Maternal and cord serum lipid profiles of preterm infants with respiratory distress syndrome

Decrease in lipid metabolic indexes in infants with neonatal respiratory distress syndrome

Incomplete pulmonary function and insufficient production of pulmonary surfactant in premature infants may affect alveolar relaxation, inducing neonatal respiratory distress syndrome (NRDS). The present study was a retrospective comparison of lipid metabolism indexes and clinic information between NRDS and non-NRDS infants. Data on general information, pregnancy, clinical symptoms, family history as well as plasma biochemical and lipid metabolic indexes were retrospectively collected and statistically analyzed from 79 patients with NRDS and 44 non-NRDS infants. Infants in the NRDS group showed lower body weight (2,055 vs. 3,225 g) and gestation age (33.39 vs. 38.53 weeks) than those in the non-NRDS group (P<0.05). Baseline information was corrected by the inverse probability of treatment weighting (IPTW) analysis. The weighted adjusted median age was the same in both groups and there was no significant difference between two groups in birth weight. The IPTW analysis revealed that the levels of plasma triglyceride (TG), total cholesterol, low-density lipoprotein, free triiodothyronine, free thyroxine, glucose, calcium (Ca2+) and phosphorus in the NRDS infants were significantly lower compared with those in the non-NRDS infants. Additionally, NRDS infants had significantly higher incidence rates of pneumonia, sepsis, brain injury infection, preterm birth, patent foramen ovale, patent ductus arteriosus and premature rupture of membranes compared with the non-NRDS infants (P<0.05). Multivariate logistic analysis showed that TG and Ca2+ were risk factors associated with NRDS (P<0.05). Infants with NRDS have significantly lower levels of plasma lipid indexes. The results of the present study provide data to guide the clinical management of NRDS.

Cord blood triglyceride and total cholesterol in preterm and term neonates: reference values and associated factors from the Japan Environment and Children's Study

This study aimed to investigate the associations between cord serum total cholesterol (TC) and triglyceride (TG)levels and perinatal factors and determine the reference levels of cord blood TC and TG in Japanese neonates. This was a prospective birth cohort study using data from the Japan Environment and Children's Study, which included data on births from 2011 to 2014 in Japan. TC and TG levels were determined in cord blood samples. A total of 70,535 pairs of neonates (male: 36,001, female: 34,524) and mothers were included. The mean cord blood TC and TG levels were 72.2 mg/dL and 24.4 mg/dL, respectively. Multiple regression analyses revealed that gestational age and birth weight were significantly associated with cord blood TC (coefficient -2.35, 95% confidence interval [CI] -2.40 - -2.22 and coefficient 0.002, 95% CI 0.002-0.003, respectively) and TG (coefficient 3.09, 95% CI 3.01-3.17 and coefficient - 0.009, 95% CI - 0.009-0.008, respectively) levels. Mean cord blood TG and TC levels decreased over the preterm period; however, these parameters increased during the term. Furthermore, the mean cord blood TC and TG levels decreased over the entire range of birth weight categories.    Conclusion: Mean cord blood TG and TC levels decreased over the preterm period; however, these parameters increased during the term. Furthermore, the mean cord blood TC and TG levels decreased over the entire range of birth weight categories in Japanese newborns. Maternal complications such as maternal parity, HDP, PROM, maternal obesity and income level were associated with cord TC and TG levels. What is Known: • No studies have ascertained the reference levels of cord blood lipid levels in Japan. What is New: • Mean cord blood TG and TC levels decreased over the preterm period; however, these parameters increased during the term.

Comparison of Serum Triglyceride and Cholesterol Levels in Premature Neonates with or without Respiratory Distress Syndrome (RDS)

Background

Deficiency or reduced transmission of long-chain fatty acids and essential fatty acids may inhibit lung growth and development. We aimed to evaluate and compare serum triglyceride and cholesterol levels in premature neonates with RDS.

Methods

This study is a cross-sectional study performed on premature neonates born in Beheshti Hospital in Isfahan in 2018. Immediately after birth and after umbilical cord clumping, blood samples were taken from the umbilical artery and triglyceride and total cholesterol levels were measured. Those patients with the diagnosis of RDS were transferred to the neonatal intensive care unit (NICU). Data regarding the laboratory results of the lipid profile in patients were compared to that in the other group.

Results

A total number of 100 neonates entered the study and were divided into 2 groups. Analysis of gender and mean gestational ages among the two groups showed no significant differences between the groups (P = 0.84 and P = 0.28, respectively). Further analysis showed a significant decreased serum cholesterol in the group 1 of patients (P = 0.01), but there were no significant differences between the two groups regarding triglyceride levels (P = 0.43). There was a significant direct relationship between gestational age and serum triglyceride levels in patients with RDS (r = 0.550, P < 0.001).

Conclusion

Here, we indicated significantly lower cholesterol levels in the cord serum of premature neonates with RDS compared to non-RDS premature neonates. Our data also showed a significant direct relationship between gestational age and serum triglyceride levels in patients with RDS. These data were in line with the previous studies.

