P3-0124 — Annual report 2014
1.
Perinatal outcomes in singleton and twin pregnancies following first-trimester bleeding

Objective: To investigate associations between first-trimester bleeding and perinatal outcomes. Study design: Registry-based survey of the period 2002 through 2010. Pregnancies with versus without first-trimester bleeding were compared using Student%s t- and %2-test. Multivariable logistic regression was used to control for potential confounders. Result: 9924 singleton and 275 twin pregnancies with first-trimester bleeding, and 160%099 singleton and 2710 twin pregnancies without bleeding were included. Bleeding increased the risk of preterm birth in singletons (odds ratio 1.48; 95% confidence interval 1.38%1.60). Risks were also increased for preterm premature rupture of membranes, abruption, previa, stillbirth and congenital anomalies, with a reduced risk of preeclampsia. The differences remained significant after adjustment for confounders. In twin pregnancies, bleeding was not significantly associated with prematurity (odds ratio 1.04; 95% confidence interval 0.81%1.34), nor with other outcomes. Conclusion: In singletons, but not in twins, the risk of perinatal complications is significantly increased after first-trimester bleeding.

COBISS.SI-ID: 1462956
2.
Lipopolysaccharide-binding protein as marker of fetal inflammatory response syndrome after preterm premature rupture of membranes

Background: Intra-amniotic inflammation with preterm premature rupture of membranes (PPROM) is a risk factor for fetal inflammatory response syndrome (FIRS) and adverse neonatal outcome. Objectives: To evaluate the diagnostic accuracy of lipopolysaccharide-binding protein (LBP) for detecting FIRS in preterm neonates born after PPROM. Methods: This was a prospective study in the level III neonatal intensive care unit (42 neonates; 23 + 6 to 31 + 6 weeks' gestation) of mothers with PPROM. Umbilical cord blood concentrations of LBP, C-reactive protein (CRP), interleukin (IL)-6 and white blood cell count with differential were measured at delivery and 24 h after birth. Neonates were classified into FIRS (n = 22) and no FIRS (n = 20) groups according to clinical criteria and IL-6 level (17.5 pg/ml). Histological examination of the placenta and umbilical cord was performed. Neurological examination at 12 months' corrected age was performed. Results: Umbilical cord blood concentration of LBP was significantly higher in the FIRS group than in the no FIRS group at delivery (median 21.6 mg/l vs. median 2.3 mg/l; p ( 0.0001) and 24 h after birth (median 17.2 mg/l vs. median 20.0 mg/l; p ( 0.001). The area under the ROC curve for FIRS at delivery was 0.98 (95% CI 0.88-1.0) for LBP, 0.92 (95% CI 0.80-0.99) for CRP and 0.82 (95% CI 0.64-0.94) for immature to total neutrophil ratio. Similar results were obtained if FIRS was defined by funisitis. Umbilical cord blood concentration of LBP at delivery was significantly higher in neonates with abnormal neurological exam at 12 months than in those with normal exam (median 19.5 mg/l vs. median 3.75 mg/l; p ( 0.015). Conclusions: In preterm neonates born to asymptomatic women with PPROM, LBP in cord blood at delivery is an excellent diagnostic biomarker of FIRS/funisitis with prognostic potential.

COBISS.SI-ID: 1201324
3.
Early prediction of spontaneous twin very preterm birth

Abstract Objective: The aim of this study was to establish early pregnancy risk indicators for spontaneous twin very preterm birth. Methods: We conducted a retrospective observational population-based study. Twenty-one potential early pregnancy risk factors were analyzed using multivariable logistic regression to determine which of them was independently associated with spontaneous twin very preterm birth. Results: Of 1815 spontaneous twin births 15.3% (277) occurred before 32 weeks. Previous preterm delivery (aOR 3.73; 95% CI, 2.52-5.52), nulliparity (aOR 2.94; 95% CI, 2.09-4.14), body mass index (18.5 (aOR 1.86; 95% CI, 1.12-3.10), body mass index %30 (aOR 1.87; 95% CI, 1.21-2.89), hysteroscopic metroplasty (aOR 1.63; 1.07-2.49), conization (aOR 2.05; 95% CI, 1.07-3.94) and monochorionicity (aOR 1.83; 95% CI, 1.28-2.63) were significantly associated with twin very preterm birth. Conclusions: Pending verification in other populations, twin pregnancies at significant risk for spontaneous very preterm birth can be identified in early pregnancy using several risk indicators.

COBISS.SI-ID: 1736364
4.
Risk factors and scoring system as a prognostic tool for epilepsy after neonatal seizures

BACKGROUND: Neonatal seizures may cause irreversible changes to the immature brain and. A scoring system for early prognostic information could be a useful clinical tool. The aim of the study was to analyze risk factors for epilepsy after neonatal seizures, to validate Garfinkleʼs scoring system, and to analyze whether a new scoring system is feasible. METHODS: A retrospective study of 176 newborns (59.1% boys, 40.9% girls, 70.5% term, 29.5% preterm; mean birth weight 2820 g), admitted to the Department of Neonatology, Division of Pediatrics, University Medical Centre, Ljubljana, because of neonatal seizures (clinical and/or neurophysiological), was performed. Epilepsy rate between 2 and 12 years of follow-up was 18.1%. Five independent predictors from Garfinkleʼs study and other known predictors were entered into hierarchical binary logistic regression models and analyzed through four steps to identify independent predictors of epilepsy. We tested whether any of the predictors was an effect modifier. RESULTS: Of five potential predictors from Garfinkleʼs score, electroencephalograph background findings and etiology were predictive. Etiologies, gestation, mode of delivery, duration of seizures, and other risk factors at birth were found to be independent predictors. Duration of seizures has a different effect on prognosis depending on the gestational age. CONCLUSION: Gestational age determines the association between duration of seizures and epilepsy. Scoring systems to predict development of epilepsy after neonatal seizures need to limit interaction between important predictor variables.

COBISS.SI-ID: 32428125
5.
Levels ofmetals in the blood and specific porphyrins in the urine in children with autism spectrum disorders

The aim of the present study was to determine the levels of metals in blood (zinc (Zn), copper (Cu), aluminium (Al), lead (Pb) and mercury (Hg)), as well as the specific porphyrin levels in the urine of patients with autism spectrum disorder (ASD) compared with patients with other neurological disorders. The study was performed in a group of children with ASD (N=52, average age=6.2 years) and a control group of children with other neurological disorders (N=22, average age=6.6 years), matched in terms of intellectual abilities (Mann-Whitney U=565.0, p=0.595). Measurement of metals in blood was performed by atomic absorption spectrometry, while the HPLC method via a fluorescence detector was used to test urinary porphyrin levels. Results were compared across groups using a multivariate analysis of covariance (MANCOVA). In addition, a generalized linear model was used to establish the impact of group membership on the blood Cu/Zn ratio. In terms of blood levels of metals, no significant difference between the groups was found. However, compared to the control group, ASD group had significantly elevated blood Cu/Zn ratio (Wald X2=6.6, df=1, p=0.010). Additionally, no significant difference between the groups was found in terms of uroporphyrin I, heptacarboxyporphyrin I, hexacarboxyporphyrin and pentacarboxyporphyrin I. However, the levels of coproporphyrin I and coproporphyrin III were lower in the ASD group compared to the controls. Due to observed higher Cu/Zn ratio, it is suggested to test blood levels of Zn and Cu in all autistic children and give them a Zn supplement if needed.

COBISS.SI-ID: 3740017