Metabolic biomarkers of small and large for gestational age newborns

Investigation of newborn blood metabolomics in varying intrauterine growth conditions

OBJECTIVES

This study aimed to investigate changes in the blood metabolic profiles of newborns with varying intrauterine growth conditions. Specifically, we analyzed the levels of amino acids, carnitine, and succinylacetone among full-term newborns, including small for gestational age (SGA), appropriate for gestational age (AGA), and large for gestational age (LGA). We aim to identify differential metabolites and metabolic pathways that may offer insights into clinical interventions.

METHODS

A total of 5106 full-term newborns were included in the study. Blood samples were obtained from all newborns between 3 and 5 days after birth and analyzed using tandem mass spectrometry to detect blood metabolites. Subsequently, we screened for different metabolites and metabolic pathways among the groups using the MetaboAnalystR package (Version 1.0.1) in R software (R-3.6.0).

RESULTS

The levels of blood amino acids and carnitine metabolism differed significantly among newborns with varying intrauterine growth conditions. Full-term SGA newborns exhibited a decrease in multiple amino acids and an increase in multiple carnitines, while full-term LGA newborns showed an increase in multiple amino acids and acylcarnitines.

CONCLUSION

Continuous monitoring of the short-term and long-term growth and metabolic status of full-term SGA and LGA newborns is warranted with individualized dietary and nutritional adjustments to promote healthy growth in a timely manner. The findings of this research contribute to the broader understanding of SGA/LGA and shall inform future research on metabolomics, interventions, and long-term outcomes.

Exposure of ambient PM2.5 during gametogenesis period affects the birth outcome: Results from the project ELEFANT

Various environmental and behavioural factors influence neonatal health. Gamete formation (gametogenesis) is a crucial period which affects embryo development and neonatal health and ambient air pollution exposure at this stage may lead to an adverse birth outcome. Previous epidemiological and toxicological research demonstrated a strong association between maternal ambient air pollution exposure and adverse birth outcomes. However, the joint exposure-outcome of paternal exposure (76 days before the last menstruation and 14 days after the last menstruation) and maternal exposure (14 days after the last menstruation) when exploring the mechanism of the influence of air pollutants on pregnancy outcome and neonatal health remains unexplored. Here, in the Project Environmental and LifEstyle FActors iN metabolic health throughout life-course Trajectories (ELEFANT), we collected the data of 10,960 singleton pregnant women with 24-42 completed gestational weeks and included them in this study. A multinominal logistic regression model was applied to investigate the association between adverse birth outcomes and ambient PM_2.5 exposure levels during spermatogenesis and oogenesis. Results from the binary classification of ambient PM_2.5 exposure showed that the risk of abnormal birthweight was significantly greater when ambient PM_2.5 exposure was both higher during spermatogenesis and oogenesis, with RRs of 1.86 (95% CI: 1.02, 3.39). The risk of macrosomia (RR: 1.88 (95% CI: 1.13, 3.12)) increased significantly when ambient PM_2.5 levels were higher during spermatogenesis. Primiparity and primigravity are more likely to be influenced by higher ambient PM_2.5 levels during spermatogenesis. In conclusion, more attention should be paid to higher exposure level of ambient PM_2.5 during spermatogenesis.

The Exploration of Fetal Growth Restriction Based on Metabolomics: A Systematic Review

Fetal growth restriction (FGR) is a common complication of pregnancy and a significant cause of neonatal morbidity and mortality. The adverse effects of FGR can last throughout the entire lifespan and increase the risks of various diseases in adulthood. However, the etiology and pathogenesis of FGR remain unclear. This study comprehensively reviewed metabolomics studies related with FGR in pregnancy to identify potential metabolic biomarkers and pathways. Relevant articles were searched through two online databases (PubMed and Web of Science) from January 2000 to July 2022. The reported metabolites were systematically compared. Pathway analysis was conducted through the online MetaboAnalyst 5.0 software. For humans, a total of 10 neonatal and 14 maternal studies were included in this review. Several amino acids, such as alanine, valine, and isoleucine, were high frequency metabolites in both neonatal and maternal studies. Meanwhile, several pathways were suggested to be involved in the development of FGR, such as arginine biosynthesis, arginine, and proline metabolism, glyoxylate and dicarboxylate metabolism, and alanine, aspartate, and glutamate metabolism. In addition, we also included 8 animal model studies, in which three frequently reported metabolites (glutamine, phenylalanine, and proline) were also present in human studies. In general, this study summarized several metabolites and metabolic pathways which may help us to better understand the underlying metabolic mechanisms of FGR.

Serum neuron-specific enolase, magnetic resonance imaging, and electrophysiology for predicting neurodevelopmental outcomes of neonates with hypoxic-ischemic encephalopathy: a prospective study

Background

Neonatal hypoxic-ischemic encephalopathy (HIE) is an important cause of mortality and morbidity. Effective indicators for the early diagnosis of brain injury after HIE and prognosis are lacking. This study aimed to examine the predictive value of serum neuron-specific enolase (NSE), amplitude-integrated electroencephalography (aEEG), and magnetic resonance imaging (MRI), alone and in combination, for the neurological outcomes in neonates with HIE.

Methods

Newborns with HIE born and treated at the Third Affiliated Hospital of An-Hui Medical University were consecutively included in this prospective cohort study (June 2013 to December 2020). Encephalopathy was classified as mild, moderate or severe according to Samat and Sarnat. All patients were assessed serum 1-day NSE and 3-day NSE levels after birth. The children were classified by neurological examination and Bayley Scales of Infant Development II at 18 months of age. ROC analysis was used to evaluate the predictive accuracy of the neurodevelopment outcomes.

Results

A total of 50 HIE neonates were enrolled (normal group: 32 (64.0%), moderate delay: 5 (10.0%), severe delay: 30(26.0%)) according to Bayley II scores. Serum 3-day NSE levels increased with worsening neurodevelopment outcomes (normal: 20.52 ± 6.42 μg/L vs. moderate: 39.82 ± 5.92 μg/L vs. severe: 44.60 ± 9.01 μg/L, P < 0.001). The MRI findings at 4–7 days after birth were significantly different among the three groups (P < 0.001). Forty-two (84.0%) children had abnormal aEEG. The combination of the three abnormalities combined together had 100% sensitivity, 97.70% specificity, 98.25% PPV, and 99.98% NPV.

Conclusions

MRI, aEEG, and 3-day NSE can predict the neurological prognosis of newborns with HIE without hypothermia treatment. Their combination can improve the predictive ability for long-term neurobehavioral prognosis.