Humans ; Infant, Low Birth Weight ; physiology ; Infant, Newborn ; Urination

PURPOSE: We performed this study to evaluate the safety of permissive hypotension management in extremely low birth weight infants (ELBWIs). MATERIALS AND METHODS: Medical records of all inborn ELBWIs admitted to Samsung Medical Center from January 2004 to December 2008 were reviewed retrospectively. Of a total of 261 ELBWIs, 47 (18%) required treatment for hypotension (group T), 110 (42%) remained normotensive (group N), and 104 (40%) experienced more than one episode of hypotension without treatment (group P) during the first 72 hours of life. Treatment of hypotension included inotropic support and/or fluid loading. RESULTS: Birth weight and Apgar scores were significantly lower in the T group than the other two groups. In the N group, the rate of pathologically confirmed maternal chorioamnionitis was significantly higher than other two groups, and the rate was higher in the P group than the T group. After adjusting for covariate factors, no significant differences in mortality and major morbidities were found between the N and P groups. However, the mortality rate and the incidence of intraventricular hemorrhage (> or =stage 3) and bronchopulmonary dysplasia (> or =moderate) were significantly higher in the T group than the other two groups. Long term neurodevelopmental outcomes were not significantly different between the N and P groups. CONCLUSION: Close observation of hypotensive ELBWIs who showed good clinical perfusion signs without intervention allowed to avoid unnecessary medications and resulted in good neurological outcomes.
Apgar Score ; Birth Weight/physiology ; Female ; Humans ; Hypotension/*physiopathology ; Infant, Extremely Low Birth Weight/*physiology ; Infant, Newborn ; Male

Adult ; Birth Weight ; Body Mass Index ; Female ; Gestational Weight Gain ; physiology ; Humans ; Labor, Obstetric ; physiology ; Pregnancy

PURPOSE: The score for neonatal acute physiology (SNAP) based on physiologic derangements, is applied to variable fields including morbidity as well as mortality estimate. We evaluate the clinical usefulness of SNAP and SNAP variants for neonatal acute severity and mortality. METHODS: Twenty-one neonates were evaluated the SNAP, SNAP-PE, SNAP-II, and SNAPPE-II, who survived more than 24 hours in Neonatal Intensive Care Unit in Department of Pediatrics, Kyunghee University from July 2003 to December 2004. A study group included 21 neonates as death group and a control group matched for gestational age and birth weight. We analyzed the differences of clinical usefulness of SNAP and SNAP variants indices between the two groups. RESULTS: 1) SNAP:The scores were ranged 2-18 (median 6.5) in survival group and 9-31 (median 13.0) in death group. 2) SNAP-PE:The scores were ranged 2-48 (median 16.5) in survival group and 23-75 (median 32.0) in death group. 3) SNAP-II:The scores were ranged 0-16 (median 10.5) in survival group and 10-62 (median 21.0) in death group. 4) SNAPPE-II:The scores were ranged 0-45 (median 24.5) in survival group and 35-109 (median 44.0) in death group. The median values were higher in those who were died:SNAP<0.05 (P-value), SNAP-PE<0.01, SNAP-II<0.01, SNAPPE-II<0.01 showing the significant differences. CONCLUSION: The study shows that SNAP and SNAP variables are useful for the evaluation of acute severity and excellent predictors of neonatal survival. They would help the management of neonatal intensive care unit.
Birth Weight ; Gestational Age ; Humans ; Infant, Newborn* ; Intensive Care, Neonatal ; Mortality ; Pediatrics ; Physiology

OBJECTIVETo explore the relation of the anogenital distance (AGD) with cryptorchidism in male newborns.

METHODSThis study included 350 male infants delivered in two community hospitals between September 2013 and September 2014. Within 24 hours after birth, a pediatric surgeon measured the AGD of the neonates and determined whether they had cryptorchidism. According to the testicular position, we divided the undescended testes into three types: upper scrotal, inguinal, and non-palpable.

