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PubMed2005

CD64 (Fcgamma receptor I) cell surface expression on maturing neutrophils from preterm and term newborn infants.

BACKGROUND: The expression of CD64 (FcgammaRI) is increased from an almost negligible to a marked level on neutrophils in patients with bacterial infections. CD64 expression on neutrophils might therefore be a potential candidate for the diagnosis of bacterial infections in infants. AIM: This study was performed to monitor changes of neutrophil expression of CD64 during the postpartum period to further evaluate the usefulness of this analysis. The possible influence on the expression of this receptor by other factors was also investigated, including respiratory distress syndrome (RDS) and preterm rupture of the membranes (PROM). METHODS: Cell surface expression of CD64 on neutrophils from preterm and term newborn infants and healthy adults was analysed by flow cytometry. The expression of the other Fcgamma receptors, CD32 and CD16, and the complement receptors CD11b/CD18 and CD35 was also analysed for comparison. RESULTS: Neutrophils from preterm newborn infants showed a moderately increased level of CD64 expression that, during their first month of life, was reduced to the level observed on neutrophils from term newborn infants and adults. In contrast, the level of neutrophil expression of CD32 and CD16 was significantly lower in preterm than term newborn infants and adults. Neutrophils from all groups indicated similar levels of CD11b expression, but the expression on neutrophils from newborn infants increased after birth. CONCLUSION: Our results showed that neutrophil expression of CD64 is moderately increased in preterm newborn infants at birth. It seems not to be influenced by RDS, PROM or other factors related to preterm birth but by bacterial infection.

Adult↗

PubMed1997

Effects of preterm birth on oral growth and development.

Preterm and low birthweight children comprise approximately 6 per cent of all live births. They are prone to many serious medical problems during the neonatal period which may affect the development of oral tissues. The present paper reviews the results of this author's own decade of research into the oral development of preterm children in the light of current understanding of the field. Studies have shown a high prevalence of generalized enamel hypoplasia in the primary dentition of around 40-70 per cent in preterm children which is likely to be associated with low bone mineral stores. The clinical significance of enamel defects is poor aesthetics, and predisposition of the lesions to dental caries. Other dental defects observed in preterm children are localized enamel hypoplasia, crown dilacerations, and palatal distortions which are usually associated with traumatic laryngoscopy and prolonged endotracheal intubation. Furthermore, recent studies have demonstrated that the rate of dental development, and dental eruption may be affected by preterm birth. Children with the lowest birthweight and shortest gestational ages have the lowest rates of dental development, particularly before six years of age. The results of these clinical studies may have significant implications in the dental management of preterm children.

Bone and Bones↗

PubMed1999

Decreased superoxide production, degranulation, tumor necrosis factor alpha secretion, and CD11b/CD18 receptor expression by adherent monocytes from preterm infants.

Preterm infants have an increased incidence of infection, which is principally due to deficiencies in neonatal host defense mechanisms. Monocyte adherence is important in localizing cells at sites of infection and is associated with enhanced antimicrobial functions. We isolated cord blood monocytes from preterm and full-term infants to study their adhesion and immune functions, including superoxide (O2-) generation, degranulation, and cytokine secretion and their adhesion receptors. O2- production and degranulation were significantly diminished, by 28 and 37%, respectively, in adherent monocytes from preterm infants compared to full-term infants (P < 0. 05); however, these differences were not seen in freshly isolated cells. We also observed a significant decrease of 35% in tumor necrosis factor alpha secretion by lipopolysaccharide-stimulated adherent monocytes from preterm infants compared to full-term infants (P < 0.05); however, this difference was not observed in interleukin-1beta or interleukin-6 production by the monocytes. The cell surface expression of the CD11b/CD18 adhesion receptor subunits was significantly decreased (by 60 and 52%, respectively) in monocytes from preterm infants compared to full-term infants (P < 0. 01). The cascade of the immune response to infection involves monocyte upregulation and adherence via CD11b/CD18 receptors followed by cell activation and the release of cytokines and bactericidal products. We speculate that monocyte adherence factors may be important in the modulation of immune responses in preterm infants.

Birth Weight↗

PubMed2006

Association between preterm birth and vaginal colonization by mycoplasmas in early pregnancy.

