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Objective: To investigate the placental morphology alterations and identify the clinical characteristics of women with polycystic ovary syndrome (PCOS) and their newborns. Pregnant women with PCOS (n = 12) and pregnant women without PCOS (n = 11) were recruited. Then, the placenta, maternal blood and cord blood were collected after delivery., Design: Clinical observational study., Setting: Not applicable., Patient(s): In the present study, pregnant women with PCOS and healthy pregnant women were recruited from the clinic of the Department of Obstetrics and Gynecology, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, China, between February 2015 and October 2015., Intervention(s): None., Main Outcome Measure(s): A proteomic analysis was performed on the placenta in women with PCOS and healthy women., Result(s): The maternal testosterone, androstenedione, dehydroepiandrosterone sulfate, free androgen index, cholesterol, apolipoprotein B, and apolipoprotein B/apolipoprotein A-I levels were significantly higher in the PCOS group than in the control group, and the offspring in the PCOS group had higher dehydroepiandrosterone sulfate, high-density lipoprotein, and cholesterol levels, when compared with the control group. The placenta in the PCOS group demonstrated infarction, calcification, and a greater intervillous space, when compared with the control group. A higher level of estrogen receptor-β protein was observed in the placenta of women with PCOS, when compared with women without PCOS. A total of 258 proteins in the placenta were identified to be significantly different, when the PCOS and control groups were compared, and fibronectin 1 exhibited the closest relationship with other differential proteins., Conclusion(s): The overexposure to hyperandrogenism and hyperlipidemia affects the functions of the placenta, which are associated with the development of metabolic disorders in newborns., (Copyright © 2020. Published by Elsevier Inc.)

Objective: Both preeclampsia and neuraxial anesthesia can alter placental perfusion, potentially affecting the neonatal status. The objective of our study is to quantify the association between type of neuraxial anesthetic and short-term neonatal morbidity among preeclamptic patients undergoing cesarean delivery., Methods: We performed a secondary analysis of a prospective observational cohort study. Women with singleton gestations and a diagnosis of preeclampsia who underwent cesarean delivery with neuraxial anesthesia were included in the analysis. Short-term neonatal morbidities, defined as neonatal intensive care unit (NICU) admission, arterial cord gas pH ≤7.2 and 5-minute Apgar <7, were compared based on type of neuraxial anesthetic., Results: A total of 4100 patients were included in the analysis, 1696 (41.4%) received spinal anesthesia 1848 (45.1%) received epidural anesthesia and 556 (13.5%) received a combined spinal-epidural (CSE). Antepartum and intrapartum characteristics significantly differed between the groups (p≤0.02). After adjusted analysis, spinal anesthesia was associated with reduced odds of NICU admission, compared with epidural or CSE (OR; 95% CI: 0.79; 0.63-0.98, 0.71; 0.53-0.94, respectively). Spinal anesthesia was also associated with lower odds of a 5-minute Apgar <7 compared with epidural anesthesia (OR 0.59; 95% CI; 0.43-0.83). We found no association between type of anesthesia and arterial cord pH ≤7.2. In stratiifed analysis by gestational age, no association between the type of neuraxial anesthesia and neonatal outcomes was noted among term infants, but associations persisted in preterm infants., Conclusions: Among women with preeclampsia undergoing cesarean delivery, spinal anesthesia may be associated with reduced short-term neonatal morbidity in preterm infants, compared with epidural or CSE.

Hypoglycemia may lead to neurological impairment; therefore, high-risk newborns are screened postnatally. However, hypoglycemia monitoring protocols often do not include cord blood acidosis as a risk factor. The study aimed to find an association between asymptomatic cord blood acidosis and hypoglycemia. All healthy term infants born at McMaster Children Hospital, Hamilton, Canada, between October 2013 and September 2014, who had umbilical cord blood pH <7.0 or base excess <12 mmol/L were studied. Infants with evidence of hypoxic-ischemic encephalopathy, birth weights outside of 10th to 95th percentiles for gestation, mothers with preeclampsia, diabetes or taking a -blockers at the time of the birth were excluded. Hypoglycemia was defined as blood glucose <2.6 mmol/L in the first two hours of life. One hundred sixtysix infants met the cord blood gas criteria, but only 16 had hypoglycemia. Although infants with mild perinatal depression are at risk for hypoglycemia, a significant association could not be proved.

Background: Approximately 8-15% of all infants are born with evidence of meconium-stained amniotic fluid (MSAF). MSAF is a potentially serious sign of fetal compromise and may indicate fetal hypoxia Objectives and aim of the work: The present study was designed to evaluate the relationship between meconium stained amniotic fluid and fetal nucleated red blood cell counts. As well, we aim to evaluate the relationship between the presence of meconium in amniotic fluid and Apgar scores in neonates., Subjects and Methods: A prospectively case-controlled study was performed on 40 women with clear amniotic fluid as control and 40 women with meconium-stained amniotic fluid as the study group. At delivery, 2 ml of umbilical cord blood was collected and analyzed for nucleated red blood cell (NRBC)., Results: The mean NRBC counts in meconium-stained amniotic fluid was significantly higher than the control group (18.35 ± 7.7 and 9.6 ± 4.96), respectively (p < .001). There were statistically significant differences concerning 1- and 5-min Apgar scores with lower values in the MSAF group (p < .001 and .001, respectively)., Conclusion: Our results support previous studies which indicate the presence of meconium can be associated with chronic fetal hypoxia as demonstrated by elevated fetal NRBC levels.

Objective: Current clinical practice of assessing neonatal condition is based on evaluation of umbilical cord arterial blood pH value rather than lactate. However, evidence shows that lactate is direct and more predictive measurement than pH or at least of equal importance. This study is to assess and compare umbilical cord arterial lactate and pH values for predicting short-term neonatal outcomes., Materials and Methods: A retrospective cohort study was conducted at the tertiary level hospital, were arterial umbilical cord blood sampling was collected according to the standard procedures. Neonatal morbidity was registered if at least one of the following conditions was noted: Apgar score at 1 min after delivery was 6 or lower, resuscitation performed, including assisted ventilation and requirement of admission to neonatal intensive care unit. Mothers-newborns pairs were allocated into two groups: newborns exposed to perinatal hypoxia (group 1) and observed as healthy newborns (group 2). Receiver operating characteristics curves (ROC) were generated to assess the predictive ability of pH and lactate for the short-term neonatal outcomes., Results: 901 neonates born at ≥37 weeks of gestation were included. Newborns exposed to perinatal hypoxia (group 1) encompassed 39 (4.3%) patients, and observed as healthy (group 2) - 862 (95.7%). Arterial umbilical cord blood pH in group 1 was 7.160 ± 0.126 as compared to 7.314 ± 0.083 in group 2; p < 0.001. Mean arterial lactate was significantly higher in group 1 than group 2 (6.423 ± 2.335 as compared to 3.600 ± 1.833; p < 0.001). The difference between areas under ROC curves representing pH and lactate was not significant (0.848 and 0.831 respectively; p = 0.6132)., Conclusion: Umbilical cord arterial lactate and pH predicted short-term neonatal outcomes with similar efficacies., (Copyright © 2017. Published by Elsevier B.V.)

