Reference range for micronutrients and nutritional marker proteins in cord blood of neonates appropriated for gestational ages

Associations between maternal and infant selenium status and child growth in a birth cohort from Dhaka, Bangladesh

Deficiency of essential trace element, Se, has been implicated in adverse birth outcomes and in child linear growth because of its important role in redox biology and associated antioxidant effects. We used data from a randomised controlled trial conducted among a cohort of pregnant and lactating women in Dhaka, Bangladesh to examine associations between Se biomarkers in whole blood (WBSe), serum and selenoprotein P (SEPP1) in maternal delivery and venous cord (VC) blood. Associations between Se biomarkers, birth weight and infant growth outcomes (age-adjusted length, weight, head circumference and weight-for-length z-scores) at birth, 1 and 2 years of age were examined using regression analyses. WB and serum Se were negatively associated with birth weight (adjusted β, 95 % CI, WBSe delivery: −26·6 (–44·3, −8·9); WBSe VC: −19·6 (–33·0, −6·1)); however, delivery SEPP1 levels (adjusted β: −37·5 (–73·0, −2·0)) and VC blood (adjusted β: 82·3 (30·0, 134·7)) showed inconsistent and opposite associations with birth weight. Positive associations for SEPP1 VC suggest preferential transfer from mother to fetus. We found small associations between infant growth and WBSe VC (length-for-age z-score β, 95 % CI, at birth: −0·05 (–0·1, −0·01)); 12 months (β: −0·05 (–0·08, −0·007)). Weight-for-age z-score also showed weak negative associations with delivery WBSe (at birth: −0·07 (–0·1, −0·02); 12 -months: −0·05 (–0·1, −0·005)) and in WBSe VC (at birth: −0·05 (–0·08, −0·02); 12 months: −0·05 (–0·09, −0·004)). Given the fine balance between essential nutritional and toxic properties of Se, it is possible that WB and serum Se may negatively impact growth outcomes, both in utero and postpartum.

Selenium status in term neonates, according to birth weight and gestational age, in relation to maternal hypertensive pathology

Background

Pregnancy represents a state of increased oxidative stress and antioxidants, in which selenium (Se) plays a pivotal role, contribute to maintain the oxidative balance. If antioxidant defenses are depleted, placental function is disrupted, resulting in pregnancy complications, including pregnancy-induced hypertension (PIH). Little is known about fetal selenium status in concomitant relation to maternal PIH, gestational age (GA) and birthweight (BW).

Methods

We examined over a 3-year period the serum (SeS) and urine selenium (SeU) status in term neonates from normotensive (nonPIH) and hypertensive (PIH) mothers as clinical markers of oxidative stress. In this retrospective observational study, 72 neonates with maternal PIH were matched for GA and BW to 72 neonates of normotensive mothers. Four groups were obtained, based on maternal PIH and BW relative to GA (appropriate-for-gestational-age-AGA, small-for-gestational-age-SGA): nonPIH-AGA (control group), nonPIH-SGA, PIH-AGA, and PIH-SGA.

Results

The results showed significant differences (p < 0.001) in selenium levels among the study groups: SeS - 44.85 ± 7.56 μg/L in nonPIH-AGA, 39.62 ± 11.42 μg/L in nonPIH-SGA, 40.01 ± 10.07 μg/L in PIH-AGA, and 25.39 ± 8.99 μg/L in PIH-SGA; SeU - 27.98 ± 7.99 μg/L in nonPIH-AGA, 22.85 ± 9.48 μg/L in nonPIH-SGA, 23.44 ± 6.73 μg/L in PIH-AGA, and 13.05 ± 5.86 μg/L in PIH-SGA. Selenium depletion was more common in neonates born from hypertensive mothers and those born small for gestational age. Though moderate in intensity, selenium levels were positively correlated with BW (0.319 for SeS, 0.397 for SeU) and negatively correlated with maternal systolic blood pressure (-0.313 for SeS, -0.324 for SeU). The main independent effects on SeS and SeU of each maternal blood pressure and birth weight turned out statistically significant. In interaction, a more pronounced effect was reached in PIH-SGA neonates.

Conclusion

Selenium status seemed to reflect the negative impact that PIH exerts in neonates during intrauterine development. Clinical markers of selenium status could thus be of great value for tracking responses of individuals to selenium supplementation as part of health improvement and harm mitigation approaches.

Association of Zn and Cu Levels in Cord Blood and Maternal Milk with Pregnancy Outcomes among the Slovenian Population

Trace elements, including zinc (Zn) and copper (Cu), are known to play important roles in human health. The present study aimed to assess the levels of Zn and Cu in cord blood and maternal milk and to analyze their association with maternal and infant characteristics and pregnancy outcomes in a Slovenian study population of mothers and their neonates recruited within the PHIME prospective cohort study. The study included 324 mothers, but the data on Zn and Cu levels in both cord blood and maternal milk was available for 243 mothers. Questionnaires were used to assess the socio-demographic and health status of the mothers, their lifestyle habits (including detailed nutritional habits), and their residential and occupational histories. Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used to measure Zn and Cu levels in cord blood and maternal milk. Low Zn levels in cord blood were associated with lower gestational age and birth weight and were correlated with an increased probability of the birth of small for gestational age (SGA) infants. Maternal smoking influenced the Cu levels in both cord blood and maternal milk. Cord blood Cu levels were higher and Cu levels in maternal milk were lower in smoking compared to non-smoking mothers. Most importantly, a decreased Zn/Cu ratio in cord blood was associated with lower gestational age and lower birth weight. This indicates the overall positive effects of Zn and negative effects of Cu on pregnancy outcomes.

Role of zinc in neonatal growth and brain growth: review and scoping review

This manuscript includes (1) a narrative review of Zinc as an essential nutrient for fetal and neonatal growth and brain growth and development and (2) a scoping review of studies assessing the effects of Zinc supplementation on survival, growth, brain growth, and neurodevelopment in neonates. Very preterm infants and small for gestational age infants are at risk for Zinc deficiency. Zinc deficiency can cause several complications including periorificial lesions, delayed wound healing, hair loss, diarrhea, immune deficiency, growth failure with stunting, and brain atrophy and dysfunction. Zinc is considered essential for oligodendrogenesis, neurogenesis, neuronal differentiation, white matter growth, and multiple biological and physiological roles in neurobiology. Data support the possibility that the critical period of Zinc delivery for brain growth in the mouse starts at 18 days of a 20-21-day pregnancy and extends during lactation and in human may start at 26 weeks of gestation and extend until at least 44 weeks of postmenstrual age. Studies are needed to better elucidate Zinc requirement in extremely low gestational age neonates to minimize morbidity, optimize growth, and brain growth, prevent periventricular leukomalacia and optimize neurodevelopment. IMPACT: Zinc is essential for growth and brain growth and development. In the USA, very preterm small for gestational age infants are at risk for Zinc deficiency. Data support the possibility that the critical period of Zinc delivery for brain growth in the mouse starts at 18 days of a 20-21-day pregnancy and extends during lactation and in human may start at 26 weeks' gestation and extend until at least 44 weeks of postmenstrual age. Several randomized trials of Zinc supplementation in neonates have shown improvement in growth when using high enough dose, for long duration in patients likely to or proven to have a Zinc deficiency. Studies are needed to better elucidate Zinc requirement in extremely low gestational age neonates to minimize morbidity, optimize growth and brain growth, prevent periventricular leukomalacia and optimize neurodevelopment.

Oxidative Stress at Birth Is Associated with the Concentration of Iron and Copper in Maternal Serum

Oxidative stress (OS) in the foetal and neonatal periods leads to many disorders in newborns and in later life. The nutritional status of pregnant women is considered to be one of the key factors that triggers OS. We investigated the relationship between the concentration of selected mineral elements in the blood of pregnant women and the concentration of 3′nitrotyrosine (3′NT) as a marker of OS in the umbilical cord blood of newborns. The study group consisted of 57 pregnant women and their newborn children. The concentrations of magnesium (Mg), calcium (Ca), iron (Fe), zinc (Zn) and copper (Cu) in maternal serum (MS) were measured by the flame atomic absorption/emission spectrometry (FAAS/FAES) method. The concentration of 3′NT in umbilical cord serum (UCS) of newborns was determined by the ELISA method. A positive correlation between MS Fe and UCS 3′NT in male newborns was shown (rho = 0.392, p = 0.053). Significantly higher UCS 3′NT was demonstrated in newborns, especially males, whose mothers were characterized by MS Fe higher than 400 μg/dL compared to those of mothers with MS Fe up to 300 μg/dL (p < 0.01). Moreover, a negative correlation between the MS Cu and UCS 3′NT in male newborns was observed (rho = −0.509, p = 0.008). Results of the study showed the need to develop strategies to optimize the nutritional status of pregnant women. Implementation of these strategies could contribute to reducing the risk of pre- and neonatal OS and its adverse health effects in the offspring.