To examine the association between colonization by two newly classified species of genital ureaplasmas (Ureaplasma parvum and U. urealyticum) in early pregnancy and subsequent late abortion or preterm birth at <34 weeks of gestation, four species of genital mycoplasmas--Mycoplasma genitalium, M. hominis, U. parvum, and U. urealyticum--as well as Chlamydia trachomatis and Neisseria gonorrhoeae were examined by PCR-based methods in a prospective cohort study of 877 women with singleton pregnancies at <11 weeks of gestation. Antibiotics were used only in cases in which C. trachomatis and/or N. gonorrhoeae was detected. Multivariate logistic-regression analysis was used to assess independent risk factors after taking maternal low body weight and past history of preterm birth into account. M. genitalium, M. hominis, U. parvum, U. urealyticum, C. trachomatis, and N. gonorrhoeae were detected in 0.8%, 11.2%, 52.0%, 8.7%, 3.2%, and 0.1% of these 877 women, respectively. Twenty-one (2.4%) women experienced late abortion or preterm birth at <34 weeks of gestation. Three factors-detection of U. parvum in the vagina (odds ratio [OR], 3.0; 95% confidence interval [CI], 1.1 to 8.5); use of antibiotics, such as penicillin and cefatrizine, for incidental inflammatory complications before 22 weeks of gestation (OR, 4.2; 95% CI, 1.6 to 10.0); and past history of preterm birth (OR, 10.4; 95% CI, 2.7 to 40.5)-were independently associated with late abortion and preterm birth. In conclusion, vaginal colonization with U. parvum, but not U. urealyticum, is associated with late abortion or early preterm birth.

Adult↗

PubMed2004

Lipopolysaccharide binding protein in preterm infants.

OBJECTIVE: To assess serum concentrations of lipopolysaccharide binding protein (LBP) in preterm infants with neonatal bacterial infection (NBI). METHODS: Blood samples were analysed of 57 preterm (28(+1) to 36(+6), median 33(+2) weeks gestation) and 17 term infants admitted to the neonatal intensive care unit within the first 72 hours of life with suspicion of NBI. Samples were obtained at first suspicion of sepsis and after 12 and 24 hours. Diagnosis of NBI was confirmed by raised concentrations of C reactive protein and/or interleukin 6. The influence of gestational age and labour was analysed. RESULTS: Maximum LBP concentrations in infants with NBI were greatly increased compared with infants without NBI (13.0-46.0 microg/ml (median 20.0 microg/ml) v 0.6-17.4 microg/ml (median 4.2 microg/ml)). LBP concentrations in infected infants were not yet significantly raised when NBI was first suspected. The LBP concentrations of preterm infants were comparable to those of term infants. Regression analysis revealed no significant effect of labour or gestational age on LBP. CONCLUSIONS: Raised LBP concentrations indicate NBI in preterm and term infants. Preterm infants of > 28 weeks gestation seem to be capable of producing LBP as efficiently as term infants. Neonatal LBP concentrations are not influenced by labour. LBP may be a useful diagnostic marker of NBI in preterm infants.

Acute-Phase Proteins↗

PubMed2005

DT5aP-Hib-IPV and MCC vaccines: preterm infants' response to accelerated immunisation.

AIMS: To describe the immune response of preterm infants to combined diphtheria/tetanus/5 component acellular pertussis-Haemophilus influenzae type b inactivated polio vaccine (DT5aP-Hib-IPV) and meningococcal serogroup C conjugate vaccine (MCC) under accelerated schedule. To compare results with term infants immunised with DT5aP-Hib-IPV and with historical data from preterm infants immunised with a DT3 component aP-Hib vaccine. METHODS: Prospective observational study in preterm infants born at <32 weeks gestation with comparison to contemporary cohort of term infants. DT5aP-Hib-IPV and MCC vaccines were given at 2, 3, and 4 months. RESULTS: Fifty preterm infants (mean gestational age 28.5 weeks) completed the study. After three doses of vaccines Hib polysaccharide IgG geometric mean concentration (GMC) was 1.21 microg/ml with 80% > or =0.15 microg/ml; MCC serum bactericidal assay geometric mean titre (GMT) was 1245 with 100% > or =8. All infants achieved protective titres to diphtheria, tetanus, and the three poliovirus types with > or =80% achieving protective rises in IgG against the five pertussis antigens. CONCLUSION: Preterm infants immunised with DT5aP-Hib-IPV and MCC vaccines show IgG responses to Hib and MCC greater than seen historically in both term and preterm infants with a DT3aP-Hib vaccine, and for pertussis antigens and poliovirus type 1 responses similar to that seen in term infants immunised with DT5aP-Hib-IPV. Responses to poliovirus types 2 and 3 are reduced, but all infants achieved protective titres.

