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Preterm premature rupture of membranes (PPROM), defined as the spontaneous rupture of the membranes before 37 weeks of gestation and prior to the onset of labor, is the leading identifiable cause of preterm delivery, occurring approximately in one third of all preterm births [1]. Although a single factor can seldom be assigned to PPROM, it is most strongly associated with the presence of intrauterine inflammation and/or infection [2]. In nearly half of PPROM cases, or cases of preterm labor with intact membranes, fetal inflammatory response syndrome is present—with increased production of lung surfactant and alterations to lung structure [3].

To the Editor. We read with great interest “Lactation Counseling for Mothers of Very Low Birth Weight Infants: Effect on Maternal Anxiety and Infant Intake of Human Milk” by Sisk et al.1 Their objective was to examine whether mothers of very low birth weight infants who initially planned to formula feed were different in terms of their levels of anxiety and maternal stress compared with mothers who had planned to breastfeed their infants. The study showed that counseling mothers …

Twin gestation is associated with higher rate of neonatal hypoglycemia than do singletons. We examined the role of specific risk factors associated with neonatal hypoglycemia of 216 premature twins and 1284 premature singletons, consecutively born in the years 1994-1996 in the Department of Pediatrics of Padua University, Italy. Significantly higher risk of hypoglycemia (Dextrostix

To the Editor .— We read with great interest “Outcome of Extremely Low Birth Weight Infants With Leukemoid Reaction” by Hsiao and Omar.1 Their objective was to examine the effect of leukemoid reaction (LR) in morbidity, mortality, and long-term developmental outcome in extremely low birth weight (ELBW) infants. The study showed that LR in ELBW infants is associated with a higher incidence of bronchopulmonary dysplasia (BPD), compared with no-LR infants. Although hypothesized in their discussion, the study by Hsiao and Omar did not investigate if …

Late-preterm infants represent the most rapidly growing group of preterm births. The majority of these infants is treated as term neonates at the regular nursery. It is noteworthy that late-preterm infants have a lower breast-feeding prevalence than term neonates. It is not known whether psychological distress affects lactogenesis or the mother-to-infant bonding. The study’s aim is to verify if late-preterm delivery is associated to psychological distress affecting Mother-to-Infant bonding and breastfeeding. The study was performed at the Departement of Gynaecology and Human. Reproduction Science of Padua University, between June and October 2011. The study group consisted of 75 mothers: 25 delivered late-preterm with caesarean section and 50 delivered with term vaginal birth. The third day after birth, four psychological tests were administered to mothers: STAI, EPDS, MIBS, LuscherColorTest. Baseline levels of prolactin and cortisol were controlled. ANOVA shows significantly higher levels of trait anxiety and state anxiety in late-preterm infants’ mothers:the average trait anxiety is 46.0 (IQR 39.0–50.0) in late-preterm infants’ mothers and 40.5 (IQR35.3–44.0) in term infants’ mothers (p=0.01); and the average state anxiety is 48.0 (IQR42.0–56.0) in late-preterm infants’ mothers and 43.0 (IQR 39.0–48.8) in term infants’ mothers (p=0.03) respectively. There are significantly higher levels of depression in late-preterm infants’ mothers: in EPDS the average is 9 (IQR 8–13) in late-preterm infants’ mothers and 6 (IQR 4–9) in term infants’ mothers (p=0.001). In MIBS, joy is lower in late-preterm infants’ mothers. In late preterm infants this is associated to reduced exclusive breastfeeding at discharge (20% vs 66%). The LuscherColourTest is comparable for both groups. Mothers who delivered late-preterm have negative emotional changes, without hormonal changes. The psychological distress is negatively associated to an altered Mother-to-Infant bonding and lactation performance.

