Volume 39, Issue 3

No abstract available

No abstract available

Listeria is commonly found in processed and prepared foods and listeriosis is associated with high morbidity and mortality. Preventative measures are well prescribed and monitoring and voluntary recall of contaminated products has resulted in a 44% reduction in the prevalence of perinatal listeriosis in the USA. Pregnant women are at high risk for listeriosis, but symptoms are non-specific and diagnosis is difficult. The intracellular life-cycle of Listeria protects the bacterium from host innate and adaptive immune responses. Antibiotic treatment requires agents able to penetrate, distribute, and remain stable within host cells. Prolonged use of high-dose ampicillin can significantly improve neonatal outcome.

The development of assisted reproduction techniques (ART) represents an important advance in the treatment of human infertility. However, their great effectiveness has brought with it an excessive increase in multiple pregnancy rates with the serious medical, financial and social consequences that they entail. Now, the scientific societies, the health professionals, and the infertile couples themselves are aware of these risks and have worked together to implement various strategies to deal with this situation. The result that is being obtained from the strategy of selectively reducing the number of embryos transferred is obvious. The pandemic of multiple pregnancies is being brought under control and so we have effective prevention of the obstetric and neonatal complications arising from it. It is to be hoped that it will also contribute to significantly reducing the rates of prematurity and thus of severe neonatal complications.

Aims: To examine the effect of a prior cesarean delivery on neonatal outcomes. Methods: We conducted a retrospective cohort study on all women with a prior livebirth who delivered at the Royal Victoria Hospital between 2001 and 2006. We defined our exposure as a positive history for cesarean delivery and used unconditional logistic regression analysis to estimate the adjusted effect of a previous cesarean delivery on adverse neonatal outcomes. Results: A total of 18,673 births took place of which 9708 were in women with a prior livebirth (77.0% with no previous cesarean delivery and 23.0% with a previous cesarean delivery). As compared to newborns delivered by mothers with no prior cesarean delivery, increasing number of prior cesarean deliveries was associated with an increasing risk of preterm birth [odds ratio (OR) 1.23, 95% confidence interval (CI) 1.09–1.39]; respiratory distress syndrome (OR 3.54, 95% CI 2.02–5.91); and admission to the neonatal intensive care unit (OR 1.41, 95% CI 1.25–1.60). These findings were predominantly due to differences in gestational age and mode of delivery. Conclusion: Having a prior cesarean delivery is associated with an increased risk of adverse neonatal outcomes. Adverse neonatal outcomes in subsequent pregnancies is additional evidence to suggest that unless specifically indicated, cesarean delivery should be avoided.

Aims: The purpose of this study is to predict the occurrence of transient tachypnea of the newborn (TTN) using amniotic lamellar body count (LBC) and compare the LBCs in neonates with TTN with the LBCs in neonates with respiratory distress syndrome (RDS) and controls. Methods: Three hundred and eighty-one amniotic fluid samples were obtained at cesarean section from 27 to 40 weeks of gestation. Samples were analyzed immediately without centrifugation and the number of lamellar bodies was counted. Results: The LBC in amniotic fluid ranged from 1,000 to 577,000/μL. An LBC cut-off value of 48,500/μL resulted in 84.7% sensitivity, 76.2% specificity, and 98.1% negative predictive value for predicting TTN. The LBC in neonates with TTN was significantly lower than that in controls (50,000 vs. 122,000; P<0.001) and significantly higher than that in neonates with RDS (50,000 vs. 21,000; P=0.042). Conclusions: We established a cut-off value of LBC for predicting the occurrence of TTN. The LBC in neonates with TTN was significantly lower than that in controls. Amniotic LBC can be a useful marker to predict if neonatal respiratory management is required.