Antibody Formation↗

PubMed1990

Postnatal circulatory adaptation in healthy term and preterm neonates.

Thirty seven healthy infants (18 born at full term and 19 preterm) were studied serially with cross sectional and Doppler echocardiography to compare their postnatal circulatory adaptation. Pulmonary artery pressure was assessed by its inverse relationship with the ratio of pulmonary artery time to peak velocity and right ventricular ejection time measured from Doppler waveform. Patency of the ductus arteriosus and interatrial shunting were assessed by imaging and Doppler ultrasound. The ratio rose after birth in all infants; it rose more slowly in the preterm infants. After 6 hours of age the mean was significantly less in the preterm group, the greatest difference being between 25 and 36 hours. By 73 to 96 hours the difference was no longer significant. There was a trend towards later ductal closure in the preterm infants but this was not significant. Atrial shunting level varied, but some left to right shunting was seen in all infants satisfactorily studied. Pulmonary artery pressure seems to fall more slowly after preterm birth even in the absence of respiratory problems, but ductal shunting persisting for more than three days is unusual in healthy preterm infants.

Adaptation, Physiological↗

PubMed1992

Neutrophil chemotaxis and adhesion in preterm babies.

To investigate the increased susceptibility to infection of very immature preterm neonates, neutrophil chemotaxis, Mac-1 adhesion receptor expression, and adherence to human umbilical vein endothelial cell monolayers (HUVE) were examined in neonates born at less than or equal to 32 weeks' gestation. Chemotaxis of neutrophils from well preterm neonates towards casein or zymosan activated serum (ZAS) was reduced (mean SE) being for casein 88.6 (3.8) microns; ZAS 76.2 (4.3) microns compared with adults (casein 117.8 (1.4) microns; ZAS 112.1 (1.4) microns), but similar to term neonate neutrophils (casein 92.7 (4.5) microns; ZAS 75.9 (3.1) microns). Stimulated Mac-1 expression showed a similar pattern: reduced on preterm neutrophils compared with adults, but similar to term neonates. Preterm and term neonate neutrophils were both hyperadherent to HUVE when unstimulated, but showed an equally impaired ability to increase adhesion following stimulation. Casein stimulated chemotaxis and stimulated Mac-1 expression 'matured' towards adult levels of performance four weeks after preterm birth. The increased incidence of sepsis in immature preterm infants is not due to greater defects of neutrophil migration.

Caseins↗

PubMed1993

Psychological distress in pregnancy and preterm delivery.

OBJECTIVE: To investigate if psychological distress during pregnancy is associated with increased risk of preterm delivery. DESIGN: Prospective, population based, follow up study with repeated measures of psychological distress (general health questionnaire), based on the use of questionnaires. SETTING: Antenatal care clinic and delivery ward, Aarhus University Hospital, Denmark. SUBJECTS: 8719 women with singleton pregnancies attending antenatal care for the initial visit between 1 August 1989 and 30 September 1991; 5872 women (67%) completed all questionnaires. MAIN OUTCOME MEASURE: Preterm delivery. Estimation of gestational age at delivery was mainly based on early ultrasound measurements. RESULTS: In 197 cases (3.6%) the woman delivered prematurely (less than 259 days). A dose-response relation between psychological distress in the 30th week of pregnancy and risk of preterm delivery was found, but distress measured in the 16th week was not related to preterm delivery. Control of confounding was secured by the use of multivariate logistic regression models. Relative risk for preterm delivery was 1.22 (95% confidence interval 0.84 to 1.79) for moderate distress and 1.75 (1.20 to 2.54) for high distress in comparison to low distress. CONCLUSIONS: Psychological distress later in pregnancy is associated with an increased risk of preterm delivery. Future interventional studies should focus on ways of lowering psychological distress in late pregnancy.

