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Alpha-fetoprotein: a marker for recurrent apnoea of prematurity?
1Department of Paediatrics and Child Health, University of Cape Town, South Africa.
Insights
High plasma alpha-fetoprotein (AFP) levels at birth may identify preterm infants at risk for recurrent apnoea. AFP levels normalized as the risk of apnoea decreased in these infants.
Area of Science:
- Neonatal Medicine
- Biochemistry
- Pediatric Pulmonology
Background:
- Preterm infants in intensive care units often experience respiratory issues.
- Alpha-fetoprotein (AFP) is a protein with potential roles in fetal development and neonatal health.
Purpose of the Study:
- To investigate plasma AFP levels in preterm infants with various neonatal conditions.
- To determine if AFP levels can predict the risk of recurrent apnoea in preterm infants.
Main Methods:
- Weekly plasma AFP measurements over 28 days in 132 preterm infants.
- Establishment of reference AFP values in 53 healthy preterm infants (29-33.9 weeks gestation).
- Comparison of AFP levels in infants with hyaline membrane disease, transient tachypnoea, recurrent apnoea, or growth retardation against controls.
Main Results:
- Significantly elevated plasma AFP in infants with recurrent apnoea; the reason remains unclear.
- Persistent apnoea risk correlated with high AFP levels, which normalized as risk decreased.
- Infants with hyaline membrane disease showed lower AFP than the apnoea group but higher than controls.
Conclusions:
- Exceptionally high birth plasma AFP may identify preterm infants susceptible to recurrent apnoea.
- Theophylline maintenance dose may influence AFP levels and apnoea risk.
- These findings are specific to infants receiving theophylline from the first week of life.
Abstract:
Plasma alpha-fetoprotein was measured each week for 28 days on 132 preterm babies who were admitted to an intensive care unit. Reference values were established on 53 of these infants who were relatively normal and whose gestations ranged from 29 to 33.9 weeks. Similar studies were done on 79 of the 132 infants with comparable gestational ages who suffered from hyaline membrane disease, transient tachypnoea, recurrent apnoea or growth retardation. Plasma AFP was significantly raised in those with recurrent apnoea but a reason was not established for this observation. The risk of apnoea persisted until AFP levels had reached the reference range. Infants with hyaline membrane disease had lower levels of plasma AFP than the recurrent apnoea group but significantly higher values than controls. Babies who are liable to develop recurrent apnoea can probably be identified at birth as their plasma AFP is exceptionally high. These conclusions refer only to babies who receive a maintenance dose of theophylline from the first week.