Aim: To analyze the spectrum of cardiovascular diseases occurring during pregnancy and delivery at a tertiary referral center. Methods: All patients presenting at our institution with pre-existing or first diagnosis of cardiac disease were recruited. Cardiac and obstetric complications and maternal and neonatal outcomes were recorded. Results: Fifty-two pregnancies in 49 women, including three pregnancy terminations were analyzed. Cardiac lesions were congenital in 26 (53.1%) and acquired in nine (18.4%); six patients (12.2%) had cardiomyopathies, eight (16.3%) ar-rhythmic conditions. A total of 42 women (85.7%) had a pre-existing cardiac condition and seven (14.3%) presented with first manifestation. Overall 22 cardiac complications occurred: five in pregnancy, eight around parturition, nine during follow-up. They included >1 New York Heart Association functional class deterioration (n=5), congestive heart failure/cardiomyopathy (n=5), valve replacement (n=4), sustained arrhythmia (n=3), cerebral insult, aortic dissection, transplantation (one case each), and death (n=2). Mean gestational age at delivery was 36+6. The cesarean section rate was 77.5%; 31.6% were performed for cardiac indications. Obstetric complications happened in 23 pregnancies (46.9%). There was no perinatal loss; cardiac defects were diagnosed in 9.3% (n=5) of offspring. Conclusion: Cardiovascular diseases occurring during pregnancy and parturition comprise a heterogeneous spectrum of conditions. Established scores aid in the identification of high-risk patients; however, in our series 14.3% women had been healthy previously.

Aims: We investigated risk factors and neonatal outcomes of preeclampsia. Methods: We analyzed data of the German Perinatal Quality Registry 2006 that contains the complete national birth cohort of 668,085 newborn infants and 647,392 mothers from 917 German obstetric clinics. Results: The prevalence of preeclampsia in 2006 was at 2.31%. Higher maternal age, gestational diabetes, no previous as well as multiple births, pre-pregnancy obesity and above-average weight gain during pregnancy were significantly associated with preeclampsia. A positive relationship between social burden (e.g., low social status, psychosocial stress) and the risk of preeclampsia appeared. Smoking appeared to be negatively correlated. Neonatal complications associated with preeclampsia in the study were small babies, acute respiratory distress syndrome, postpartum neonatal hypoglycemia and low Apgar scores. We did not observe an increased rate of stillbirths with preeclampsia pregnancies. Conclusions: Further studies and interventions regarding prenatal care should not focus only on how better diagnostic and treatment procedures can be implemented but also on how these diagnostic and treatment procedures can reach high-risk groups.

Aims: Micro RNAs (miRNAs) are small, single-strand RNAs, playing an important role in post-transcriptional gene regulation. The placenta is considered to play a key role in pathogenesis of preeclampsia. The purpose of this study was to demonstrate deregulation of miRNAs in placentas with preeclampsia using formalin-fixed and paraffin-embedded (FFPE) tissues. Methods: Expression levels of 162 miRNAs were measured in FFPE placental tissues (5 with severe preeclampsia, 5 from a control group) using a quantitative qPCR based technique. Results: Six miRNAs were more than 2-fold over-expressed in severe preeclampsia: let-7b, miRNA-302*, miRNA-104, miRNA-128a, miRNA-182* and miRNA-133b. Gene ontology analyses were performed using the algorithms “TargetScanS”, “microRNA”, and “PicTar”. Conclusions: Two of the up-regulated miRNAs (miRNA-182* and miRNA-133b) are putative regulators of the transcript variants 1 and 2 of the BCL2-like gene, which controls apoptosis. miRNA-182* is also a probable angiogenesis regulator via angiogenin and VEGF-B. Apoptosis and angiogenesis are major mechanisms presumed to be involved in the pathogenesis of preeclampsia. Moreover, usability of qPCR technique based miRNA profiling for FFPE tissues was proofed. Hence FFPE tissue is the most widely used material for retrospective clinical studies, this method has a great property for future investigations in placenta research.

Aims: We evaluated if killer cell immunoglobulin-like receptor 3DL2 gene (KIR3DL2) polymorphisms are a key factor in the development of preeclampsia. Methods: In this case-control study, 105 pregnant women with PE (PE group) were enrolled. Their A52G in exon 3 and C32T in exon 9 polymorphisms of the KIR3DL2 genotypes were determined by polymorphism chain reaction-restriction fragment length polymorphism (PCR-RFLP) from venous blood samples and compared with the corresponding KIR3DL2 genotypes of 103 pregnant women with uncomplicated pregnancies (control group). Results: Carriers of the A allele in exon 3 of KIR3DL2 gene occurred less frequently in PE than in controls [P=0.001; odds ratio (OR)=2.65, range: 1.5–4.7]. No significant difference was found about allelic frequencies of KIR3DL2 gene C32T in exon 9 in women with preeclampsia as compared to controls. A significant difference between the two groups of genotypic frequencies of KIR3DL2 gene A52G in exon 3 and KIR3DL2 gene C32T in exon 9 polymorphisms was found (P=0.003 and P=0.000). There was no significant difference between genotypic or allelic frequencies in women with mild preeclampsia compared to sever preeclampsia. Conclusions: Our results suggest that carriers of A allele in exon 3 have a decreased susceptibility to PE. It is likely that the presence of the CC genotype in exon 9 has a considerable effect on disease progression. The mutation of the two sites is not associated with the severity of preeclampsia.

