Search

Proprotein Convertase Subtilisin/Kexin-Type 9 (PCSK9), a modulator of low-density lipoprotein (LDL) cholesterol metabolism, has been reported to be a promising biomarker for evaluating lipoprotein metabolism; however, evidence in infants is limited. In the current study, we sought to investigate potential differences in serum PCSK9 levels between infants with deviant birth weight and controls. We enrolled 82 infants, classified into 33 small (SGA), 32 appropriate (AGA), and 17 large for gestation (LGA) infants. Serum PCSK9 was measured on routine blood analysis within the first postnatal 48 h. PCSK9 was significantly higher in SGA as compared to AGA and LGA infants [322 (236–431) as compared to 263 (217–302) and 218 (194–291) ng/ml respectively, p =.011]. In comparison to term AGA infants, PCSK9 was significantly elevated in preterm AGA and SGA infants. We also found a significantly higher level of PCSK9 in term female SGA infants as compared to term male SGA infants [325 (293–377) as compared to 174 (163–216) ng/ml, p =.011]. PCSK9 was significantly correlated with gestational age (R = –0.404, p <.001), birth weight (R = –0.419, p <.001), total cholesterol (R = 0.248, p =.028) and LDL cholesterol (R = 0.370, p =.001). SGA status (OR 2.56, p =.004, 95% CI 1.83–4.28) and prematurity (OR 3.10, p =.001, 95% CI 1.39–4.82) were strongly related to serum PCSK9 levels. PCSK9 levels were significantly associated with total and LDL cholesterol. Moreover, PCSK9 levels were higher in preterm and SGA infants, suggesting that PCSK9 might be a promising biomarker for evaluating infants with increased later cardiovascular risk. What's already known? Proprotein Convertase Subtilisin/Kexin-Type 9 (PCSK9) is a promising biomarker for evaluating lipoprotein metabolism; however, evidence in infants is limited. Infants that were born with a deviant birth weight have a unique lipoprotein metabolism profile. What this study adds? Serum PCSK9 levels were significantly associated with total and LDL cholesterol. PCSK9 levels were higher in preterm and small for gestation infants, suggesting that PCSK9 might be a promising biomarker for evaluating infants with increased later cardiovascular risk. [ABSTRACT FROM AUTHOR]

Objective C-reactive protein (CRP) is one of the most extensively used biomarkers in the investigation of early-onset sepsis (EOS). Current evidence suggests the normal kinetics of serum CRP should be considered when evaluating infants for presumable EOS. The current study aimed to evaluate the CRP kinetics, and to establish percentiles in a cohort of term and near-term infants with no evidence of confirmed or clinical EOS. Methods We retrospectively reviewed the medical records of all neonates ≥34 weeks’ gestation screened for presumable EOS, from January until December 2019. We also recorded the clinical management, the blood culture, serial CRP, and white blood cell count analysis of each infant. All infants that received antibiotics for confirmed or presumed EOS were excluded from the analysis. Results During the study period, 145 infants were detected; 109 (75%) term and 36 (25%) preterm. Term infants had significantly higher median values of CRP at all time points in comparison to preterm infants. Term infants presented a significant rise of CRP at 24 and 36 h, with a peak at 24 h (median 4 (range 1–12) mg/L). Preterm infants had a significant rise of CRP at 24 but not at 36 h, with a peak at 24 h (median 3 (range 1–9) mg/L). In term infants, the 90th percentile of CRP at 24 h was 10.80 mg/L and the 97th percentile was 12.00 mg/L. In preterm infants, the 90th percentile of CRP at 24 h was 7.60 mg/L and the 97th percentile was 8.00 mg/L. Conclusions Term and near-term asymptomatic infants had a rise in CRP during the first days of life. Term infants had a more pronounced CRP response in comparison to preterm infants. [ABSTRACT FROM AUTHOR]

We describe a novel deletion causing heterozygous εγδβ-thalassemia (εγδβ-thal) across three generations of a Greek family. The Greek deletion is about 72 kb in length, spanning from the hypersensitive site 4 (HS4) in the locus control region (LCR) to the 3' end of the β-globin gene, thus encompassing the entire β-globin gene cluster. The deletion caused severe but transient neonatal anemia and a non transfusion-dependent chronic hemolytic anemia state later in life, resembling mild β-thalassemia intermedia (β-TI) rather than β-thalassemia (β-thal) trait, as had been previously reported. Apart from the presentation of clinical and laboratory characteristics, the challenges involving clinical management are also discussed. [ABSTRACT FROM AUTHOR]