RESULTSTotally 39 cases of cryptorchidism were found in the 350 newborns. The AGD of the cryptorchidism infants was significantly shorter than that of the normal neonates ([2.01 ± 0.22] vs [2.35 ± 0.19] cm, P < 0.01), and statistically significant differences remained even when preterm and low birth-weight infants were excluded ([2.32 ± 0.14] vs [2.06 ± 0.19] cm; (2.37 ± 0.17) cm vs (2.12 ± 0.12) cm, all P < 0.01). The newborns with higher-position cryptorchidism had a shorter AGD, though with no significant difference (F = 0.434, P > 0.05). No significant differences were observed in the AGD between unilateral and bilateral cryptorchidism ([1.96 ± 0.13] vs [2.02 ± 0.17] cm, P > 0.05).

CONCLUSIONShorter AGD is associated with a higher incidence of cryptorchidism in male newborns. AGD could serve as a potential biomarker for disruption of androgen action during the male programming window period.

Androgens ; physiology ; Cryptorchidism ; diagnosis ; Humans ; Infant, Low Birth Weight ; Infant, Newborn ; Infant, Premature ; Male ; Perineum ; abnormalities

No abstract available.
Birth Weight ; Erythrocytes/ultrastructure ; Gestational Age ; Human ; Infant, Newborn* ; Infant, Premature* ; Prospective Studies ; Reticuloendothelial System/physiology* ; Spleen/physiology*

INTRODUCTION: Neonatal care advances have resulted in improved survival but have raised concerns of increase in neurodevelopmental impairment. This study looked at long-term neurodevelopmental outcomes at ages 5 and 8 years of very low birthweight infants born in the 2000s as compared to the 1990s. Neurodevelopmental assessment at 2 years old was compared to that at 5 and 8 years to determine if assessment at 2 years was predictive of later outcomes. MATERIALS AND METHODS: A retrospective cohort study of consecutive infants with birthweight less than 1250 grams admitted to a tertiary centre in Singapore between January 1994 to December 1995 (Epoch I) and January 2004 to December 2005 (Epoch II) were included. Neurodevelopmental impairment was defined as having intelligence quotient (IQ) of less than 70, cerebral palsy, legal blindness, or hearing impairment requiring hearing aids. RESULTS: Mean gestational age was lower for Epoch II compared to Epoch I (28.1 ± 2.5 vs 29.4 ± 2.7 weeks, = 0.004). Death or neurodevelopmental impairment rates did not differ (24.3% and 17.1% at 5 years old, = 0.398; 29.1% and 25.0% at 8 years old, = 0.709). There was improvement in visual impairment rate at 8 years in Epoch II (10.7% vs 34.0%, = 0.024). Mean IQ was better in Epoch II (109 and 107 vs 97 and 99 at 5 [ = 0.001] and 8 years [ = 0.047], respectively). All infants with no neurodevelopmental impairment at 2 years remained without impairment later on. CONCLUSION Over a decade, neurodevelopmental outcomes did not worsen despite lower mean gestational age. Long- term improvement in IQ scores and a reduction in visual impairment rates were seen. Our data suggests that children without neurodevelopmental impairment at 2 years are without impairment later on; therefore, they may need only developmental monitoring with targeted assessments instead of routine formal IQ assessments.
Child ; Child, Preschool ; Humans ; Infant, Newborn ; Infant, Premature ; physiology ; Infant, Very Low Birth Weight ; physiology ; Neurodevelopmental Disorders ; etiology ; Singapore

BACKGROUNDGestational diabetes mellitus (GDM) is associated with both short- and long-term adverse health consequences for both the mother and her offspring. The aim was to study the prevalence and risk factors for GDM in Beijing.

METHODSThe study population consisted of 15,194 pregnant women attending prenatal care in 15 hospitals in Beijing, who delivered between June 20, 2013, and November 30, 2013, after 28 weeks of gestation. The participants were selected by cluster sampling from the 15 hospitals identified through random systematic sampling based on the number of deliveries in 2012. A questionnaire was designed to collect information.

