Introdução: Anemia é uma patologia sistêmica e um problema de saúde pública em todo o mundo, inclusive entre prematuros que são considerados grupo de risco. Objetivo: Determinar a prevalência de anemia ferropriva e deficiência de ferro com um ano de idade corrigida em pré-termos de muito baixo peso e verificar os possíveis fatores de risco associados. Metodologia: estudo transversal aninhado a uma coorte de pré-termos em uso profilático de ferro, nascidos com peso inferior a 1500 gramas e idade gestacional menor de 34 semanas, já existente, composta de crianças em acompanhamento regular no ambulatório de seguimento de prematuros de hospital terciário aos doze meses de idade corrigida. O diagnóstico de anemia foi feito pela presença de hemoglobina menor que 11g/dL, e a deficiência de ferro foi determinada por níveis de ferritina inferiores a 10mcg/L, saturação de transferrina menor que 10% e o VCM (volume corpuscular médio) menor que 80fL. Métodos estatísticos: ANOVA One-Way, Qui-quadrado, t de Student, Mann-Whitney, exato de Fisher e Regressão de Poisson. Resultados: Foram incluídas 310 crianças, com prevalência de 26,5% de anemia (n=82), já a prevalência de deficiência de ferro foi de 48%. O maior consumo de leite de vaca aos seis meses de idade corrigida, a menor idade da mãe, o maior número de gestações e ter nascido pequeno para a idade gestacional foram independentemente associadas à anemia após ajustes. Conclusões: A prevalência de anemia é alarmante, e os fatores que mais influenciaram este alto índice foram: menor idade materna, maior número de gestações, menor peso de nascimento para a idade gestacional e maior consumo de leite de vaca aos seis meses de idade corrigida. Estratégias educacionais, alimentares e ambientais poderão impactar em menor prevalência de anemia no seguimento após a alta. / Introduction: Anemia is a systemic condition and a public health issue worldwide, premature infants that are considered a high-group risk. Objective: To ascertain the prevalence of iron deficiency and iron-deficiency anemia at 1 year corrected age in very low birth weight preterm infants and potential risk factors therefor. Methods: An existing cohort of very low birth weight preterm infants (weight <1500 g and gestational age <34 weeks at birth) receiving prophylactic iron supplementation and regular follow-up at the outpatient prematurity clinic of a tertiary referral hospital was assessed at 12 months corrected age. Anemia was diagnosed by a hemoglobin level <11 g/dL, and iron deficiency, by ferritin levels <10 mcg/L, transferrin saturation <10%, and MCV (mean corpuscular volume) <80 fL. Statistical methods included one-way ANOVA, Poisson regression, and chi-square, Student’s t, Mann-Whitney U, and Fisher’s exact tests. This study was approved by the local Research Ethics Committee. Results: The sample comprised 310 infants. The overall prevalence of anemia was 26.5% (n=82), and that of iron deficiency, 48%. Four factors were independently associated with anemia after adjustment: greater cow’s milk intake at 6 months corrected age, younger maternal age, greater number of pregnancies and small for gestational age status. Conclusions: The prevalence of anemia in this sample was concerning. The most influential determinants of anemia were: younger maternal age, greater number of pregnancies, small for gestational age status and cow’s milk intake at 6 months corrected age. Educational strategies geared to proper feeding and environmental factors may help decrease the prevalence of anemia after discharge in very low birth weight preterm infants.