Ceruloplasmin as a source of Cu for a fungal pathogen

Copper is an essential metal for virtually all organisms, yet little is known about the extracellular sources of this micronutrient. In serum, the most abundant extracellular Cu-binding molecule is the multi‑copper oxidase ceruloplasmin (Cp). Cp levels increase during infection and inflammation, and pathogens can be exposed to high Cp at sites of infection. It is not known whether Cp might serve as a Cu source for microbial pathogens and we tested this using the opportunistic fungal pathogen Candida albicans. We find that C. albicans can use whole serum as a Cu source and that this Cu is sensed by the transcription factor protein Mac1. Mac1 activates expression of Mn-SOD3 superoxide dismutase and represses Cu/Zn-SOD1 during Cu starvation and both responses are regulated by serum Cu. We also show that purified human Cp can act as a sole source of Cu for the fungus and likewise modulates the Mac1 Cu stress response. To investigate whether Cp is a Cu source in serum, we compared the ability of C. albicans to use serum from wild type versus Cp^-/- mutant mice. We find that serum lacking Cp is deficient in its ability to trigger the Mac1 Cu response. C. albicans did accumulate Cu from Cp^-/- serum, but this Cu was not efficiently sensed by Mac1. We conclude that Cp and non-Cp Cu sources are not equivalent and are handled differently by the fungal cell. Overall, these studies are the first to show that Cp is a preferred source of Cu for a pathogen.

The relationship between umbilical cord blood vitamin A levels and late preterm infant morbidities: a prospective cohort study

The aim of this study is to explore the association between umbilical cord blood (UCB) vitamin A levels and late preterm infants morbidities. We conducted a prospective cohort study of 208 late-preterm infants(from 34 ⁰/₇ to 36 ⁶/₇ weeks gestational age) between January 1, 2014 and June 30, 2015. UCB specimens were collected shortly after birth, and vitamin A levels were determined by enzyme-linked immunosorbent assay. Prevalence of low UCB vitamin A level < 0.7 μmol/L was 37.5% in late preterm infants. In comparison to vaginal delivery, cesarean section was associated with UCB vitamin A level < 0.7 μmol/L (P < 0.001). Nevertheless, UCB vitamin A levels did not correlate with gestational age, birth weight, and gender. UCB vitamin A level < 0.7 μmol/L was not an independent risk factor for hospitalization, oxygen supplementation, hyperbilirubinemia, sepsis, and respiratory distress syndrome.Conclusions: Low umbilical cord blood vitamin A levels are common among late-preterm infants. Cesarean section delivery is associated with low umbilical cord blood vitamin A level. Low umbilical cord blood vitamin A levels at birth do not increase morbidity of late-preterm infants, including hyperbilirubinemia, sepsis, and respiratory distress syndrome. What is Known: • Late preterm infants have a higher morbidity and mortality rates when compared to term infants. • Low plasma vitamin A levels increase the risk of preterm infants' morbidity. What is New: • Late preterm infants commonly have low level of umbilical cord blood vitamin A. • Low umbilical cord blood vitamin A level at birth appears to be not associated with the morbidity of late-preterm infants. • Cesarean section is associated with low umbilical cord blood vitamin A level < 0.7 μmol/L compared with vaginal delivery.

Oxidative stress biomarkers in the preterm infant

Oxidative stress (OS) plays a key role in the pathophysiology of preterm infants. Accurate assessment of OS remains an analytical challenge that has been partially addressed during the last few decades. A plethora of approaches have been developed to assess preterm biofluids to demonstrate a link postnatally with preterm OS, giving rise to a set of widely employed biomarkers. However, the vast number of different analytic methods and lack of standardization hampers reliable comparison of OS-related biomarkers. In this chapter, we discuss approaches for the study of OS in prematurity with respect to methodologic considerations, the metabolic source of different biomarkers and their role in clinical studies.

Newborn micronutrient status biomarkers in a cluster-randomized trial of antenatal multiple micronutrient compared with iron folic acid supplementation in rural Bangladesh

BACKGROUND

Daily antenatal multiple micronutrient (MM) compared with iron folic acid (IFA) supplementation from early pregnancy improved birth outcomes and maternal micronutrient status in rural Bangladesh, but effects on newborn status are unknown.

OBJECTIVE

We examined cord blood micronutrient biomarkers in relation to antenatal MM and IFA supplementation and maternal gestational micronutrient status in rural Bangladeshi newborns.

DESIGN

In a double-blinded, cluster-randomized trial of antenatal IFA or MM (with the same IFA content), we analyzed cord blood plasma from 333 singleton births, and corresponding maternal plasma at 32.5 ± 2.6 wk of gestation, for ferritin (iron stores), folate, cobalamin (vitamin B-12), retinol (vitamin A), 25-hydroxyvitamin D [25(OH)D, vitamin D status], α-tocopherol (vitamin E), zinc, thyroglobulin, and free thyroxine (iodine status). Intervention effects and associations were determined using linear regression, exploring maternal status as a mediator of intervention effects on cord biomarkers.

RESULTS

The MM intervention increased cord ferritin (mean: +12.4%; 95% CI: 1.3, 24.6%), 25(OH)D (mean: +14.7%; 95% CI: 4.8, 25.6%), and zinc (mean: +5.8%; 95% CI: 1.0, 10.8%). Cord folate (mean: +26.8%; 95% CI: 19.6, 34.5%), cobalamin (mean: +31.3%; 95% CI: 24.6, 38.3%), 25(OH)D (mean: +26.7%; 95% CI: 23.2, 30.3%), α-tocopherol (mean: +8.7%; 95% CI: 3.6, 13.7%), zinc (mean: +2.3%; 95% CI: 0.5, 4.2%), thyroglobulin (mean: +20.1%; 95% CI: 9.0, 32.2%) and thyroxine (mean: +1.5%; 95% CI: 0.0, 3.0%) increased per 1-SD increment in maternal status (all P < 0.05); ferritin and retinol changed by +2.0%; 95% CI: -8.9, 14.3%; P = 0.72; and +3.5%; 95% CI: -0.4, 7.3%; P = 0.07, respectively. Ferritin, folate, cobalamin, zinc, and thyroglobulin averaged 1.57-6.75 times higher and retinol, α-tocopherol, and 25(OH)D 0.30-0.84 times lower in cord than maternal plasma, suggesting preferential maternal-fetal transfer of iron, folate, cobalamin, and zinc; limited transfer of fat-soluble vitamins; and high fetal iodine demand.

CONCLUSIONS

Antenatal MM supplementation increased newborn ferritin, 25(OH)D, and zinc, while maternal and newborn folate, vitamins B-12, D, and E, zinc, and iodine biomarkers were positively related. Despite limited effects of MM, better maternal micronutrient status was associated with improved micronutrient status of Bangladeshi newborns. This trial was registered at clinicaltrials.gov as NCT00860470.

Analysis of copper, selenium, and zinc in newborn dried bloodspots using total reflection X-ray fluorescence (TXRF) spectroscopy

Background

There exists great interest in using dried bloodspots across the clinical, public health, and nutritional sciences to characterize circulating levels of essential elements yet current methods face several challenges related to instrumentation, quality control, and matrix effects. Elemental analysis via total X-ray fluorescence (TXRF) may help overcome these challenges. The objective of this study was to develop and apply a novel TXRF-based analytical method to quantify essential elements (copper, selenium, zinc) in dried bloodspots.

Methods

Analytical methods were developed with human whole blood standard reference materials from the Institut National de Santé Publique du Québec (INSPQ). The method was developed in careful consideration of several quality control parameters (e.g., analytical accuracy, precision, linearity, and assay range) which were iteratively investigated to help refine and realize a robust method. The developed method was then applied to a quantitative descriptive survey of punches (n = 675) taken from residual dried bloodspots from a newborn screening biobank program (Michigan BioTrust for Health).

Results

The analytical method developed to quantify the three target elements in dried bloodspots fared well against a priori quality control criteria (i.e., analytical accuracy, precision, linearity and range). In applying this new method, the average (±SD) blood copper, selenium, and zinc levels in the newborn samples were 1,117.0 ± 627.1 µg/L, 193.1 ± 49.1 µg/L, and 4,485 ± 2,275 µg/L respectively. All the elements were normally distributed in the sample population, and the measured concentrations fall within an expected range.