Combined elevated midpregnancy tumor necrosis factor alpha and hyperlipidemia in pregnancies resulting in early preterm birth

OBJECTIVE

The objective of the study was to determine whether pregnancies resulting in early preterm birth (PTB) (<30 weeks) were more likely than term pregnancies to have elevated midtrimester serum tumor necrosis factor alpha (TNF-α) levels combined with lipid patterns suggestive of hyperlipidemia.

STUDY DESIGN

In 2 nested case-control samples drawn from California and Iowa cohorts, we examined the frequency of elevated midpregnancy serum TNF-α levels (in the fourth quartile [4Q]) and lipid patterns suggestive of hyperlipidemia (eg, total cholesterol, low-density-lipoproteins, or triglycerides in the 4Q, high-density lipoproteins in the first quartile) (considered independently and by co-occurrence) in pregnancies resulting in early PTB compared with those resulting in term birth (n = 108 in California and n = 734 in Iowa). Odds ratios (ORs) and 95% confidence intervals (CIs) estimated in logistic regression models were used for comparisons.

RESULTS

Early preterm pregnancies were 2-4 times more likely than term pregnancies to have a TNF-α level in the 4Q co-occurring with indicators of hyperlipidemia (37.5% vs 13.9% in the California sample (adjusted OR, 4.0; 95% CI, 1.1-16.3) and 26.3% vs 14.9% in the Iowa sample (adjusted OR, 2.7; 95% CI, 1.1-6.3). No differences between early preterm and term pregnancies were observed when TNF-α or target lipid abnormalities occurred in isolation. Observed differences were not explicable to any maternal or infant characteristics.

CONCLUSION

Pregnancies resulting in early PTB were more likely than term pregnancies to have elevated midpregnancy TNF-α levels in combination with lipid patterns suggestive of hyperlipidemia.

Correlation of cord blood lipid heterogeneity in neonates with their anthropometry at birth

OBJECTIVE

Fetus with intrauterine stress may exhibit programmed changes that can alter its metabolism and bear severe risk for diseases in adult life. The current study was designed to assess the correlation between cord blood lipid profile with the anthropometric data in neonates.

MATERIALS AND METHODS

146 newborn babies born at Dr. T M A Pai Hospital, Udupi were screened and their birth weight, length, head circumference and abdominal circumference were noted at birth. Umbilical cord blood samples were analyzed for total cholesterol, triglycerides (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL). Infants were also grouped further based on gestational age (GA) and sex-adjusted birth weight percentiles into three groups i.e. Small for gestational age (SGA), Appropriate for gestational age (AGA) and Large for gestational age (LGA) for comparison of their lipid profiles. Inclusion criteria were normal fetal heart rate at birth and an APGAR score >7. Statistical significance of relation between lipid profile and anthropometry was done using ANOVA and Pearson correlation coefficient.

RESULTS

Triglycerides were significantly higher in babies with higher ponderal index (PI) than those with lower PI (P = 0.011). The TG level of SGA babies were significantly higher as compared to AGA group (P = 0.001). The LDL levels in neonates with higher abdominal circumference were significantly lower than those with lower AC (P = 0.019). Mean HDL levels were higher in neonates with larger AC, but not statistically significant. Maternal BMI had no influence on neonates' lipid profile.

CONCLUSION

Abnormal intrauterine milieu created by maternal changes during gestation may bear a profound impact on lipid metabolism in neonates, which may account for their differences in lipid profile and anthropometry at birth.

Very low-density lipoprotein in the cord blood of preterm neonates

Human fetuses have markedly low levels of serum lipids and a unique lipoprotein profile with respect to quality, with low-density lipoprotein (LDL)-like particle as the dominant cholesterol carrier. However, little is known about triglyceride (TG) distribution. In addition, lipid metabolism is important in lung development, with indications that TG from very low-density lipoprotein (VLDL) is essential for surfactant synthesis. We investigated TG distribution in preterm neonate cord blood and the relationship of VLDL-TG levels with respiratory distress syndrome (RDS). The study included 103 appropriate-for-gestational-age neonates (61 males). We performed serum lipoprotein analyses in cord blood by high-performance liquid chromatography with gel permeation columns. Term neonates had low cord blood TG concentrations distributed equally to the LDL and VLDL fractions. However, preterm neonates had even lower TG concentrations, with VLDL as the dominant carrier. The LDL-TG and high-density lipoprotein-TG concentrations in cord blood increased gradually with gestational age, but cord blood VLDL-TG concentrations increased dramatically from 32 to 34 weeks of gestational age. Neonates with RDS exhibited no RDS-specific lipoprotein profile; however, most were born before the timing of the dramatic VLDL-TG increase. Our results suggest that 34 weeks of gestation is a critical period for TG metabolism, indicating the need for evaluation of the lipid nutritional state in preterm neonates.