Objetivo: determinar a associação de crises epilépticas neonatais por diagnóstico clínico em pré-termos de muito baixo peso ao nascer com o desfecho neurológico no segundo ano de vida. Métodos: estudo de coorte, com análise retrospectiva de dados coletados prospectivamente. Incluídos recém nascidos pré-termos de muito baixo peso ao nascer (menor que 1500g) que tenham sobrevivido ao período neonatal e acompanhados no ambulatório de follow up da instituição. As crises epilépticas neonatais foram determinadas por critério clínico. O desfecho foi avaliado através da escala de Bayley II, medidas de perímetro cefálico, presença de deficiências sensoriais e óbito. O grupo com crises foi comparado ao grupo sem crises de acordo com o desfecho neurológico. Testes empregados na análise estatística: Qui-quadrado ou exato de Fisher (variáveis qualitativas), teste t de Student (variáveis quantitativas), risco relativo como medida de associação, Regressão de Poisson. Resultados: Trezentos e dois pacientes foram incluídos no estudo, com idade gestacional média de 30,4 ± 2,28 semanas e peso de nascimento médio 1182 ± 228,6 gramas. Sessenta pacientes (20%) tiveram crise epiléptica neonatal por diagnóstico clínico. O grupo com crises tinha médias de idade gestacional e peso significativamente menores, além de uma maior incidência de morbidades neonatais. Em relação ao desfecho neurológico, a diferença entre os grupos foi significativa, com um risco relativo estimado de 1,34 , com IC 95% 1,09-1,66 (p=0,006). Corrigindo-se com a regressão passo a passo, este efeito diminuiu, especialmente quando incluídas as variáveis de morbidade neurológica. Conclusão: Pacientes pré-termos com crises epilépticas neonatais apresentam um risco aumentado de desfecho neurológico adverso no segundo ano de vida. sobreposição entre as crises neonatais e as patologias que o pré-termo está exposto dificultam a determinação do seu impacto no desenvolvimento desses pacientes. / Purpose: to establish the association between clinical neonatal seizures in very low birth weight preterm infants and the neurological outcome in the second year of corrected age. Methods: cohort study, with retrospective analyses of prospective collected data. We included very low birth weight newborns (less than 1500g), which survived to the neonatal period, in regular follow-up, who were born between November/2003 and June/2010. Neonatal seizures were determined by clinical criteria. The outcome was assessed by the results of Bayley II scales, head circumference measurements, presence of sensorial deficits and death. The group with seizures was compared to the group without seizures. Statistical methods included Chi-square, Student’s t, Fisher’s exact tests and Poisson regression. Results: we included 302 patients, with mean gestational age and birth weight of respectively 30.4 ± 2.28 weeks and 1182 ± 228.6 grams. Sixty patients (20%) had clinical neonatal seizures. The group with seizures had lower gestational age and birth weight, and a greater incidence of neonatal morbidities. The relative risk of a worse neurological outcome was 1.34, with a CI 95% of 1.09 – 1.66 (p=0.006). After the Poisson regression this effect was reduced, especially when the neurological variables were included. Conclusion: preterm newborns with neonatal seizures are at increased risk for worse neurological outcome in the second year of life. The overlap among the neonatal seizures and the morbidities that these infants are exposed to increases the difficulty to define its impact in the patient neurological outcome.

Introdução: Há pouca informação a respeito do crescimento cerebelar em recém-nascidos de muito baixo peso (RNMBP). Tradicionalmente as funções cerebelares são relatadas como controle do tônus, postura e coordenação da atividade motora. Entretanto, há um incremento de evidências da implicação do cerebelo na cognição, linguagem, memória e aprendizagem motora. No pré-termo com seqüelas neurológicas, o cerebelo está relacionado com alterações cognitivas e distúrbios emocionais. Objetivo: Avaliar o crescimento cerebelar do nascimento até o termo em recém-nascidos de muito baixo peso (RNMBP). Comparar o diâmetro transverso cerebelar (DTC) de recémnascidos a termo com recém-nascidos de muito baixo peso na idade corrigida correspondente ao termo. Método: RNMBP foram incluídos seqüencialmente no estudo e seus DTCs foram medidos por ultrassonografia craniana nas primeiras 48 horas após o nascimento e no momento da alta hospitalar de todos. A fossa posterior foi examinada através da fontanela Mastóidea usando o aparelho de US GE LOGIC 5 e a medida do DTC realizada no plano coronal. O grupo controle foi formado por recém-nascidos a termo normais com idade gestacional pareada com a idade gestacional pós menstrual corrigida dos RNMBP,sendo seus DTCs medidos nas primeiras 48 horas após o nascimento. Idade gestacional, peso de nascimento, perímetro cefálico e idade da alta foram obtidos dos RNMBP; e idade gestacional, peso de nascimento e perímetro