Conclusions

This study developed and applied a novel and robust method to simultaneously quantify three essential elements. The method helps overcome challenges in the field concerning elemental analysis in dried bloodspots and the findings help increase understanding of nutritional status in newborns.

Thiol-Redox Regulation in Lung Development and Vascular Remodeling

Significance: Redox homeostasis is finely tuned and governed by distinct intracellular mechanisms. The dysregulation of this either by external or internal events is a fundamental pathophysiologic base for many pulmonary diseases. Recent Advances: Based on recent discoveries, it is increasingly clear that cellular redox state and oxidation of signaling molecules are critical modulators of lung disease and represent a final common pathway that leads to poor respiratory outcomes. Critical Issues: Based on the wide variety of stimuli that alter specific redox signaling pathways, improved understanding of the disease and patient-specific alterations are needed for the development of therapeutic targets. Further Directions: For the full comprehension of redox signaling in pulmonary disease, it is essential to recognize the role of reactive oxygen intermediates in modulating biological responses. This review summarizes current knowledge of redox signaling in pulmonary development and pulmonary vascular disease.

Retinol status and associated factors in mother-newborn pairs

BACKGROUND

Vitamin A deficiency is still considered to be a nutritional problem during pregnancy, lactation and early childhood. The present study aimed to assess the vitamin A status of women and their newborns in the Brazilian Northeast and to determine the association between retinol in the maternal serum, umbilical cord blood and colostrum.

METHODS

Vitamin A status in 65 pairs of women and newborns was assessed from samples of the mother's serum, umbilical cord serum and colostrum using high-performance liquid chromatography. The inadequacy of the vitamin A status of mothers and infants was identified if the retinol values were <0.7 µmol L^- 1 in maternal serum or umbilical cord blood or <1.05 µmol L^-1 in colostrum.

RESULTS

The prevalence of inadequate maternal vitamin A status was 21.5% (95% CI: 11.5%-31.5%) and 13.8% [95% confidence interval (CI) = 5.4%-22.2%] based on maternal serum and colostrum, respectively. Among newborns, 41.5% (95% CI = 29.3%-53.5%) presented a low status of vitamin A based on cord serum. Multiple linear regression analysis identified that maternal serum retinol is a predictor of umbilical cord retinol (P = 0.005). Retinol in maternal serum was lower in mothers who were less educated (P = 0.04) and colostrum retinol was higher in older (P = 0.04) and multiparous (P = 0.002) mothers.

CONCLUSIONS

Vitamin A deficiency is a common problem among mothers attended in public hospitals in Northeast Brazil and maternal retinol concentrations are associated with retinol status in newborns. Maternal age, parity and educational level were related to the maternal vitamin A status.

INTRAUTERINE GROWTH AND THE VITAMIN E STATUS OF FULL-TERM AND PRETERM NEWBORNS

OBJECTIVE

To determine the concentration of alpha-tocopherol in umbilical cord serum of full-term and preterm newborns, in order to assess the nutritional status of both groups in relation to the vitamin and its possible correlation with intrauterine growth.

METHODS

A cross-sectional observational study conducted with 140 newborns, of which 64 were preterm and 76 were full-term. They did not have any malformations, they came from healthy mothers, who were nonsmokers, and delivered a single baby. Intrauterine growth was evaluated by weight-to-gestational age at birth, using Intergrowth-21st. Thealpha-tocopherol levels of umbilical cord serum were analyzed by High Performance Liquid Chromatography.

RESULTS

The mean concentration of alpha-tocopherol in umbilical cord serum for preterm and full-term infants was 263.3±129.5 and 247.0±147.6 µg/dL (p=0.494). In the preterm group, 23% were small for gestational age, whereas in the full-term group, this percentage was only 7% (p=0.017). Low levels of vitamin E were found in 95.3% of preterm infants and 92.1% of full-term infants. There was no correlation between alpha-tocopherol levels and weight to gestational age Z score (p=0.951).

CONCLUSIONS

No association was found between alpha-tocopherol levels and weight to gestational age at birth. Intrauterine growth restriction was more frequent in preterm infants and most infants had low levels of vitamin E at the time of delivery.

Elemental Metabolomics and Pregnancy Outcomes

Trace elements are important for human health and development. The body requires specific micronutrients to function, with aberrant changes associated with a variety of negative health outcomes. Despite this evidence, the status and function of micronutrients during pregnancy are relatively unknown and more information is required to ensure that women receive optimal intakes for foetal development. Changes in trace element status have been associated with pregnancy complications such as gestational diabetes mellitus (GDM), pre-eclampsia (PE), intrauterine growth restriction (IUGR), and preterm birth. Measuring micronutrients with methodologies such as elemental metabolomics, which involves the simultaneous quantification and characterisation of multiple elements, could provide insight into gestational disorders. Identifying unique and subtle micronutrient changes may highlight associated proteins that are affected underpinning the pathophysiology of these complications, leading to new means of disease diagnosis. This review will provide a comprehensive summary of micronutrient status during pregnancy, and their associations with gestational disorders. Furthermore, it will also comment on the potential use of elemental metabolomics as a technique for disease characterisation and prediction.

Vitamin A Supplementation during Pregnancy Enhances Pandemic H1N1 Vaccine Response in Mothers, but Enhancement of Transplacental Antibody Transfer May Depend on When Mothers Are Vaccinated during Pregnancy

Background

In the growing embryo, the vitamin A requirement is tightly regulated. Maternal vitamin A deficiency during pregnancy may alter maternal immune function to accommodate the fetus.

Objective

Our primary objective was to determine the effect of oral vitamin A supplementation (VAS) during pregnancy and until 6 mo postpartum on pandemic H1N1-vaccine responses in mothers and their infants at 6 mo of age.

Methods

In this randomized controlled clinical trial, pregnant women (n = 112) during the second trimester (mean ± SD: 14 ± 1 wk) were assigned to receive either an oral dose of 10,000 IU vitamin A or placebo weekly until 6 mo postpartum. During the third trimester, mothers received a single dose of inactivated pandemic H1N1-influenza vaccine. Hemagglutination-inhibition (HAI) titer was measured in cord, infant, and maternal blood samples. Multivariate regressions with adjustments were used for data analysis.

Results

Seventy-six percent of women had low plasma retinol concentrations (<1.05 μmol/L) in their second trimester. VAS of mothers increased vitamin A concentrations in cord blood by 21.4% and in colostrum by 40.7%. At 6 mo postpartum, women in the vitamin A group had 38.7% higher HAI titers and a higher proportion of HAI titer of ≥1:40 of the cutoff compared with the placebo group. A total of 54.5% of infants had an HAI titer ≥1:40 at 6 mo of age, but there was no difference in HAI titer in infants between groups. Overall, HAI in cord blood did not differ between groups, but in the placebo group, cord blood HAI was negatively associated with maternal "vaccination-to-delivery intervals" (rs = -0.401; P = 0.5), and maternal VAS increased cord blood HAI 6-fold if antenatal immunization was administered ≥10 wk before delivery.

Conclusions

In a community with low vitamin A status, weekly maternal VAS during pregnancy and postpartum increases the breast-milk vitamin A concentration and enhances prenatal H1N1-vaccine responses in mothers, but the benefits of maternal VAS in transplacental antibody transfer may depend on the time of gestation when mothers were vaccinated. This trial was registered at clinicaltrials.gov as NCT00817661.

Urinary trace metals individually and in mixtures in association with preterm birth

One in ten infants born in the United States is born preterm, or prior to 37 weeks gestation. Exposure to elevated levels of metals, such as lead and arsenic, has been linked to higher risk of preterm birth (PTB), but consequences of lower levels of exposure and less studied metals are unclear. We examined the associations between 17 urinary trace metals individually and in mixtures in relation to PTB. The LIFECODES birth cohort enrolled pregnant women at <15 weeks gestation at Brigham and Women's Hospital in Boston. We selected cases of PTB (n = 99) and unmatched controls (n = 291) and analyzed urine samples for a panel of trace metals (median: 26 weeks gestation). We used logistic regression models to calculate the odds ratio (OR) for PTB and subtypes of PTB based on presentation at delivery. Subtypes included spontaneous and placental PTB. We used elastic net (ENET) regularization to identify individual metals or pairwise interactions that had the strongest associations with PTB, and principal components analysis (PCA) to identify classes of exposures associated with the outcome. We observed increased odds of PTB (OR: 1.41, 95% Confidence Interval [CI]: 1.12, 1.78) in association with an interquartile range difference in urinary copper (Cu). We also observed an increased OR for selenium (OR: 1.33, 95% CI: 0.98, 1.81). ENET selected Cu as the most important trace metal associated with PTB. PCA identified 3 principal components (PCs) that roughly reflected exposure to toxic metals, essential metals, and metals with seafood as a common source of exposure. PCs reflecting essential metals were associated with increased odds of overall and spontaneous PTB. Maternal urinary copper in the third trimester was associated with increased risk of PTB, and statistical analyses for mixtures indicated that after accounting for correlation this metal was the most important statistical predictor of the outcome.