Introduction: Cervical cancer in second trimester of pregnancy is an oncologic challenge. Cisplatin is recommended to prevent cancer progression. This is a series correlating in vivo cisplatin concentration in the fetomaternal compartment and in breast milk with child development. Methods: Eight consecutive patients with cervical cancer diagnosed during the second trimester underwent conization/biopsy and/or pelvic laparoscopic lymphadenectomy (LAE). Delay of pregnancy in combination with neoadjuvant monochemotherapy was performed. After 2–4 cycles of cisplatin monochemotherapy cesarean section followed by radical hysterectomy was performed above 31 weeks of gestation. Synchronous samples from maternal blood, umbilical cord blood, and amniotic fluid were taken and analyzed. A probe of breast milk was taken from three patients. Pediatric aftercare was done every three months postpartum. Results: Laparoscopic LAE was uncomplicated in all patients. In seven out of eight patients lymph nodes were tumor free. Nine healthy babies were delivered. Pediatric follow-up showed normal development. Cisplatin concentrations in the umbilical cord and amniotic fluid were 31–65% and 13–42% of the amount in maternal blood, respectively. In breast milk, cisplatin was detectable in 1–10% of maternal blood concentration. Conclusion: Knowledge of significant lower cisplatin concentrations in fetal compartment and normal child growth provides additional security to apply cisplatin in pregnancy. Breastfeeding cannot be recommended.

Aims: The aim of this study was to investigate retinol-binding protein-4 (RBP4) levels in maternal and umbilical cord serum in patients in the third trimester of pregnancy with preeclampsia in comparison to levels in normal pregnant women. Methods: The RBP4 levels in maternal and umbilical cord serum were measured and compared by enzyme-linked immunosorbent assay in 16 normal pregnant and 16 patients with preeclampsia. Results: Both maternal and umbilical cord serum RBP4 levels were significantly decreased in patients with preeclampsia, as compared to normal pregnant women (maternal serum, median 168.0 μg/mL vs. 202.0 μg/mL, P<0.001; umbilical cord serum, median 147.9 μg/mL vs. 193.0 μg/mL, P<0.001). Preeclampsia was independently related to RBP4 levels of maternal and umbilical cord serum. Conclusion: Both maternal and umbilical cord serum RBP4 levels were lower in patients with preeclampsia than in normal pregnant women in the third trimester of pregnancy.

We defined neonates as small, appropriate, or large for gestational age (SGA, AGA, LGA) based on birth weight, length, and head circumference. We analyzed the effects on the somatic classification of maternal body mass index (BMI) (<18.5, 18.5–24.99, 25.0–29.99, ≥30) and smoking during pregnancy (0, 1–7, 8–14, ≥15 cigarettes daily). Data were from the German Perinatal Survey (1998–2000; 433,669 cases). The following refers to the classification by birth weight. In the normal maternal weight population SGA rates increased with cigarette consumption: 9.8%, 17.8%, 21.6%, and 25.4% for non-smokers, and smokers of 1–7, 8–14, and ≥15 cigarettes daily, respectively. In non-smoking underweight women the SGA rate was 17.4%. In underweight smokers of ≥15 cigarettes daily the SGA rate was 38.5% [odds ratio 5.77, 95% confidence interval 5.10–6.53, compared with normal weight non-smokers]. In the normal maternal weight population, LGA rates were 9.9%, 5.3%, 4.6%, and 3.5% for non-smokers, and smokers of 1–7, 8–14, and ≥15 cigarettes daily, respectively. In the obese, LGA rates were 20.9% (non-smokers) and 11.4% (≥15 cigarettes). Similar findings were obtained for the somatic classifications based on birth length and head circumference. Results for the various combinations of maternal BMI and smoking status in the three classification systems are described. Our findings may assist in individualized risk assessment for SGA and LGA births.