Nous avons etudie les antecedents cliniques chez les prematures avec dysplasie bronchopulmonaire (DBP), dont le poids de naissance etait inferieur a 1,75 kg. Ils ont fait partie d'une serie prospective de traitment par l'indomethacine du fait du Canal Arteriel (CA) « silent », evalue au troisieme jour de vie par l'echographie bidimensionelle et le Doppler pulse au NECU du Departement de Pediatrie de l'Universite de Padoue, entre Janvier 1987 et Decembre 1991. Sur les 290 enfants suivis, 96 etaint touches par le CA «Silent» (33%) et 77 avaient repondu au traitement a l'indomethacine (80%). En tout 79 (27%) avaient developpe une DBP, et parmi ceux-ci l'incidence de la DBP etait statistiquement plus elevee chez les enfants atteints de CA « silent», 47 sur 96 (49 ± 9%) contre 32 sur 194 (16 ± 3%) sans CA. L'analyse statistique a montre que chez les prematures avec CA «silent» le development de la DBP etait correle au 99% C.L. au bas poids de naissance: en fait la moyenne et la mode de distribution du poids de naissance etaient statistiquement plus bas en presence de DBP, 1,03 kg contre 1,24 kg, et 0,88 kg contre 1,65 kg respectivement. En outre, les prematures avec CA «silent» n'ayant pas repondu au premier cycle d'indomethacine et/ou soumis plus tard a l'intervention chirurgicale, ont presente un poids de naissance statistiquement plus bas par raport a ceux qui ayaient repondu precocement, 1,06 kg contre 1,18 kg, et en meme temps ont presente une incidence statistiquement plus elevee de DBP (63 ± 20% contre 43 ± 9%). De ces donnes nous avons conclu que, bien que «silent», le CA augmente en soi l'incidence de DBP, meme s'il beneficie d'une intervention precoce. Du plus, le bas poids de naissance des enfants affectes par le CA «silent» represente un facteur contribuant au development de la DBP.

Premature neonates with bronchopulmonary dysplasia (BPD) frequently present borderline hypoxemia and the risk for oxygen desaturation may increase in relation to the posture. Our aim was to see if infants with BPD experience severe hypoxemia (SaO2 < 85%) in a hammock, a ‘containing’ posture considered advantageous to neuromotor and relational development of the preterm. Fifteen pulse oximetry recordings (Ohmeda B105 3760 Pulse Oximeter) were obtained in 15 subjects (range of gestational age and postnatal age 27–30 and 33–48 weeks, respectively; range of birth weight and body weight at entrance to the study 0.64–1.35 and 0.97–2.24 kg, respectively) before, during and after placement in a hammock; each testing period lasted 15 min, and each baby served as his or her own control. BPD preterm infants were receiving oxygen therapy by continuous flow standard nasal cannulas (FiO2 > 25%, < 40%). The analysis of the data, that have a rough gaussian distribution, indicates a worsening of SaO2 in the hammock position. In fact, mean ± SEM, median and range of the SaO2 values in pre- and posthammock position are comparable, but are significantly different at 99.9% confidence level (CL) in prehammock vs. hammock posture and at 98% CL in posthammock vs. hammock posture. Moreover, the percent of time with SaO2 < 85% during the periods recorded increased about 10 ± 5% in a hammock (24 ± 4%), in comparison to pre- (14 ± 3%) and posthammock position (15 ± 3%). These results suggest that oxygen-dependent BPD preterm infants in the hammock posture may experience severe hypoxemia that in part limits the possible advantages of the ‘containment’.

To determine the effect of a short course of methylxanthines on renal function and on urinary calcium excretion, 20 premature neonates affected by apnea or moderate respiratory distress syndrome were randomly assigned to either a theophylline treatment or to a caffeine treatment group. The protocol included a 24-hour pretreatment study period (I) and a subsequent 24-hour period (II) following 5 days of theophylline (loading dose 5 mg/kg i.v., maintenance dose 2.5 mg/kg/l2 h) or caffeine (loading dose 10 mg/kg i.v., maintenance dose 2.5 mg/kg/l2 h) administration. Pre- and postxanthine treatment serum sodium, potassium, calcium and phosphorus remained stable, while serum creatinine decreased significantly (p < 0.05). Furthermore, from period I to period II, sodium urine excretion, fractional Na excretion and creatinine clearance remained statistically comparable in both study groups, along with a significant increase (p < 0.05) in calciuria, urinary Ca/creatinine and urinary Ca/Na. Predose caffeine and theophylline serum levels, assessed on the 5th day of treatment, were 12.8 ± 1.8 and 7.9 ± 1.7 μg/ml, respectively. Compared to control healthy untreated prematures, the studied premature infants showed a statistically significant increase in urine calcium excretion (10- to 15-fold), which was more evident in the theophylline group. Our data suggest further investigation to determine the long-term renal effects of methylxanthines in premature neonates, to improve assessment of the risk of nephrocalcinosis and osteopenia, in particular in association with various diuretic therapies.