RESULTSA total of 2987 (19.7%) women were diagnosed with GDM and 208 (1.4%) had diabetes in pregnancy (DIP). Age (OR: 1.053, 95% CI: 1.033-1.074, P < 0.01), family history of diabetes mellitus (OR: 1.481, 95% CI: 1.254-1.748, P < 0.01), prepregnancy body mass index (BMI) (OR: 1.481, 95% CI: 1.254-1.748, P < 0.01), BMI gain before 24 weeks (OR: 1.126, 95% CI: 1.075-1.800, P < 0.01), maternal birth weight (P < 0.01), and fasting plasma glucose at the first prenatal visit (P < 0.01) were identified as risk factors for GDM. In women with birth weight <3000 g, GDM rate was significantly higher.

CONCLUSIONSOne out of every five pregnant women in Beijing either had GDM or DIP and this constitutes a huge health burden for health services. Prepregnancy BMI and weight gain before 24th week are important modifiable risk factors for GDM. Ensuring birth weight above 3000 g may help reduce risk for future GDM among female offsprings.

Birth Weight ; physiology ; Body Mass Index ; Diabetes, Gestational ; metabolism ; Female ; Glucose Tolerance Test ; Humans ; Pregnancy ; Prevalence ; Risk Factors ; Weight Gain ; physiology

Objective: To characterize the relationship between the levels of plasma methyl donor and related metabolites (including choline, betaine, methionine, dimethylglycine and homocysteine) and fetal growth in twin pregnancies. Methods: A hospital-based cohort study was used to collect clinical data of 92 pregnant women with twin pregnancies and their fetuses who were admitted to Peking University Third Hospital from March 2017 to January 2018. Fasting blood was collected from the pregnant women with twin pregnancies (median gestational age: 18.9 weeks). The levels of methyl donors and related metabolites in plasma were quantitatively analyzed by high-performance liquid chromatography combined with mass spectrometry. The generalized estimation equation was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and neonatal outcomes of twins, and the generalized additive mixed model was used to analyze the relationship between maternal plasma methyl donors and related metabolites levels and fetal growth ultrasound indicators. Results: (1) General clinical data: of the 92 women with twin pregnancies, 66 cases (72%) were dichorionic diamniotic (DCDA) twin pregnancies, and 26 cases (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The comparison of the levels of five plasma methyl donors and related metabolites in twin pregnancies with different basic characteristics showed that the median levels of plasma choline and betaine in pregnant women ≥35 years old were higher than those in pregnant women <35 years old, and the differences were statistically significant (all P<0.05). (2) Correlation between plasma methyl donor and related metabolites levels and neonatal growth indicators: after adjusting for confounding factors, plasma homocysteine level in pregnant women with twins was significantly negatively correlated with neonatal birth weight (β=-47.9, 95%CI:-94.3- -1.6; P=0.043). Elevated methionine level was significantly associated with decreased risks of small for gestational age infants (SGA; OR=0.5, 95%CI: 0.3-0.9; P=0.021) and low birth weight infants (OR=0.6, 95%CI: 0.4-0.9; P=0.020). Increased homocysteine level was associated with increased risks of SGA (OR=1.5, 95%CI: 1.0-2.2; P=0.029) and inconsistent growth in twin fetuses (OR=1.9, 95%CI: 1.0-3.7; P=0.049). (3) Correlation between the levels of plasma methyl donors and related metabolites and intrauterine growth indicators of twins pregnancies: for every 1 standard deviation increase in plasma choline level in pregnant women with twin pregnancies, fetal head circumference, abdominal circumference, femoral length and estimated fetal weight in the second trimester increased by 1.9 mm, 2.6 mm, 0.5 mm and 20.1 g, respectively, and biparietal diameter, abdominal circumference and estimated fetal weight increased by 0.7 mm, 3.0 mm and 38.4 g in the third trimester, respectively, and the differences were statistically significant (all P<0.05). (4) Relationship between plasma methyl donor and related metabolites levels in pregnant women with different chorionicity and neonatal birth weight and length: the negative correlation between plasma homocysteine level and neonatal birth weight was mainly found in DCDA twin pregnancy (β=-65.9, 95%CI:-110.6- -21.1; P=0.004). The levels of choline, betaine and dimethylglycine in plasma of MCDA twin pregnancy were significantly correlated with the birth weight and length of newborns (all P<0.05). Conclusion: Homocysteine level is associated with low birth weight in twins, methionine is associated with decreased risk of SGA, and choline is associated with fetal growth in the second and third trimesters of pregnancy.
Adult ; Female ; Humans ; Infant, Newborn ; Pregnancy/metabolism* ; Betaine/metabolism* ; Birth Weight/physiology* ; Choline/metabolism* ; Cohort Studies ; Fetal Development/physiology* ; Fetal Weight/physiology* ; Homocysteine/metabolism* ; Methionine/metabolism* ; Pregnancy, Twin/physiology* ; Biomarkers/metabolism* ; Pregnancy Trimesters/physiology* ; Pregnancy Outcome