Objective: This prospective observational study evaluated maternal symptoms and characteristics that predict successful labor induction with oral misoprostol. Methods: A total of 244 consecutive women undergoing labor induction voluntarily completed a questionnaire about subjective sensations and pain scores during the induction protocol. Maternal and neonatal characteristics were collected retrospectively from patient files. On the first day of induction, oral misoprostol (50 μg) every 4 h up to three doses was used. Results: A total of 46% of the parturients delivered or reached the active phase of labor 24 h after the initial dose of misoprostol (ID). In the whole study, 87% of the women delivered vaginally. In multivariable analysis, rupture of membranes, cervical dilatation before the initial dose, maternal sensation of painful contractions at 8 h after the initial dose, and gestational age, were found to be associated with successful labor induction. Conclusions: Maternal sensation of painful contractions 8 h after an ID is an independent predictive factor of successful labor induction (defined as delivery or active phase of labor 24 h after beginning of induction). Other independent predictive factors are rupture of membranes, cervical dilatation before the initial dose, and gestational age.

Objective: To evaluate the correlation between sonographic measurements of nuchal translucency (NT) and neonatal birth weight in non-diabetic population. Methods: A retrospective analysis was performed on all singleton term pregnancies delivered at our hospital between 2004 and 2008. Data collected included maternal age, parity, NT measurement, results of glucose challenge test, birth weight, gestational age at delivery, and fetal gender. Results: The study population comprised of 1649 patients. The mean NT was 1.3±0.5 mm. Male fetuses had a significantly thicker NT (1.3±0.5 vs. 1.2±0.4; P<0.001). NT significantly correlated to birth weight (P=0.002). This correlation was independent of neonatal gender. The median NT in the large for gestational age (LGA) neonates was significantly higher than in the non-LGA neonates (1.4 mm vs. 1.2 mm, P=0.001). Equations for the predicted probability for delivering LGA neonates were derived using either NT alone or in combination with parity. An increase in 0.1 mm in the NT has the odd ratio of 1.042 for delivering an LGA neonate (P=0.02). Conclusions: NT correlated with LGA neonates in term non-diabetic patients. This correlation was independent of the neonatal gender. The predictive clinical impact of NT was limited to LGA neonates.

Aim: To evaluate the ability of the Score for Neonatal Acute Physiology-Version II (SNAP-II) to predict mortality in infants with persistent pulmonary hypertension of the newborn (PPHN). Methods: A prospective cohort study of 41 infants with PPHN admitted to our neonatal intensive care unit between June 2008 and March 2010, who underwent a SNAP-II test within 12 h of admission. Results: Of the 41 infants, 14 died (34.1%) and 27 survived (65.9%). The SNAP-II scores were significantly higher in infants who died (50.1±18.5 vs. 35.7±16.8, P=0.02). Each point increase in the SNAP score increased the odds of mortality by 1.04 [95% confidence interval (CI) 1.01–1.07, P<0.01]. Infants who had a SNAP-II score of ≥43 had the greatest mortality risk with an odds ratio (OR) of 10.00 (95% CI 1.03–97.50). The SNAP-II model showed moderate discrimination in predicting mortality with a result of 0.72 (95% CI 0.56–0.88) under the receiver operating characteristic curve. The lowest blood pressure, lowest PaO 2 /FIO 2 ratio, and urine output within the first 12 h of admission were also independently found to be good predictors of an increased risk for death. Conclusion: The SNAP-II scoring system significantly predicted mortality. PPHN infants with a SNAP-II score of ≥43 had the greatest mortality risk.

Objective : To estimate the influence of fetal growth restriction (FGR) on neonatal morbidity and mortality among premature discordant twin neonates. Study design: Our medical records (2002–2007) of preterm twins born at 24–37 weeks’ gestation were reviewed. Significant discordance was defined as >15% difference in birth weight. Small for gestational age (SGA) was defined as birth weight <10 th percentile, and appropriate for gestational age (AGA) was between the 10 th and 90 th percentile, according to a twin and sex-adjusted gestational age nomogram. The SGA/AGA group comprised of one SGA twin and its AGA pair (30 pairs). Another group of non-SGA discordant twins was also evaluated (n=40 pairs, AGA/AGA). The morbidity and mortality rates were compared between the groups. Results : Of the selected outcome variables, the only ones in which the incidence was significantly lower for SGA neonates than their AGA pairs were respiratory distress syndrome (5 vs. 11, P=0.014), apnea (1 vs. 9, P=0.004) and the need for respiratory support (5 vs. 14, P=0.002). Anemia, erythropoietin therapy and hyperbilirubinemia were significantly higher in the SGA twin. All selected outcome variables had similar rates within the AGA/AGA pairs. Conclusion : FGR among premature discordant twin pairs is associated with significantly lower rates of respiratory morbidity and higher anemia and erythropoietin therapy rates. Overall morbidity is similar for discordant non-FGR twin pairs.