Objective: To determine which parameter of the umbilical arterial cord gas analysis, pH, base deficit (BD) or lactate has a bigger predictive ability for neonatal morbidity at term., Method: We conducted a four-year retrospective cohort study including all non-anomalous, singleton, vertex, term births with neonatal acidemia (umbilical arterial cord gas pH ≤ 7.1). The primary outcomes were a composite neurological morbidity and a composite systemic morbidity. The predictive ability of lactate, BD and pH was compared using receiver operator characteristic (ROC) curves. Optimal cutoff values of lactate, BD and pH were estimated based on their maximal Youden Index., Results: We identified 466 acidemic neonates who had paired and validated cord blood gas data. The ROC curve analysis revealed that pH, BD and lactate had a similar predictive ability for neurological (AUC: 0.81; 0.78; 0.83, respectively) and systemic neonatal morbidity (AUC: 0.77; 0.82; 0.82, respectively). The combination of pH ≤ 7.0 and lactate ≥ 7.0 mmol/L presented similar validity to that of pH ≤ 7.0 and BD ≥ 12 mmol/L, but both were comparable to pH alone., Conclusions: pH, BD and lactate have similar predictive ability for adverse neonatal outcomes among acidemic neonates. Umbilical arterial lactate could replace BD as a measure of the metabolic component in acidemic neonates. However, neither BD nor lactate demonstrated in this study to improve the predictive ability of pH alone for short-term neonatal outcomes.

Objective: The assessment of neonatal well-being is paramount in delivery rooms. For that purpose, it is recommended in France to carry out a systematic neonatal umbilical cord blood gas analysis. The aim of this study is to evaluate how umbilical cord blood gas sampling is realised, analysed and interpreted by midwives in a French regional perinatal network., Materials and Methods: We conducted a survey focused on randomly selected midwives partitioning in different maternities that constitute the "Alsace" regional perinatal network. A questionnaire concerning the modalities of umbilical cord blood sampling, its analysis and the interpretation of results was used during interviews with included midwives., Results: Fifty-one midwives were included in the study (15.8% of whom were working in delivery rooms). Only 13% of maternities constituting the perinatal network did not realise systematic neonatal umbilical cord blood analysis. Among interviewed midwives, 78.4% reported umbilical cord clamping after the first breath of the child. Among the midwives included, 86.3% of them realise sampling from the umbilical artery and 29.4% from both umbilical artery and vein. For 86.3% of interviewed midwives, the leitmotif of realising umbilical blood sampling was medico-legal. More than two third of included midwives interpret blood gas taking into account two parameters (either pH and base excess, or lactate). They settled at 7.0-7.2, the limit below which a newborn might present sequelae., Discussion and Conclusion: This study shows that the neonatal umbilical cord blood gas analysis at birth is almost systematic in this regional French perinatal network. It is realised primarily for medico-legal purpose. However, there are significant variations in sampling procedures and interpretation. This should lead to the establishment within each maternity of a neonatal umbilical cord blood gas sampling protocol along with a midwifery training program., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Objective: We aimed to evaluate the umbilical cord blood (CB) hematocrit (Hct) levels in women with anterior located placenta previa (PP)., Methods: This is a prospective case-control study performed in a tertiary level maternity hospital. Thirty seven pregnant women diagnosed with anterior PP (study group) and 37 women without PP (control group) included into the study. Groups were matched with regard to age, gestational age, and fetal gender. All women underwent Cesarean section. Umbilical CB Hct levels of the newborns were measured. Demographics, operative features, and neonatal outcomes were recorded., Results: Umbilical CB Hct levels were statistically significantly higher in the PP patients compared with controls (p: 52.6±5.0 vs. 47.5±5.0, p < 0.001). Preoperative maternal hemoglobin (Hgb) and Hct levels were similar in the two groups. However, postoperative Hb and Hct levels were significantly lower in the study group (p: 0.003, p < 0.001, respectively). Intraoperative complication rates were higher in this group. Neonatal Apgar scores were lower and neonatal intensive care unit admission was more common in the PP group when compared with controls., Conclusion: We think that anterior PP is associated with increased umbilical CB Hct levels. Neonatologists should consider this condition in the infants born to mothers with anterior PP.

We assessed the hematopoietic stem and progenitor cell (HSPC) population in the cord blood of neonates born to mothers with gestational diabetes mellitus (GDM) in a hypothesis generating pilot study, due to that, neonatal polycythemia may be the consequence of GDM pregnancy. Forty-five pregnant women with GDM (last trimester mean HbA1C = 33.9 mmol/mol) and 42 (nondiabetic) control pregnant women were enrolled after their routine 75 g oral glucose tolerance test (OGTT) between the 24th and 28th gestational week (with expected differences in their mean routine clinical characteristics: plasma glucose at OGTT: 0' = 5.07 vs. 4.62 mM, 120' = 8.9 vs. 5.76 mM, age = 35.07 vs. 31.66 years, prepregnancy body mass index = 27.9 vs. 23.9 kg/m(2), GDM vs. control, respectively) on a voluntary basis after signing the informed consent. EDTA-treated cord blood samples were analyzed by flow cytometry and the software Kaluza1.2 using CD45 and CD34-specific fluorescent antibodies to identify the HSPC population (CD34(+) cells within the CD45(dim) blast gate). The proportion of CD34(+)CD45(dim) HSPCs among the nucleated cells was significantly (P < 0.05, statistical power = 60.8%) higher in the cord blood samples of neonates born to mothers with GDM (median 0.38%) compared to neonates born to nondiabetic mothers (median 0.32%) and according to treatment types (P < 0.05) median: control 0.32%, GDM-diet only 0.37%, GDM-on insulin 0.45%; control versus GDM on insulin (P < 0.05). The increased proportion of circulating CD34(+)CD45(dim) cells in the cord blood may possibly be related to altered fetal stem cell mobilization in GDM pregnancy, yet these results should be interpreted only as preliminary due to the small sample sizes.