cefálico dos recém-nascidos controles. Teste T de Student’s e correlação de Pearson foram empregados.O estudo foi aprovado pelo Comitê de Ética da instituição. Resultados: Foram incluídos 24 RNMBP e 24 controles. Os RNMBP tiveram idade gestacional media de 30,5± 1,7 semanas, peso de nascimento de 1247± 190 gramas, perímetro cefálico de 27,3 ± 1,5 cm, DTC de 3,28 ± 0,28 cm e idade cronológica da alta de 45,9 ± 12,3 dias. Comparação entre os dois grupos: A idade gestacional corrigida dos RNMBP e a idade gestacional dos controles foram semelhantes (37,04 ± 1,73 semanas e 37,3 ± 1,8 semanas, respectivamente; p= 0,612).O peso dos RNMBP na alta foi significativamente inferior aos controles pareados (2,019 ± 209 g e 2631 ± 423 g; p‹0,0001). Perímetro cefálico dos RNMBP na alta e dos controles, foram respectivamente, 32,23 ± 1,39 centímetros e 33,0 ± 1,6 centímetros (p= 0,098) O DTC aumentou significativamente do nascimento até a alta nos RNMBP; sendo ainda significativamente inferior aos seus pares ao termo ( 4,19 ± 0,41cm e para os controles foi 4,5 ± 0,41 cm; p=0,008). Houve uma correlação positiva entre o perímetro cefálico e o crescimento cerebelar nos RNMBP. Dois RNMBP apresentaram leucomalácia cística e quatro leucomalácia peri-ventricular difusa na ressonância magnética do primeiro ano de vida. Avaliando-se apenas os RNMBP sem leucomalácia peri-ventricular, o crescimento cerebelar foi similar aos recém-nascidos controles (p= 0.135), mas foi menor nos recém-nascidos de muito baixo peso com leucomalácia peri-ventricular quando comparados com os controles (p= 0,005). Conclusões: O crescimento cerebelar foi similar nos recém-nascidos de muito baixo peso sem leucomalácia peri-ventricular e nos controles, e menor naqueles com leucomalácia periventricular em comparação aos controles. Nossos dados sugerem que o crescimento cerebelar é normal na ausência de dano supratentorial. / Introduction: There is little information on cerebellar growth in very low birth weight infants (VLBWI). The cerebellar functions are traditionally reported as tonus, posture and coordination of motricity activity. However, there is an evidence growth of the relation of the cerebellum in cognition, language, memory and motor learning. In VLBWI with neurologic injuries the cerebellum is related to cognitive alterations and emotional disturbance. Objective: Evaluate cerebellar growth from birth up to term in VLBWI. Compare transverse cerebellar diameter (TCD) of term infants and VLBWI at term corrected age. Design/Methods: VLBWI were sequentially included in the study. TCD was measured by cranial ultrasound in the first 48 hours after birth and at hospital discharge in all of them. The posterior fossa was examined through the Mastoid fontanelle using a General Eletric LOGIQ 5 scanner and TCD measurement was taken in the coronal plane. Control group was formed by normal term infants with gestational age that matched VLBWI corrected pos menstrual age. TCD was measured in the first 48 hours after birth. Data on gestational age, birth weight, head circumference, and age at discharge were collected from VLBWI; and gestational age, birth weight, and head circumference from controls newborns. Student’s T test and Pearson correlation were employed. Study was approved by institutional Ethic Committee. Results: We enrolled 24 VLBWI and 24 controls. VLBWI had mean gestational age 30.5±1.7 weeks, birth weight 1247±190 grams, head circumference 27.3 ±1.5cm,TCD 3.28± 0.28 cm, and chronological age at hospital discharge 45.9±12.3 days. Comparison between both groups: VLBWI corrected age at discharge and controls gestational age were similar: 37.4±1.73 weeks and 37.3±1,8 (p=0.612),VLBWI weight at discharge and controls birth weight was significantly inferior to controls: 2019±and 2631±423 grams (p‹ 0.0001),VLBWI head circumference at discharge and controls head circumference: 32.23±1.39 and 33.0 ±1.6 cm (p=0.098),VBWI TCD at discharge and controls TCD: 4.19±0.41 and 4.5±0.41 cm (p=0.008).TCD increased significantly form birth up to hospital discharge in VLBWI (p< 0.001); being still significantly inferior to its term infants matched. There was a significant positive correlation between head circumference and cerebellar growth in VLBWI. Two very low birth weight infants presented cystic and four diffuse peri-ventricular leukomalacia at magnetic resonance image in the first year. Evaluating only the VLBWI without periventricular leukomalacia the cerebellar growth was similar to controls (p=0.135), but it was smaller in VLBWI with peri-ventricular leukomalacia when compared with controls (p=0.005). Hence we divided the case group in with or without peri-ventricular leukomalacia. We compared the two groups with the control group. Conclusions: Cerebellar growth was similar in very low birth Wright infants without periventricular leukomalacia and controls, and smaller in cases with peri-ventricular leukomalacia than in controls. We suggest that cerebelar growth is normal in the absence of supratentorial injury.