centile with normal Doppler umbilical artery (UA) and intrauterine growth restriction (IUGR), EFW 2 standard deviation. aIMT was measured by ultrasonography during third trimester. Carbohydrate profile in mothers and fetuses at delivery was assessed. Results: Between 165 women enrolled, 97 were controls, 57 SGA and 11 IUGR. There were no significant differences in maternal age and BMI among the groups. IUGR presented a lower birth weight and a higher aIMT compared to SGA and AGA fetuses (P < 0.05). There was a significant positive correlation between maternal and fetal values for adiponectin, insulin, glucose and HOMA index. Adiponectin was significantly lower in the mother than in the fetus (P < 0.05) while NEFA and glucose were higher (P < 0.05). Maternal adiponectin and NEFA in SGA were significantly higher than in AGA (P < 0.05); moreover there was a significant positive correlation of fetal glucose with fetal aIMT not observed in AGA (P < 0.05), and in SGA fetuses a high aIMT correlated with high insulin resistance. In addition, in IUGR high aIMT was associated with high insulin concentrations. A significant negative correlation between maternal adiponectin and fetal aIMT was found in AGA, while in the SGA group the correlation was significantly positive (P < 0.05). Conclusions: This study suggests that aIMT could be associated with fetal glucose metabolism alteration, and that maternal metabolic disorders might reflect on fetal metabolism and influence the structure of fetal vessels.

according to international criteria. aIMT was measured by ultrasonography during third trimester of pregnancy. Results: 120 with GDM and 600 physiological patients were enrolled. aIMT was measured at a median gestational age of 32 weeks (IQR 30–34). There were no differences in parity, maternal age and gestational age at delivery between the groups. Fetal weight at delivery was higher in the GDM group than in the general population (3332.61 gr ± 507.94 versus 3088.1 gr ± 663.7 in the general population). aIMT and diameter of abdominal aorta were increased in the first group (0.65 ± 0.21 mm vs. 0.58 ± 0.21; 4.16 mm (±1.2) vs. 3.78 mm (±1.09), respectively, (P < 0.05) in comparison to the general population. The same difference in aIMT persisted even when the thickness was converted in MoM (1.1 (±0.33) versus 1.03 (±0.33) in the general population). There was a statistically correlation between aIMT MoM and birth weight in GDM group. Conclusions: Fetuses born from mother affected by GDM could be affected by in utero vascular damage.

cardiac function, carotid artery diameter, IMT and stiffness nor in endothelial function. Conclusions: ARED flow seems to contribute to an irreversible restriction of aortic growth persisting into adulthood, while the carotid artery, an adjacent elastic artery, has unchanged geometry and mechanical properties. Even if no altered left ventricular geometry or function were revealed at present, the smaller diameter and higher systolic pressure reflection in the central aorta might have negative consequences for left ventricular performance in the future by increasing aortic impedance.

Background and Aims: Chorioamnionitis is an antenatal inflammatory state: it can induce fetal inflammatory response syndrome and postnatal leukemoid reaction which have been associated to chronic lung disease of preterm infants. The aim of this study was to evaluate if the measure of neonatal WBC, a widely used marker of inflammation, may predict bronchopulmonary dysplasia (BPD) in VLBW infants with histological chorioamnionitis (HCAM).

