[Abnormalities in neonatal brain ultrasound examination in relation to cord blood TNF and chorioamnionitis]. / Nieprawidlowosci obrazu ultrasonograficznego mózgowia u noworodków a stezenie TNF we krwi pepowinowej i zmiany zapalne blon plodowych.

The study was undertaken to determine whether PIVH and PVL in neonates are related to cord blood TNF levels and chorioamnionitis. The study material consisted of 54 neonates--31 preterm and 23 full-term. 39 of those babies were born to mothers with clinical signs of intrauterine infection, but only in 20 cases histologic chorioamnionitis were recognised. In the whole study newborns brain ultrasound examination was taken during the first 3 days of life. Abnormal head ultrasound (PIVH--17 cases or PVL--6 cases) was diagnosed in 23 babies. That was found that brain damage, recognised during neonatal period, was mainly connected with prematurity and signs of maternal infections but not with cord blood TNF levels. We conclude that prolongation of pregnancy as well as early recognition and proper treatment of intrauterine infection can prevent PIVH and PVL in neonates.

[Hypoglycemia in newborn of the diabetic mother in relation to some indicators of perinatal hypoxia]. / Wystepowanie hipoglikemii u noworodków matek z cukrzyca a wybrane wskazniki niedotlenienia okoloporodowego.

DESIGN: To examine whether perinatal hypoxia increases the risk of occurrence of hypoglycaemia--between first and second hour of life--in newborn of the diabetic mother. MATERIAL AND METHODS: The study material consisted of 151 newborns born to 58 pregestational and 93 gestational diabetes mothers. The occurrence of hypoglycaemia was examined in accordance with some perinatal hypoxia indicators such as: 1 and 5 minutes Apgar scores, umbilical arterial blood gas analysis and cord blood erythropoietin (EPO) level. RESULTS: Newborns of the diabetic mothers in whom hypoglycaemia was recognised had lower 1 minutes Apgar scores, lower pH values, higher pCO2 values and higher EPO levels than those, in whom normoglycaemia was recognised. CONCLUSIONS: Low 1 minutes Apgar scores and occurrence of even mild perinatal hypoxia are factors increasing the risk of hypoglycaemia in the group of newborns of the diabetic mothers in the time between first and second hour of life.

[Respiratory distress syndrome in newborns of diabetic mothers in the years 1987-1998]. / Wystepowanie zaburzen oddychania u noworodków matek z cukrzyca w latach 1987-1998.

The aim of the study was to estimate which factors contribute to high frequency of RDS in our newborns of the diabetic mothers treated with intensive insulin therapy. The study material consisted of 574 newborns (394 from GDM and 180 from IDDM mothers) born in the years 1987-1998. In the analysed group there were compared: frequency of occurrence of RDS, severity of RDS as well as factors which can contribute to occurrence of RDS. That was found that, in the PGDM group prematurity, low Apgar score and delivery by caesarean section and in the GDM group--prematurity, low Apgar score and male sex are factors contributed the most to occurrence of RDS. That was also found that the risk of occurrence of RDS in the PGDM group was 5 to (transient tachypnoe) to 3 times (RDS) greater than in the GDM group. We conclude that PGDM and prematurity are factors the most connected with the occurrence of RDS in newborns born to diabetic mothers.

[Cord blood insulin level in relation to metabolic control of maternal diabetes, duration of pregnancy and neonatal birth weight]. / Stezenie insuliny we krwi pepowinowej a stopien wyrównania gospodarki weglowodanowej u ciezarnych z cukrzyca, czas trwania ciazy i masa ciala noworodków.

The aim of the study was to examine whether an association between cord blood insulin level (Ic) and maternal glycemic control, duration of pregnancy as well as neonatal birthweight exists. The study was performed in diabetic group consisted of 149 diabetic mothers (91 with GDM and 58 with IDDM) and 149 their babies as well as in the control group consisted of 100 healthy mothers and 100 their babies. Maternal glycemic control was indirectly assessment by using HbA1c and fructosamine levels estimated on the day of delivery. That was found a significant positive correlation between Ic and maternal HbA1c and fructosamine levels as well as between Ic and neonatal birthweight in the diabetic group. That was also found the significant negative correlation between Ic and duration of pregnancy in the diabetic group. We conclude that fetal hyperinsulinemia is a result of poor glycemic control during the last weeks of diabetic pregnancy. Furthermore the significant association exists between cord blood hyperinsulinemia and preterm delivery as well as higher birthweight of newborns born to diabetic mothers.

[Cord blood erythropoietin in relation to glycemic control in the last weeks of pregnancy]. / Stezenie erytropoetyny we krwi pepowinowej a stopien wyrównania gospodarki weglowodanowej w ostatnich tygodniach ciazy.

