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Volume 5, No. 3, September, 2004
CORD BLOOD CHOLESTEROL, APOPROTEINS A-1 & B AND LIPOPROTEIN (a) IN INFANTS OF DIABETIC MOTHERS
FATMA Z. ABD EL-BASSET & AZZA H. ABOU GHALIA
Departments of Pediatrics and *Biochemistry, Faculty of Medicine Ain-Shams University
ABSTRACT
This study aimed to assess some lipoprotein atherogenic parameters in cord blood of infants of diabetic mothers (IDM) and to study their relation to birth weight (BW), cord blood glucose and type of maternal diabetes. Thirty IDM as well as 26 control neonates were included, clinically assessed and classified as appropriate for gestational age (AGA) and macrosomic. For IDM, the onset of maternal diabetes; either pre-gestational diabetes (PGD) or gestational diabetes (GD) and the type (1 or 2) were defined.
Enzymatic Colorimetric Assay was applied to assess cord blood glucose, Total Cholesterol (TC), High Density Lipoprotein-Cholesterol (HDL-C), Low Density Lipoprotein-Cholesterol (LDL-C), Lipoprotein (a) (Lp(a)), Apoprotein A-1 (Apo A-1) and Apoprotein B (Apo B). Atherogenic indicator ratios were calculated and statistical analysis performed using IBM computer.
Results: IDM at birth were significantly heavier than controls (P<0.0001). They had significantly higher than control cord blood values of LDL-C (P=0.01), TC/HDL-C (P<0.05) and LDL-C/HDL-C (P=0.001) in all IDM. This pattern was also seen in IDM with maternal diabetes type 1 with additional higher Apo B than control (P<0.05). On the other hand, those with maternal type 2 had a lipoprotein pattern that was not significantly different from control neonates.
Neonates with maternal GD were the heaviest in this series (mean BW: 4.35+/- 0.68 kg). They had significantly higher TC (P<0.05) & LDL-C (P<0.01) than neonates with maternal type 2 DM & control. These values, however, were not significantly correlated to BW. Despite comparable BW, cord blood values in those of type 2 PGD were significantly lower than those with maternal GD as regards TC (P<0.05) and LDL-C (P<0.05)
Macrosomia was noted in 60% of IDM. Significantly higher than control LDL-C/HDL-C was noted in macrosomic IDM (P<0.05). They had larger size (P>0.05) but smaller number (P<0.05) of HDL & LDL particles than AGA ones. The latter had a cord blood lipoprotein–cholesterol profile similar to all IDM & significantly different from control with higher Apo A-1 (P<0.05) and Apo B (P<0.01) values in addition. Cord blood values of Apo B were negatively correlated with birth weight (P=0.02, Spearman's Rho = -0.42).
Mean cord blood Lp(a) in IDM (7.352 +/-7.35 mg/dl) was not significantly (P>0.05) different from that of control (5.135 + / - 1.76 mg/dl ). It was far below the cut off cord blood risk value for thromboembolism (> or = 30 mg/dl).
Mean cord blood glucose in IDM (46.67 +/- 15.52 mg/dl) lied in the euglycemic range but it was significantly (P<0.001) lower than control value (70.54 +/- 7.6 mg/dl) and was negatively correlated with cord blood Lp (a) (P=0.004, Spearman's Rho= -0.53).
Conclusion: Dyslipidemia even in absence of macrosomia may be noted in IDM at birth. It might be longitudinally followed for early prediction of cardiovascular disease. The potential atherogenic risk as indicated by cord blood lipoprotein profile is especially high with insulin-dependant type of maternal diabetes.
Evaluation of Serum Cortisol and ACTH levels in Neonatal Sepsis
Hashim MS, MD*, Aboulghar HM, MD*, El-Gayar DF., MD**, Homam A.O., Ms*Department of Pediatrics and Neonatology Cairo University. ** Department of Chemical pathology, Cairo University
Abstract
Objective: To study the effect of neonatal sepsis on the level of Serum Cortisol, and ACTH.
Study design: A prospective controlled study including thirty consecutively born full term AGA neonates with sepsis and twenty healthy newborns as a control group. Complete history (prenatal, natal, postnatal) and signs and symptoms with complete blood investigations and culture for every child. Serum Cortisol level was measured in all patients using enzyme chemiluminescent technique on the immulite (DPC). Serum ACTH level was measured in all cases using the same method.
Results of our study showed that there was no statistically significant difference in the level of serum cortisol when comparing the case group with the control group. There was a highly significant difference in the level of serum ACTH level being lower in the case group. There was a highly significant relationship between serum cortisol level and prognosis, being much lower in patients that died than those that survived.