Adolescent↗

PubMed2004

Prospective randomised controlled trial of an infection screening programme to reduce the rate of preterm delivery.

OBJECTIVE: To evaluate whether a screening strategy in pregnancy lowers the rate of preterm delivery in a general population of pregnant women. DESIGN: Multicentre, prospective, randomised controlled trial. SETTING: Non-hospital based antenatal clinics. PARTICIPANTS: 4429 pregnant women presenting for their routine prenatal visits early in the second trimester were screened by Gram stain for asymptomatic vaginal infection. In the intervention group, the women's obstetricians received the test results and women received standard treatment and follow up for any detected infection. In the control group, the results of the vaginal smears were not revealed to the caregivers. MAIN OUTCOME MEASURES: The primary outcome variable was preterm delivery at less than 37 weeks. Secondary outcome variables were preterm delivery at less than 37 weeks combined with different birth weight categories equal to or below 2500 g and the rate of late miscarriage. RESULTS: Outcome data were available for 2058 women in the intervention group and 2097 women in the control group. In the intervention group, the number of preterm births was significantly lower than in the control group (3.0% v 5.3%, 95% confidence interval 1.2 to 3.6; P = 0.0001). Preterm births were also significantly reduced in lower weight categories at less than 37 weeks and <or= 2500 g. Eight late miscarriages occurred in the intervention group and 15 in the control group. CONCLUSION: Integrating a simple infection screening programme into routine antenatal care leads to a significant reduction in preterm births and reduces the rate of late miscarriage in a general population of pregnant women.

Adult↗

PubMed1996

Visual evoked potentials and dietary long chain polyunsaturated fatty acids in preterm infants.

The influence of dietary long chain polyunsaturated fatty acid (LCP) supply, and especially of docosahexaenoic acid (DHA), on evoked potential maturation, was studied in 58 healthy preterm infants using flash visual evoked potentials (VEPs), flash electroretinography (ERG), and brainstem acoustic evoked potentials (BAEPs) at 52 weeks of postconceptional age. At the same time, the fatty acid composition of red blood cell membranes was examined. The infants were fed on breast milk (n = 12), a preterm formula supplemented with LCP (PF-LCP) (n = 21), or a traditional preterm formula (PF) (n = 25). In the breast milk and PF-LCP groups the morphology and latencies of the waves that reflect the visual projecting system were similar; in the PF group the morphology was quite different and the wave latencies were significantly longer. This could mean that the maturation pattern of VEPs in preterm infants who did not receive LCP was slower. Moreover, a higher level of erythrocyte LCP, especially DHA, was found in breast milk and PF-LCP groups compared with the PF group. ERG and BAEP recordings were the same in all three groups. These results suggest that a well balanced LCP supplement in preterm formulas can positively influence the maturation of visual evoked potentials in preterm infants when breast milk is not available.

Breast Feeding↗

PubMed1998

Immunogenicity of hepatitis B vaccine in preterm infants.

AIM: To assess the immunogenicity of hepatitis B vaccine in preterm and term infants, given in a sequence of three doses beginning soon after birth. METHOD: The immunogenicity of hepatitis B vaccine was assessed in 176 preterm infants (< 35 weeks of gestation), immunised soon after birth, and compared with that in 46 term infants. Titres of hepatitis B antibodies were determined one to two months after the third vaccine. The significance of the differences between the term and preterm groups was determined using Student's t test. RESULTS: A similar proportion of infants in both preterm and term groups attained protective titres of hepatitis B antibodies (88.7% vs 93.4%, respectively; p = NS). However, the term infants had a higher geometric mean titre of antibodies after the third vaccine than did the preterm infants (701.2 (745.0) vs 469.1 (486.2) mU/ml, respectively; p < 0.03). CONCLUSION: Hepatitis B vaccine is effective in most preterm infants when given soon after birth. It may be advisable to determine the immune response at 12-24 months of age to booster the non-responders.

Antibody Formation↗

PubMed1999

Sodium potassium adenosine triphosphatase activity in preterm and term infants and its possible role in sodium homeostasis during maturation.