The relationship between cord blood erythropoietin (EPO) and maternal HbA1c and fructosamine levels were examined in the aim to answer a question, whether occurrence of prenatal hypoxia in newborns of diabetic mothers depends from maternal glycemic control during the last weeks of pregnancy. The study was performed in the group of 178 mothers and newborns divided into two groups: diabetic and control. The diabetic group consisted of 116 mothers (33 with IDDM and 83 with GDM) and newborns and the control group consisted of 62 healthy mothers and newborns. Maternal HbA1c (Micro Column Test BIORAD Prospecta) and fructosamine (Roche fructosamine Test) levels were estimated on the day of delivery. Cord blood to estimate EPO (radioimmunoassay) and fructosamine levels were drawing immediately after delivery the babies. The relationship between the study parameters were calculated on the basis of a covariance analysis test. In the diabetic group the significant positive correlation between EPO and maternal HbA1c and fructosamine levels was found as well as between EPO and fetal fructosamine levels. We conclude that higher levels of cord blood EPO are associated with poor maternal glycemic control during the last weeks of pregnancy.

[Cord blood insulin and erythropoietin levels in relation to the mode of delivery]. / Stezenie insuliny i erytropoetyny w krwi pepowinowej a sposób zakonczenia ciazy.

UNLABELLED: The aim of the study was evaluation, whether cord blood insulin (Ic) and erythropoietin (EPO) levels differ in accordance with mode of delivery: cesarean section (CS) or vaginal delivery (VD). MATERIAL AND METHODS: The study was performed in the diabetic group consisted of 148 newborns of diabetic mothers (NDM)--90 of them with GDM and 58 with IDDM as well as in the control group consisted of 100 newborns born to healthy mothers. 52.0% of NDM and 38.0% control subjects were delivered by cesarean section. The most frequent reason for performing CS in the diabetic group was fetal distress before labor and in the control group--fetal distress during labor. Cord blood Ic and EPO levels were compared in accordance with type of delivery: CS or VD. Into statistical analysis Mann-Whitney test was used. RESULTS: There were found that cord blood Ic and EPO levels in NDM born by CS are significantly higher than in those born by VD (Ic--38.2 +/- 41.5 versus 26.6 +/- 38.6 mIU/ml adequately and EPO--51.8 +/- 76.0 versus 26.8 +/- 29.9 mU/ml adequately). There were no such differences in the control group. CONCLUSIONS: 1. Fetal hyperinsulinemia in perinatal period is often connected with occurrence of indications for performing cesarean section in pregnant women with diabetes mellitus. 2. Cesarean section in diabetic pregnant women is often connected with previous fetal hypoxia.

[Estimated levels of fructosamine in venous blood of pregnant women and in cord blood]. / Wspólzaleznosc miedzy stezeniem fruktozaminy we krwi zylnej kobiet rodzacych oraz we krwi pepowinowej.

In the study there was estimated maternal (Fm) and cord blood (Fc) fructosamine levels in 151 diabetic (58 PGDM and 93 GDM) and 100 control subjects on the day of delivery. It was found that Fm and Fc levels in PGDM and GDM groups were significantly higher than in the control group. It was also found the significantly positive correlation between Fm and Fc levels in all study groups. It leads to the conclusion that pregnant diabetic women and their fetuses were hyperglycemic during the last 2 weeks of pregnancy. Our results indicate that on the basis of maternal fructosamine levels it is possible to apply on indirect estimation of metabolic status of the fetus.

Multiple pregnancy: factors contributing to early infant's breast-feeding--own experience.

The aims of the study were as follows: 1. to evaluate the effectiveness of current program to promote breast-feeding in our population of infants from multiple pregnancy; 2. to define factors responsible for failure in early breast-feeding establishing and/or maintaining breast-feed during the hospitalization of the babies in neonatal department. 122 newborn infants (2 sets of triplets and 58 twin pairs) born in the Clinic for Pathology of Pregnancy and Labor in Szczecin, Poland, in the years 1995 (January)-1999 (May) from multiple pregnancy were included in the study. In the examined material there were estimated neonatal conditions at birth, neonatal complications, which may disturb successful breast-feeding as well as other factors contributing to early breast-feeding, the way of feeding the babies during neonatal period and the mean time of starting breast-feeding. It was found that most of the examined babies were born with the features of prematurity: mean gestational age was 35.6 +/- 2.2 weeks and mean birthweight--2225.3 +/- 193.2 grams. Only 57.4% of babies were born in good conditions according to Apgar scores. Factors which influence in a negative way early breast-feeding were as follows: respiratory disturbance (22.1%), temporary oral nutrition intolerance due to sickness of the baby or early onset of infections (27.5%), operative delivery (62.3%), medicine taken by mothers (13.9%) and failure in maternal lactation (8.2%). Factors disturbing a normal course of breast-feeding were: phototherapy due to hyperbilirubinemia (20.5%) and late onset of infections (1.6%). In most cases breast-feeding was started 3-4 days after birth and the most frequent way of feeding was formula followed or in combination with maternal milk (at discharge in 86.9% of babies). We concluded that exclusive breast-feeding, despite program of promotion, is a rarity in population of newborn babies born from multiple pregnancy; time to start breast-feeding in this population is usually 3-4 days after delivery. Most pre-term and full-term twins are discharged from neonatal department on maternal milk--exclusively or in combination with formula in situation of scarce maternal milk for two or more infants--what should be considered as our professional success.