Background: Galectin-3 binding protein (Gal3BP) is a glycoprotein isolated in colostrum that may be an immunologically active component with effects on the neonatal immune system. This compound has been found in the blood of term newborn infants, but has not been studied in preterm infants., Objective: Compare umbilical cord plasma Gal3BP concentration between preterm and term infants., Study Design: Observational study of mother-infant pairs consented at UCSD Medical Center comparing umbilical cord plasma Gal3BP concentration in preterm and term infants. Umbilical cord plasma was collected at birth and stored at -80°C before Gal3BP analysis by ELISA. This study was powered to evaluate differences in preterm and term infant Gal3BP concentration. The secondary aim was to determine the effect of maternal and infant clinical factors on Gal3BP concentration., Results: A total of 64 preterm and 30 term umbilical cord plasma samples were analyzed. By univariate analysis, Gal3BP concentration was elevated in the setting of prematurity, maternal diabetes, antenatal steroid exposure, and increasing maternal parity (p <  0.05); and decreased in chorioamnionitis (p = 0.03). Using a multiple linear regression model prematurity, chorioamnionitis and maternal diabetes remained significant., Conclusions: Umbilical cord plasma Gal3BP concentration is elevated in prematurity. This may reflect inflammatory states in infant and mother, but further study is warranted.

Iodine nutrition status amongst neonates can be assessed by estimating thyroid stimulating hormone (TSH). According to WHO, if more than 3 % of the neonates have TSH levels of 5 mlU/l and more in a population, it indicates presence of iodine deficiency (ID). Iodine deficiency is an endemic health problem in Solan district, Himachal Pradesh (HP) state. ID leads to mental retardation, deaf mutism, squint, dwarfism, spastic diplegia, neurological defects and congenital anomalies. The aim is to determine iodine nutrition status of neonates of Solan district. In Solan district, six hospitals/community health centers providing obstetric services and conducting more than 100 deliveries per annum were identified and enlisted. Two hospitals were selected keeping in view of operational feasibility. A total of 683 umbilical cord blood samples of neonates were collected on filter paper and analyzed for TSH. It was found that 63.2 % of the neonates had TSH levels of more than 5 mlU/l indicating iodine deficiency in the Solan district. Iodine deficiency was a public health problem in Solan district, HP.

The human hemostatic system is developmentally regulated, resulting in qualitative and quantitative differences in the mediators of primary and secondary hemostasis as well as fibrinolysis in neonates and infants. Although gestational age-related differences in coagulation factor levels occur, the existence of a unique neonatal platelet phenotype remains controversial. Complicated by difficulties in obtaining adequate neonatal blood volumes with which to perform functional assays, ambiguity surrounds the characterization of neonatal platelets. Thus, much of the current knowledge of neonatal platelet function has been based on studies from cord blood samples. Studies suggest that cord blood-derived platelets, as a surrogate for neonatal platelets, are hypofunctional when compared with adult platelets. This relative platelet dysfunction, combined with a propensity toward thrombocytopenia in the neonatal intensive care unit population, creates a clinical conundrum regarding the appropriate administration of platelet transfusions. This review provides an appraisal of the distinct functional phenotype of neonatal platelets. Neonatal platelet transfusion practices and the impact of the relatively hypofunctional neonatal platelet on those practices will be considered.

Objective: The aim of the study is to determine if umbilical cord serum concentrations of interleukin-6 (IL-6), C-reactive protein (CRP), and myeloperoxidase (MPO), in pregnancies at risk for preterm birth (PTB), are associated with neonatal morbidities and/or altered neurodevelopmental outcomes in the children., Study Design: Umbilical cord serum samples were collected at birth from 400 newborns delivered within a multicenter randomized controlled trial of repeated versus single course of antenatal corticosteroids (ACs), in women at increased risk for PTB. Newborns were followed through discharge and were evaluated between 36 and 42 months corrected age with neurological examination and Bayley Scales of Infant Development. Umbilical cord serum concentrations of IL-6, CRP, and MPO were determined using enzyme-linked immunoassays. Multivariate logistic regression analyses explored the relationship between umbilical cord serum IL-6, CRP, and MPO levels, adverse newborn outcomes, and PTB < 32 weeks of gestational age (GA)., Results: Univariate analysis revealed that umbilical cord IL-6 above the 75th percentile was associated with increased respiratory distress syndrome (RDS) and chronic lung disease (CLD), but not with necrotizing enterocolitis (NEC), intraventricular hemorrhage (IVH), or neonatal sepsis; however, this association was not significant after adjusting for GA at delivery and treatment group. No significant associations between CRP or MPO and RDS, CLD, NEC, sepsis, or IVH were evident. Regression analysis revealed that CRP above the 75th percentile was associated with a decreased risk of CLD (odds ratio, 0.10; 95% confidence interval, 0.02-0.41). No associations between umbilical cord IL-6, CRP, or MPO and MDI < 70 or PDI < 70 were evident. Umbilical cord serum concentrations of IL-6, CRP, and MPO, above the 75th percentile, were associated with more frequent PTB < 32 weeks of GA., Conclusion: Elevated umbilical cord serum concentration of CRP is associated with reduced risk for CLD even after adjusting for GA at delivery. Occurrence of levels > 75th percentile of IL-6, CRP, and MPO in umbilical cord serum was associated with PTB < 32 weeks of GA. Elevated umbilical cord serum concentrations of IL-6, CRP, and MPO at birth were not associated with poor neurodevelopmental outcomes., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

Early-onset neonatal sepsis (EONS) continues to be a severe condition associated with a high mortality and morbidity. However, symptoms and laboratory markers of this serious condition are nonspecific and currently there are no available standard tests to provide perfect diagnostic accuracy. An early recognition and initiation of antimicrobial therapy are essential in order to prevent morbidity and mortality. Hepcidin, the key regulator of iron homeostasis, is also an acute-phase reactant, which has a critical role in inflammation and contributes to host defense by interfering with microorganism's access to iron. Since hepcidin expression is induced by interleukin-6 (IL-6), it also plays role in the innate immune system. Recently, endogenous expression of hepcidin by macrophages and neutrophils in response to bacterial pathogens confirmed its role in innate immunity. The clear link between the hepcidin molecule and innate immunity may be used for the detection of EONS. We hypothesized that an increased level of hepcidin in cord blood may be used as a reliable biological marker of EONS and designed a prospective cohort study to test this hypothesis and collected pilot data. Cord blood samples of all infants born between January 2009 and December 2010 at our university hospital were collected after parental consent and a total of 38 infants were enrolled in the study who fulfilled the sepsis criteria. The range of cord blood hepcidin was found to be significantly increased in newborns with EONS (min-max: 118.1-8400 ng/mL). To the best of our knowledge, this is the first study to investigate the pathophysiologic relevance of hepcidin in EONS and demonstrate increased levels of hepcidin in cord blood as an acute-phase reactant in response to sepsis., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Context: An inverse relationship between total serum 25-hydroxyvitamin D (25-OH D) and increased adiposity has been established in children, adolescents, and adults. However, the relationship between neonatal adiposity and vitamin D status has not been reported. Both maternal obesity and vitamin D deficiency in pregnancy are common and are associated with adverse pregnancy outcomes., Objective: The aim of the study was to determine the relationship between vitamin D levels in mothers and newborns, as influenced by maternal obesity, and evaluate these associations with neonatal adiposity., Design, Setting, and Patients: Sixty-one maternal-neonatal pairs participated in this cross-sectional study at an academic medical center. Mothers had a prepregnancy body mass index that was normal or obese., Outcome Measures: Maternal and cord blood sera were assayed for 25-OH D, and neonatal body composition was measured by air displacement plethysmography., Results: Mothers had similar and sufficient levels of 25-OH D when measured at 36-38 wk gestation, irrespective of body mass index category (normal weight, 46.05, vs. obese, 49.84 ng/ml; P = not significant). However, cord blood 25-OH D was higher in neonates of normal-weight mothers compared to neonates of obese mothers (27.45 vs. 20.81 ng/ml; P = 0.02). The variance in cord blood 25-OH D was explained by four factors: maternal 25-OH D level, the presence of maternal obesity, maternal age, and neonatal adiposity (r(2) = 0.66)., Conclusion: Obese women transfer less 25-OH D to offspring than normal-weight women, despite similar serum levels. Cord blood 25-OH D levels directly correlate to neonatal percentage body fat. These novel findings underscore the evolving relationships between maternal obesity, vitamin D nutritional status, and adiposity in the neonatal period that may influence subsequent childhood and adulthood vitamin D-dependent processes.