Umbilical Serum Copper Status and Neonatal Birth Outcomes: a Prospective Cohort Study

Our study aimed to assess the distribution of copper (Cu) in umbilical cord serum and estimated the association between umbilical serum Cu status and neonatal birth outcomes in a Chinese population. Through the Ma'anShan Birth Cohort Study, 2689 maternal-singleton pairs with detailed birth records and available serum samples were identified. The tertile levels of ln-transformed Cu were used to define low, medium, and high levels for serum Cu. The median for umbilical cord serum Cu was 298.2 μg/L with a range of 123.1-699.6 μg/L in this study population. Our study found a positive association between the concentration of serum Cu in the umbilical cord and the duration of gestation. Compared with medium Cu levels, we found that infants with low Cu levels had a significant higher risk of preterm birth (OR = 5.06, 95% CI 2.74, 9.34) and early-term birth (OR = 1.36, 95% CI 1.10, 1.69) in the crude model. We also found that infants with high Cu levels had a significant higher risk of late- or post-term birth (OR = 1.47, 95% CI 1.11, 1.95). A significant higher risk of preterm, early-term, and late- or post-term birth still remained, even after adjustment for potential confounding factors. Our findings suggested that both Cu deficiency and Cu overload had an adverse effect on neonatal birth outcomes.

Selenium fortification of infant formulas: does selenium form matter?

Selenium is a trace element essential for the health and development of the growing infant. It is a necessary component of proteins and enzymes required for a variety of functions, including antioxidant defense, modulation of the inflammatory response, and production of thyroid hormones. In breast-fed infants, selenium stores depend on the selenium content of the mother's diet. In formula-fed infants, selenium levels are correlated to the residual selenium stores accumulated in utero and the level and type of selenium fortification used in the formula. Today, the United States Food and Drug Administration (FDA) recommends that infant formulas contain selenium at levels between 2.0 and 7.0 μg per 100 kcal. While the US FDA does not recommend a particular selenium form for fortification, evidence indicates that organically bound selenium forms (e.g., selenomethionine and selenium-enriched yeast) are better absorbed and retained than inorganic forms (e.g., selenite and selenate). Preliminary data from studies in adults do suggest that fortification with standardized selenium-enriched yeast may offer benefits compared to fortification with other organically bound selenium forms. However, because most studies evaluating the impact of selenium fortification of infant formula have assessed inorganic selenium supplements, additional research into the bioavailability and outcomes associated with the use of selenium-enriched yeast in infants is needed.

Selenium: implications for outcomes in extremely preterm infants

Extremely preterm infants are at high risk for morbidities including bronchopulmonary dysplasia, intraventricular hemorrhage, and retinopathy of prematurity likely related to their exposure to reactive oxygen and nitrogen species early in life. Selenium is a trace mineral contributes to the proper function of multiple systems including immunity, redox regulation, and inflammation via the "selenoenzymes" glutathione peroxidase, thioredoxin reductase, and selenoprotein P. Given that selenium accretion via the placenta occurs primarily during the third trimester, preterm neonates are born selenium deficient. While the role of selenium in animals and adults is better described, publications are lacking in the neonatal population regarding consequences of selenium deficiency or toxicity, accurate monitoring of levels, and proper enteral and parental dosages. This review highlights the role of selenium as it relates to the optimal function of antioxidant systems in extremely preterm infants in order to highlight the gaps in knowledge as it relates to the pathogenesis and prevention of morbidities in this population.

Selected maternal, fetal and placental trace element and heavy metal and maternal vitamin levels in preterm deliveries with or without preterm premature rupture of membranes

AIM

To compare maternal, fetal and placental trace element (magnesium, zinc and copper) and heavy metal (cadmium and lead) and maternal vitamin (retinol, α [alpha]-tocopherol, vitamin D₃ , 25-hydroxyvitamin D₃ and 1,25-dihydroxyvitamin D₃ ) levels in preterm deliveries with and without preterm premature rupture of membranes (PPROM).

METHODS

Sixty-eight patients giving birth preterm were grouped into preterm deliveries with PPROM (n = 35) and without PPROM (n = 33). Following delivery, maternal and umbilical cord blood sera and placental tissue samples were obtained. While magnesium, zinc, copper, cadmium and lead levels were measured in all samples, the levels of retinol, α-tocopherol, vitamin D₃ , 25-hydroxyvitamin D₃ and 1,25-dihydroxyvitamin D₃ were measured only in maternal serum.

RESULTS

While magnesium level in maternal serum and zinc levels in both maternal and umbilical cord sera were lower, placental magnesium level was higher in preterm deliveries with PPROM (P < 0.01). Umbilical cord serum magnesium, placental tissue zinc and maternal and umbilical cord sera and placental tissue copper, cadmium, and lead levels did not differ between the groups (P > 0.05). In preterm deliveries with PPROM, 25-hydroxyvitamin D₃ and retinol levels were higher, while vitamin D₃ and 1,25-dihydroxyvitamin D₃ levels were lower in maternal serum (P < 0.05). Maternal serum α-tocopherol levels were similar between the groups.

CONCLUSION

Compared to spontaneous preterm births, PPROM is associated with low maternal serum together with high placental tissue magnesium and low maternal and umbilical cord sera zinc levels. Higher retinol and 25-hydroxyvitamin D₃ and lower vitamin D₃ and 1,25-dihydroxyvitamin D₃ maternal serum levels are also evident in these patients.

Association of zinc and copper with clinical parameters in the preterm newborn

BACKGROUND

Given that preterm infants are born at a time of rapid fetal growth, they are at risk of deficiency of essential nutrients for brain development, including zinc (Zn) and copper (Cu). This study evaluate the relationship between serum Cu or Zn, gestational age (GA) and anthropometric parameters at birth in preterm infants.

METHODS

This was a retrospective study of infants <35 weeks' GA from January 2010 to August 2012. We collected the data from medical records of 59 preterm infants at birth with regard to GA, anthropometric parameters, and serum Cu and Zn levels. Correlation of Cu, Zn, and GA with anthropometric parameters at birth was then done.

RESULTS

Zn was inversely correlated with GA, bodyweight (BW), body length (BL), and head circumference (HC), and Cu was inversely correlated with the standard deviation (SD) score for BW, BL, and HC. On stepwise multiple regression analysis, GA was a significant independent predictor of Zn level, and HC SD score was a significant independent predictor of Cu level.

CONCLUSIONS

Prematurity influences Zn, and intrauterine head growth restriction influences Cu at birth in preterm infants. Further research is needed to evaluate the relationship between intrauterine growth restriction and brain Cu metabolism.

Trace elements, oxidative status and antioxidant capacity as biomarkers in very low birth weight infants

Reference data on trace elements, oxidative status and antioxidants in very low birth weight infants (VLBW) are limited and need to be updated for use in clinical settings. Serum and urine of 30 VLBW infants (mean weight, 1167g) at mean age of 23.8 (t0) and 37.8 (t1) days were analyzed. Cadmium (Cd), copper (Cu), iron (Fe), mercury (Hg), manganese (Mn), selenium (Se) and zinc (Zn), nitrate/nitrite (NOx), catalase (CAT), CuZnFeMn-superoxide dismutases (CuZnFeMn-SODs), total antioxidant capacity (SAC: sum of thiols, proteins, bilirubin, uric acid, β-beta-carotene, ascorbic acid, vitamin E) and total oxidative status (SOS: sum of lipo- and hydroperoxides) were determined. A higher urinary excretion of Cu and Zn was observed at t0 than at t1; while an increase in urine Cd was found at t1 respect to t0. A deficiency in serum levels of Cu and Zn was also found. A lower CAT activity, a higher total oxidants level (SOS) and a reduction of total antioxidant barriers (SAC) were observed in some infants. No Fe and Mn deficiency or Hg overload was found; also CuZnFeMn-SODs and NOx levels did not change. The findings showed that losses of trace elements and incomplete mineral body stores were more pronounced in the earlier life stage (at 23.8th day) than later on; moreover, antioxidant defenses were poor and lipo- and hydroperoxides were higher still at 5 weeks of infants' life.