Bronchopulmonary Dysplasia in Very Low Birth Weight Infants with Histological Chorioamnionitis: a Case-Control Study

Objective: Previously we showed that aorta intima-media thickness (aIMT) in IUGR fetuses with Doppler abnormalities is higher than in AGA. The aim of the present study is to validate this finding in twin pregnancies with the co-twin affected by IUGR or SGA. Methods: Prospective longitudinal study has been performed in our University hospital between January 2009 and February 2011. IUGR co-twin was defined as fetuses with estimated fetal weight (EFW) 2 SD) and SGA fetuses with EFW< 10th percentile and normal Doppler velocimetry. aIMT was evaluated during routine third trimester ultrasonography. Results: Sixty-three twin pregnancies were enrolled in the study. Among them 80 twins were AGA, 20 IUGR and 26 SGA. Median GA at birth was 35 weeks (range 32-36), and median birth weight 1665 g (range1246-1840), 2172 g (range 1838-2333), 2295 (range 1910-2550) in IUGR, SGA and AGA, respectively, showing a statistical difference between IUGR vs AGA (p< 0.0001) and vs SGA (p=0.003). Median gestational age at aIMT measurements was 30 weeks (range 29-32). There was a significative difference in aIMT between IUGR, SGA and AGA. Conclusions: aIMT is higher in IUGR compared to SGA vs AGA and in SGA vs AGA fetuses, highlighting that Doppler velocimetry and birth weight are predictors of aorta stiffness. Moreover, to our knowledge this is the first study considering aIMT in twin pregnancies, which may be considered a model of study to detect early cardiovascular markers in the same environment.

Intrauterine Growth Restriction, Aortic Wall Thickening and Glomerular Proteinuria During Infancy

Objectives: The aim of this study is to evaluate three dimensional cerebroplacental ratio (CPR 3D) using 3D power Doppler angiography (3D PDA) in the intrauterine monitoring of the growth restricted fetuses (IUGR). Methods: Cerebroplacental ratio (CPR), the ratio between PI of MCA and PI of umbilical artery (UA), is a better predictor for adverse outcome than a single vessel considered alone. We defined CPR 3DPDA as the ratio between vascular indices of a region of fetal brain (ROI) and the vascular indices of the placenta using 3DPDA methodology. The ROI evaluated were a ‘frontal zone’, sprinkled mainly by anterior cerebral artery, obtained tracing a contour passing through the anterior side of cavum septum pellucido (CSP) surrounding part of temporal and frontal bone. Then a second ROI obtained tracing a contour from temporal bones of the width of CSP included (’temporal zone’) sprinkled by middle cerebral artery MCA. We considered 3DPDA vascular indexes (VI = vascularisation FI = flow, VFI = vascularisation and flow). We enrolled 33 IUGR fetuses and 81 adeguate for gestational age, as control cases (24–38 weeks). IUGR fetuses were divided into 2 groups: group 1, IUGR with normal flussimetry of umbilical artery (UA) and MCA; group 2, IUGR with abnormal UA-PI (mean > 2 SD) and abnormal MCA-PI (PI < 2 SD). We calculated the 2D CPR and the CPR 3D of the frontal and temporal cerebral zones for all vascular indexes. Results: Values of 2D CPR were in accordance with the expected ones. CPR 3D, applying VI and VFI, both in frontal and temporal zone demonstrated a statistically significant different values compared with control cases. Conclusions: CPR 3D can be considered a new parameter: it demonstrates the vascular redistribution in frontal and temporal zones during the ‘brain sparing effect’ in IUGR fetuses also in the group of IUGR fetuses without bidimensional pathological flussimetry.

