Umbilical cord blood vitamin A levels in relation to the outcome of late-preterm infant: A prospective study

Abstract Background: Low Vitamin A levels of plasma increase the risk of neonates’ morbidity. However, whether umbilical cord blood (UCB) vitamin A levels have an association with the outcomes of late-preterm infants (LPI) is not well established. This study aimed to determine umbilical cord blood vitamin A levels and their correlation with outcomes of late-preterm infants. Methods: We prospectively studied 208 LPI between January 1, 2014，and June 30, 2015. The specimens of UCB were collected shortly after birth, and vitamin A levels were determined by Enzyme-Linked Immunosorbent Assay. All singleton newborns, with 34+0 weeks to 36+6 weeks’ gestational age, were eligible for study inclusion in the studied time intervals. Exclusion criteria included significant congenital malformations or chromosomal abnormality or congenital metabolic disease, or life-threatening disease. All subjects were implemented to follow up, and jaundice, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, death, etc. were recorded. Results: The prevalence of low UCB vitamin A level <0.7 μmol/L was 37.5% in LPI. UCB vitamin A levels of LPI with cesarean section was lower than that with vaginal delivery (0.734 (0.634-0.796) μmol/L VS 0.904 (0.666-1.100) μmol/L P = 0.001). Additionally, binary logistic regression analysis revealed that the cesarean section was an independent risk factor for UCB vitamin A level < 0.7 μmol/L. However, UCB vitamin A levels did not correlate with gestational age, birth weight, and sex. Neonates with hospitalization or oxygen supplementation or RDS group had significantly lower UCB vitamin A levels than their counterparties ( P < 0.05), other than with hyperbilirubinemia or sepsis ( P > 0.05). However, univariate binary logistics regression analysis suggested that UCB vitamin A level < 0.7 μmol/L was not an independent risk factor for hospitalization, oxygen therapy, hyperbilirubinemia, sepsis and RDS. Conclusions: Low umbilical cord blood vitamin A levels are common among late-preterm infants. Delivery with cesarean section is an independent risk factor for low umbilical cord blood vitamin A level. However, there is no evidence that low vitamin A level is associated with morbidity of late-preterm infants, including hyperbilirubinemia, sepsis and respiratory distress syndrome.

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One Less Painful Procedure: Using Umbilical Cord Blood as Alternative Source to Admission Complete Blood Count

American Journal of Perinatology ◽

10.1055/s-0037-1601565 ◽

2017 ◽

Vol 34 (12) ◽

pp. 1178-1184 ◽

Cited By ~ 3

Author(s):

Neera Prakash ◽

Joseph Decristofaro ◽

Echezona Maduekwe

Keyword(s):

Blood Cell ◽

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Gestational Age ◽

Blood Count ◽

Complete Blood Count ◽

Late Preterm ◽

Late Preterm Infants

Objective This study aims to evaluate the use of umbilical cord blood as an alternative to the admission complete blood count (CBC) in the well-appearing late preterm neonates admitted to the neonatal intensive care unit. Study Design Paired umbilical cord and admission blood CBC samples from well late preterm infants were compared using a two-sample t-test or analysis of variance with an unequal variance for differences in the hemoglobin, platelet counts, white blood cell, and absolute neutrophil counts. Results A total of 100 infants were enrolled in the study. The study included 46 females, 5 Asian, 9 Black, 35 Hispanic, 51 White, with a mean gestational age of 35.3 ± 1 weeks (range: 34–36.5 weeks), and a mean birth weight of 2,347 ± 491 g (range: 1,840–4,260 g). Around 80% were appropriate for gestational age, 5% were large for gestational age, and 15% were small for gestational age. The median difference between the cord and admission blood samples were hemoglobin: 1.1 g/dL, platelet: 7.50 × 103 cells/μL, white blood cell count: 2.3 × 103 cells/μL, and absolute neutrophil count: 0.6 × 103 cells/μL. Conclusion The cord and admission blood testing were not statistically or clinically different when compared. In well late preterm infants, the NICU admission blood CBC may be replaced with an umbilical cord blood CBC.