Levels of Silicon in Maternal, Cord, and Newborn Serum and Their Relation With Those of Zinc and Copper

BACKGROUND

Evidence of silicon's importance to health has been gradually accumulating. Nevertheless, there are few studies comparing serum silicon levels in newborns with maternal levels. Likewise, little is known concerning the inter-relation between silicon and other trace elements.

OBJECTIVE

The present study evaluated maternal and newborn levels of serum silicon and their relation to those of zinc and copper.

METHODS

We measured serum silicon, copper, and zinc in 66 pregnant women, in the umbilical cord of their infants, and in 44 newborns, by atomic absorption spectrophotometry. All the samples were from fasted subjects.

RESULTS

Serum silicon level in term newborns (20.6 ± 13.2 μmol/L) was significantly higher than in umbilical cord (8.9 ± 3.5 μmol/L; P < 0.0001). Mean serum silicon level in maternal vein (7.7 ± 3.4 μmol/L) was lower than that in umbilical cord, although differences were not significant. We also found higher levels of zinc (P = 0.008) and lower levels of copper (P < 0.0001) in cord blood compared with maternal blood. Umbilical venous/maternal venous level ratios of zinc, copper, and silicon were 1.5 ± 0.5, 0.2 ± 0.1, and 1.3 ± 0.7, respectively. There was a positive correlation between silicon and zinc levels (r = 0.32), and a negative correlation between copper and zinc levels (r = -0.35).

CONCLUSIONS

It seems that there is a positive gradient of silicon from the mother to her fetus. Silicon levels were higher in newborn than in cord blood, and correlated significantly with that of zinc but not copper. Additional investigations are needed to further define the role of silicon and its interaction with other trace elements during the perinatal period.

Serum copper concentrations in hospitalized newborns

BACKGROUND

Low serum Cu and ceruloplasmin (Cp) concentrations in newborns can be the first indication of a severe Cu deficient intake or, alternatively, of genetic diseases affecting Cu metabolism. However, Cu and Cp concentrations can also be influenced by other variables that render their quantitative results difficult to interpret. Therefore, it is necessary to identify these variables and stratify Cu and Cp concentrations according to these altering factors.

METHODS

Serum Cu and Cp concentrations for 564 hospitalized newborns (0-12days of life) are stratified according to their age, prematurity (birth weight or gestational age), type of feeding and inflammatory state (assessed by the serum high sensitivity C-reactive protein (hs-CRP) level) to identify potential correlations.

RESULTS

Serum Cu and Cp concentrations are influenced by all four variables analyzed, although inflammation is the most significant: the greater the hs-CRP concentration, the greater the serum Cu and Cp concentrations. Prematurity is also an important factor and preterm infants often show very low Cu and Cp concentrations. Age of life and type of feeding have in turn a more modest effect on these magnitudes, being slightly greater at 3-5days of age in breastfed newborns.

CONCLUSIONS

Inflammation and prematurity are the main variables affecting serum Cu and Cp concentrations in newborns. Therefore, hs-CRP should always be assayed in parallel to Cu status. When there is an inflammatory state proper interpretation of these concentrations can be challenging.

Association between maternal vitamin E status and alpha-tocopherol levels in the newborn and colostrum

Vitamin E is important because of its antioxidant activity in situations of oxidative stress, especially postnatally. Hence, the objective was to verify whether maternal alpha-tocopherol level is associated with the alpha-tocopherol levels of the newborn and colostrum. This is a cross-sectional study of 58 women and their term newborns from a public hospital. Blood and colostrum were collected to measure alpha-tocopherol levels by high-performance liquid chromatography. Mothers with serum alpha-tocopherol levels <16.2 mmol L(-1) and newborns <11.6 mmol L(-1) were indicative of deficiency or low levels. Mothers were divided into two groups: <16.2 mmol L(-1) and those with levels ≥16.2 mmol L(-1) . The mean (95% confidence interval) serum alpha-tocopherol levels of mothers, umbilical cords and colostrum were 28 (24-32), 6 (5-8) and 39 mmol L(-1) (32-45), respectively (P < 0.001); 19% of the women and 90% of the newborns had low alpha-tocopherol levels. Maternal alpha-tocopherol level was associated with that of the umbilical cord. Newborns from mothers at risk of deficiency had low alpha-tocopherol levels (P < 0.001). Colostrum levels of vitamin E were not influenced by maternal serum. Maternal deficiency influenced the vitamin E level of the umbilical cord but does not in the colostrum, evidencing distinct transfer mechanisms via the mammary gland.

Alpha-Tocopherol Concentration in Colostrum and Serum of Women With Premature Labor

OBJECTIVE

The aim of the study was to evaluate and compare the levels of alpha-tocopherol in colostrum milk and serum of mothers with premature birth, classified as severe prematurity and moderate prematurity.

METHODS

Cross-sectional study with 65 women, 18 births classified as severe prematurity (<32 weeks of gestation) and 47 as moderate prematurity (≥32 weeks of gestation). The study only included mothers without any conditions associated with pregnancy and who had a single conception without any malformation. Samples of serum and colostrum were collected during fasting in the immediate postpartum, and alpha-tocopherol was analyzed by high-performance liquid chromatography. To determine the biochemical nutritional status of vitamin E, a serum cutoff (11.6 μmol/L) was adopted. The Student t test for independent variables compared the average concentrations of alpha-tocopherol in serum and colostrum among prematurity groups. Differences were considered significant when P < 0.05.

RESULTS

The alpha-tocopherol concentrations in colostrum were similar in both groups, being 34.5 ± 20.2 μmol/L for women with severe prematurity and 35.1 ± 16.3 μmol/L for moderate prematurity. For the serum of puerperal women with severe prematurity, alpha-tocopherol concentration was, however, lower than in women with moderate prematurity, 22.2 ± 4.4 μmol/L versus 27.1 ± 8.6 μmol/L (P < 0.05). The serum levels of alpha-tocopherol indicated nutritional risk at 5.6% (n = 1) of women with severe prematurity and 4.3% (n = 2) for those with moderate prematurity.

CONCLUSIONS

Severe prematurity affected the levels of alpha-tocopherol in maternal serum; however, the level of prematurity did not change the concentration of vitamin E in colostrum.

Zinc in Early Life: A Key Element in the Fetus and Preterm Neonate

Zinc is a key element for growth and development. In this narrative review, we focus on the role of dietary zinc in early life (including embryo, fetus and preterm neonate), analyzing consequences of zinc deficiency and adequacy of current recommendations on dietary zinc. We performed a systematic search of articles on the role of zinc in early life. We selected and analyzed 81 studies. Results of this analysis showed that preservation of zinc balance is of critical importance for the avoidance of possible consequences of low zinc levels on pre- and post-natal life. Insufficient quantities of zinc during embryogenesis may influence the final phenotype of all organs. Maternal zinc restriction during pregnancy influences fetal growth, while adequate zinc supplementation during pregnancy may result in a reduction of the risk of preterm birth. Preterm neonates are at particular risk to develop zinc deficiency due to a combination of different factors: (i) low body stores due to reduced time for placental transfer of zinc; (ii) increased endogenous losses; and (iii) marginal intake. Early diagnosis of zinc deficiency, through the measurement of serum zinc concentrations, may be essential to avoid severe prenatal and postnatal consequences in these patients. Typical clinical manifestations of zinc deficiency are growth impairment and dermatitis. Increasing data suggest that moderate zinc deficiency may have significant subclinical effects, increasing the risk of several complications typical of preterm neonates (i.e., necrotizing enterocolitis, chronic lung disease, and retinopathy), and that current recommended intakes should be revised to meet zinc requirements of extremely preterm neonates. Future studies evaluating the adequacy of current recommendations are advocated.

Selenium deficiency and the effects of supplementation on preterm infants

OBJECTIVE

This study aimed to review the literature about blood concentrations of selenium associated with gestational age, feeding, supplementation and related clinical features in preterm infants.

DATA SOURCES

Systematic review in the following databases: MEDLINE, PubMed, Google academics, SciELO. org, ScienceDirect (Elsevier) and CINAHL-Plus with Full Text (EBSCO). Articles published up to January 2013 with the keywords "selenium deficiency", "selenium supplementation", "neonates", "infants", "newborn" and "preterm infants" were selected.

DATA SYNTHESIS

The studies reported that low blood selenium levels are associated with increased risk of respiratory diseases. Preterm infants, especially with low birth weight, presented lower selenium levels. Selenium deficiency has also been associated with the use of oral infant formula, enteral and parenteral nutrition (with or without selenium addition). The optimal dose and length of selenium supplementation is not well-established, since they are based only on age group and selenium ingestion by breastfed children. Furthermore, the clinical status of the infant affected by conditions that may increase oxidative stress, and consequently, selenium requirements is not taken into account.