The levels of some enzymes of lysosomal origin were assayed during days 2 and 5 of life in plasmas from 11 sets of twin neonates and from 25 neonates from single pregnancies (13 of weight appropriate for gestational age and 12 small for their gestational age) as controls. The plasma enzyme levels were also determined in the correspondent twin and control mothers 2 days after delivery. N-Acetyl-β-d-glucosaminidase isoenzymes were assayed after chromatofocusing separation. All the plasma enzyme levels were higher in the group of twin neonates and of their mothers than in the respective control groups with differences highly statistically significant for two enzymes, β- d -galactosidase and α- d -glucosidase. In neonate plasma lysosomal enzymes are increased at the fifth day of life with respect to the second day. Full term control neonates showed the same enzyme trend. For the N-acetyl-β-d-glucosaminidase the more significant differences concerned the isoenzyme I2-P (pregnancy). The pattern of the lysosomal enzymes in the twins resembled that of neonates of diabetic mothers who had had no insulin therapy. Since lysosomal enzymes are considered to be particularly sensitive indicators of carbohydrate metabolism abnormalities, we conclude that twin pregnancies are more at risk for these abnormalities than single ones.

During a screening protocol of early echocardiographic diagnosis (ATL MK 600) and treatment of “silent” PDA in RDS preterms with BW ≤ 1.750 kg, clinical data on premature twins were collected, including diagnosis of both PDA and BPD, to investigate whether twin birth influences PDA incidence and BPD development. Out of the 290 RDS preterms evaluated, 96 (33%) showed evidence of PDA, and a total of 79 (27%) developed BPD, 47 (16%) with associated PDA and 32 (11%) without PDA. Out of 238 singletons, 74 (31%) presented “silent” PDA and a total of 75 (31%) developed BPD, 44 (18%) with associated PDA, and 31 (13%) without PDA. In 52 other twins (18% of the total number of babies studied), 22 (42% of this subgroup) presented evidence of “silent” PDA, and 4 (8% of the subgroup), developed BPD, 3 with associated PDA (6% of the subgroup), and 1 without PDA (2% of the subgroup). From these data, it is inferred that that low-birthweight twins are at high risk for PDA hemodynamic complications during RDS, and may benefit from early induced ductal closure. Instead, in RDS twins, BPD was statistically less frequent (at the 99% C.L.) probably because twinning enhances fetal lung maturity, influencing enzymatic and nonenzymatic protective systems of lung defence.

Objective: to assess whether Doppler velocimetry is predictive of neonatal outcome in bichorionic and monochorionic twin pregnancies complicated by intrauterine growth restriction. Methods: were collected retrospectively data of all twin pregnancies complicated by intrauterine growth restriction during the period between January 2006 and December 2009. Intrauterine Growth Restricted fetuses (IUGR) were defined as fetuses with estimated fetal weight (EFW) 2 SD) and Small for Gestational Age (SGA) fetuses with EFW< 10th percentile and normal Doppler velocimetry. SGA infants were defined birth weight below the 10th percentile according to reference curves for gestational age. Were registered recovery in NICU and neonatal outcomes. Results: among 349 infants considered, the incidence of selective intrauterine growth restriction with alteration of Doppler velocimetry was found to be 5.7%, while of SGA of 20.3%. The condition of IUGR was associated with an inferior birth weight (median 1241, IQR 785-1700 p< 0.0001) and gestational age at delivery (median 31 gestational age, IQR 30-33 p< 0.0001). The Apgar at 5′ is also lower than the non IUGR group (8 vs 9, range 8-9 p = 0.03). There was no statistically significant differences between IUGR and non IUGR group; moreover there wasn't a significant different outcome between IUGR and SGA neonates. Conclusions: alterations in Doppler velocimetry allow to identify a group of fetuses with intrauterine growth restriction at risk. In terms of neonatal outcome there are no significant differences of morbidity and mortality between IUGR and no IUGR.

Objective: At birth, infants needing neonatal resuscitation are positioned under a radiant infant warmer (RIW) at 37°C. We aimed to evaluate the performance of three different RIWs in a delivery room setting. Methods: Temperatures were measured (Incu Fluke Biomedical, Bio-Tek Instruments, Everett, WA, USA) under 3 RIWs: (a) GE Healthcare PANDA i-RES, (b) Draeger Babytherm 8010 and (c) Fisher & Paykel IW 930. Measurements were obtained at baseline, at 10 and 20 minutes after switching the power from 0 to 100% and maintaining the setting temperature constant at 24°C. Results: Table 1 Conclusions: Temperature under RIW is significantly influenced by the utilized device. This aspect would be considered for management of neonates at birth.