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

10.21203/rs.2.19533/v2 ◽

2020 ◽

Author(s):

En-Fu Tao ◽

Cai-E Chen ◽

Yun-Qin Chen ◽

Lin-Yan Cai ◽

Tian-Ming Yuan

Keyword(s):

Risk Factor ◽

Vitamin A ◽

Cesarean Section ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Gestational Age ◽

Independent Risk Factor ◽

Distress Syndrome ◽

Late Preterm ◽

The Relationship

Abstract Background: Low plasma vitamin A levels increases the risk of neonates’ morbidity. However, the relationship between umbilical cord blood (UCB) vitamin A levels and late-preterm infant (LPI) consequences is inconclusive. Herein, we attempted to clarify the association between UCB vitamin A levels and LPI morbidities.Methods: We conducted a prospective cohort study of 208 LPI (from 34+0 to 36+6 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. Jaundice, sepsis, respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and death were recorded.Results: Prevalence of low UCB vitamin A level <0.7 μmol/L was 37.5% in LPI. Cesarean section was an independent risk factor of UCB vitamin A level < 0.7 μmol/L. Nevertheless, UCB vitamin A levels did not correlate with gestational age, birthweight, 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. However, cesarean section, gestational age < 35 weeks and birthweight < 2500 g were independent risk factors for hospitalization and RDS. In addition, cesarean section increased the risk of oxygen supplementation, while gestational age < 35 weeks increased the risk of hyperbilirubinemia. Conclusions: Cesarean section delivery is an independent risk factor of low UCB vitamin A levels, and increases the risk of RDS. On the basis of our results, there is no association between low vitamin A levels and morbidity of late-preterm infants, including hyperbilirubinemia, sepsis and respiratory distress syndrome. Trial registration: Not applicable.

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Umbilical cord milking versus delayed cord clamping in term and late-preterm infants: a systematic review and meta-analysis

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767058.2021.1884676 ◽

2021 ◽

pp. 1-11

Author(s):

Amrit Jeevan ◽

Anitha Ananthan ◽

Manjari Bhuwan ◽

Haribalakrishna Balasubramanian ◽

Shripada Rao ◽

...

Keyword(s):

Systematic Review ◽

Preterm Infants ◽

Umbilical Cord ◽

Meta Analysis ◽

Late Preterm ◽

Delayed Cord Clamping ◽

Late Preterm Infants ◽

Cord Clamping ◽

Umbilical Cord Milking

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106: Umbilical Cord Blood Cortisol Levels and Hemodynamic Status on the First Day of Life in Preterm Infants Less than 32 Weeks Gestation

Paediatrics & Child Health ◽

10.1093/pch/20.5.e72a ◽

2015 ◽

Vol 20 (5) ◽

pp. e72-e72

Author(s):

S Manickaraj ◽

S Buddhavarapu ◽

N Brown ◽

K Yusuf

Keyword(s):

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Hemodynamic Status ◽

Cortisol Levels

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Allogeneic Umbilical Cord Blood Red Cell Concentrates: An Innovative Blood Product for Transfusion Therapy of Preterm Infants

Neonatology ◽

10.1159/000368296 ◽

2014 ◽

Vol 107 (2) ◽

pp. 81-86 ◽

Cited By ~ 12

Author(s):

Maria Bianchi ◽

Carmen Giannantonio ◽

Serena Spartano ◽

Maria Fioretti ◽

Alessandra Landini ◽

...

Keyword(s):

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Blood Product ◽

Red Cell ◽

Transfusion Therapy

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Autologous Umbilical Cord Blood‐Derived Cell Administration in Extreme Preterm Infants: CORD‐SAFE Study

Stem Cells Translational Medicine ◽

10.1002/sctm.12814 ◽

2020 ◽

Vol 9 (S1) ◽

Author(s):

Atul Malhotra ◽

Lindsay Zhou ◽

Iona Novak ◽

Courtney McDonald ◽

Suzanne Miller ◽

...