CONCLUSIONS

Prematurity and low birth weight can contribute to low blood selenium in premature infants. Selenium supplementation seems to minimize or prevent clinical complications caused by prematurity.

Characterization of the vitamin A transport in preterm infants after repeated high-dose vitamin A injections

BACKGROUND/OBJECTIVES

Preterm infants have low vitamin A stores at birth, and parenteral administration of high-dose vitamin A reduces pulmonary morbidity. The aim was to characterize vitamin A transport and status.

SUBJECTS/METHODS

Prospective study of 69 preterm infants (median birth weight 995 g, gestational age 28 weeks), in which 51 received 5000 IU vitamin A three times per week intramuscular (i.m.) for 4 weeks and 18 infants without i.m. vitamin A served as controls. Serum retinol, retinyl palmitate, total retinol-binding protein 4 (RBP4), retinol-unbound RBP4 (apo-RBP4) and transthyretin concentrations were determined at days 3 (D3) and 28 (D28) of life.

RESULTS

D3 retinol concentrations were low for the entire group (382 (285/531) nmol/l; median/interquartile range) and unrelated to gestational age. D28 retinol was unchanged in controls (382 (280/471) nmol/l), but increased in the vitamin A group (596 (480/825) nmol/l; P<0.001). A similar pattern was observed for RBP4. The calculated retinol-to-RBP4 ratio rose in vitamin A infants (D3: 0.81 (0.57/0.94), D28: 0.98 (0.77/1.26); P<0.01) but not in controls. In the vitamin A group, the retinol-to-RBP4 ratio was >1 in 15% of all infants on D3 and in 45% of infants on D28, but was ⩽1 in all, but one, controls on D28.

CONCLUSIONS

In preterm infants receiving a 4-week course of high-dose i.m. vitamin A, serum retinol concentrations increased by 55%, with molar concentrations of retinol exceeding those of RBP4 in 45% of the infants suggesting transport mechanisms other than RBP4.

The effect of newborn vitamin A supplementation on infant immune functions: trial design, interventions, and baseline data

In recent years, neonatal vitamin A supplementation is considered as an essential infant-survival intervention but the evidence is not conclusive. This randomized controlled clinical trial was conducted to evaluate the effect of vitamin A on immune competence in early infancy. Results would provide a mechanistic basis for understanding the effect of this intervention on infant survival. Within 2 days of birth, infants born at one maternity clinic located in a poor slum area of Dhaka city were supplemented with either 50,000 IU vitamin A or placebo. Live attenuated oral polio vaccine (OPV) and BCG vaccine were provided after supplementation. Infants also receive diphtheria, pertussis, tetanus (TT), hepatitis B (HBV) and Haemophilus influenzae B vaccines (pentavalent combination) along with OPV at 6, 10 and 14 weeks of age. Infant thymus size, anthropometry, feeding practice and morbidity data were collected at regular interval. Infant blood samples were collected to determine T-cell-receptor excision circle (TREC), total, naïve and memory T cells and mucosal targeting lymphocytes including Treg cells. TT-, HBV-, BCG- and OPV-specific T cell blastogenic, cytokine and plasma cell antibody responses were also measured. In 16 mo enrollment period, 306 newborns, equal number of boys and girls, were enrolled. ~95% completed the 4-month follow-up period. Baseline characteristics are presented here. Anthropometry and immune assays with fresh blood samples were completed immediately while stored samples were analyzed in single batches at the end of the trial. Connecting different aspects of immunological data in early infancy will help elucidate immune competence for protecting infection. Trial registration ClinicalTrials.gov: NCT01583972.

VitaminA, E, and D deficiencies in tunisian very low birth weight neonates: prevalence and risk factors

BACKGROUND

Preterm neonates are at high risk of vitamin deficiencies, which may expose them to increased morbidity and mortality. This study aimed to determine the prevalence and risk factors for vitamin A, E, and D deficiencies in Tunisian very low birth weight (VLBW) neonates.

METHODS

A total of 607 VLBW and 300 term neonates were included in the study. Plasma vitamins A and E were assessed by high performance liquid chromatography and vitamin D was assessed by radioimmunoassay.

RESULTS

Prevalence of vitamin A, E, and D deficiencies were dramatically elevated in VLBW neonates and were significantly higher than term neonates (75.9% vs. 63.3%; 71.3% vs. 55.5%; and 65.2% vs. 40.4%, respectively). In VLBW neonates, the prevalence of vitamin deficiencies was significantly higher in lower classes of gestational age and birth weight. Vitamin E deficiency was associated with pre-eclampsia [odds ratio (OR) (95% confidence interval, 95% CI), 1.56 (1.01-2.44); p < 0.01] and gestational diabetes [4.01 (1.05-17.0); p < 0.01]. Vitamin D deficiency was associated with twin pregnancy [OR (95% CI), 2.66 (1.33-5.35); p < 0.01] and pre-eclampsia [2.89 (1.36-6.40); p < 0.01].

CONCLUSION

Vitamin A, E, and D deficiencies are very common in Tunisian VLBW neonates and are associated with pre-eclampsia. Improved nutritional and health support for pregnant women and high dose vitamins A, E, and D supplementation in VLBW neonates are strongly required in Tunisia.

Analysis of circulating lipid-phase micronutrients in humans by HPLC: review and overview of new developments

Retinol, tocopherols, coenzyme Q10, carotenoids, and vitamin D are lipophilic compounds shown to function as important health-protective agents by mitigating the damaging effects of oxidative and other injury. Scientific interest in evaluating these compounds has resurfaced in recent years, particularly in the nutritional, clinical and epidemiologic fields, and has precipitated the development of a multitude of new analytical techniques. This review considers recent developments in HPLC-based assays since 2007 for the simultaneous determination of these lipid-phase compounds utilizing exclusively serum or plasma as these matrices are mostly used in clinical and epidemiological investigations. We also provide an overview of blood measurements for selected carotenoids, tocopherols, coenzyme Q10 and retinol from the last 15years of healthy umbilical cord blood, children, and adults.

Changes in the concentrations of biochemical indicators of diet and nutritional status of pregnant women across pregnancy trimesters in Trujillo, Peru, 2004-2005

BACKGROUND

In developing countries, deficiencies in essential micronutrients are common, particularly in pregnant women. Although, biochemical indicators of diet and nutrition are useful to assess nutritional status, few studies have examined such indicators throughout pregnancy in women in developing countries.

METHODS

The primary objective of this study was to assess the nutritional status of 78 Peruvian women throughout pregnancy for 16 different nutritional indicators including fat-soluble vitamins and carotenoids, iron-status indicators, and selenium. Venous blood samples from which serum was prepared were collected during trimesters one (n = 78), two (n = 65), three (n = 62), and at term via the umbilical cord (n = 52). Questionnaires were completed to determine the demographic characteristics of subjects. Linear mixed effects models were used to study the associations between each maternal indicator and the demographic characteristics.

RESULTS

None of the women were vitamin A and E deficient at any stage of pregnancy and only 1/62 women (1.6%) was selenium deficient during the third trimester. However, 6.4%, 44% and 64% of women had ferritin levels indicative of iron deficiency during the first, second and third trimester, respectively. Statistically significant changes (p ≤ 0.05) throughout pregnancy were noted for 15/16 nutritional indicators for this Peruvian cohort, with little-to-no association with demographic characteristics. Three carotenoids (beta-carotene, beta-cryptoxanthin and trans-lycopene) were significantly associated with education status, while trans-lycopene was associated with age and beta-cryptoxanthin with SES (p < 0.05). Concentrations of retinol, tocopherol, beta-cryptoxanthin, lutein + zeaxanthin and selenium were lower in cord serum compared with maternal serum (p < 0.05). Conversely, levels of iron status indicators (ferritin, transferrin saturation and iron) were higher in cord serum (p < 0.05).

CONCLUSION

The increasing prevalence of iron deficiency throughout pregnancy in these Peruvian women was expected. It was surprising though not to find deficiencies in other nutrients. The results highlight the importance of continual monitoring of women throughout pregnancy for iron deficiency which could be caused by increasing fetal needs and/or inadequate iron intake as pregnancy progresses.

The effect of maximum storage on iron status, oxidative stress and antioxidant protection in paediatric packed cell units

BACKGROUND

Premature babies may receive multiple transfusions during the first weeks of their life. Strong associations exist between the receipt of blood transfusions and the development of the major consequences of prematurity such as retinopathy and chronic lung disease. The possible physiological link between the receipt of blood and disease is unclear, but iron-induced oxidative damage and/or bacterial colonisation would promote these conditions. Premature babies are poorly equipped to deal with any increases in iron and oxidative load that they may acquire via blood transfusions. To determine whether there are any relationships between these factors, we studied iron and oxidative status of just expired (i.e. 36 days old) paediatric red blood cell (RBC) packs.