Background: “INSURE” (INtubation, SURfactant, Extubation) is an individualized therapy for RDS treatment of preterm infants, whose utilization in terms of efficacy and failure has not been completely defined in comparison to “rescue” mode. Objective: Determine INSURE utilization, efficacy (post-treatment FiO2 and aAPO2 decrease), and failure (surfactant repetition) in comparison to traditional rescue mode supplementation. Materials and Methods: Among 824 premature infants NICU admitted at Padua University Hospital during 2006-2009, 209 (25.4%) were managed by rescue surfactant replacement (100 mg/kg, Curosurf®) if required < 40% oxygen, including 42 (20.1%) by “INSURE” mode. Each INSURE premature infant was compared to 2 consecutive controls, matched for delivery route, gestational age, and sex. Results: INSURE premature infants, comparable for antenatal steroids, Apgar score, and birth weight showed a significantly higher efficacy in terms of post-treatment median (IQR) FiO2 (26 (21 - 40) vs 21 (21 - 29; p=0.03) and aAPO2 (0.48 (0.45-0.60) vs 0.58 (0.53-0.72);p=0.03) decrease. In addition, INSURE group required less surfactant repetition (16 vs 44,4%; p 0.01). Conclusions: Our data proved “INSURE” significant efficacy in reducing post-treatment oxygen requirement and surfactant repetition in RDS infants in comparison to traditional “rescue” mode.

Background and aim: Elective cesarean section incidence is rising worldwide. The current study examinated elective cesarean section (ECS) influences on maternal anxiety, hormones levels and breastfeeding in the first six months after birth, comparing with emergency cesarean section and vaginal delivery (VD). Methods: We contacted 106 consecutive mothers, included in the study according to specific criteria. The mother anxiety levels were evaluated according to the State-Trait Anxiety Inventory-Y (STAI-Y) questionnaire. We tested stresses hormones (prolactin, TSH, cortisole) immediately after delivery and after three days. We assessed the newborn baby nutrition pattern in the delivery room, after one week from the birth and after 30 days, 3 and 6 months (WHO). Results: ECS represents a negative factor for earlier breastfeeding, compared to VD (p=0.02), with anxiety levels (p=0.15), hormones levels (prolactin p=0.05) and lack of breastfeeding in delivery room (p < 0.05). The caesarean section (p=0.005), early breastfeeding in the delivery room (p=0.0009) and type of delivery (p < 0.05) are determinants in breastfeeding after 7 days, 3 and 6 months. Breastfeeding mothers have lowest state anxiety levels (p=0.04). Stress hormones levels change in connection with the type of delivery, but only prolactin result to be significant for earlier breastfeeding (p=0.05). The type of delivery influences breastfeeding in the third month (p=0.005). Conclusions: ECS influences negatively breastfeeding in early life, conditioning it in the delivery room, after three and six months, the hormones and the anxiety levels, with consequences on baby growth and development influencing the relationship with his mother.

Results: Median gestational age of fetuses was 33 weeks (range 28–36). There were 24 IUGR with abnormal Doppler velocimetry, 34 IUGR with normal Doppler velocimetry and 102 AGA fetuses. Median aIMT values were significantly higher in IUGR fetuses with Doppler abnormalities (1.2 mm, range 0.85–1.85) compared to IUGR with normal Doppler velocimetry (0.8 mm, range 0.6–0.9) and AGA fetuses (0.6 mm, range 0.5–0.7) (P < 0.0001). aIMT showed a linear correlation with the type of Doppler abnormality particularly in fetuses with absent or reverse diastolic flow in umbilical artery (n = 10). Conclusions: The present study highlights that fetuses with IUGR and Doppler abnormalities show an increased thickness in the aorta intima media, which may reflect an early sign of cardiovascular dysfunction as previously described.

