Background: The purpose of this study was to compare electronic fetal heart rate monitoring (EFM) characteristics between APPROPRIATE FOR GESTATIONAL AGE (AGA ) and Small FOR GESTATIONAL AGE (SGA) fetuses and to determine whether SGA fetuses have specific abnormalities.Materials and Methods: Among children born from Apr 2002 to Mar 2003 in Arash hospital, we identified 300 singleton infants born after 36 weeks gestation of uncomplicated pregnancies in whom second-trimester (24-27 weeks gestation) EFM records were obtained. Individual components of fetal heart rate (FHR) pattern; baseline rate, baseline FHR variability, presence of acceleration and periodic and episodic deceleration, and birth characteristics were compared between AGA and SGA infants or between pregnancies with or without second-trimester decelerations. Statistical analysis was perFORmed using Student t, Chi square and Fisher exact test.Results: Among 300 infants, 261 (87%) were AGA and 39 (13%) were SGA; 65 had and 235 did not have second-trimester decelerations. Baseline FHR variability, second- trimester decelerations and intrapartum FHR decelerations were significantly higher in SGA fetuses than in AGA fetuses (P<0.05). Birth weight and GESTATIONAL AGE were significantly lower in SGA fetuses than in AGA fetuses (P<0.05). There were no significant differences in baseline rate and acceleration ,maternal AGE and parity, Apgar score in 1 minute, meconium staining, mode of delivery, NICD admission, between SGA and AGA infants. Small FOR GESTATIONAL AGE infants were more frequent in pregnancies with second-trimester decelerations compared with those without second-trimester deceleration (P<0.05). Baseline FHR variability in pregnancies with second-trimester decelerations was significantly higher than in pregnancies without second-trimester deceleration (P<0.05).Conclusion: Periodic or episodic decelerations and increased FHR variability during late second-trimester EFM were associated with an increased risk of SGA infant.

Objective: Placental hormones such as resistin, adiponectin, ghrelin and leptin are known to have considerable role in fetal growth and there are some articles published in this area recently. Nevertheless there is a shortAGE of data showing association between resistin level and fetal growth, that was why we decided to conduct a study to evaluate this association.Methods: This study was approved by ethic committee of pediatric health research center and research vice chancellor of Tabriz University of Medical Sciences. In this case-control study we measured the insulin, glucose and resistin in the cord blood of neonates with GESTATIONAL AGE of 37 weeks or more in Al Zahra tertiary hospital from March 2011 to March 2012. Thirty-nine APPROPRIATE FOR gestation AGE (AGA) neonates and 41 small FOR gestation AGE (SGA) neonates were studied.Findings: The umbilical cord blood resistin level was not found to have significant correlation with the type of delivery [normal vaginal delivery (NVD) or cesarean-section (C-S)], neonate's gender, maternal AGE or body mass index (BMI). There was no significant difference in the levels of Insulin and glucose between AGA and SGA groups. Resistin level of blood cord in AGA group was 613.76±180.10 (range: 132.6-983.80 ng/ml) and in SGA group it was 1303.47±537.07 (range: 800.9-3001 ng/ml) (P<0.001). Neonates’ weight in AGA group was 3162.82±407.92 g and in SGA group it was 2425.85±32.84 g (P<0.001).Conclusion: In this study resistin level had reverse correlation with fetal weight in term neonates. The SGA neonates with growth insufficiency have higher resistin levels in their cord blood than AGA neonates with same GESTATIONAL AGE. It is recommended to conduct more studies in future with larger population of patients to clarify the resistin role in neonatal birth weight.