AIM: To investigate sodium (NA(+)) potassium (K(+)) adenosine triphosphatase (ATPase) activity in newborn infants at different gestational ages, to elucidate the mechanism underlying poor renal sodium conservation in preterm infants. METHODS: Fifty three healthy newborn infants, gestational age 30-42 weeks, were studied. Umbilical cord red blood cell Na(+) K(+)ATPase activity, plasma renin activity, and plasma aldosterone activities were measured in all of them. Red blood cell Na(+) K(+)ATPase activity was re-examined in eight preterm infants, one and two weeks after birth. Total and ouabain sensitive ATPase activity was measured spectrophotometrically using a method that couples ATP hydrolysis with NADH oxidation. RESULTS: Red blood cell Na(+) K(+)ATPase activity was significantly lower (p<0.01) in preterm babies with a gestational age below 35 weeks, compared with those with aged 35 weeks and above: 2.3 (0.8) and 6.7 (1.3) nmol NADH/minute/mg protein, respectively. There was no correlation between gestational age, Na(+) K(+)ATPase, plasma renin activity and aldosterone values either in the preterm or term babies. Two weeks after birth, irrespective of gestational age, the enzyme activity of the preterm babies increased to values similar to those observed in the term neonates at birth. CONCLUSION: The differences in sodium homeostasis between term and preterm babies are modulated via changes in Na(+) K(+)ATPase activity.

Gestational Age↗

PubMed2001

Blood transfusion increases radical promoting non-transferrin bound iron in preterm infants.

BACKGROUND: Blood transfusion has been recognised as a risk factor for the development of retinopathy of prematurity (ROP) or chronic lung disease (CLD) in preterm infants, but the precise mechanism involved is not understood. AIM: To investigate the level of non-transferrin bound "free" iron, which has the potential to promote the generation of reactive oxygen species, and its redox status in the plasma of preterm infants immediately before and after blood transfusion. METHODS: Twenty one preterm infants with a median gestational age and birth weight of 27 weeks and 1021 g respectively were prospectively enrolled in the study. Sixteen of the 21 infants developed ROP and/or CLD. The infants were transfused with concentrated red blood cells at a median age of 32 days. The plasma concentration of total bleomycin detectable iron (BDI) was measured and also the ferrous iron (Fe(2+)) activity by bleomycin-iron complex dependent degradation of DNA. RESULTS: Even before blood transfusion, BDI was detectable in one third of the blood samples, and all but one sample had ferrous iron activity. After transfusion, both BDI and ferrous iron activity were significantly increased, in contrast with the situation in full term infants. Plasma ascorbic acid (AA) concentration was significantly decreased after blood transfusion, whereas the level of its oxidation product, dehydroascorbic acid (DHAA), and the DHAA/AA ratio were significantly increased compared with before the transfusion. The activity of plasma ferroxidase, which converts iron from the ferrous to the ferric state, was appreciably decreased in preterm infants, as expected from their very low plasma caeruloplasmin concentration. CONCLUSIONS: Plasma non-transferrin bound iron was significantly increased in preterm infants after blood transfusion and existed partly in the ferrous form, because of the low ferroxidase activity and the reduction of ferric iron (Fe(3+)) by ascorbic acid. This finding was specific to preterm infants and was not observed in full term infants after blood transfusion. Non-transferrin bound "free" iron may catalyse the generation of reactive oxygen species, which may be responsible for the clinical association of blood transfusion with ROP and CLD.

Anti-Bacterial Agents↗

PubMed2002

Socioeconomic status and preterm birth: New Zealand trends, 1980 to 1999.

BACKGROUND: While a number of countries have reported rising preterm birth rates over the past two decades, none has examined the effects of socioeconomic status on preterm birth at a national level. AIM: To document the changing incidence of preterm birth in New Zealand over the past 20 years and to determine whether particular socioeconomic or ethnic subsections of the population have contributed disproportionately to the changes seen. METHODS: Birth registration data routinely available from the New Zealand Health Information Service were analysed for the period 1980-99. Information for a total of 1 079 478 singleton live births was linked by Domicile Code to the New Zealand Deprivation Index, a small area index of deprivation. RESULTS: Singleton preterm birth rates rose by 37.2% during the 20 year period, from 4.3% in 1980 to 5.9% in 1999. Rates increased by 71.9% among those living in the most affluent areas, but by only 3.5% among those living in the most deprived areas, resulting in the disappearance of a socioeconomic gradient in preterm birth that had existed during the early 1980s. CONCLUSIONS: This study challenges traditional thinking on the associations between socioeconomic status and preterm birth. Further research is necessary if the changes that have occurred in New Zealand over the past 20 years are to be fully understood.