Keyword(s):

Cord Blood ◽

Preterm Infants ◽

Umbilical Cord ◽

Umbilical Cord Blood

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The Effect of Anesthesia on Chemokine Production in the Cord Blood Off Neonates.

Blood ◽

10.1182/blood.v108.11.3875.3875 ◽

2006 ◽

Vol 108 (11) ◽

pp. 3875-3875

Author(s):

Barbara Krolak-Olejnik ◽

Igor Olejnik

Keyword(s):

Logistic Regression ◽

Cesarean Section ◽

Cord Blood ◽

Vaginal Delivery ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Tissue Injury ◽

Severe Depression ◽

Chemokine Production ◽

Cc Chemokines

Abstract Animal experiments have shown a correlation between anesthesia and surgery on one hand, and depressed immune response and infections on the other hand. Patients who are anergic or become anergic post-operatively and patients with a severe depression of T lymphocyte proliferative responses are at the risk of developing life-threatening sepsis. Activation of inflammatory mediators and the acute inflammatory response remains a local event after minor injury, whereas more severe tissue injury may provoke a systemic response. Chemokines play a major role in the course of inflammatory events. Chemokines represent a large superfamily of chemotactic cytokines that facilitate leukocyte recruitment and activation during immunological response at the site of inflammation. The majority of chemokines are members of CC or CXC family, based on relative position of their cysteine residues. CXC chemokines containing the ELR sequence, such as IL-8, GRO-α and ENA-78 attract mainly neutrophils, while CC chemokines such as RANTES, MIP-1α and MIP-1β do not act on neutrophils, but attract monocytes, eosinophils, basophils and T lymphocytes. The aim of the study was to investigate chemokine production in the umbilical cord blood of neonates with regard to mother’s anesthesia during labor. We also tried to answer the question, whether cesarean section can influence the concentrations of chemokines in the neonate. Concentrations of the chemokines were quantified in the umbilical cord blood by specific ELISA using double-antibody sandwich technique according to manufacturer’s instructions (Quantikine IL-8, GRO-α, ENA-78, RANTES, MIP-1α and MIP-1β, R&D Systems). The study group comprised 115 singleton neonates, without congenital malformations. All neonates were mature, appropriate for gestational age, the APGAR score were ≥ 8 in the first minute of life. The mothers were infection free during pregnancy and before delivery, which was performed either vaginally (n=69), or by cesarean section, urgent (n=16) or scheduled (n=30). Descriptive statistics are given by median and quartiles. Overall group comparisons were carried for each chemokine using the Mann-Whitney’s U- test and logistic regression (Wald Chi2test, OR, −95%CL, +95% CL). Concentrations of CC chemokines were similar in all examined neonates. Concentrations of CXC chemokines were higher in neonates born by normal spontaneous vaginal delivery (without any anesthesia). MIP-1α and MIP-1β were lower but not significantly both in urgent (systemic anesthesia) and scheduled (epidural anesthesia) cesarean section. RANTES concentrations were also lower in cesarean section (p=0,00001), but similar in urgent and scheduled cesarean section. Model of logistic regression of RANTES concentration in the umbilical cord blood neonates born vaginally and by cesarean section showed significant odds ratio (OR = 6,83; −95%CL= 3,34; +95% CL =13,97; p=0,00005). Vaginal delivery promotes the production of CXC chemokines, mainly RANTES, which are implicated in neonatal immunity. Mother’s anesthesia during cesarean section does not alter chemoattractant cytokines in the cord blood of neonates. Cesarean section, perhaps injury stress or others mediators (immunologic, endocrine, oxygen) may down regulate CXC chemokines.