Background: Vitamin D deficiency during pregnancy is associated with some adverse pregnancy outcomes but its relationship with fetal growth is unknown.Objective: We compared the 25-hydroxy vitamin D levels between mothers and their small FOR GESTATIONAL AGE (SGA) newborns with mothers and their APPROPRIATE FOR GESTATIONAL AGE (AGA) newborns.Materials and Methods: The study population included pregnant women that referred to Afzalipour Hospital in Kerman from 2012 to 2013. The case and control group consisted of 40 pregnant mothers with SGA and AGA newborns, respectively. The maternal and infants 25-hydroxy vitamin D levels were measured in the two groups.Results: 25-hydroxy vitamin D deficiency (<20 ng/ml) was statistically higher in women with SGA newborns in comparison to women with AGA newborns (p=0.003).Vitamin D deficiency was higher among the SGA newborns in comparison to AGA newborns (25% vs. 17.5%), although this finding was not statistically meaningful (p=0.379). The relationship of vitamin D deficiency levels between mothers and infants in both the SGA group and the AGA group was significant.Conclusion: Our study reveals a high prevalence of vitamin D deficiency in women with SGA infants in comparison to women with AGA children. In addition, maternal vitamin D deficiency is associated with its deficiency in newborns.

Objective: Intensified manAGEment of GESTATIONAL diabetes mellitus can normalize birth weight. However, it is still unknown whether intrauterine exposure to maternal diabetes is a risk factor FOR changing hormone levels involved in the development of insulin resistance in these infants. We compared insulin and leptin levels in APPROPRIATE FOR GESTATIONAL AGE (AGA) infants of diabetic and non diabetic mothers.Methods: We perFORmed a cross-sectional study in the department of Neonatology of the Hospital of Gynecology-Pediatrics, in Leon, Mexico. We evaluated 182 full term AGA newborns (86 infants of diabetic and 96 of non-diabetic mothers). A venous blood sample was taken from cord blood immediately after the separation of the placenta and glucose, insulin and leptin levels were measured. In all diabetic mothers HbA1c was also evaluated immediately post-partum.Findings: Leptin, insulin and insulin resistance index were significantly higher in infants of diabetic mothers.Leptin levels were positive correlated with insulin, parents` body mass index and AGE in the entire group. In infants of diabetic mothers only insulin levels showed a significantly correlation, whereas in those of nondiabetic mothers only mothers` AGE was significantly correlated with leptin levels.Conclusion: AGA infants of diabetic mothers showed higher leptin, insulin levels and insulin resistance index than those of non-diabetic mothers.

Background Fetal growth restriction is one of the main causes of perinatal mortality that can be predicted by ferritin. We aimed to evaluate the role of ferritin in prediction of mothers with APPROPRIATE-FOR-GESTATIONAL-AGE (AGA), Small-FOR-GESTATIONAL AGE (SGA) and intrauterine growth restriction (IUGR). Materials and Methods: In this cohort study, we screened 73 mothers with GESTATIONAL AGEs of 32-34 weeks. If amniotic fluid index (AFI) was normal and there was no circulation defect, the fetuses were classified in SGA group and in case of presence of oligohydramnios or circulation defect; they were classified in IUGR group. Also, fetuses with normal growth were classified in AGA group. We evaluated the serum ferritin, hemoglobin, and iron of the mothers. Moreover, we evaluated the levels of placenta ferritin, Hb, and hematocrit in the delivery room. Results: In this study, 28 patients were categorized in AGA group, 15 patients in SGA group and 30 patients in IUGR group. Mean weight of all infants was 2210. 60 ± 932. 77 grams. Also, the mean AFI of all infants was 9. 81 ± 3. 59. The mean ferritin level of all mothers was 30. 29 ± 10. 80 and IUGR group had the highest and AGA group had the lowest ferritin levels (P=0. 015). Maternal ferritin (μ g/l) (Sen: 67. 9%, Sp: 61. 9%), maternal hematocrit (%) (Sen: 70%; Sp: 62. 8%, ) and maternal Hb (Sen: 70%, Sp: 65. 1%, ) could predict IUGR. Conclusion Increased (>34 μ g/l) and decreased (<26 μ g/l) levels of maternal serum ferritin level may be correlated with IUGR and SGA fetuses, respectively. Thus, measurement of maternal serum ferritin level in addition to sonography can be a useful marker in differentiating SGA and IUGR fetuses.

