Growth velocity during the first postnatal week of life is linked to a spurt of IGF-I effect.

There is adequate evidence that growth during the perinatal period is linked to the risk of several adult onset diseases, and recent findings indicate that the insulin-like growth factor (IGF) system is involved in prenatal growth, as reflected in birthweight. However, whether major components of the IGF system are involved in the immediate post-natal growth has not been studied. Maternal questionnaires were completed, and laboratory measurements of several variables, including IGF-I, IGF-II and IGF-binding protein-3 (IGFBP-3), were made for a total of 331 apparently healthy full-term newborns, from whom routine blood samples were taken during the first 5 days of their life. Birthweight and weight at the time of bleeding were among the recorded variables, and the difference divided by the age in days of the newborn was considered as reflecting immediate postnatal growth velocity. Immediate postnatal growth velocity was strongly positively associated with IGF-I. The squared adjusted correlation coefficient was 0.29 when IGF-I was incorporated in the model predicting postnatal growth velocity but was only 0.08 when IGF-I was excluded. In contrast, IGF-II and IGFBP-3 had no effect on postnatal growth velocity. It thus appears that IGF-I underlies growth during the immediate postnatal period. To the extent that perinatal growth may affect adult onset diseases, the findings of this study suggest that the action of IGF-I during the immediate postnatal period may represent a process of major importance.

Birth size and neonatal levels of major components of the IGF system: implications for later risk of cancer.

Pre- and perinatal conditions and processes may affect the risk for some forms of cancer in later life, while the insulin-like growth factor (IGF) system may play a role in both early somatic growth and later carcinogenesis. Birth weight and length, and the variation of major components of the IGF system immediately after birth, were analyzed in relation to selected physiological and pathological variables. The study comprised 331 healthy full-term newborns from whom blood samples were taken during routine phlebotomy no later than the fifth day of life. Measurements of IGF-I, IGF-II and IGF-binding protein-3 concentrations were performed. Birth length and weight were measured and information on socio-economic and medical variables was recorded. The concentrations of all three proteins were lower when blood bilirubin levels were high, possibly as a result of compromised liver function and/or as a component of an activated acute phase reaction. Birth weight was significantly higher by about 46 g among children whose IGF-I was higher by one SD, while the associations of birth weight and length with other components of the IGF system were in the predicted directions, albeit only in trend. We conclude that in early life, growth is related to the IGF system, mostly IGF-I. The latter is lower in children with jaundice, possibly because of hepatic dysfunction and/or as part of an acute phase reaction. We speculate that elevations of IGF-I in early life might explain the increased risk of cancer in individuals born with a higher birth weight.

Are there common triggers of preterm deliveries?

OBJECTIVE: To assess the effect(s) of transient events which are perceived as stressful on the inseption of preterm delivery. DESIGN: A case-control study, with immature infants as cases and borderline term babies as controls. SETTING: A teaching maternity hospital in Athens. POPULATION: All infants born at less than 37 weeks of gestation, during a twelve-month period. METHODS: Information was collected about maternal socio-demographic and lifestyle characteristics, clinical variables and stressful events occurring within two weeks prior to delivery. MAIN OUTCOME MEASURES: Factors affecting the risk of preterm delivery. RESULTS: Extreme prematurity (<33 weeks) is more common among younger (<25 years of age) and older (>29 years of age) women and is positively associated with parity, body mass index and smoking, whereas it is inversely associated with educational level, regular physical exercise and serious nausea/vomiting. After controlling for these factors, however, only coitus during the last weeks of pregnancy had a significant triggering effect on prematurity (P = 0.004, odds ratio 3.21, 95% CI 1.45 to 7.09 for very immature babies, and P = 0.04, OR = 2.20, 95% CI 1.03 to 4.70 for immature babies). On the contrary, several events perceived as stressful, such as illness of relatives or friends, husband's departure, loss of employment, were unrelated to the onset of premature labour. CONCLUSIONS: Coitus during the last few weeks of pregnancy appears to increase the risk of preterm delivery, while a possible detrimental effect of physical exertion seems more limited. Stressful events should not receive undue attention as possible causes of preterm delivery.

Outcome prediction in Greek neonatal intensive care units using a score for neonatal acute physiology (SNAP)

OBJECTIVES: This study was undertaken to evaluate the performance of the score for neonatal acute physiology (SNAP) in Greece, to examine the predictive power of SNAP calculated during the 12 hours after admission in comparison with customarily calculated SNAP during the first 24 hours, and to assess SNAP during the second 12 hours from admission as a measure of response to treatment. METHODOLOGY: A total of 579 newborns admitted to three neonatal intensive care units (NICUs) from two cities in Greece were enrolled in the study; SNAP was determined during the first 12 hours, the second 12 hours, and the first 24 hours from admission to the NICU and calculated using an algorithm based on deviations from normal values of 26 physiologic parameters. RESULTS: All three variants of SNAP were powerful predictors of vital status at discharge, as well as of duration of stay among survivors. A five-point increase in SNAP in the first 12 hours corresponds to a more than twofold ratio in the odds for death, whereas a five-unit difference in SNAP from the second 12 hours corresponds to a more than threefold ratio. The combined 24-hour score was similar to that for the first 12 hours. A considerable advantage of SNAP was its independence from more traditional predictors of neonatal death, notably gestational age, birth weight, and Apgar score. The combination of all of these predictors improved further the overall predictive potential. CONCLUSIONS: SNAP is a useful tool in medical research and can be applied in different population groups. Its independence from birth weight underlines its added value to predict fatality ratios. Moreover, the results of the present study indicate that SNAP can be estimated without loss of predictive efficiency during the first 12 hours from admission to the NICU, whereas SNAP during the second 12 hours adequately reflects the effectiveness of early medical interventions.