MATERIALS AND METHODS

Just expired paediatric RBC packs were obtained from the local blood bank. The extracellular medium surrounding the RBC was separated by centrifugation and the following parameters measured: total iron concentration, total iron binding capacity, non-transferrin-bound iron [NTBI], haemoglobin, total and reduced ascorbate, and malondialdehyde concentration.

RESULTS

The extracellular fluid of the paediatric packs (n =13) was rich in iron, a high percentage of which (36%) was present as potentially toxic NTBI. It was highly redox active with limited antioxidant protection and iron-binding capacity.

DISCUSSION

The extracellular medium surrounding packed RBC could potentially be toxic if administered to patients with limited iron sequestering and antioxidant capacity, such as premature babies. Further studies are required to determine at what point during storage these changes become potentially harmful so that clinical studies can examine the optimal storage time for blood destined for premature babies.

Galectin-3 in cord blood of term and preterm infants

In recent years galectin-3 has gained attention as a signalling molecule, mainly in inflammatory diseases. Data on galectin-3 expression in neonates, however, are limited, and expression of this lectin in cord blood has not yet been reported. The aim of this study was to determine galectin-3 levels in cord blood of term and preterm neonates as well as galectin-3 levels in cord blood of term neonates after stimulation with the prevalent pathogen Streptococcus agalactiae. Cord blood samples were incubated for 24 h and galectin-3 levels were assessed by enzyme-linked immunosorbent assay. There is a positive correlation between gestational age and galectin-3 levels in cord blood. Expression of galectin-3 is significantly higher in cord blood of small-for-gestational-age infants compared to appropriate-for-gestational-age infants. Stimulation with an invasive but not with a colonizing strain of S. agalactiae induced expression of galectin-3. Galectin-3 is expressed constitutively in cord blood of neonates and seems to play a role in the innate immunity of this population.

Body burdens of mercury, lead, selenium and copper among Baltimore newborns

Umbilical cord blood or serum concentrations of mercury, lead, selenium and copper were measured with inductively coupled plasma mass spectrometry in a population of 300 infants born in Baltimore, Maryland. Geometric mean values were 1.37 μg/L (95% confidence interval: 1.27, 1.48) for mercury; 0.66 μg/dL (95% CI: 0.61, 0.71) for lead; and 38.62 μg/dL (95% CI: 36.73, 40.61) for copper. Mean selenium was 70.10 μg/L (95% CI: 68.69, 70.52). Mercury, selenium and copper levels were within exposure ranges reported among similar populations, whereas the distribution of lead levels was lower than prior reports; only one infant had a cord blood lead above 10 μg/dL. Levels of selenium were significantly correlated with concentrations of lead (Spearman's ρ=0.20) and copper (Spearman's ρ=0.51). Multivariable analyses identified a number of factors associated with one of more of these exposures. These included: increase in maternal age (increased lead); Asian mothers (increased mercury and lead, decreased selenium and copper); higher umbilical cord serum n-3 fatty acids (increased mercury, selenium and copper), mothers using Medicaid (increased lead); increasing gestational age (increased copper); increasing birthweight (increased selenium); older neighborhood housing stock (increased lead and selenium); and maternal smoking (increased lead). This work provides additional information about contemporary prenatal element exposures and can help identify groups at risk of atypical exposures.

The possible role of selenium status in adverse pregnancy outcomes

The present study reviews the possible role of Se status during pregnancy regarding adverse pregnancy outcomes, with emphasis on those related to diminished antioxidant activity and increased oxidative stress. Studies have reported that Se could play an important role in adverse outcomes such as miscarriages, neural tube defects, diaphragmatic hernia, premature birth, low birth weight, pre-eclampsia, glucose intolerance and gestational diabetes. Also, low Se status has been associated with adverse outcomes among HIV-infected pregnant women and their offspring. Nevertheless, the function of Se in the aetiology of pregnancy complications is yet to be elucidated. Available evidence presents the following limitations: most study designs do not allow conclusions about causal relationships; study populations, selection of subjects, research setting, procedures for defining sample size and analytical methods are often poorly described; many studies fail to adjust for important confounding variables. In addition, population studies assessing the relationship between Se intake during pregnancy and health outcomes are scarce. Further research is still needed to clarify the role of Se status in adverse pregnancy outcomes, especially those related to augmented oxidative stress.

Retinol status of newborn infants is associated with congenital diaphragmatic hernia

OBJECTIVE

Genetic analyses in humans suggest a role for retinoid-related genes in the pathogenesis of congenital diaphragmatic hernia (CDH). The goal of this study was to investigate the vitamin A status of mothers and their newborns in association with CDH.

METHODS

We conducted a hospital-based, case-control study with 22 case and 34 control mothers and their newborns. In maternal and cord blood samples, retinol and retinol-binding protein (RBP) levels were measured with high-performance liquid chromatography and an enzyme-linked immunosorbent assay, respectively. Univariate and multivariate logistic regression analyses were performed to determine crude and adjusted risk estimates.

RESULTS

Case newborns had significantly lower levels of retinol (0.60 vs 0.76 μmol/L; P=.003) and RBP (5.42 vs 7.11 mg/L; P=.02) than did control newborns. The multivariate logistic regression analysis showed lower levels of retinol and RBP in association with CDH risk; the odds ratio for retinol levels of <15th percentile (<0.61 μmol/L) was 11.11 (95% confidence interval: 2.54-48.66; P=.001), and that for RBP levels of <15th percentile (<4.54 mg/L) was 4.00 (95% confidence interval: 1.00-15.99; P=.05). Retinol and RBP levels were not different between case and control mothers.

CONCLUSIONS

CDH is strongly associated with low retinol and RBP levels in newborns, independent of maternal retinol status. This is an important finding supporting the idea that human CDH is linked with abnormal retinoid homeostasis.

Umbilical cord serum cytokine levels and risks of small-for-gestational-age and preterm birth

While elevated levels of proinflammatory cytokines are clearly associated with preterm birth, the relation between cytokines and fetal growth is unclear. The authors examined associations between umbilical cord serum cytokine concentrations and risk of small-for-gestational-age (SGA) and preterm birth. This cross-sectional analysis was nested within a National Institute of Child Health and Human Development-University of Alabama population-based cohort study of high-risk prenatal care patients in Jefferson County, Alabama. Patients were enrolled between 1985 and 1988. For 370 singletons, umbilical cord serum concentrations of interferon gamma (IFN-gamma), tumor necrosis factor alpha, and interleukins 12p70, 4, and 10 were determined. Associations between each cytokine and SGA and preterm delivery were evaluated using log binomial regression. Increasing log concentration of tumor necrosis factor alpha was associated with an increased risk of preterm birth (risk ratio (RR) = 2.00, 95% confidence interval (CI): 1.31, 3.06). IFN-gamma was associated with a decreased risk of SGA birth (RR = 0.78, 95% CI: 0.61, 1.01). After stratification for preterm birth status, the association between IFN-gamma concentration and SGA birth was pronounced among preterm babies (RR = 0.56, 95% CI: 0.31, 1.01). The observations regarding IFN-gamma, which is involved in the activation of adaptive immune responses and regulation of trophoblast function, suggest that IFN-gamma levels at birth may be related to fetal growth restriction.

Trace elements and antioxidant enzymes in extremely low birthweight infants

Oxygen radicals are believed to contribute to typical diseases of prematurity, such as bronchopulmonary dysplasia (BPD), intraventricular haemorrhage (IVH), retinopathy of prematurity (ROP) and necrotising enterocolitis (NEC). Our aim was to investigate whether these disorders are associated with disturbances in antioxidant enzyme activities and with low trace elements, which are co-factors of antioxidant enzymes. 209 infants with birthweight less than 1000g were enrolled into a European multicentre randomised erythropoietin (rhEPO) trial; 155 developed one or more of the above mentioned diseases. We analysed Zn, Cu, Fe, Se in plasma and red blood cells (RBCs), superoxide dismutase (CuZn-SOD), glutathione peroxidase (GSH-Px), and catalase (CAT) in RBCs on the 3rd and 68th day of life. Zn, Fe, Se in plasma, and Se in RBCs decreased (p<0.01), and Zn in RBC (p<0.001), CuZn-SOD (p<0.01) and CAT increased (p<0.05), whereas GSH-Px remained unchanged. No differences were observed between the rhEPO and control groups. Antioxidant enzyme activities did not correlate with gestational age. In infants with BPD, IVH, ROP, or NEC, CuZn-SOD and CAT (p<0.05) were higher at day 68 than in infants without these diseases. CuZn-SOD and GSH-Px at 3 days and CuZn-SOD at 68 days correlated positively (p<0.05) with the duration of oxygen treatment. In conclusion, in ELBW infants, trace element concentrations decreased over the first 10 weeks of life. Lower trace element concentrations, did not affect the activities of CuZn-SOD, GSH-Px, and CAT. Typical diseases of prematurity were not associated with decreased antioxidant enzyme activities.