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Pre-Emptive Rituximab for the Prevention of EBV-Related PTLD in Umbilical Cord Blood Transplantion Patients

Blood ◽

10.1182/blood.v118.21.3031.3031 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3031-3031

Author(s):

Sheila Mitsuma ◽

Jose Licona ◽

Robert Lynch ◽

Amy Sievers ◽

Corey Cutler ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Cord Blood ◽

Umbilical Cord ◽

Umbilical Cord Blood ◽

Cumulative Probability ◽

High Risk Population ◽

Viral Loads ◽

Ebv Dna ◽

Ebv Viremia

Abstract Abstract 3031 Objective: We observed a high rate of Epstein-Barr virus (EBV) associated post-transplant lymphoproliferative disease (PTLD) in our umbilical cord blood transplantation (UCBT) patients. We retrospectively analyzed all UBCTs performed at our institution in order to 1) define risk factors for the development of PTLD and 2) assess whether pre-emptive therapy with rituximab (RTX) altered the incidence and outcomes of PTLD in patients with EBV viremia. Patients and Methods: One hundred twenty-seven patients underwent UCBTs, with primarily double cord units, between March 2003 and April 2010. EBV viral loads were monitored by quantitative PCR. Viremia was defined as any detectable level of EBV DNA in peripheral blood. EBV events included all cases of isolated viremia, sustained viremia (≥ 2 positive viral loads on two separate dates), or biopsy/autopsy proven PTLD. One to four weekly doses of RTX (375mg/m2) were given pre-emptively to prevent PTLD in patients with sustained viremia. The frequency of monitoring, the decision to treat with RTX and the duration of treatment were at the clinician's discretion. Fisher's exact test and Cox modeling were used to evaluate the effect of clinical variables on the probability of developing PTLD. Results: Cohort Characteristics: Ninety-nine of 127 patients (77%) underwent reduced-intensity conditioning (RIC) transplantion. Eighty-five (86%) of those who received RIC transplants were conditioned with fludarabine, melphalan and anti-thymocyte globulin (ATG). Seventy-nine of the 99 patients (80%) who underwent RIC transplantation received ATG doses at 6mg/kg or greater. PTLD rate and risk factors: Thirty-three patients (26%) had an EBV event. 9 patients (7%) had isolated viremia. No patient with isolated viremia was treated with RTX and none developed PTLD. 11 patients developed sustained viremia but not PTLD. Thirteen patients (10%) had biopsy-proven PTLD, a one-year cumulative probability of 12% (95% CI, 0.08–0.15). All patients who developed PTLD underwent RIC transplant and received at least 6mg/kg of ATG. ATG use was found to be a statistically significant risk factor for PTLD (p = 0.02) yet ATG use was not associated with decreased survival. Age, primary disease, degree of HLA match, graft-versus-host disease (GVHD) and type of GVHD prophylaxis were not identified as PTLD risk factors. Effect of pre-emptive rituximab: 14 patients developed sustained viremia and did not have clinical evidence of PTLD at the time viremia was detected (12%). Twelve of these patients were treated pre-emptively with RTX. EBV DNA became undetectable in 9 of 12 (67%) of these patients, none of whom developed PTLD. EBV viremia resolved in 1 patient without RTX; this patient did not develop PTLD. One patient died of other causes before RTX could be given. Viremia initially cleared in one patient who later progressed to PTLD but achieved complete remission after treatment with virus-specific cytotoxic T-lymphocytes (CTL). Viremia did not resolve in 2 patients, both of whom developed PTLD. Despite treatment with virus-specific CTL both died of PTLD. The adjusted hazard ratio (HR) for the development of PTLD among patients with sustained viremia was 230 (95% CI, 29–1856); the adjusted HR of pre-emptive rituximab was 0.24 (95% CI, 0.07 – 0.9). Conclusions: ATG doses of 6mg/kg or greater were associated with PTLD in the UBCT population. Isolated EBV viremia was not a risk factor for the development of PTLD. Sustained EBV viremia conferred considerable risk. This risk of developing PTLD in patients with sustained viremia was reduced when RTX was given as pre-emptive therapy in this cohort. Further studies to better define the optimal duration of RTX therapy are needed. Prophylactic immune reconstitution with closely HLA-matched virus-specific CTL may also be an alternative option in this high-risk population. Disclosures: No relevant conflicts of interest to declare.

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