[Show abstract][Hide abstract] ABSTRACT: Objective:To measure the adrenocorticotropic hormone (ACTH) and cortisol (F) cord plasma levels in preterm and term infants in relation to their mode of delivery.Study Design:We studied 180 newborns appropriate for gestational age (GA) with birth weights between 365 and 4380 g and GAs between 21 and 41 weeks divided into three groups: born by vaginal delivery (VD), elective cesarean section (ECS) and emergency cesarean section (EMCS). ACTH and F levels were valued with enzyme-linked immunosorbent assay testing. Median concentrations were compared between groups by Student's T-test for independent and paired data. Multiple regression analysis was used to investigate the effect of GA on F and ACTH concentrations.Result:A significant positive correlation between GA and plasma concentrations of ACTH (P<0.05) was found in the whole population, but not between GA and F (P=NS). A significant positive correlation was found between GA and plasma concentrations of both ACTH (P=0.01) and F (P=0.03) in VD. In those born by ECS, we demonstrated a positive correlation not only between plasma concentrations of ACTH (P=0.0000) and F (P=0.00002), respectively, with GA, but also a correlation between ACTH and F (P=0.0004). No significant correlations were found in the EMCS group (P=NS).Conclusion:Our results suggest simultaneous pituitary-adrenal maturation, which is complete only at term. The responsiveness of preterm babies to different stressful stimulations is similar to the terms' but quantitatively lower, and the secretion of ACTH and F may not suffice in severe pathological circumstances.Journal of Perinatology advance online publication, 10 January 2013; doi:10.1038/jp.2012.165.
Journal of perinatology: official journal of the California Perinatal Association 01/2013; · 1.59 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Placental pathology assists in characterizing the antenatal environment and may provide information about the baby's subsequent development. We aim to assess whether histological patterns of placenta are associated with an increased risk of perinatal diseases and to evaluate how different patterns of placental dysfunction can affect the neurodevelopmental outcome.
We analyzed the histopathological characteristics of 105 singleton placentas from infants born between 23 and 31 weeks of gestation and we assessed pair-wise correlations with perinatal diseases. Estimated relative risks were calculated from odds ratios.
Histological chorioamnionitis (CA group) was detected on 51 of 100 placentas tested. Lesions of uteroplacental circulation (abruption, infarction or thrombosis, perivillous fibrin deposition, syncytial knots; vasculopathy group) were detected on 29. 25 normal placentas served as controls. The incidence of bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) was higher in CA than in control group. The risk of developing retinopathy of prematurity (ROP), intraventricular hemorrhage (IVH) and PDA was higher in CA than in vasculopathy group.
At low gestational age CA, rather than placental lesions of vasculopathy, negatively impacts perinatal outcome. Clinical significance of histologic vasculopathy remains questionable. Other pathophysiological mechanisms than those associated with placental changes may occur following dysfunction of uteroplacental circulation.
The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 02/2012; 25 Suppl 1:110-3. · 1.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Congenital chylothorax is a rare condition characterized by the accumulation of lymph fluid in the pleural space that causes respiratory and circulatory dysfunctions, immune deficiencies, hypoalbuminemia, electrolyte imbalance and alterations of the coagulation. Mortality rates are elevated and can rise to 50%. Therapy consists in conservative treatment based on thoracic drainage combined with total parenteral nutrition or use of low-fat high-protein diet supplemented with medium chain triglycerides. In case of failure surgical intervention may be considered. During the last years some authors have experienced the use of octreotide with doubtful results. In no case the drug impact on insulin, GH and cortisol secretion in neonatal age has been investigated and only in one case the effect on thyroid hormones has been assessed. We report the case of a 36-week baby with congenital chylothorax treated with octreotide for 42 days. The drug was well tolerated but hormonal level measurements showed a deep depression of insulin secretion unaccompanied by alterations of glucose levels. Levels of GH and TSH showed only a transitory decrease. ACTH and cortisol remained normal. At 5 months, the measurements of hormonal levels did not show significant alterations. It is not possible to determine if such a drug played an essential role in the solution of the pleural effusion, but it is important to emphasize that a prolonged treatment with octreotide has not caused, in our case, persistent hormonal alterations.
[Show abstract][Hide abstract] ABSTRACT: Preterm infants are at risk of osteopathy of prematurity (OP). The present study aims to assess quantitative ultrasound as a safe and non-invasive method in evaluating bone mineral status in the critically ill preterm infant.
Sixty preterm infants (27 females) have been evaluated in the Neonatal Intensive Care Unit of the University Hospital of Siena. Gestational age was between 22 and 36 weeks and birth weight ranged between 610 and 3240 g. A single operator did all the measurements on the second metacarpus by the DBM Sonic BP (IGEA). Ultrasound parameters were bone transmission time (BTT, micros) and speed of sound (SOS, m/s).
