Abstract
A total of 45 infants, including 20 appropriate-size-for-gestational-age infants (AGAs), 19 large-size-for-gestational-age infants (LGAs) and 6 infants of diabetic mothers (IDMs), had determinations of their pulmonary excretion rate of carbon monoxide (VeCO) in the first postnatal week as an index of bilirubin production. We calculated a ratio (Rw) of birth weight to ideal weight (50th percentile for gestational age) as a relative measure of infant size. We also measured maternal glycosylated hemoglobin (Hb AIc) in the postpartum period as a reflection of the time-integrated blood glucose level over the weeks preceding delivery. Mean values for maternal Hb AIc in the postpartum period, infant Rw, and VeCO were all significantly increased for the LGAs and IDMs compared to the normal AGAs. Nine LGAs had mothers whose Hb AIc levels were >2 S.D. higher than the mean Hb AIc level for mothers of normal AGAs. The infants whose mothers had the highest Hb AIc levels were not always the ones with the highest bilirubin production rates. These findings suggest that maternal Hb AIc in the postpartum period, infant size, and bilirubin production are associated phenomena, but that a postpartum time-integrated measure of blood glucose level over the weeks preceding parturition may not reflect changes in other associated factors which can affect infant erythropoiesis. The LGAs are not a homogeneous group, and some may have mothers with missed abnormalities of gestational glucose metaoblism.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Bakken AF, Thaler MM (1972) Metabolic regulation of heme catabolism and bilirubin production: I. Hormonal control of hepatic heme oxygenase activity. J Clin Invest 51:530–536
Bartoletti AL, Stevenson DK, Ostrander CR, Johnson JD (1979) Pulmonary excretion of carbon monoxide in the human infant as an index of bilirubin production. I. Effects of gestational and postnatal age and some common neonatal abnormalities. J Pediatr 94:952–955
Berk PD, Rodkey RL, Blaschke TF, Collison HA, Waggoner JG (1974) Comparison of plasma bilirubin turnover and carbon monoxide production in man. J Lab Clin Med 83: 29–37
Carson BS, Philipps AF, Simmons MA, Battaglia FC, Meschia G (1980) Effects of a sustained insulin infusion upon glucose uptake and oxygenation of the ovine fetus. Pediat Res 14:147–152
Dubowitz LMS, Dubowitz V, Goldberg C (1970) Clinical assessment of gestational age in the newborn infant. J Pediatr 77:1–10
Fallstrom SF (1968) Endogenous formation of carbon monoxide in newborn infants. IV. On the relation between the blood carboxyhaemoglobin concentrations and pulmonary elimination of carbon monoxide. Acta Paediatr Scand 57:321–329
Finne PH, Halvorsen S (1972) Regulation of erythropoiesis in the fetus and newborn. Arch Dis Child 47:683–687
Hubbell JP Jr, Drorbaugh JE, Rudolph AJ, Auld PAM, Cherry RB, Smith CA (1961) Early versus late feeding of infants of diabetic mothers. N Engl J Med 265:835–837
Landaw SA, Callahan EW Jr, Schmid R (1970) Catabolism of heme in vivo: Comparison of the simultaneous production of bilirubin and carbon monoxide. J Clin Invest 49:914–925
Lubchenco L, Hansman C, Dressler M (1963) Intrauterine growth as estimated from liveborn birth weight at 24 to 42 weeks gestation. Pediatrics 32:793–800
Miller HC, Wilson HM (1943) Macrosomia, cardiac hypertrophy, erythroblastosis, and hyperplasia of islands of Lagerhans in infants born to diabetic mothers. J Pediatr 23: 251–266
Miyahara S, Takahashi H 61971) Biological CO evolution. Carbon monoxide evolution during auto- and enzymatic oxidation of phenols. J Biochem 69:231–233
Naets JP, Gans M (1980) Inhibitory effect of glucagon and erythropoiesis. Blood 55:997–1002
Naeye RL (1965) Infants of diabetic mothers: A quantitative morphologic study. Pediatrics 35:980–988
Ostrander CR, Johnson JD, Bartoletti AL (1976) Determining the pulmonary excretion rate of carbon monoxide in newborn infants. J Appl Physiol 40:844–848