Adult↗

PubMed2003

Weaning preterm infants: a randomised controlled trial.

OBJECTIVE: To assess the effect on growth and iron status in preterm infants of a specially devised weaning strategy compared with current best practices in infant feeding. The preterm weaning strategy recommended the early onset of weaning and the use of foods with a higher energy and protein content than standard milk formula, and foods that are rich sources of iron and zinc. SUBJECTS AND DESIGN: In a blinded, controlled study, 68 preterm infants (mean (SD) birth weight 1470 (430) g and mean (SD) gestational age 31.3 (2.9) weeks) were randomised to either the preterm weaning strategy group (n = 37) or a current best practice control group (n = 31), from hospital discharge until 1 year gestation corrected age (GCA). MAIN OUTCOME MEASURES: Weight, supine length, occipitofrontal head circumference, and intakes of energy, protein, and minerals were determined at 0, 6, and 12 months GCA. Levels of haemoglobin, serum iron, and serum ferritin were assayed at 0 and 6 months GCA. RESULTS: Significant positive effects of treatment included: greater increase in standard deviation length scores and length growth velocity; increased intake of energy, protein, and carbohydrate at 6 months GCA and iron at 12 months GCA; increased haemoglobin and serum iron levels at 6 months GCA. CONCLUSIONS: The preterm weaning strategy significantly influenced dietary intakes with consequent beneficial effects on growth in length and iron status. This strategy should be adopted as the basis of feeding guidelines for preterm infants after hospital discharge.

Age Factors↗

PubMed2004

Employment, working conditions, and preterm birth: results from the Europop case-control survey.

STUDY OBJECTIVE: To analyse the relation between preterm birth and working conditions in Europe using common measures of exposure and to test whether employment related risks varied by country of residence. DESIGN: A case-control study in which cases included all consecutive singleton preterm births and controls included one of every ten singleton term births in each participating maternity unit. Data about working conditions were obtained by interview from women after delivery. SETTING: Sixteen European countries. PARTICIPANTS: The analysis included 5145 preterm and 7911 term births of which 2369 preterm and 4098 term births were to women employed during pregnancy. Analyses of working conditions were carried out for women working through at least the third month of pregnancy. MAIN RESULTS: Employed women did not have an excess risk of preterm birth. Among working women, a moderate excess risk was observed for women working more than 42 hours a week (OR = 1.33, CI = 1.1 to 1.6), standing more than six hours a day (OR = 1.26, CI = 1.1 to 1.5), and for women with low job satisfaction (OR = 1.27, CI = 1.1 to 1.5). There were stronger links in countries with a lower overall level of perinatal health and a common practice of long prenatal leaves. CONCLUSION: These findings show that specific working conditions affect the risk of preterm birth. They also suggest employment related risks could be mediated by the social and legislative context.

Case-Control Studies↗

PubMed1999

Study of environmental, social, and paternal factors in preterm delivery using sibs and half sibs. A population-based study in Denmark.

OBJECTIVE: The aim of this study was to evaluate the influence on preterm delivery of changes in putative genetic and environmental risk factors between two consecutive births. Low social status is a suspected risk indicator of preterm delivery, but the impact of social mobility has not been studied before. PARTICIPANTS: The study uses national cohorts in which women act as their own controls. Subjects were identified by means of registries: 10,455 women who gave birth to a preterm child and had a subsequent live birth between 1980 and 1992 and 9849 women who gave birth to a child after 37 completed weeks of gestation and had a subsequent live born child in the same time period formed the cohorts. METHODS: The risk of having a premature infant in the subsequent pregnancy was analysed in each cohort as a function of changes in male partner, residency, occupation, and social status between the two pregnancies. RESULTS: There was a strong tendency to repeat a preterm delivery (18% v 6% in the general population). Social decline was associated with a moderate increase in the recurrence risk (OR: 1.22; 95% CI: 1.02, 1.47). In the reference cohort the risk of preterm delivery associated with changing from a rural to an urban municipality was 2.03 (95% CI: 1.14, 3.64). CONCLUSIONS: Social decline and moving to an urban municipality may be associated with preterm delivery.

Adolescent↗