Objective: To investigate the insulin resistance status in SGA infants at 12 months and its relationship with auxological and metabolic parameters. Methods: One group of 45 SGA and one of 50 appropriate for gestational age infants were followed from birth to the end of the first year of life. At 12 months, skinfold thickness, waist circumference, and blood levels of glucose, insulin, adiponectin, leptin, resistin, visfatin, retinol-binding protein 4, IGFs, lipids profile were determined, and the HOMA-IR index was calculated. Results: The SGAs had increased insulin (5.2 ± 2.7 versus 2.9 ± 2.4 μIU/ml,p = 0.012) and HOMA-IR (1.09 ± 0.9 versus 0.59 ± 0.55,p = 0.016). In multiple regression, insulin resistance indices were independently correlated with low-birth-weight (β = −2.92,p = 0.015 for insulin,β = −2.98,p = 0.011 for HOMA-IR) but not with catch-up growth in either height or weight or any other metabolic parameter. Resistin was higher in the SGAs (5.1 ± 2.1 versus 3.9 ± 2.1 ng/ml,p = 0.03) and independently correlated with low-birth-weight but not insulin resistance. Resistin was negatively correlated with total cholesterol (R = −0.33,p = 0.007) and positively with lipoprotein(a) (R = 0.49,p = 0.001). Conclusion: Low-birth-weight, but not catch-up growth or adiposity tissue hormones, was correlated with insulin resistance at 12 months in non-obese SGA infants. The higher resistin in SGA infants and its correlation with total cholesterol and lipoprotein(a) need further clarification. [ABSTRACT FROM PUBLISHER]

Objective: Documentation of examination of brain structural development by magnetic resonance imaging (MRI) beyond the neonatal period is scarce for both preterm and small for gestational age (SGA) infants. Aim: To investigate structural brain development during infancy in preterm children born SGA by MRI. Methods: A total of 205 preterm infants, 139 appropriate for gestational age (AGA) and 66 SGA, of which 33 had birth weight (BW) < 3rd percentile and 33 had BW 3rd-10th percentile, were examined prospectively by brain MRI at the corrected age of 5 months. The total volume of the brain, ventricles and cerebellum, the area of vermis and corpus callosum, and the height of the pituitary, mesencephalon and pons were estimated on MRI. Results: Brain volume was smaller in the SGA < 3rd percentile infants, independent of other perinatal factors. Chronic lung disease was an independent predictor of low brain volume. Pituitary height was greater in SGA < 3rd percentile than in AGA infants. The corpus callosum area was less in SGA < 3rd percentile than in SGA of 3rd-10th percentile infants. Conclusions: Preterm infants born SGA with BW < 3rd percentile had differences in brain structural measurements at the corrected age of 5 months, compared with preterm AGA infants, which could have implications for their neurocognitive development. [ABSTRACT FROM AUTHOR]

Objective. Small-for-gestational age (SGA) neonates born prematurely may be at higher risk for adverse effects during the early postnatal period than premature neonates born appropriate for gestational age (AGA).This study aims to study comparatively morbidity and mortality in SGA and AGA neonates born with low gestational age (GA). Methods. The study population included all preterm infants born alive with GA 24-31 weeks in Northwestern Greece during a 9-year period and hospitalized in the regional neonatal intensive care unit (NICU). The association of SGA status with neonatal death, and with chronic lung disease (CLD), intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), and sepsis was assessed, using multiple logistic regression analysis. Results. Of 210 infants without congenital anomalies born at GA 24-31 weeks, 51 were SGA and 159 were AGA. CLD was more common in SGA than in AGA neonates (57.1%% vs 29.3%%, p < 0.05), but no differences were found in the rates of IVH, NEC, ROP, RDS, and sepsis. The mortality rate in the SGA group was 33.3%% vs 17%% in the AGA group ( p < 0.01), and in the subgroups 28-31 weeks 24.1%% vs 6.3%%, respectively, ( p < 0.01). In logistic regression analysis, SGA status was strongly associated with increased mortality and CLD, independent of confounding factors [[odd ratios and confidence intervals: 3.4 (CI: 1.8-10.6) p == 0.03 and 3.9 (CI: 1.7-11.5) p < 0.01, respectively. Conclusions. SGA neonates with GA 24-31 weeks were at increased risk of development of CLD and of neonatal death compared with AGA neonates of the same GA. [ABSTRACT FROM AUTHOR]

Objective. To investigate perinatal risk factors that may be associated with impaired renal function during the first 2 weeks of life. Methods. The case notes of 150 neonates of gestational age (GA) 34-36 weeks and 494 of GA > 36 weeks were studied. Clinical risk factors were retrieved, along with indices of renal function: serum creatinine (SeCr), fractional excretion (FE) of sodium (FENa) and potassium (FEK), and the urinary calcium to creatinine ratio (UCa/UCr). Associations were identified by multiple and logistic regression analysis. Results. In infants with GA > 36 weeks, raised SeCr was related to perinatal stress, odds ratio (OR): 1.9, confidence interval (CI): 1.2-2.9, p < 0.05, and to duration of treatment with aminoglycosides (AGs) ( t = 2.4, p < 0.01); FEK was associated with jaundice ( t = −3.1, p < 0.01), and FENa with duration of AGs treatment ( t = 2.6, p < 0.01). Full-term neonates with both hypoxic-ischemic encephalopathy (HIE) and AGs administration had an 80% increase in OR for impaired SeCr levels. In infants of GA 34-36 weeks, SeCr was related to perinatal stress (OR: 9, CI: 1.3-38, p < 0.05), FEK to jaundice ( t = −2.1, p < 0.05), and FENa to duration of AGs administration ( t = 2.2, p < 0.05) and antenatal steroid treatment (OR: 0.8, CI: 0.6-0.95, p < 0.05). Conclusion. In neonates, renal impairment, being multifactorial in origin, may be caused by the additive effect of different perinatal factors. The strong negative relationship observed between jaundice and K excretion merits further investigation. [ABSTRACT FROM AUTHOR]