Conclusion: The use of Serum Cortisol and ACTH level estimation might be of use for early detection of neonatal sepsis.The serum cortisol and ACTH levels in neonatal sepsis might be of prognostic value.Studies to demonstrate the possible role of steroid administration in cases of neonatal sepsis are needed.Key words: Neonatal sepsis - Adrenal function - ACTH - Cortisol
Complete primary repair of bladder exstrophy: Experience in neonates
Ayman A. El Boghdady, Ashraf A. Kabesh, and Ahmed Hamed
Pediatric Surgery Unit, Ain Shams UniversityAbstract
Background: Complete repair of bladder exstrophy in the newborn includes bladder, posterior and penile urethral closure, together with epispadias repair and abdominal wall closure without bladder neck reconstruction. Objective: To access the value of complete primary repair of bladder exstrophy in neonates. Patients and Methods: Over the last 3 years, 13 neonates having classic bladder exstrophy were studied, 10 neonates (8 boys and 2 girls) had been subjected to complete primary repair within the first 72 hours of life, while the remaining 3 neonates had a very small bladder, so were excluded from the study. The urinary bladder and urethra were closed in continuity with epispadias repair by total penile disassembly. Abdominal ultrasonography was done preoperatively and every 3 months after reconstruction. Voiding cystourethrography was done 3 months post-reconstruction and then annually. Results: All repairs were successful except for two patients who developed complete disruption of the repair. A normal orthotopic urethral meatus was achieved but two boys developed distal penile hypospadias, one developed urethrocutaneous fistula and one developed urethral meatal stenosis and was treated by ventral meototomy. A bladder stone developed in one girl which was removed by cystolithotomy. Two patients developed breakthrough febrile urinary infection that was managed conservatively. Postoperative abdominal ultrasonography was done 3 months after surgery and revealed normal renal growth in all patients, it also revealed grade II hydronephrosis in 12 renal units (60%), abdominal ultrasonography repeated 6 months after surgery revealed persistent grade II hydronephrosis in 9 renal units (45%). Voiding cystourethrography revealed grade II to III vesicoureteral reflux in 13 renal units (65%). Two boys had regular voiding with 80 to 100 minutes dry intervals, four boys and 1 girl had regular voiding with 50 to 70 minutes dry intervals and 2 were incontinent. Conclusion: Complete primary repair appears to offer improved continence and decreases the number of surgical procedures required to treat exstrophy. The results are encouraging as there is no short-term evidence of major complications.
Contribution of Low Birth Weight and Very Low Birth Weight Infants to Perinatal Mortality
Abd El-Rahman A., Lotfy G.*
Pediatric & Obstetric* Departments Suez Canal University HospitalAbstract
Objective: to determine the total perinatal mortality rate, and to study the contribution of VLBW and LBW infants to perinatal mortality. Patients and Methods: A retrospective study over a 3-year period, information were collected from the case files of the affected mothers and their babies. Setting: the neonatal intensive care unit, and obstetric department, Suez Canal University Hospital. Results: showed an inverse relationship between infants birth weight and perinatal mortality. Perinatal mortality rate among very low birth weight (VLBW) infants was 567 per thousand compared with 61.2 per thousand among low birth weight (LBW) infants and 10.7 per thousand in infants of normal birth weights (NBW). Infants of LBW and VLBW constituted only 8.2% of all deliveries (226 out of total 2744 deliveries), but accounted for 51.8% of all perinatal deaths (29 out of total 56 perinatal deaths) and 69.2% of all neonatal deaths (18 out of total 26 neonatal deaths). The major cause of death being respiratory distress syndrome (RDS). Conclusion: VLBW and LBW had a major contribution to perinatal mortality rate.
ULTRASOUND ASSESSMENT AND NEONATAL OUTCOME OF TWIN ICSI PREGNANCY: A PROSPECTIVE CONTROLLED OBSERVATIONAL STUDY.
Aboulghar HM, MD*, Aboulghar MM, MD**, Gayar D MD***
*Department of Pediatrics and Neonatology, ** Department of Obstetrics and Gynecology, ***Department of Chemical Pathology- Cairo University.Abstract
Objective: To study the value of ultrasound in prediction of complications in ICSI twin pregnancies, and to study the neonatal, chromosomal and long term outcome of multiple pregnancies conceived by ICSI.
Study design prospective controlled study of 83 ICSI twin pregnancies and 164 babies regarding ultrasound, neonatal, chromosomal and follow up. The findings were compared to a control group of 90 singleton ICSI pregnancies all studied similarly.