Aim: To investigate the effects of delayed cord clamping (DCC) on peripheral hematopoietic progenitor cells (HPCs) and hematological parameters in premature infants (<32 weeks) during the neonatal period. Methods: This was a prospective, randomized, and controlled, single-center study. Prior to delivery, 21 infants were randomly assigned to immediate cord clamping (ICC) at 5–10 s and 21 infants to DCC at 30–45 s. One milliliter blood sample was taken in the first 30 min of life. HPCs were measured by three-color flow cytometry using monoclonal antibodies. Results: There were no significant differences between groups in either maternal or neonatal demographics. All HPC counts were higher in the ICC group, but the difference was not significant. CD34+ cell counts were 45.3±36.6/μL in the ICC and 33.2±26.6/μL in the DCC group (P=0.33); multi-potent progenitor cell counts were 43.2±35/μL in the ICC and 31.1±26.6/μL in the DCC group (P=0.28); and hematopoietic stem cell counts were 2.1±2.1/μL in the ICC and 2.1±3.1/μL in the DCC group (P=0.66). Conclusion: Contrary to our expectation, all HPC counts were lower in the DCC group.

Aims: We determined the association between short-term neonatal morbidities, such as bronchopulmonary dysplasia (BPD) and intraventricular hemorrhage (IVH), and Ureaplasma spp. in amniotic fluid, placental and amniotic mem-brane of preterm infants. Methods: This study enrolled 257 patients who were born by cesarean section at <34 weeks’ gestation. Patients were divided into two groups according to detection of Ureaplasma spp. by culture-based and/or polymerase chain reaction (PCR) techniques. Results: Significant differences were observed between both groups for all IVH (P=0.032) and IVH grades III or IV (P=0.013), as wells as for BPD [odds ratio (OR) 5.46, 95% confidence interval (CI) 2.02–14.77], oxygen requirement at 28 days postnatal age (OR 1.93, 95% CI 1.00–3.70), and for death between 28 days and 36 postmenstrual weeks or BPD (OR 4.20, 95% CI 1.77–9.96). Ureaplasma spp. was a significant predictor (P<0.001) of BPD after correcting for birth weight (P=0.003) and positive pressure ventilation (P=0.001). Conclusions: In our study population Ureaplasma spp. was associated with BPD and IVH in preterm infants even after adjustment for multiple risk factors.

Aim: To assess the impact of prenatal antibiotic treatment on procalcitonin (PCT) and C-reactive protein (CRP) concentrations in cord blood, and on the rate of positive neonatal blood cultures. Methods: Neonates with early-onset infection (Group A; n=46) were compared with healthy controls (Group B; n=240). We evaluated the relationship between prenatal antibiotic therapy and early-onset infection, and for interactions with antibiotic therapy in the neonate immediately after birth. Results: In the Group A antibiotics were administered significantly more often prenatally and more often to neonates just after birth. The percentage of negative blood cultures in infected neonates was higher when antibiotic treatment was instituted prenatally. Differences in cord blood PCT and CRP concentrations were significant between both groups and were independent of prenatal antibiotic treatment. Streptococcus agalactiae was the most frequent species. Conclusions: Almost one-third of neonates present with early-onset infection in spite of prenatal antibiotic therapy. Cord blood PCT and CRP measurements may be helpful in the diagnosis of infection also in cases when antibiotic therapy was started prenatally. Prenatal antibiotic administration reduced the number of positive blood cultures in neonates with early-onset infection and was associated with a greater rate of antibiotic treatment after birth in neonates without infection.