Background: Although the effects of cardiac troponin I (cTnI) have been documented in infants, the associations among the value of maternal and cord blood total homocysteine (Hcy) levels, cord blood cTnI and the score for neonatal acute physiology and perinatal extension II (SNAPPE-II) values in infants have not been documented. The aim of this study was to determine the value of maternal total Hcy (mtHcy) and cord blood total Hcy (ctHcy) levels, cTnI and SNAPPE-IIas predictive factors of morbidity in newborns., Methods: Maternal and cord blood samples were routinely collected for analysis from all prospective participating volunteers. In this case–control study, both hospitalized (n = 71) and non-hospitalized (n = 148) newborns were identified and followed until discharge., Results: Regression analysis revealed that pre-eclampsia, gestational age, mtHcy and SNAPPE-II values were significantly and independently associated with morbidity. Cord blood pH, ctHcy levels, SNAPPE-II values, and pre-eclampsia were associated with mtHcy levels. A similar association was found among cTnI, cord blood pH, mtHcy levels and ctHcy levels. The specificity and sensitivity values of mtHcy in predicting newborn morbidity were 62% and 78%, respectively,while the specificity and sensitivity values of SNAPPE-II in predicting newborn morbidity were 96% and 97%,respectively., Conclusions: Elevated mtHcy levels were associated with cTnI, SNAPPE-II values, cord blood gas, and neonatal morbidities. These results suggest that SNAPPE-II may be an early predictor of morbidity after delivery and that elevated mtHcy levels may be an early prenatal biomarker of morbidity in newborns.

One collectin (mannan-binding lectin, MBL) and three ficolins (M-ficolin/ficolin-1, L-ficolin/ficolin-2 and H-ficolin/ficolin-3) share the capability to activate complement via the lectin pathway. This property depends on the ability of these lectins to form complexes with MBL-associated serine proteases (MASPs), particularly MASP-2. We report the results of an investigation of cord blood MASP-2 concentrations in a large, ethnically homogeneous cohort (n=1788) of neonates. The median value of MASP-2 in cord sera was determined to be 93 ng/ml (range <25-812). Serum MASP-2 concentrations correlated with gestational age and birthweight and were significantly lower in premature babies and other pre-term babies compared with term babies. Neonates with MASP-2 concentrations below 42 ng/ml were deemed to be MASP-2 deficient. That group had a shorter mean gestational age and a higher incidence of premature and low birthweight babies, but not of perinatal infections when compared with the others. Indeed, there was a trend towards higher MASP-2 concentrations amongst babies with infections. Among 362 samples tested for the D120G single nucleotide polymorphism (SNP) of the MASP2 gene, no homozygote for that mutation was found. Heterozygosity for this allele significantly influenced the protein concentration, but not the lectin pathway of complement activity (MBL-MASP-2 complex activity). Moreover, no association of this SNP was apparent with prematurity, low birthweight or perinatal infections.

Aim of the Study: The pattern of the complications observed in the foetus and newborn of diabetic mothers has been changed owing to improvement of care and treatment. Due to the introduction of the Saint Vincent Declaration goals, the improvement in prognosis of diabetic mothers has been noted. The goals are being pursued in our country. The aim of the study was to evaluate whether there is an association between maternal glycated haemoglobin, cord blood insulin level and general condition in infants of diabetic mothers., Material and Methods: In the study 158 newborns of diabetic mothers (86 G1, 56 G2, 16 P) and 171 newborns of the healthy mothers were evaluated. In the newborns of diabetic mothers venous cord blood samples were collected at delivery and analyzed for insulin and fructosamine level in relation to the maternal glycated haemoglobin., Results: The mean birth weight was significantly different between the control group 2885 +/- 905 g and the diabetic group 3199 +/- 617 g. The positive correlation between cord blood insulin level and birth weight in the diabetic group was observed; that indicates the higher fetal insulinemia influence on increased birth weight. Neither the correlation between birth weight and fructosamine nor birth weight and glycated haemoglobin were found. The mean glycated hemoglobin level was 5.17% (G1 5.15%, G2 5.18%, P 5.30%)., Conclusions: There is an association between cord blood insulin level in infants of diabetic mothers and birth weight. Increased insulin level is correlated with hypoglycemia. The incidence of cesarean section, macrosomia, hypoglycemia, hyperbilirubinemia in the study group was not different in comparison to control subject.

Introduction: The prematurity rate in our country is 8-9 %. Despite the decrease in neonatal mortality during the last decade, there is still a high incidence of neonatal morbidity and its subsequent sequelae. It is well known that the fetal inflammatory response plays an important role in the presence of neonatal morbidity. The aim of this study is to determine if interleukin 6 (IL-6) measurements in cord blood are a useful parameter to recognize those preterms with higher probability of suffering neonatal morbidity., Patients and Method: Descriptive and prospective study in newborns with gestational ages (GA) < or = 34 weeks. We determined IL-6 levels in cord blood; white cell count and C reactive protein (CRP) levels at 0, 12, 24 and 72 hours of life, and blood culture at admission. Clinical data was also collected, including perinatology factors, symptomatology on admission and subsequent evolution until discharge or death., Results: We included 99 newborns with a GA between 23 and 34 weeks and birth weights between 480 and 2,855 g. Levels of IL-6 > 10 pg/ml show a significant correlation between maternal fever and/or chorioamnionitis (P = 0.005), a weak but significant correlation (P = 0.05, r = 0.3) between increased levels of CRP at 24 hours of life and Critical Risk Index for Babies (CRIB) score > or = 4 (P < 0.003, r = 0.2) and a significant correlation (P = 0.04) with the presence of periventricular leukomalacia (PVL) and with length of hospital stay (P = 0.0015). Patients with a lower GA show a trend to have higher levels of IL-6., Conclusions: IL-6 could be a useful and early marker of neonatal morbidity. Its rapid ability to predict neonatal morbidity gives it an advantage over other classical blood markers.