We aim to compare Insulin like Growth Factor (IGF-1), leptin, and cortisol concentrations in maternal and umbilical cord vein and to investigate the relationship between these values and fetal growth in APPROPRIATE FOR GESTATIONAL AGE (AGA) and small FOR GESTATIONAL AGE (SGA) neonates.Materials and Methods: In a case-control study, maternal and umbilical cord venous samples were collected from 25 SGA neonates and 25 AGA neonates in the obstetric ward at Hafez Hospital, Shiraz, Iran, between 2004 and 2005. Serum levels of IGF-1, leptin, and cortisol were measured by specific radioimmunoassay using commercial kits.Results: Mean maternal AGE was 25.38±5.22 years (range 17-38 yr) and mean GESTATIONAL AGE was 37.92±1.79 weeks (range 34-41 weeks). Mean concentration of leptin and IGF-1 in cord blood was lower in SGA as compared with AGA neonates (p<0.0.12 and p<0.001, respectively). Maternal serum concentration of IGF-1 and cortisol were lower in SGA neonates (p<0.032 and p<0.011, respectively), however there was no significant difference in the concentration of maternal leptin levels between the two groups. A correlation was observed between the head circumference of neonate and maternal cortisol levels in the SGA group (p<0.01).Conclusion: Low IGF-1 and leptin concentrations in cord blood and low maternal serum concentration of IGF-1 and cortisol are associated with growth retardation in SGA as compared to AGA neonates. Also maternal cortical level plays an important role in intrauterine brain development of SGA neonates.

Gender has been unmasked as a key determinant of body adiposity and endocrine homeostasis in the human fetus. Increasing evidence suggests that girls are more insulin resistant than boys at all AGEs from birth to adolescence. Furthermore, type 2 diabetes in children is commoner in girls than in boys. These gender based differences seen early in life could reflect differences in intrinsic insulin resistance or postnatal behavior.

Objective: Delayed passAGE of stool is a result of both GESTATIONAL immaturity and illness severity. Small FOR GESTATIONAL AGE (SGA) preterm infants are at high risk of gastrointestinal (GI) complications. We aimed to analyse the effects of a strict nutrition and stool protocol on GI problems in SGA compared to APPROPRIATE FOR GESTATIONAL AGE (AGA) preterm infants.Methods: Retrospective cohort analysis including all preterm infants with delayed meconium passAGE hospitalized at the Neonatal Intensive Care Unit of the Medical University of Graz, Austria. Infants were identified by a local data system and by the use of a strict feeding and stool protocol between 2001 and 2009. Main outcome parameters included neonatal morbidity, surgical intervention and mortality.Findings: Twenty-six SGA (median GA 28.6 weeks, birth weight 825 grams, 46% males) were compared to 101 AGA (median GA 28.4 weeks, birth weight 1168 grams, 55% males) preterm infants. Clinical signs of delayed meconium passAGE did not differ significantly between groups. Differences regarding percentAGE of necrotizing enterocolitis, ileus, spontaneous intestinal perFORation, and surgical intervention did not differ between groups. Mortality rate was significantly higher in SGA (11.5%) compared to AGA (2.9%) infants (P=0.03).Conclusion: Despite similar morbidity SGA infants exhibited higher lethal complication rates following delayed meconium passAGE compared to AGA infants.

Background: The diagnosis of acute bacterial meningitis rests on CSF examination by lumbar puncture. BeFORe lumbar puncture, intracranial mass lesions that increase intracranial pressure, must be ruled out, so brain CT-scan may be considered. In this study we evaluated the accuracy of physical examination FOR intracranial mass in patients with meningismus. Materials and Methods: 100 patients who had symptoms and signs of acute meningitis were evaluated and then brain scan was perFORmed. After this, clinical manifestations were compared with CT results and sensitivity, specificity, positive and negative predictive values and accuracy were analyzed.Results: 73% of patients were men and 27% women. Most of patients were between 22 to 31 years old. 34% of patients had meningitis, 22% had SOL, 69% had one neurological symptom or sign at least. As a whole, sensitivity, specificity, pos. and neg. predictive values and accuracy in diagnosis of contradictions of L.P. are 90.9%,37.1%,28.9%,93.5%,59% . Conclusion: This study shows that with help of symptoms and signs fundoscopy in patients suspected to have meningitis, we can perFORm LP without brain CT preliminary.