To evaluate in preterm infants whether polyethylene caps prevent heat loss after delivery better than polyethylene occlusive wrapping and conventional drying.This was a prospective, randomized, controlled trial of infants29 weeks' gestation including 3 study groups: (1) experimental group in which the heads of patients were covered with a polyethylene cap; (2) polyethylene occlusive skin wrap group; and (3) control group in which infants were dried. Axillary temperatures were compared at the time of admission to the neonatal intensive care unit (NICU) immediately after cap and wrap removal and 1 hour later.The 96 infants randomly assigned (32 covered with caps, 32 wrapped, 32 control) completed the study. Mean axillary temperature on NICU admission was similar in the cap group (36.1 degrees C +/- 0.8 degrees C) and wrap group (35.8 degrees C +/- 0.9 degrees C), and temperatures on admission to the NICU were significantly higher than in the control group (35.3 degrees C +/- 0.8 degrees C; P.01). Infants covered with polyethylene caps (43%) and placed in polyethylene bags (62%) were less likely to have a temperature36.4 degrees C on admission to the NICU than control infants (90%). In the cap group, temperature 1 hour after admission was significantly higher than in the control group.For very preterm infants, polyethylene caps are comparable with polyethylene occlusive skin wrapping to prevent heat loss after delivery. Both these methods are more effective than conventional treatment.

a trend of increasing aortic thickness with severity of intrauterine growth restriction, which was not correlated in AGA fetuses. Aortic diameters and blood flow velocity were significantly higher in IUGR fetuses compared to AGA (4.53 ± 0.87 mm vs 3.55 ± 0.69 mm, p

Biostatistical Unit, Department of Neuroscience, University ofPadua, Padua ItalyObjective: To investigate the influence of active and quietsleep on auditory event related potentials recorded inpreterm infants.Methods: Eighteen preterm newborns underwent auditoryevent related potentials during quiet and active sleep, beforedischarge from neonatal intensive care unit. An auditoryoddball paradigm was used with frequently occurring‘standard’ tones at 1000 Hz and rarely occurring ‘deviant’tones at 2000Hz.The waveforms recorded at Fz,Cz,Pz,T3 andT4 locations were divided into twenty 50ms. intervals andabsolute mean amplitude within each interval was calculatedfor statistical analysis.Results: In active sleep, at Fz location, the responses tostandard and deviant stimuli were significantly different(p=0.005), the difference involved the time period from200 to 300 ms. after stimulus (time bins 7th p=0.006 and8th p

47 THE 634GC POLYMORPHISM IN THE REGULATORY 5 = UNTRANSLATED REGION (5 = UTR) OF THE VASCULAR ENDOTHELIAL GROWTH FACTOR (VEGF) GENE IS ASSOC WITH UNEXPLAINED RECURRENT PREGNANCY LOSS (RPL). ALEXANDRA ELLER, D. WARE BRANCH, LESA NELSON, ROBERT SILVER, University of Utah, Salt Lake Ci Utah, Taueret Laboratories, Salt Lake City, Utah OBJECTIVE: Decreased expression of VEGF has been associated with R Thus, we sought to determine if polymorphisms associated with altered expre of VEGF are more common among women with unexplained RPL compar multiparous controls. STUDY DESIGN: Case-control study comparing the allele frequencies of f polymorphisms in VEGF among 47 women with unexplained RPL and 81 matched, multiparous controls using Fisher =s exact test. Unexplained RPL w defined as 3 unexplained pregnancy losses prior to 20 weeks gestation an more than one live birth; controls were women with 2 live births and no pre nancy losses. RESULTS: Within the regulatory 5 = UTR of VEGF, the allele frequency of minor C allele at position 634 is higher among women with unexplained R compared to multiparous controls (0.43 vs. 0.30, p 0.04). No difference was foun in the allele frequencies of three other VEGF polymorphisms in women wit explained RPL compared to multiparous controls: 1154 G/A (0.30 vs. 0.2 p 0.46), 2578 C/A (0.48 vs. 0.37, p 0.09), and 936 C/T (0.14 vs. 0.1 p 1.00). CONCLUSION: Altered gene expression of VEGF may play a role in the et of early pregnancy failure in a subset of women with unexplained RPL.