Background: The aim of this study was to test the diagnostic model of combining procalcitonin (PCT) and C-reactive protein (CRP) levels in the cord blood and routinely used biochemical parameters and clinical data in the prediction of early onset neonatal infection., Methods: PCT and CRP concentrations were measured in cord blood of neonates with infection (group A, n=46) and compared with uninfected neonates (group B, n=240). Inclusion criteria for group A were based on obstetric history, clinical data and results of laboratory tests. Logistic regression was applied. The receiver operating characteristic (ROC) curves were constructed for PCT, CRP and the diagnostic model., Results: There was a highly significant (p<0.000001) difference in PCT and CRP concentrations between both groups. The cut-off point for PCT in cord blood was 1.22 ng/mL [sensitivity % (SE%) 80.43, specificity % (SP%) 71.67, positive predictive value % (PPV%) 35.24, negative predictive value % (NPV%) 95.03], and 1.0 mg/L for CRP (SE% 73.91, SP% 77.92, PPV% 39.08, NPV% 93.97). In total, seven variables were included in the model (concentrations of PCT and CRP in cord blood, tocolysis, nutritional status of the newborn, Apgar score, neutrophil ratio and red blood cell count in neonatal venous blood), which proved to offer the highest sensitivity (91.3%; 95% CI: 83-99) and specificity (90%; 95% CI: 86-94) for the detection of early onset neonatal infection. The likelihood ratio for the model was high at 9.13, with PPV% 63.64 (95% CI: 52-75), NPV% 98.18 (95% CI: 96-100) and calculated area under the curve at 0.973., Conclusions: The diagnostic model based on seven clinical and laboratory parameters, using the concentration of PCT and CRP measurements in the cord blood, could be a useful tool for the prediction of early onset neonatal infection.

Background: Adipokines are involved in the regulation of many inflammatory processes and are present at very high concentrations in cord blood of term infants., Objective: We analysed data of a large prospective birth cohort study to examine whether adiponectin and leptin concentration in cord blood are determinants of wheezing disorders in children within the first 2 years of life., Methods: Seven hundred and forty mothers and their newborns were included in this analysis. Adiponectin and leptin concentrations were measured in cord blood. The cumulative incidence of physician-reported asthma or obstructive bronchitis was recorded during a 2-year follow-up., Results: During the first 2 years of life, asthma or obstructive bronchitis was reported by the caring paediatricians for 157 (19.6%) of the children. We found a strong interaction of cord blood adiponectin and history of atopic disease in the mother with respect to the risk of physician-reported asthma or obstructive bronchitis (P=0.006). Compared with children with cord blood levels in the middle quintile (reference category), the odds ratios for physician-reported asthma or obstructive bronchitis in the bottom quintile and top quintile were 0.14 [95% confidence interval (CI) 0.02-0.90] and 2.12 (95% CI 0.67-6.66), respectively (P for trend=0.0003), among children of mothers with a history of atopy. This association was independent of other established risk factors. Leptin levels in cord blood were not associated with risk of asthma or obstructive bronchitis., Conclusions: In children of mothers with a history of atopy, concentrations of adiponectin in cord blood could play an important role in determining risk of wheezing disorders in early childhood.

Surfactant protein D (SP-D) is a collectin that plays an important role in the innate immune system and takes part in the surfactant homeostasis by regulating the surfactant pool size. The aims of this study were to investigate the values of SP-D in umbilical cord blood and capillary blood of premature infants and to relate the levels to perinatal conditions. A total of 254 premature infants were enrolled in the present study. Umbilical cord blood was drawn at the time of birth and capillary blood at regular intervals throughout the admission. The concentration of SP-D in umbilical cord blood and capillary blood was measured using ELISA technique. The median concentration of SP-D in umbilical cord blood was twice as high as in mature infants, 769 ng/mL (range 140-2,551), with lowest values in infants with intrauterine growth retardation (IUGR) and rupture of membranes (ROM). The median concentration of SP-D in capillary blood day 1 was 1,466 ng/mL (range 410-5,051 ng/mL), with lowest values in infants born with ROM and delivered vaginally. High SP-D levels in umbilical cord blood and capillary blood on day 1 were found to be more likely in infants in need for respiratory support or surfactant treatment and susceptibility to infections. We conclude that SP-D concentrations in umbilical cord blood and capillary blood in premature infants are twice as high as in mature infants and depend on several perinatal conditions. High SP-D levels in umbilical cord blood and capillary blood on day 1 were found to be related to increased risk of RDS and infections.

Apoptotic neuronal loss may be responsible for altered brain development associated with prematurity and perinatal insults. Neurotrophins play crucial roles in protecting neurons from entering or progressing along an apoptotic pathway. The present study examined levels of neurotrophins in human umbilical cord blood from infants at different gestational ages and clinical conditions. We collected 60 samples of cord blood and categorized them accordingly into three gestational age groups: group A (24-28 wk), group B (29-35 wk), and group C (>/=36 wk). Neurotrophin levels were determined by using brain-derived neurotrophic factor (BDNF) and neurotrophin 3 (NT3) ELISA. Clinical data were obtained by medical chart analysis. The BDNF levels were 884 +/- 386, 1421 +/- 616, and 2190 +/- 356 pg/mL in group A, group B, and group C, respectively. Significant differences were found between groups A and B (p = 0.038), groups A and C (p = 0.0001), and groups B and C (p = 0.001). Infants with severe intraventricular hemorrhage had significantly lower cord blood BDNF levels (925 +/- 513 pg/mL) compared with their normal counterparts (1650 +/- 674 pg/mL; p = 0.021). NT3 levels did not show significant change either across gestational ages or with the presence of intraventricular hemorrhage. Cord blood levels of BDNF may reflect the degree of neural maturity in premature infants. Interestingly, when a complete course of antenatal steroids was given, BDNF and NT3 cord blood levels were higher than when no steroid was given. Increased neurotrophins levels may also mediate improved neurodevelopmental outcome in infants who received antenatal steroids.