Results: The twin pregnancy group showed a gestational age ranging between 28 to 39 weeks with a mean of 36.2, the gestational age of control group was between 33 and 40 weeks with a mean of 38.5 weeks and a standard deviation of 1.3. Thirty seven patients (45.5%) delivered preterm and 46 patients (55.4%) delivered at term. In the control group only 7 patients ( 7.7%) delivered preterm, whereas 83 delivered at term (93.3%), preterm delivery being defined as before 37 weeks gestation.
Birth weight was divided into weight groups and it was found that in the study group 1.83% were below 1000 gm, 4.9% were between 1000 and 1500 gm., 43.9% had a birth weight of 2000-2500 gm, and 42% were above 2500 gm, while in the control group, birth weights were higher with 16.1% babies between 1500 and 2500 gm and 80.6% above a birth weight of 2500 gm. with a standard deviation of 3.1. In the Twin group 16% babies required admission to NICU. When looking at the control group 5.4%. Analysis of the final outcome of pregnancy showed 18 deaths out of 164 babies among the twins (11%) and no mortalities within the singleton group. None of the 83 pair of twins showed any major fetal anomalies, except for one patient . Ultrasound assessment of the cervix in 33 patients, of the study group, revealed a significant difference in the mean cervical length of the preterm and term group ( at or before 37 weeks ) 34.4 +/- 8.5 mm & 41.0 +/-5.2 mm respectively; P=0.01. The mean cervical inner-to-inner diameter of women who delivered at or before 34 weeks of gestation (8 +/- 6.4 mm) was significantly different than that of women who delivered after 34 weeks of gestation (3.8+/- 1.3 mm); P=0.04.
Conclusion: Multiple pregnancies in ART should be limited through limiting the number of embryos transferred. Sonography can be used as a predictive factor in the assessment of pregnancy outcome in twins.
Keywords: ultrasound, ICSI, neonates, outcome, costs
EARLY DETECTION OF NEONATAL SEPSIS VALIDITY OF DETERMINATION OF IL-6 CD14
Amina M. Abdel Wahab*, Hesham F. El Sayed* Salma E. Amin* & Alaa El Din S. Abdel Hamid**El Hussieny M. El Hussieny*
Departments of Pediatrics* and Clinical Pathology**, Suez Canal University
Abstract
Objective: Evaluation of the predictive value of IL-6 and CD14 as early diagnostic tests for neonatal sepsis.
Methods: This is a prospective study carried out in the NICU Suez Canal University Hospital. It comprised 90 neonates; group A included 30 neonates presenting with risk factors for infection and group B included 60 neonates that presented with clinical manifestations of sepsis. Fifteen healthy newborn babies comprised group C and served as controls. After thorough history taking and clinical examination the following laboratory investigations were performed : Complete blood count (CBC) including differential count, CRP, blood culture and sensitivity tests, estimation of IL-6, serum CD 14 (sCD 14) and membrane CD 14 (m CD 14) levels.
Results: A significant increase in serum IL-6 level was observed among symptomatic newborns as compared to healthy ones (182.7±207.88 pg/ml versus 70.61±39.45 pg/ml).
A significant increase in IL-6 was observed among high risk neonates as compared to healthy ones (110.25±84.05 pg/ml versus 70.61±39.45 pg/ml). A significant +ve correlation was found between IL-6 and CRP in the symptomatic group (p<0.05). Serum IL-6 in the symptomatic newborns correlated positively with gestational age, I/T ratio, platelet count and toxic granulations in WBCs and sCD 14 while it correlated negatively with mCD 14.
A high significant increase in sCD 14 values in symptomatic group compared to healthy group was observed (5.9±2.2 ?g/ml versus 1.4±0.9 ?g/ml). Also a high significant decrease in m CD 14 level in symptomatic group compared to healthy group was detected (8.8±5.3 MFI versus 22.3±3.6 MFI). There was a significant increase in sCD 14 level in patient group who died as compared to those who improved (6.8±1.7 ?g/ml versus 3.2±0.8 ?g/ml). On the contrary m CD 14 level showed high significant decrease in those who died compared to those who improved (6.7±4 MFI versus 14.2±4.2 ?FI).
Conclusion: Both serum IL-6 and sCD 14 are significantly increased in neonates with sepsis or those with suspicion of sepsis in comparison to healthy neonates. Assessment of IL-6 level might be used as an early reliable tool for diagnosis and prediction of neonatal sepsis. Measurement of CD 14 (s and m) levels might improve the diagnostic efficacy of other markers. In addition elevated serum level might be used as a prognostic marker for prediction of patients’ outcome
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