.7) mm Hg] and PaCO2 [(54.0 ± 11.2) mm Hg vs. (48.5 ± 5.4) mm Hg; P > 0.05]. (2) The level of CK-MB in neonates with fetal distress[ (48 ± 59) U/L] was significantly higher than that of healthy neonates [(36 ± 27) U/L]. However, no significant difference was found in CK [(194 ± 73) U/L vs. (162 ± 95) U/L] and BNP levels [(519 ± 309) ng/L vs. (481 ± 216) ng/L; P > 0.05]. (3) Spearman rank correlation analysis showed that CK-MB level was negatively correlated with pH (r = -0.296, P < 0.05) and BE (r = -0.318, P < 0.05) of umbilical artery blood, while BNP level was positively correlated with umbilical lactic acid (r = 0.278, P < 0.05). No correlation was found between other parameters (P > 0.05). CONCLUSIONS: Intrauterine distress without neonatal asphyxia had effect on fetal myocardial injury. CK-MB can be used as a sensitive parameter for monitoring the development of myocardial injury. The severity of myocardial injury was related to fetal acidosis.

[Pregnant outcomes and neonatal anthropometry in women with abnormal glucose challenge test and normal oral glucose tolerance test during pregnancy.].

OBJECTIVE: To evaluate the influences of abnormal glucose challenge test(GCT) on pregnancy outcomes and neonatal anthropometric data in women with normal oral glucose tolerance test(OGTT). METHODS: Totally 214 women who delivered in the First Affiliated Hospital of Sun Yat-sen University from November 2006 to December 2007 were enrolled. 50 g GCT was performed at 24-28 weeks of gestation and 75 g OGTT would be followed if GCT >/= 7.8 mmol/L. Those patients, whose OGTT results below the following criteria (5.3 mmol/L, 10.0 mmol/L, 8.6 mmol/L, 7.8 mmol/L), were classified as normal OGTT. Altogether, 116 of the 214 women with abnormal GCT and normal OGTT were collected as the study group and the rest 98 women with normal GCT as the control group. The pregnant outcomes of the two groups were analyzed. The neonatal anthropometry, including birth weight, body length, head circumference and shoulder circumference, were recorded. Other neonatal anthropometric data, such as upper arm circumference, tricep skinfold thickness and hypodermic fat thickness of abdomen were measured by a tape measure within 24 hours after birth. RESULTS: (1) Pregnant outcomes: No significant difference was found in the rate of assisted vaginal delivery, polyhydramnios, premature rupture of membranes and fetal distress between the study and control group [10.3% (12/116) vs 4% (4/98), 5.2% (6/116) vs 10% (10/98), 13.8% (16/116) vs 17% (17/98), 20.7% (24/116) vs 13% (13/98), P > 0.05, respectively], but the rate of cesarean section, spontaneous vaginal delivery and large for gestational age babies in the study group were different from those of the control [72.4% (84/116) vs 51% (51/98), 17.2% (20/116) vs 45% (44/98), 25.9% (30/116) vs 6% (6/98), P < 0.05, respectively]. (2) Neonatal anthropometry: The birth weight of the study group was significantly higher than that of the control group [(3.4 +/- 0.4) kg vs (3.3 +/- 0.4) kg, P < 0.05], but no significant difference was shown in any other neonatal anthropometric results between the study and control group, including body length [(49.9 +/- 1.3) cm vs (49.7 +/- 1.4) cm], head circumference [(33.4 +/- 1.5) cm vs (33.8 +/- 1.7) cm], shoulder circumference [(35.4 +/- 2.3) cm vs (35.0 +/- 2.3) cm], upper arm circumference [(11.0 +/- 0.7) cm vs (10.9 +/- 0.8) cm], tricep skinfold thickness [(9.7 +/- 1.0) mm vs (9.9 +/- 1.4) mm] and hypodermic fat thickness of abdomen [(7.2 +/- 1.2) mm vs (7.2 +/- 1.0) mm; all P > 0.05]. CONCLUSION: Women with abnormal GCT alone may have no significant influences on neonatal anthropometric data, but might have more cesarean section, large for gestational age babies, and neonatal birth weight than those women with normal GCT.