Ostrander CR, Stevenson DK, Johnson JD (in press) Pulmonary excretion rates of carbon monoxide: Differences between premature and full-term infants. Biol Neonate
O'Sullivan JB, Mahan CM (1966) Glucose tolerance test. Variability in pregnant and non-pregnant women. Am J Clin Nutr 19:345–351
Pedersen J (1977) Correlation of birth weight with White's classification. In: Pedersen J (ed) The pregnant diabetic and her newborn. Williams and Wilkins Co, Baltimore, pp 126–127
Peevy KJ, Landaw SH, Gross SJ (1980) Hyperbilirubinemia in infants of diabetic mothers. Pediatrics 66:417–419
Persson B (1974) Assessment of metabolic control in diabetic pregnancy. In: Size at birth. CIBA Foundation Symposium, Associated Scientific Publishers, Amsterdam, pp 247–267
Schacter BA, Marver HS, Mayer JA (1972) Hemoprotein catabolism during stimulation of microsomal lipid peroxidation. Biochim Biophys Acta 279:221–227
Schwartz HC, King KS, Schwartz AL, Edmunds D, Schwartz R (1976) Effects of pregnancy on hemoglobin A in normal, gestational diabetic, and diabetic women. Diabetes 25:1118–1122
Singer K, Chernoff AI, Singer L (1951) Studies of abnormal hemoglobins. I. Their demonstration in sickle cell anemia and other hematologic disorders by means of alkali denaturation. Blood 6:413–428
Stevenson DK, Bartoletti AL, Ostrander CR, Johnson JD (1979) Pulmonary excretion of carbon monoxide in the human infant as an index of bilirubin production. II. Infants of diabetic mothers. J Pediatr 94:956–960
Stevenson DK, Ostrander CR, Johnson JD (1979) Effect of erythrocyte destruction on the pulmonary excretion rate of carbon monoxide in adult male Wistar rats. J Lab Clin Med 94:649–654
Susa JB, McCormick KL, Widness JA, Oh W, Singer DB, Adamson K, Schwartz R (1978) Primary hyperinsulinemia in the rhesus monkey fetus (Abstract no. 156). Presented at the Society for Gynecologic Investigation, 25th Annual Meeting, Atlanta
Taylor PM, Wolfson JH, Bright NH, Birchard EL, Derinoz MN, Watson DW (1963) Hyperbilirubinemia in infants of diabetic mothers. Biol Neonate 5:289–298
Thaler MM, Gemes DL, Schmid R (1972) Enzymatic conversion of heme to bilirubin in normal and starved fetuses and newborn rats. Pediatr Res 6:197–201
Tenhunen R, Marver HS, Schmid R (1969) Microsomal heme oxygenase. Characterization of the enzyme. J Biol Chem 244:6388–6394
Widness JA, Schwartz HC, Thompson D, King KC, Kahn CB, Oh W, Schwartz R (1978) Glycohemoglobin (Hgb A): A predictor of birth weight in infants of diabetic mothers. J Pediatr 92:8–12
Widness JA, Schwartz HC, Thomson D, Oh W, Schwartz R (1978) Haemoglobin A (Glycohaemoglobin) in diabetic pregnancy: An indicator of glucose control and fetal size. Brit J Obstetr Gynecol 85:812–817
Widness JA, Susa JB, Garcia JF, Singer DB, Sehgal P, Oh W, Schwartz R, Schwartz HC (1981) Increased erythropoiesis and elevated erythropoietin in infants born to diabetic mothers and in hyperinsulinemic rhesus fetuses. J Clin Invest 67:637–642
Zetterstrom R, Strindberg B, Arnhold RG (1958) Hyperbilirubinemia and AB0 hemolytic disease in newborn infants of diabetic mothers. Acta Paediatr Uppsala 47:238–250
Author information
Authors and Affiliations
Additional information
This investigation was supported in part by grants from the General Clinical Research Program of the Division of Research Resources, National Institutes of Health (RR-00081), the Thrasher Research Fund, the United States Public Health Services (AM-25603), the National Institutes of Health (HD-14426), and by the National Institutes of Health Biomedical Research Support Grant (5S01RR05583)
Rights and permissions
About this article
Cite this article
Stevenson, D.K., Ostrander, C.R., Cohen, R.S. et al. Pulmonary excretion of carbon monoxide in the human infant as an index of bilirubin production. Eur J Pediatr 137, 255–259 (1981). https://doi.org/10.1007/BF00443253
Received:
Issue Date:
DOI: https://doi.org/10.1007/BF00443253