Introdução: Anemia é uma patologia sistêmica e um problema de saúde pública em todo o mundo, inclusive entre prematuros que são considerados grupo de risco. Objetivo: Determinar a prevalência de anemia ferropriva e deficiência de ferro com um ano de idade corrigida em pré-termos de muito baixo peso e verificar os possíveis fatores de risco associados. Metodologia: estudo transversal aninhado a uma coorte de pré-termos em uso profilático de ferro, nascidos com peso inferior a 1500 gramas e idade gestacional menor de 34 semanas, já existente, composta de crianças em acompanhamento regular no ambulatório de seguimento de prematuros de hospital terciário aos doze meses de idade corrigida. O diagnóstico de anemia foi feito pela presença de hemoglobina menor que 11g/dL, e a deficiência de ferro foi determinada por níveis de ferritina inferiores a 10mcg/L, saturação de transferrina menor que 10% e o VCM (volume corpuscular médio) menor que 80fL. Métodos estatísticos: ANOVA One-Way, Qui-quadrado, t de Student, Mann-Whitney, exato de Fisher e Regressão de Poisson. Resultados: Foram incluídas 310 crianças, com prevalência de 26,5% de anemia (n=82), já a prevalência de deficiência de ferro foi de 48%. O maior consumo de leite de vaca aos seis meses de idade corrigida, a menor idade da mãe, o maior número de gestações e ter nascido pequeno para a idade gestacional foram independentemente associadas à anemia após ajustes. Conclusões: A prevalência de anemia é alarmante, e os fatores que mais influenciaram este alto índice foram: menor idade materna, maior número de gestações, menor peso de nascimento para a idade gestacional e maior consumo de leite de vaca aos seis meses de idade corrigida. Estratégias educacionais, alimentares e ambientais poderão impactar em menor prevalência de anemia no seguimento após a alta. / Introduction: Anemia is a systemic condition and a public health issue worldwide, premature infants that are considered a high-group risk. Objective: To ascertain the prevalence of iron deficiency and iron-deficiency anemia at 1 year corrected age in very low birth weight preterm infants and potential risk factors therefor. Methods: An existing cohort of very low birth weight preterm infants (weight <1500 g and gestational age <34 weeks at birth) receiving prophylactic iron supplementation and regular follow-up at the outpatient prematurity clinic of a tertiary referral hospital was assessed at 12 months corrected age. Anemia was diagnosed by a hemoglobin level <11 g/dL, and iron deficiency, by ferritin levels <10 mcg/L, transferrin saturation <10%, and MCV (mean corpuscular volume) <80 fL. Statistical methods included one-way ANOVA, Poisson regression, and chi-square, Student’s t, Mann-Whitney U, and Fisher’s exact tests. This study was approved by the local Research Ethics Committee. Results: The sample comprised 310 infants. The overall prevalence of anemia was 26.5% (n=82), and that of iron deficiency, 48%. Four factors were independently associated with anemia after adjustment: greater cow’s milk intake at 6 months corrected age, younger maternal age, greater number of pregnancies and small for gestational age status. Conclusions: The prevalence of anemia in this sample was concerning. The most influential determinants of anemia were: younger maternal age, greater number of pregnancies, small for gestational age status and cow’s milk intake at 6 months corrected age. Educational strategies geared to proper feeding and environmental factors may help decrease the prevalence of anemia after discharge in very low birth weight preterm infants.