Aim: The aim of this study was to evaluate the ability of the admission Score for Neonatal Acute Physiology – Perinatal Extension-II (SNAPPE-II) to predict adverse outcome among premature very low birth weight (BW) infants with abnormal Doppler blood flow in the uterus secondary to severe placental insufficiency of early onset. Methods: A total of 86 neonates, weighing between 360 and 1498 g, were studied. Descriptive statistics of the population were reported. The areas under the receiver operating characteristics curves for the SNAPPE-II were calculated. The calibration of the model was assessed using the technique of Hosmer-Lemeshow. Adverse outcome was defined as mortality or the development of the following diagnoses: (1) periventricular-intraventricular hemorrhage (PIH); (2) retinopathy of prematurity stage 3 or 4; (3) periventricular leukomalacia; (4) bronchopulmonary dysplasia; (5) necrotizing enterocolitis (NEC). Results: The SNAPPE-II area under curve was 0.86 (95% CI: 0.78–0.94) for mortality and 0.76 (95% CI: 0.65–0.86) for the prediction of adverse outcomes. Analyzing each morbidity variable, the SNAPPE-II AUC varied between 0.51 for NEC and 0.72 for PIH. Conclusion: SNAPPE-II shows accuracy in the predic-tion of adverse outcome for this highly selective group of very low BW infants compromised by severe placental insufficiency.

Objective: We aimed to find a single numeric cut-off point in order to predict respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN), through quantification of the lamellar bodies (LBs) count. Materials and methods: Two hundred and twenty-seven single pregnancies delivered within 48 h from amniocentesis in a III level university hospital in a period between 1996 and 2007. LBs counts were determined by amniotic fluid (AF) sampling and after centrifugation in a commercially available Coulter counter. LBs counts were performed in order to predict the risk of neonatal RDS and also evaluated against the risk of TTN by means of the most suitable receiver operator characteristic (ROC) curve in order to predict RDS and TTN. Results: The best LBs cut-off to significantly predict TTN was ≤35,000/μL [sensitivity 86%, specificity 75%, positive predictive value (PPV) 22% and negative predictive value (NPV) at 96%]. An LBs count ≤32,000/μL was the best compromise between sensitivity and specificity in predicting RDS or TTN [sensitivity 86%, specificity 83%, PPV 37% and NPV at 97%]. Conclusions: The quantification of LBs is a reliable method, simple to execute, useful in predicting RDS, and may be useful in evaluating suspicion of TTN.

Vaginal delivery of the macrosomic fetus may result in hemorrhage of intra-abdominal organs. Mostly affected organs are the liver and adrenal glands. Hemorrhage of liver is usually occurs as a subcapsular hemorrhage and it is clinically presented an abdominal mass without symptoms of anemia. But intraparenchymal hemorrhage of liver is very rare and there is no sign of abdominal mass. However, in contrast to subcapsular hemorrhage, symptoms of anemia are rapidly developed in newborns. A macrosomic newborn by vaginal delivery at term. Within 6 h after delivery, the patient showed pallor without tachycardia and hypotension. In laboratory studies, hemoglobin level falled from 14 g/dL to 10 g/dL within 6 h. Physical examination revealed no signs of abdominal mass. Intraparenchymal hemorrhage in the sixth segment of liver and right adrenal hemorrhage were detected on the ultrasonographic scan. Hepatic function tests were normal in the whole follow-up period, and hemorrhage resolved within two weeks. Following months after discharge, adrenal hemorrhage also resolved without any complication. Hepatic hemorrhages, causing hemorrhagic anemia in neonates, usually occur in subcapsular form. Intraparenchymal hepatic hemorrhage should especially be considered in those newborns, which are rapidly developed symptoms of anemia without any abdominal mass.

We assessed the anthropometric characteristics of symmetric (SGA-S) and asymmetric (SGA-A) term newborns and describe their subcutaneous fat differences. We assessed perinatal data, maternal characteristics and anthropometric variables (including skinfold thicknesses) in 139 small for gestational age (SGA) term infants, classified as symmetric and asymmetric according to their ponderal index (using the 10 th percentile as the cut-off criterion). Despite an overall small body size and lower amounts of subcutaneous fat than the reference population, SGA-S term newborns showed a proportionate body fat distribution and SGA-A were thinner and had a lower percentage of central subcutaneous fat than SGA-S. These findings, resulting from intrauterine growth restriction, could be associated with different early and later postnatal outcomes among SGA groups.

No abstract available