Fetal and neonatal arrhythmia in one of the twins--a case history.

There are a lot of publications about fetal arrhythmia in singletons, but up to now there are no published data about fetal arrhythmia in multiple pregnancies. In the present study a case history of fetal and neonatal arrhythmia in one of twins from two mothers treated with betamimetic agents due to imminent preterm labor is reported and discussed. A first case with fetal bradycardia due to complete A-V block had congenital cordis abnormalities (VSD and PFO). The second case with prenatal detected extrasystoles had normal heart anatomy. Digoxin was administered to the mother, in the aim to treat fetal arrhythmia without success, because the baby had postnatal bradycardia. After hospitalisation in Cardiology Department the described cases were successfully treated. In both cases the second twins were without neonatal arrhythmia and with no structural heart abnormalities. We summarise that in situation of detection fetal arrhythmia the complexity of the problems experienced may warrant early referral to a tertiary centre where the overall management of the mother, fetus and neonate, may be undertaken.

[Arterial blood pressure 3-8 years after EPH gestosis in mothers and their children]. / Cisnienie tetnicze krwi w 3-8 lat po przebytej gestozie EPH u matek i urodzonych przez nie dzieci.

The analysis covered 61 women with a history of EPH gestosis and 63 children born to them as well as 30 healthy women with normal arterial blood pressure during pregnancy and their 30 children aged 3-8 years. Hypertension exceeding 145/95 mm Hg was found in 26 mothers out of 61 at the moment of examination. In the other 35 patients from the EPH gestosis group arterial blood pressure was still within the norm, but diastolic blood pressure (DBP) values were significantly higher than in the control group. The values of DBP in children from mothers with EPH gestosis were higher than the values of DBP in children from the control group. However significantly higher values were observed only in children from mothers with constantly elevated blood pressure.

[Evaluation of fetal lung maturation in rabbits after giving carnitine and carnitine with betamethasone to pregnant rabbits]. / Ocena dojrzalosci pluc plodów króliczych po stosowaniu u królic ciezarnych karnityny i karnityny z betametazonem.

Investigations were carried out on 24 pregnant white New Zealand rabbits and their 210 fetuses. Eight pregnant rabbits received intravenous injections of carnitine on the 25th, 26th and 27th day of pregnancy, in doses of 80 mg/kg/24 hours. Eight other pregnant rabbits were given carnitine in the same manner and betamethasone intramuscularly on the 25th and 26th day of pregnancy in doses of 0.1 mg/kg/24 hours. Eight control pregnant rabbits received intravenous and intramuscular injections of normal saline. In all the groups caesarean section was performed on the 28th day of pregnancy. The contents of lecithin and sphingomyelin in lung homogenates of fetuses and in amniotic fluid were determined by thin-layer chromatography. The lungs of the fetuses were subjected to morphological studies in light and in electron microscopes. The studies proved that carnitine given during pregnancy accelerated biochemical and morphological maturation of fetal rabbit lungs. However, administration of carnitine in combination with betamethasone does not provide better effect than the administration of carnitine alone.

[Serological conflict: relation between antibody titer, Liley's zone and the condition of the fetus and newborn infant]. / Konflikt serologiczny: zwiazek miedzy mianem przeciwcial i strefa Lileya a stanem plodu i noworodka.

On the basis of analysis of 128 cases of serological incompatibility it was found that antibodies to Rh in titres of 1/8 or less constituted a good prognostic factor, and without evidence of fetal distress in USG examination this was not an indication to treatment undertaking. If the titre is from 1/16 to 1/128 the prognosis is worse and the degree of fetal haemolytic disease risk may be estimated on the basis of USG and Liley's zone. The prognosis is very bad in case of titre exceeding 1/128 and high Liley's zone, and without effective treatment of haemolytic disease in fetal life only few fetuses survive.