Objetivo: determinar a associação de crises epilépticas neonatais por diagnóstico clínico em pré-termos de muito baixo peso ao nascer com o desfecho neurológico no segundo ano de vida. Métodos: estudo de coorte, com análise retrospectiva de dados coletados prospectivamente. Incluídos recém nascidos pré-termos de muito baixo peso ao nascer (menor que 1500g) que tenham sobrevivido ao período neonatal e acompanhados no ambulatório de follow up da instituição. As crises epilépticas neonatais foram determinadas por critério clínico. O desfecho foi avaliado através da escala de Bayley II, medidas de perímetro cefálico, presença de deficiências sensoriais e óbito. O grupo com crises foi comparado ao grupo sem crises de acordo com o desfecho neurológico. Testes empregados na análise estatística: Qui-quadrado ou exato de Fisher (variáveis qualitativas), teste t de Student (variáveis quantitativas), risco relativo como medida de associação, Regressão de Poisson. Resultados: Trezentos e dois pacientes foram incluídos no estudo, com idade gestacional média de 30,4 ± 2,28 semanas e peso de nascimento médio 1182 ± 228,6 gramas. Sessenta pacientes (20%) tiveram crise epiléptica neonatal por diagnóstico clínico. O grupo com crises tinha médias de idade gestacional e peso significativamente menores, além de uma maior incidência de morbidades neonatais. Em relação ao desfecho neurológico, a diferença entre os grupos foi significativa, com um risco relativo estimado de 1,34 , com IC 95% 1,09-1,66 (p=0,006). Corrigindo-se com a regressão passo a passo, este efeito diminuiu, especialmente quando incluídas as variáveis de morbidade neurológica. Conclusão: Pacientes pré-termos com crises epilépticas neonatais apresentam um risco aumentado de desfecho neurológico adverso no segundo ano de vida. sobreposição entre as crises neonatais e as patologias que o pré-termo está exposto dificultam a determinação do seu impacto no desenvolvimento desses pacientes. / Purpose: to establish the association between clinical neonatal seizures in very low birth weight preterm infants and the neurological outcome in the second year of corrected age. Methods: cohort study, with retrospective analyses of prospective collected data. We included very low birth weight newborns (less than 1500g), which survived to the neonatal period, in regular follow-up, who were born between November/2003 and June/2010. Neonatal seizures were determined by clinical criteria. The outcome was assessed by the results of Bayley II scales, head circumference measurements, presence of sensorial deficits and death. The group with seizures was compared to the group without seizures. Statistical methods included Chi-square, Student’s t, Fisher’s exact tests and Poisson regression. Results: we included 302 patients, with mean gestational age and birth weight of respectively 30.4 ± 2.28 weeks and 1182 ± 228.6 grams. Sixty patients (20%) had clinical neonatal seizures. The group with seizures had lower gestational age and birth weight, and a greater incidence of neonatal morbidities. The relative risk of a worse neurological outcome was 1.34, with a CI 95% of 1.09 – 1.66 (p=0.006). After the Poisson regression this effect was reduced, especially when the neurological variables were included. Conclusion: preterm newborns with neonatal seizures are at increased risk for worse neurological outcome in the second year of life. The overlap among the neonatal seizures and the morbidities that these infants are exposed to increases the difficulty to define its impact in the patient neurological outcome.