BTT positively increased with birth gestational age (r=0.72, P<0.001, F-Ratio=62.4428), birth weight (r=0.7827, P<0.001, F-Ratio=91.7274) and birth length (r=0.7729, P<0.001, F-Ratio=86.0748). SOS was also related with gestational age (r=0.2937, P<0.023, F-Ratio=5.4768), birth weight (r=0.2634, P<0.042, F-Ratio=4.3250) and birth length (r=0.3252, P<0.011, F-Ratio=6.8596). Small infants for gestational age showed BTT values lower then infants with appropriate size for gestational age (P<0.03). There was no difference between male and female infants.
Quantitative ultrasound is a non-invasive method, which is easy to perform in a Neonatal Intensive Unit, safe, harmless and gentle. This method detects subtle differences in bone mineral status, according to gestational age, weight and length. Quantitative ultrasound is a useful screening tool for early detection of bone status in newborns and a valid method for the longitudinal assessment of bone in growing children.
[Show abstract][Hide abstract] ABSTRACT: Prematurity is a known risk factor for hypoglycaemia, hyperglycemia, neonatal sepsis and other common neonatal complications, possibly associated with glucoregolatory hormone (insulin and glucagon) alterations. Insulin and glucagon levels change also in relation to gender, mode of delivery and postnatal clinical severity. Because of the lack of reference range in literature, the aim of this study is to assess plasma insulin and glucagon levels in preterm appropriate for gestational age (AGA) infants of birth weight <1500 g (very low birth weight, VLBW) as a function of gestation, birth weight, gender and mode delivery.
The authors examined 48 preterm AGA infants (mean birth weight 1 163+/-286 g, mean gestational age 28.2+/-2.4 weeks). The infant population was subdivided in relation to gestational age, weight, gender, mode of delivery and assisted ventilation at 5-7(th) days. Plasma glucose, insulin and glucagon levels were assessed in all newborns at birth and at 5-7(th) days of life. Data were analyzed using t-test.
A negative correlation between insulin and gestational age was observed (P<0.05). At birth, no significant differences regarding plasma glucose, insulin and glucagon levels were observed as a function of the examined category variables. At the 5-7(th) days of life, insulin levels were significantly higher in newborns with gestational age =or<27 weeks (P<0.02), in the female gender (P<0.02) and in the infants born to emergency Cesarean delivery (P<0.05).
These findings indicate potentially useful reference range values for plasma insulin and glucagon in the VLBW population.
[Show abstract][Hide abstract] ABSTRACT: Altered thyroid function in small for gestational age newborns: study based on screening test for congenital hypothyroidism Journal of Pediatric Sciences. 2010;4:e55 JPS 2 J o u r n a l o f P e d i a t r i c S c i e n c e s 2010;4: e55 Introduction Babies with a birth weight and/or length below the 10th percentile of a population of the same gestational age are defined small-for-gestational-age (SGA) 1, 2. There may be many causes of intrauterine growth retardation and birth of SGA babies. Various pathophysiological mechanisms and endocrine-metabolic alterations characterize this condition 1, 3-5. These alterations may affect neonatal adaptation and future health in infancy and adulthood: indeed, higher incidences of pathologies such as cardiovascular events, metabolic syndrome, hypertension and obesity have been demonstrated 6-12. Few studies have compared thyroid function in SGA and appropriate-for-gestational-age (AGA) newborns. Conflicting results have been published for neonatal plasma concentrations of T4 and TSH, though the papers are difficult to compare because Abstract: Background and Aims: Unequivocal data is not yet available on alterations in plasma concentrations of thyroid hormones that may characterize small-for-gestational-age (SGA) newborns. We used data from screening for congenital hypothyroidism in a large population to evaluate the relationship between growth restriction and thyroid function in the first week of life. Materials and Methods: Subjects: 14,092 newborns (13,333 appropriate-for-gestational-age (AGA) and 759 SGA) screened for congenital hypothyroidism on the third day of life. The screening test measured plasma concentrations of TSH and T4 by fluoroimmunoenzyme assay. Results: Comparison of SGA and AGA newborns revealed lower serum concentrations of T4 in preterm and term SGA infants (P=0.0001), whereas concentrations of TSH were significantly higher only in term SGA infants (P=0.0001). T4 concentrations were positively correlated with gestational age in SGA and AGA groups, whereas TSH concentrations were only correlated with gestational age in the AGA group. 1.84% of SGA babies were recalled for TSH and T4 anomalies against only 0.93% of AGA newborns (p=0.01). Conclusion: SGA babies had a higher incidence of transient hypothyroidism and required accurate follow-up and close monitoring of thyroid function.