Transthyretin (aka Prealbumin): why is it part of TPN labs?

AS IN OTHER NICUs, OUR PATIENTS on total parenteral nutrition (TPN) have routine labs done for monitoring. In our unit, these labs include electrolytes, hemoglobin, triglycerides, liver function studies, and transthyretin (TTR) (still called prealbumin). In polling the other neonatal nurse practitioners, I realized that none of us completely understood the utility of following the TTR level. That was the impetus for this column.

Iron homeostasis in the neonate

The regulation of the availability of micronutrients is particularly critical during periods of rapid growth and differentiation such as the fetal and neonatal stages. Both iron deficiency and excess during the early weeks of life can have severe effects on neurodevelopment that may persist into adulthood and may not be corrected by restoration of normal iron levels. This article provides a succinct overview of our current understanding of the extent to which newborns, particularly premature newborns, are able (or not able) to regulate their iron status according to physiologic need. Postnatal development of factors important to iron homeostasis such as intestinal transport, extracellular transport, cellular uptake and storage, intracellular regulation, and systemic control are examined. Also reviewed are how factors peculiar to the sick and premature neonate can further adversely influence iron homeostasis and exacerbate iron-induced oxidative stress, predispose the infant to bacterial infections, and, thus, compromise his or her clinical situation further. The article concludes with a discussion of the areas of relative ignorance that require urgent investigation to rectify our lack of understanding of iron homeostasis in what is a critical stage of development.

Placental expression of ceruloplasmin in pregnancies complicated by severe preeclampsia

There is consensus that ischemia/reperfusion injury associated with preeclampsia (PE) promotes both placental damage and the release of factors leading to maternal endothelium dysfunction, a hallmark of this potentially life-threatening syndrome. These factors include plasminogen activator inhibitor-1 (PAI-1) and soluble fms-like tyrosine kinase-1 (sFlt-1). The goal of this study was to further characterize placental factors involved in the pathophysiology of PE. Thus, DNA microarray gene profiling was utilized to identify mRNA differentially regulated in placentas from women with severe PE compared to both preterm (PC) and term control (TC) groups. Microarray studies detected an upregulation of mRNA for ceruloplasmin, a copper-containing iron transport protein with antioxidant ferroxidase properties, in PE compared to PC and TC placentas, respectively. Quantitative real-time PCR confirmed these results by demonstrating significant increases in ceruloplasmin mRNA in PE vs PC and TC placentas. Supporting previous reports, the expression of sFlt-1 and PAI-1 were also upregulated in PE placentas. Immunohistochemistry localized ceruloplasmin to the intervillous space in PE and PC placentas, whereas stronger syncytial staining was noted in PE. Western blotting confirmed a significant increase in ceruloplasmin levels in placental tissue in PE compared to PC groups. PCR identified the presence of mRNA for ceruloplasmin in primary cultures of syncytiotrophoblasts, but not villous-derived fibroblasts, suggesting that syncytium is the site of ceruloplasmin synthesis in placenta. Hypoxic treatment (1% O(2)) of syncytiotrophoblasts enhanced levels of ceruloplasmin mRNA approximately 25-fold, a significantly greater upregulation than that noted for PAI-1 and sFlt-1, suggesting that enhanced ceruloplasmin expression is a sensitive marker of syncytial hypoxia. We suggest that syncytial ceruloplasmin and its associated ferroxidase activity, induced by the hypoxia accompanying severe PE, is important in an endogenous cellular program to mitigate the damaging effects of subsequent reperfusion injury at this site.

Diagnosis of Wilson's disease: a comprehensive review

Wilson's disease is an autosomal recessive disorder of copper metabolism. The culprit gene is ATP7B. The worldwide prevalence is about 1 in 30,000, which may vary by population. Higher prevalence rates were reported using more sensitive screening techniques and pilot population screening. Typical presentations include neuropsychiatric and hepatic dysfunction, whereas atypical presentations are protean. Diagnosis relies on a high clinical suspicion, typical neurological symptoms, presence of Kayser-Fleischer rings, and reduced serum ceruloplasmin concentration. The conventional value of < 0.20 g/l is not a universal diagnostic value. Age of the subjects and analytical variations should be considered when interpreting these levels. Patients with inconclusive findings require further investigations such as 24 h urinary free-copper excretion, penicillamine challenge test, liver copper measurement, and detection of gene mutations. Direct molecular diagnosis remains the most decisive tool. Other tests such as non-ceruloplasmin-bound copper are unreliable. Potential pitfalls and limitations of these diagnostic markers are critically reviewed in this paper. The mainstays of therapy are trientine, penicillamine, and/or zinc. Liver transplantation is lifesaving for those with advanced disease. Ceruloplasmin oxidase activity and serum free-copper concentration should be monitored in patients on long-term de-coppering therapy to prevent iatrogenic copper deficiency.

Transthyretin levels are not related to Apgar score in low birth weight and very low birth weight infants

BACKGROUND

Previous studies have reported an increased incidence of thyroid dysfunction in premature/low birth weight infants. The cord blood concentrations of transthyretin (TTR), a thyroid hormone binding protein, have also been found to be decreased in preterm infants. While thyroid hormone concentrations are decreased in sick infants, it is not known if physical condition influences TTR levels. Serial concentrations of TTR following birth have not previously been reported.

AIMS

To measure serial serum concentrations of TTR in premature infants following birth, and determine whether TTR levels are related to physical condition.

METHODS

A cohort of 65 premature very low birth weight (VLBW) and LBW infants were studied. Serum samples were obtained on the day of birth, and for 8 weeks following birth. Apgar scores at birth as well as the incidence of respiratory distress syndrome (RDS) were noted.

RESULTS

Baseline serum T4 concentrations and Apgar scores were significantly lower in VLBW infants, while the severity of RDS was significantly higher in the VLBW group. Multivariate analyses revealed that T4 levels were negatively associated with RDS, while TSH concentrations were positively related to gestational age. TTR concentrations were not related to gestational age at birth, Apgar score, or RDS, and did not change markedly over 8 weeks.

CONCLUSIONS

These findings suggest that serum TTR concentrations are not related to birth weight/gestational age and are not associated with either clinical condition at birth (as assessed by Apgar score) or the occurrence of RDS. Reference values for TTR concentrations in VLBW and LBW infants are provided from birth to 8 weeks of age.

Erythrocyte indices, microminerals and ratios, antioxidants and lipids in Centrum Materna diet-supplemented Omani mothers

Venous (maternal) and cord blood (neonatal) samples of Omani women who had a daily supplement of Centrum Materna multivitamin and multimineral tablet throughout pregnancy were investigated at late preterm (n=37) and at term (n=37) delivery for erythrocyte indices, micromineral, antioxidant, and lipid values. Hemoglobin (Hb), hematocrit (HCT), mean cell volume (MCV), red cell distribution width (RDW), copper (Cu), zinc (Zn), ceruloplasmin, erythrocyte Cu-Zn superoxide dismutase (Cu-Zn SOD), cholesterol, apolipoprotein (apo) A-I and apo B were measured by appropriate analytical systems. Cu/zinc and Cu/ceruloplasmin ratios were calculated. The erythrocyte indices were normal in neonatal blood but showed borderline anemia in maternal blood of both groups. There were significantly decreased values of Cu (P=0.012), Zn (P=0.001), apo A-I (P=0.029), and Cu/ceruloplasmin ratio (P=0.032) in late preterm compared to term mothers. Significantly decreased values of Cu (P=0.003), ceruloplasmin (P<0.0001), apo A-I (P=0.024), and Cu/Zn ratio (P=007) were observed in late preterm relative to term neonates. Late preterm mothers were significantly younger (P=0.027) than term mothers. Maternal age correlated positively with apo A-I (r=0.424, P=0.012) and negatively with Cu/Zn ratio (r=-0.353, P=0.040). The findings suggest that with daily dietary Centrum Materna supplementation throughout pregnancy, hematological indices were maintained within normal in mothers and neonates, but the levels of microminerals and micromineral ratios were subnormal in late preterm mothers and their neonates.