Submitted by Kamila Costa (kamilavasconceloscosta@gmail.com) on 2015-07-30T20:30:54Z No. of bitstreams: 2 Dissertação - Jamile L Freire.pdf: 613265 bytes, checksum: 6717901329ef990dbfa3295cede3d795 (MD5) ficha catalografica.pdf: 1849 bytes, checksum: c0de4bb17c675bdb8d657be247620a06 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-08-04T14:03:15Z (GMT) No. of bitstreams: 2 Dissertação - Jamile L Freire.pdf: 613265 bytes, checksum: 6717901329ef990dbfa3295cede3d795 (MD5) ficha catalografica.pdf: 1849 bytes, checksum: c0de4bb17c675bdb8d657be247620a06 (MD5) / Approved for entry into archive by Divisão de Documentação/BC Biblioteca Central (ddbc@ufam.edu.br) on 2015-08-04T14:07:45Z (GMT) No. of bitstreams: 2 Dissertação - Jamile L Freire.pdf: 613265 bytes, checksum: 6717901329ef990dbfa3295cede3d795 (MD5) ficha catalografica.pdf: 1849 bytes, checksum: c0de4bb17c675bdb8d657be247620a06 (MD5) / Made available in DSpace on 2015-08-04T14:07:46Z (GMT). No. of bitstreams: 2 Dissertação - Jamile L Freire.pdf: 613265 bytes, checksum: 6717901329ef990dbfa3295cede3d795 (MD5) ficha catalografica.pdf: 1849 bytes, checksum: c0de4bb17c675bdb8d657be247620a06 (MD5) Previous issue date: 2012-11-01 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Low Birth Weight (LBW), multifactorial event and implicated as a major contributor to the rise in infant mortality in developing countries. The objective of this study was to investigate the determinants of LBW. Cross-sectional study of descriptive population-based involved 384 mothers attended in a public hospital. Forms with closed questions were used on the socioeconomic, demographic condition of pregnancy and nutritional standard features, and anthropometric measurements of prenatal card. The results showed an incidence of LBW infants 6.5%, not registering this association influence of socioeconomic variables (p> 0.05). In relation to maternal characteristics, the number of consultations in prenatal care, the previous history of abortion and the type of delivery showed a statistically significant relationship in determining the BPN (p <0.05). Among LBW infants 7.3% were children of adolescents (p> 0.05), and zero the occurrence of this event in mothers with older age (≥ 35 years). Analysis of these results shows a low occurrence of LBW in the universe studied, however it reinforces the need to implement a program of assistance and guidance to more efficient prenatal care for pregnant women teens. / O Baixo Peso ao Nascer (BPN), evento de etiologia multifatorial e incriminado como um dos principais responsáveis da elevação da mortalidade infantil nos países em desenvolvimento. O objetivo deste trabalho foi investigar os fatores determinantes do BPN. Estudo transversal de base populacional descritivo envolveu 384 puérperas atendidas em uma maternidade pública. Foram utilizados formulários com perguntas fechadas sobre a condição socioeconômica, demográfica, características da gestação e padrão nutricional, sendo as medidas antropométricas obtidas do cartão do pré-natal. A análise dos resultados evidenciou uma ocorrência de RNBP de 6,5%, não se registrando nesta associação influencia das variáveis socioeconômicas (p>0,05). Em relação às características maternas, o número de consultas realizadas no pré-natal, a história pregressa de aborto e o tipo de parto apresentaram relação estatisticamente significativa na determinação do BPN (p<0,05). Dentre os RNBP 7,3% eram filhos de adolescentes (p>0,05), sendo nula a ocorrência deste evento nas mães com idade mais avançada (≥ 35 anos). A análise destes resultados evidencia uma baixa ocorrência de BPN no universo estudado, entretanto reforça a necessidade de implementação de um programa de assistência e orientação ao pré-natal mais eficiente para as gestantes adolescentes.

Doctor of Philosophy / Department of Animal Sciences and Industry / Duane L. Davis / Intrauterine growth restriction (IUGR) affects all mammals. In the swine industry IUGR pigs result from intrauterine crowding. Prenatal programming in IUGR pigs has substantial effects on myogenesis and adipogenesis. Prenatal programming due to IUGR is also a problem in humans and long-term effects on adipogenesis are well established for small for gestational age (SGA) babies. Mesenchymal stem cells (MSCs) are the precursors for adipocytes. The umbilical cord contains a population of MSCs in Wharton’s jelly (WJ) and they can be harvested postnatally without ethical issues. Therefore, WJMSCs are proposed as models for studying prenatal programming of adipogenesis. We selected genes from studies of adipogenesis in humans and other species and examined their expression in pig WJ. We assigned pigs within litter as High, Medium, or Low birth weight and evaluated these categories for expression of Cox1, Cox2, EGR1, PPARɣ1, PPARɣ2, and Pref1. Differences due to size classification within litter were limited but there were correlations between weaning weight and delta cycle threshold (ΔCt) for EGR1 (r = 0.28; P < 0.009), PPARɣ1 (r = 0.29; P < 0.007), and PPARɣ2 (r = 0.30; P < 0.005). This may be consistent with the reports for SGA babies where EGR1 is upregulated by prenatal growth restriction. To gain insight into when during pregnancy IUGR affects WJ cells we collected umbilical cords at d 60 and d 95. In d 60 umbilical cords, small fetuses had increased (P = 0.06) Cox1 gene expression. We tested the ability of d 60 WJ cells to undergo adipogenic differentiation using standard protocols and a cycling protocol that exposed the cells to adipogenic differentiation conditions interposed with a rest phase with high insulin. It has been reported that the cycling protocol revealed increased glucose uptake in WJ cells from human SGA babies. We found that d 60 WJ cells did not show adipogenic differentiation in any of the protocols tested however glucose uptake correlated negatively with birth weight at Cycle 0 (P < 0.02; r = 0.61). In summary, pig WJ cells reveal some effects of IUGR but they appear to differ from the relationship demonstrated reported for human SGA babies. A new finding was that at midgestation pig WJ cells do not appear to be competent to complete adipogenesis. We also studied nursing managements to improve outcomes for IUGR pigs. Colostrum intake may be a problem, particularly for light weight pigs and those born later during farrowing. Split suckling is the removal of some pigs to allow others unrestricted nursing access. We temporarily removed the six heaviest pigs and this treatment increased gain and weight by d 7 of age. Colostrum intake was highest for the high birth weight pigs. When we temporarily removed the first half of the litter, colostrum intake was increased for the second half of litter born and the difference in immunocrit was reduced between the two litter halves.