OBJECTIVETo evaluate the effects of nonnutritive sucking (NNS) on the nutrient intake, physical growth, feeding-related complications and whole gastrointestinal transit time (WGTT) in premature infants.

METHODSThirty eight healthy appropriate for gestational age premature infants (birth weights ranged from 1 050 g to 1 790 g) accepting intermittent nasogastric feeding (INGF) were randomized into NNS group and N-NNS group according to INGF with and without NNS and fed with the same milk formula. The following data were collected and recorded, the physical growth parameters (e.g, body weight, length and head circumference) and the birth-weight regaining time, the fluid intake (including both intravenous and oral), caloric intake, time of reaching 418.4 kJ/(kg.d) by enteral feeding, time of putting nasogastric tube, stool frequency and characters, and relevant complications. WGTT were monitored.

RESULTSThe birth-weight regaining time in NNS group was significantly shorter than that in N-NNS group [(8.8 +/- 3.7) d vs (11.1 +/- 3.0) d, P < 0.05]. Within two weeks after feeding, there was no significant difference in the increase of body weight, length and head circumference between the two groups (P > 0.05). The time of reaching 418.4 kJ/(kg.d) by enteral feeding in NNS group was significantly shorter than that in N-NNS group [(12.3 +/- 5.1) d vs (15.7 +/- 5.2) d, P < 0.05]; the times of putting nasogastric tube were respectively (13 +/- 10) d and (17 +/- 12) d, but the difference was not significant (P > 0.05). The morbidity of such complications as vomiting and abdominal distension was lower in NNS group than that in N-NNS group, but the difference was not statistically significant (P > 0.05). However, the morbidity of gastric residue in NNS was significantly lower than that in N-NNS (P < 0.05). WGTT of the second week in NNS group was significantly shorter than that in N-NNS [(33 +/- 13) h vs (45 +/- 20) h, P < 0.05]. Stool frequencies of the second week in NNS group were significantly more than those in N-NNS group [(2.26 +/- 0.17) times/d vs (1.79 +/- 0.58) times/d, P < 0.05]. However, there were no significantly differences in WGTT and stool frequencies of the first week between the two groups (P > 0.05).

CONCLUSIONNNS was recommended as a beneficial intervention for premature infants during intermittent nasogastric tube feeding.

Enteral Nutrition ; Female ; Gastrointestinal Motility ; physiology ; Gastrointestinal Tract ; physiology ; Humans ; Infant Nutritional Physiological Phenomena ; Infant, Low Birth Weight ; growth & development ; Infant, Newborn ; Infant, Premature ; growth & development ; Infant, Very Low Birth Weight ; growth & development ; Male ; Sucking Behavior