Objective: To estimate whether higher magnesium levels in umbilical cord blood at delivery are associated with increased total pediatric (fetal + neonatal + postneonatal) mortality., Methods: During the Magnesium and Neurologic Endpoints Trial, in addition to randomizing mothers having preterm labor into arms containing magnesium sulfate, other tocolytic agents, or saline controls, we obtained biologic specimens at delivery, including umbilical cord venous blood on which was determined the serum ionized magnesium level using the AVL 988-4 analyzer (Graz, Austria). Laboratory results were then matched with the pediatric mortalities. The study power was based on the anticipated reductions in neonatal intraventricular hemorrhage related to magnesium usage from 18.9% to 4.4%. For alpha =.05, 1-beta (power)=80%, two tailed, the total number of infants needed would be 140., Results: Of 149 mothers who gave permission for randomization, ionized magnesium levels were available for 82 children. Seven deaths occurred (one immediately before delivery, three as neonates, and three in the postneonatal period). The median level of ionized magnesium among the seven dead children was 0.76 mmol/L; among the 75 survivors, the median level of ionized magnesium was 0.55 mmol/L (Mann-Whitney U test, P =.03). Using multivariable logistic regression analysis, the association remained statistically significant when controlling for possible confounding factors (adjusted odds ratio 7.7, 95% confidence interval 1.2, 47.6, P =.03)., Conclusion: These findings of a dose response between serum ionized magnesium and deaths in children increase our concern about the improper use of tocolytic magnesium.

Streptococcus agalactiae (group B streptococcus, GBS) is the major pathogen of neonatal sepsis. In some newborns, GBS sepsis may have a severe course, including septic shock with a high mortality rate, whereas other newborns are colonized with GBS on their surfaces without any clinical signs of bacterial infection. The reason for this discrepancy is far from clear. We sought, in this study, to compare cytokine expression in cord blood mononuclear cells after stimulation with GBS strains isolated from newborns with sepsis, and strains isolated from newborns without any symptoms of invasive infection. Cord blood mononuclear cells were incubated with either heat-killed bacteria of different strains or lipopolysaccharide, respectively. After 6 and 24 h, cells were harvested and cytokine mRNA-expression was analyzed by reverse-transcriptase PCR. Likewise, supernatants were tested for IL-6 and tumor necrosis factor-alpha concentrations by enzyme immunoassay. When comparing IL-6 and tumor necrosis factor-alpha secretion, there were significantly higher IL-6 levels after stimulation with sepsis than with colonizing isolates. Likewise, mRNA expression of IL-6, IL-1 beta, and IL-12p40 was significantly higher after stimulation with sepsis isolates. This was also true when normalizing to cytokine expression after stimulation with lipopolysaccharide. These findings indicate that the different clinical pictures in response to GBS, either septic infection or colonization, might reflect strain-specific properties. If the respective characteristics can be defined, it might become possible to distinguish by molecular methods potentially "dangerous" from "harmless" strains. Moreover, our findings underline the essential role of these cytokines in the pathogenesis of neonatal GBS sepsis.

The purpose of our study was to evaluate lipid peroxidation products and scavenging enzyme activity in placenta and cord blood as well as the estimation of acid-base status and blood gases. Seventy five pregnant patients and their newborns were investigated. Twenty eight had pre-gestational diabetes mellitus (PGDM) and 19 gestational diabetes mellitus (GDM). The following parameters were measured: malondialdehyde (MDA) concentrations, glutathione (GSH) levels, the activity of CuZn dismutase (SOD) (Bioxytech, France). Base excess, pO2, pCO2 and pH were measured in arterial and venous samples. Statistical analysis was performed using Mann-Whitney U test. MDA levels and GSH content increased significantly, while SOD activities declined in diabetic group. Newborns of PDGM mothers had essentially diminished pH and rised both, pCO2 and base deficit. There were no any significant differences in parameters of acid-base balance in newborns of patients with GDM as compared with healthy patients. Our results suggest, that in diabetic patients the fetuses are exposed to increased oxidative stress. The evaluation of antioxidant defence and lipid peroxidation, apart from routine measurement of acid-base balance, might serve as a useful marker of fetal distress in diabetic patients.

Objective: To study the use of a modification of the classical biophysical profile by the combination of computerized analysis of fetal heart rate (cCTG) and the amniotic fluid index (AFI) in the prediction of neonatal acidemia at birth., Methods: We considered 89 singleton third trimester high risk pregnancies delivered by cesarean section, with an AFI evaluated within 24 hrs from birth, and an antepartum cCTG performed within 6 hrs from delivery. We assigned values for AFI (oligo/anhydramnios = 1, normal = 0) and cCTG (Dawes-Redman criteria, not satisfied = 1, satisfied = 0). The endpoint was to predict an abnormal neonatal outcome as defined by an umbilical artery (UA) pH < or = 7.2., Results: Fifteen neonates presented an UA pH < or = 7.2. By performing a logistic regression, we found that cCTG + AFI score (abnormal value 1-2) was able to significantly predict a pH value (< or = 7.20) with an Odds Ratio = 2.83 (p < 0.02). The diagnostic accuracy of the combination of cCTG + AFI was as follows: sensitivity: 80%, specificity: 58%., Comment: We suggest that the combination of cCTG + AFI included in the simple score we propose, may be of value in the prediction of neonatal acidemia and help in the management of third trimester high risk pregnancies.

Fetuses with homozygous alpha-thalassemia 1, in which the deletion of all four alpha-globin genes results in the absence of any alpha-globin chains, are severely anemic with clinical features of hydrops fetalis. Definitive diagnosis of alpha-thalassemia 1 carriers is difficult since there are few red cell abnormalities. Recently Chui et al. found that minute amounts of embryonic zeta-globin chains are present in adult hemoglobin of the Southeast Asian type of alpha-thalassemia 1 carriers. In this study, we screened 521 cord bloods for alpha-thalassemia 1. Hemoglobin analysis, including quantitation of Hb Bart's, was performed using the automated HPLC, alpha-thalassemia short program (VARIANT, Bio-Rad, Hercules, CA). Of these, 200 cord blood samples in which Hb Bart's was demonstrated were tested for the presence of zeta-globin chains by ELISA using labeled anti-zeta monoclonal antibody. Zeta-globin ranged between 0.21 and 0.83% in 19 specimens carrying alpha-thalassemia 1 gene. In the remaining 90 out of 109 specimens in which Hb Bart's was greater than 1.2%, zeta-globin was less than 0.17%. DNA analysis revealed the presence of normal alpha-genotype and other types of alpha-thalassemia including alpha-thalassemia 2 and Hb Constant Spring. One false positive was found in which the zeta-globin was 0.25% by ELISA but in which PCR indicated an alpha-thalassemia 2 heterozygote. Ninety-one samples with Hb Bart's of less than 1.2% by HPLC are most likely normal with a zeta-globin range between 0 and 0.14%. This study also showed that the frequency of alpha-thalassemia 1 in Bangkok is 3.65%.