Abstract The main objective of the present follow-up study was to investigate auditory processing by using auditory event related potentials (ERPs), and language development to determine whether a correlation exists between auditory ERPs and language development. Auditory processing was investigated in very low birth weight (VLBW) preterm children and matched controls at mean ages of 4 and 6 years to determine whether there are differences in ERPs between VLBW preterm children and controls. Language development was measured at the mean ages of 2, 4 and 6 years to investigate the developmental course of language learning and to determine whether a relationship exists between ERPs, especially mismatch negativity (MMN), and language development. Auditory ERPs were also measured in children with AS (mean age 9;1 years) and matched controls to assess whether differences can be found between these two groups of children. Language development in children with AS was not investigated for this study. VLBW preterm children exhibited difficulties in the auditory processing at the level of obligatory ERPs, MMN, late MMN (lMMN) and behavioural tests. Both language comprehension and production were deficient in the preterm group compared to their controls. Lexical development was the most prominent phenomenon differentiating preterm children from their controls. MMN and lMMN amplitudes were attenuated most in children with naming difficulty at the ages of 4 and 6 years. Weak or totally missing MMN at the age of 4 years was mainly found in children with naming difficulties. Children with AS also displayed abnormalities in auditory processing, as indexed by delayed MMN latency. MMN was most delayed in the right hemisphere and specifically for tones. In conclusion: VLBW preterm children and children with AS exhibited difficulties in auditory processing. MMN correlated well with language development in preterm children. Therefore, auditory ERPs, especially MMN, should be used in combination with language measures to identify the children at a risk for deficient auditory processing and language delays.

D.Cur. / The feeding of low birth weight babies remains a challenge. Mother's milk is deficient in protein, calcium, magnesium and phosphate. These elements need to be supplemented in order for the low birth weight baby to grow under optimal conditions. The objective of the study was to compare the growth of the low birth weight baby, who was only fed mothers milk, to the low birth weight babay who was fed mother's milk with a commercial fortifier, using mass, lenght and head circumference as a guide. The literature study has shown that there are different methods which can be used to compliment the deficiencies in mothers's milk, for example: premature milk formula, alternating mother's milk with premature milk formula, additional additives to mother's milk and commercial fortifiers. Previous research of mother's milk fortifiers has shown that the biochemistry has positvely influenced their growth. Six patients were used in the experimental group and received 25% mother's milk and 75% fortifier. The control group consisted of eight babies who only received mother's milk. All the babies met the criteria and reached the 1600 gram weight by the time the study was completed. The Mann Whitney U test was used to calculate the results. No significant statistical growth was seen in any of the areas tested. It was concluded that mother's milk should be fortified, despite the results of the study, as mother's milk is definitely deficient in certain nutrients. It is possible to use mother's milk fortifiers in a stronger consentration.

京都大学 / 0048 / 新制・論文博士 / 博士(医学) / 乙第13379号 / 論医博第2213号 / 新制||医||1047(附属図書館) / (主査)教授 川上 浩司, 教授 滝田 順子, 教授 古川 壽亮 / 学位規則第4条第2項該当 / Doctor of Medical Science / Kyoto University / DFAM