Amino acid and acylcarnitine profiles in perinatal asphyxia: a case-control study.

OBJECTIVE: To estimate cord blood amino acid and acylcarnitine levels in term newborns exposed to perinatal asphyxia. MATERIALS AND METHODS: We studied 45 asphyxiated term newborns (cases) and 20 gestational age-matched healthy newborns (control). 16 cases developed HIE according to clinical scoring and amplitude-integrated electroencephalography. Asphyxiated cases were accordingly subdivided into: HIE group (n = 16) and Asphyxia group (n = 29). Amino acid and acylcarnitine levels were measured in cord blood dried spot samples from all newborns using ultra-performance liquid chromatography-mass spectrometry (UPLC-MS). Data were analyzed using one-way ANOVA with post hoc test and MetaboAnalyst-2. RESULTS: Distinct metabolite alterations were detected in cases versus control, in HIE versus Asphyxia, and in Survivors within HIE group (n = 6) versus nonsurvivors (n = 10). Principal component analysis (PCA) and partial least squares-discriminate analysis (PLS-DA) showed increased levels of methionine and certain acylcarnitines, but reduced levels of ornithine, histidine, and arginine. Metabolite set enrichment analysis (MSEA); compared to KEGG library metabolite sets, identified some disorders with similar metabolomic derangements. CONCLUSIONS: We report UPLC-MS detectable alterations of amino acids and acylcarnitines in asphyxiated newborns at birth, that can serve as early diagnostic bedside biomarkers for HIE and predictors for its short-term outcome, and in the near future, as therapeutic targets.

Sustained versus intermittent lung inflation for resuscitation of preterm infants: a randomized controlled trial.

AIM: To evaluate efficacy and safety of delivery room (DR) sustained lung inflation (SLI) in resuscitation of preterm neonates. METHODS: Randomized Controlled Trial including 112 preterm infants randomized to either SLI (n = 57) using T-piece resuscitator [maximum three inflations with maximum pressure of 30 cmH2O for 15 s followed by continuous positive airway pressure (CPAP) of 5-7 cmH2O] or conventional bag/mask inflation (CBMI) (n = 55) using traditional self-inflating bag (maximum pressure of 40 cmH2O at a rate of 40-60 per min). Failure was defined as the need for DR or first 72 h intubation. Cord and 2-h post-resuscitation blood samples were collected to measure interleukin (IL)-1ß and tumor necrosis factor-α levels before and after intervention. RESULTS: SLI was associated with significantly higher success rate compared to CBMI [75.4 versus 54.5%; p = 0.017], lower need for DR intubation [5.3% versus 23.6%; (X2 = 7.7; p = 0.005)], higher 5-min-Apgar score (median 8 versus 7; p = 0.018), shorter duration on nasal-CPAP (p = 0.017), and non-significantly different air leak (7% versus 11%; p = 0.3) and bronchopulmonary dysplasia rates among survivors (2% versus 11%; p = 0.09). Post-resuscitation IL-1ß plasma levels increased significantly in CBMI (p = 0.009) and not in SLI group. CONCLUSION: Delivery room SLI is more effective than intermittent bag and mask inflation for improving short-term respiratory outcome in preterm infants, without significant adverse effects.

Early Zinc Supplementation and Enhanced Growth of the Low-Birth Weight Neonate.

BACKGROUND: Nutritional deficits are almost universal in Low-Birth Weight babies. Zinc is essential for normal infant growth and its supplementation assists growth probably through insulin-like growth factor-1. AIM: This double-blind randomized-controlled trial aimed at evaluating the role of zinc in catch-up growth of low-birth-weight infants and investigating its proposed mediator. MATERIAL AND METHODS: The study was conducted in Ain Shams University Maternity Hospital. Two hundred low-birth-weight neonates were simply randomized to either oral zinc therapy or placebo. Anthropometric measurements were recorded at birth, 3, 6, and 12 months; including weight, recumbent length, head, waist, chest, and mid-upper arm circumferences, and triceps and sub-scapular skin fold thickness. RESULTS: We found that initial and 3-months measurements, except weight, were comparable in the 2 groups. All measurements at 6- and 12-months, except sub-scapular skin-fold-thickness, were significantly higher in zinc group than placebo. Catch-up growth, at 12-months, was significant in zinc group and was significantly higher in appropriate-for-gestational-age vs. small-for-gestational-age, in preterm vs. term, and in male vs. female infants. The median 6-months insulin-like growth factor-1 levels were significantly higher in zinc group. CONCLUSION: We conclude that early start of oral zinc supplementation in low-birth-weight neonates assists catch-up growth, probably through rise of insulin-like growth factor-1.