The role of the sensory neuropeptide calcitonin gene-related peptide (CGRP) was studied in preterm and term neonates with sepsis and shock. CGRP levels in blood were measured by RIA. The identity of immunoreactive CGRP (irCGRP) in adult and infant human blood was confirmed by reverse phase-HPLC. CGRP levels were analyzed in a total of 189 samples (95 from cord blood and 94 from neonates). The gestational ages ranged from 24 to 43 wk, and the birth weights ranged from 520 to 4445 g. Cord samples were collected immediately after delivery and infant blood samples were collected within 12 h of birth. Samples were coded, and the data were assigned to groups after determination of CGRP levels. There was a weight- and gestation-dependent increase in irCGRP in the newborn population. The direct correlation of circulating CGRP with ascending birth weight and gestation may have significance in the development of the fetus. Infants with and without certain complications were grouped in 500-g intervals. CGRP levels in cord blood were significantly elevated when certain stressful situations existed in the mother. These included culture-positive chorioamnionitis, placental abruption, and severe preeclampsia. There was a similar elevation in CGRP in patient blood in infants with culture-positive sepsis and/or shock with blood pressure <2 SD from the mean for corresponding gestation. CGRP levels did not differ between male and female infants and did not appear to be influenced by type of delivery (vaginal versus cesarean section). There was no significant difference in CGRP level between cord and patient blood in preterm neonates, but at term gestation cord blood levels were slightly higher than those in the patient blood. These results suggest that inflammation and hemodynamic imbalance (e.g. shock) are associated with increased in CGRP levels in the circulation in neonates. Future studies will focus on the biologic effects of elevated CGRP during neonatal complications and will examine the utility of CGRP measurement for diagnosis and treatment of disease in preterm infants.

Objective: To examine whether perinatal complications induce the production of macrophage-colony stimulating factor (M-CSF), we have compared M-CSF levels in the cord blood between normal neonates and neonates with complications., Methods: The M-CSF levels were determined by enzyme-linked immunosorbent assay (ELISA)., Results: In 54 normal neonates, the M-CSF level was 1859 +/- 287 U/ml (mean +/- S.D.), being significantly higher than the serum M-CSF level in normal adults (697 +/- 132 U/ml). Compared with M-CSF levels in normal neonates, significantly higher levels were evidenced in neonates with perinatal complications including premature rupture of the membranes, neonatal asphyxia, meconium staining of the amniotic fluid and maternal anemia. However, no difference in M-CSF concentrations was observed irrespective of complication types; furthermore, the M-CSF level was highly correlated with the leukocyte counts in the neonates with complications, but not in normal neonates. Incidentally, CRP levels were within normal limits in most of these neonates,, Conclusion: M-CSF levels in the cord blood from neonates with premature rupture of the membranes, neonatal asphyxia, meconium staining of the amniotic fluid and maternal anemia were significantly higher than those in the cord blood sampled from normal neonates. The stress given to neonates may account for the higher M-CSF levels rather than infections.

Objective: To determine the prevalence, magnitude, and type of fetal acidemia associated with contemporary obstetric anesthetic techniques., Methods: Umbilical artery blood gases were obtained in 1601 singleton pregnancies delivered by elective cesarean., Results: General anesthesia was used in 371 (23%) women, epidural in 286 (18%), combined spinal-epidural in 659 (41%), and spinal in 231 (14%). Approximately 18% of infants exposed to regional anesthetics had umbilical artery blood pH values 7.19 or less, 42 (3%) infants had pH values less than 7.10, and nine (1%) had values 6.99 or less. The incidence of fetal acidemia was greater in spinal and combined spinal-epidural procedures compared to epidural anesthetics. Fetal acidemia was predominantly respiratory in type because carbon dioxide pressure was abnormally increased when fetal acidemia was diagnosed., Conclusions: Regional anesthesia is associated with fetal acidemia, occasionally severe, and has features of an acute respiratory type of acidemia. Fetal acidemia is less frequent with epidural anesthesia compared to subarachnoid techniques.

Among 10 440 newborns, 522 with upper 5 percentile values for very low-low density lipoprotein cholesterol in cord serum were selected for follow-up studies. Follow-up was possible in 446 of these 522 families (85%) and familial hypercholesterolemia (FH) was diagnosed in 11. In 273 of the 522 children, serum lipids were determined between the ages of 1 and 2 years and were now found to be normal, except in the 11 children with FH. Furthermore the serum lipids were compared in subgroups of these 273 children divided according to obstetric complications (i.e. low birth-weight, perinatal asphyxia and antepartum betamethasone treatment), which may cause a rise in serum lipids at birth. No differences were found between these subgroups at the age of 1--2 years.

Vasopressin concentrations were measured in the cord blood of thirty infants, thirteen delivered vaginally and seventeen by Caesarean section. There was no correlation with maternal values but the concentration following vaginal delivery (13.5 microunits/ml +/- 7.9 SD) was significantly higher than that following Caesarean section (4.2 microunits/ml +/- 6.6 SD). Gestational age did not affect the concentrations, which fell during the first week of life and then rose gradually in term and pre-term infants. High levels were found in seven sick babies. There was no correlation in the first 3 weeks of life between plasma vasopressin and plasma or urine osmolality in well and sick babies.

C peptide is secreted by pancreatic beta cells in amounts equimolar with insulin, and its levels provide a direct indication of endogenous fetal levels of insulin despite the presence of maternal insulin antibodies. To determine the presence of hyperinsulinemia and its relation to the development of complications in infants of diabetic mothers, we measured cord serum levels of C peptide in 79 infants of diabetic mothers and 62 infants of nondiabetic mothers. Infants of diabetic mothers had higher cord levels of C peptide, which were significantly associated with neonatal hypoglycemia and macrosomia (P less than 0.001) but not with hyaline-membrane disease. Cord levels of C peptide in infants of diabetic mothers were elevated at the earliest gestational age studied (less than 34 weeks) and were directly related to the severity of maternal diabetes, as assessed by the White classification. We conclude that hyperinsulinemia is present in infants of diabetic mothers and that it is related to some major complications in such infants.

Serum alpha 2-macroglobulin (alpha 2-M) levels were measured in cord sera of Chinese, Caucasian and Ghurka babies in Hong Kong by the antibody-agar radial immunodiffusion technique. The values for male babies of the three ethnic groups were 293 +/- 59, 323 +/- 79 and 303 +/- 72 mg./100 ml., respectively; those for female babies were 287 +/- 74, 315 +/- 74 and 317 +/- 7) mg./100 ml., respectively. Although a general similarity of cord serum alpha 2-M levels was evident at birth, it was noted that ethnic differences in the level of this serum protein only become apparent later in life. The value obtained for Caucasian cord serum alpha 2-M in Hong Kong was significantly lower than a published value for Caucasians elsewhere.

Colloid osmotic pressure of umbilical cord plasma was measured in 242 healthy infants, in 34 infants with respiratory distress syndrome (RDS), in 18 infants with asphyxia, in 13 infants who were small for gestational age, in 15 infants born to mothers with diabetes mellitus, and in 18 infants born to mothers with pregnancy-induced hypertension. In healthy infants, colloid osmotic pressure correlated highly significantly with umbilical cord blood total protein level, gestational age, and birth weight. In infants with RDS, no correlation between colloid osmotic pressure and gestational age or birth weight was found. Infants with RDS and gestational age between 36 and 38 weeks had significantly lower colloid osmotic pressure than healthy infants, whereas colloid osmotic pressure of infants with RDS and gestational age between 32 and 35 weeks did not differ from that of healthy infants of corresponding gestational age. Healthy term infants delivered by cesarean section had significantly lower colloid osmotic pressure than infants delivered vaginally. Infants with asphyxia had significantly higher colloid osmotic pressure than healthy infants. Colloid osmotic pressure is related to the lung maturity of the near-term and term neonate. Infants with a colloid osmotic pressure greater than 16 mm Hg are unlikely to develop RDS.

A critical study based on 3291 analyses of blood from the umbilical cord, and the consequences. In routine analyses acidosis (pH 7.10) was found in 2.03%. This percentage is considered too high. Protracted labor carries special risks. Conventional and intensive care supervision, when risks are foreseen, are often ineffective, since 48.8% of acidoses were recognized only post partum. More general intensive observation with internal cardiotocography and microinvestigations of blood appears to be the only way in which the frequency of acidosis could be decisively reduced.

In studying the human lipid transport system as it changes from the fetal to the adult form, data were collected on cord sera levels of lipids and apolipoproteins (A-I, A-II, ApoB, C-I, C-II, C-III, ApoD, and ApoE) from infants whose lipid metabolism might have been modified by a variety of factors present before, at, or after delivery. The results clearly indicated that many factors affect the levels of both lipids and apolipoproteins at birth. Method of delivery had little effect except in relation to either fetal immaturity (increased total cholesterol) or fetal stress (increased triglycerides). Birth weight was related to changes in free cholesterol, C-I, C-III, and ApoE levels. Gestational age had greater impact upon both serum lipids and apolipoproteins. With increasing fetal maturity, total cholesterol, free cholesterol, A-II, C-II, and ApoE progressively fell whereas triglyceride and ApoD rose. A variety of clinical disorders were also associated with changes in serum lipid and apolipoproteins. Anencephaly produced marked increases in both free and total cholesterol as well as most apolipoproteins. Significant reductions in triglyceride and ApoD levels were found in infants who subsequently became ill in the postnatal period with problems relating to carbohydrate metabolism (e.g., infants of diabetic mothers). Infants with respiratory distress were found to have decreased levels of total cholesterol and ApoB, both of which are increased in prematurity, a condition with which respiratory distress (RD) is usually associated. The changes in cord sera lipid and apolipoprotein levels found in a variety of clinical situations may provide new diagnostic approaches to postnatal problems arising in the newborn.

The usefulness of a combined screening for acute-phase glycoproteins and IgM level in cord sera to denote various intrauterine or delivery-associated disorders was tested in approximately 2,000 consecutive cord sera. Increased glycoprotein level, measured by sensitive and technically simple concanavalin A binding nephelometry, showed a significant association with birth injuries and abnormalities of amniotic fluid, whereas raised IgM levels were linked to maternal genitourinary infections and to cesarean sections performed because of fetal distress. The correlation between these putative risk indices was poor (r = 0.38). Both indices were connected with severe neonatal disease and/or poor outcome of the child, but since such conditions were also otherwise evident at birth, routine screening by these tests was considered unwarranted.

In 275 neonates mean cord blood cholesterol level was 70 +/- 17 (SD) mg/dl, with a range from 30 to 153 mg/dl. Mean cord blood triglyceride level was 33 +/- 26 (SD) mg/dl, with a range of 5-192 mg/dl. In an attempt to correlate perinatal problems and hypercholesterolemia in neonates we compared 15 hypercholesterolemic neonates who had cord blood cholesterol levels above 95 mg/dl, range 100-153 mg/dl, and triglyceride levels less than 65 mg/dl, with 65 normal neonates whose cord blood cholesterol levels were less than 95 mg/dl and triglyceride values were less than 65 mg/dl. We also compared 19 hypertriglyceridemic neonates who had cord blood triglyceride levels greater than 65 mg/dl, range 66-192 mg/dl, and cholesterol levels less than 95 mg/dl with the 65 normal neonates. Elevated cord blood cholesterol values greater than 95 mg/dl or triglyceride values greater than 65 mg/dl were associated with maternal-fetal problems related to unfavorable intralterine environment, fetal distress, and fetal anoxia. There was a significant correlation between post-term delivery and hypercholesterolemic neonates, and low Apgar scores and maternal hypertension were more often associated with hypertriglyceridemic infants. There was no association between serum cholesterol or triglyceride levels and prolonged ruptured membranes, cesarean section, maternal diabetes, or maternal hypothyroidism. Consequently, we think that when neonates are identified who have elevated cholesterol or triglyceride levels, the possible influence of maternal-fetal perinatal complications should be considered. Speculation Infants with familial hypercholesterolemia may be identified by increases in cord blood cholesterol concentrations. Elevated cord blood cholesterol or triglyceride values of some neonates, however, may represent hyperlipoproteinemia related to neonatal stress associated with maternal-fetal perinatal problems.

This study was undertaken to evaluate the effect of preeclampsia on maternal and cord blood clotting parameters. Pregnant controls and preeclamptics plus their offspring had plasma analyzed for prothrombin time, partial thromboplastin time, fibrinogen, and clotting activity for factors II, V, VII, VIII, IX, X, XII, plus factor II antigen. Maternal data was consistent with that previously reported by numerous authors. The cord blood data showed that neonates of the preeclamptic mother had elevated fibrinogen and decreased II, V and VII activity, plus decreased II antigen. The data indicates that abnormal clotting parameters seen in the neonates from preeclampic mothers may result from impaired liver function and not as previously thought, from a deficiency in neonatal vitamin K.

Our regional cord blood screening programme for detecting neonatal hypothyroidism using initial cord blood thyroxine (T4) determinations, with supplemental thyrotropin (TSH), and triiodothyronine resin uptake (T3U) measurements, gave an incidence of thyroid abnormalities of 1/3000 births, with 1/5000 infants having severe primary hypothyroidism. No hypothyroid infant detected in the programme had been suspected clinically before the screening and, in retrospect, only a few babies had any signs of hypothyroidism. Supplemental TSH and T3U determinations were required on 8-12% of the population screened initially with a T4 test to avoid missing affected cases. With an initial T4 and supplementary TSH and T3U testing on cord blood serum, recalls to exclude primary hypothyroidism were reduced to 0.16% of the screened population. The incidence of abnormalities detected in this cord blood screening programme was comparable with that reported by others using neonatal dried blood screening methods, indicating that cord blood screening can be effective provided the appropriate recall criteria and transport conditions are used. Nevertheless, for several practical reasons, neonatal dried blood methods are recommended as the screening test of choice for surveying large populations over extensive geographical areas.