Factors influencing the accuracy of fetal weight estimation with a focus on preterm birth at the limit of viability: a systematic literature review

BACKGROUND Fetal weight estimation (FWE) is an important factor for clinical management decisions, especially in imminent preterm birth at the limit of viability between 23(0/7) and 26(0/7) weeks of gestation. It is crucial to detect and eliminate factors that have a negative impact on the accuracy of FWE. DATA SOURCES In this systematic literature review, we investigated 14 factors that may influence the accuracy of FWE, in particular in preterm neonates born at the limit of viability. RESULTS We found that gestational age, maternal body mass index, amniotic fluid index and ruptured membranes, presentation of the fetus, location of the placenta and the presence of multiple fetuses do not seem to have an impact on FWE accuracy. The influence of the examiner's grade of experience and that of fetal gender were discussed controversially. Fetal weight, time interval between estimation and delivery and the use of different formulas seem to have an evident effect on FWE accuracy. No results were obtained on the impact of active labor. DISCUSSION This review reveals that only few studies investigated factors possibly influencing the accuracy of FWE in preterm neonates at the limit of viability. Further research in this specific age group on potential confounding factors is needed.

Tools for mass screening of G6PD deficiency: validation of the WST8/1-methoxy-PMS enzymatic assay in Uganda.

BACKGROUND The distribution of the enzymopathy glucose-6-phosphate dehydrogenase (G6PD) deficiency is linked to areas of high malaria endemicity due to its association with protection from disease. G6PD deficiency is also identified as the cause of severe haemolysis following administration of the anti-malarial drug primaquine and further use of this drug will likely require identification of G6PD deficiency on a population level. Current conventional methods for G6PD screening have various disadvantages for field use. METHODS The WST8/1-methoxy PMS method, recently adapted for field use, was validated using a gold standard enzymatic assay (R&D Diagnostics Ltd ®) in a study involving 235 children under five years of age, who were recruited by random selection from a cohort study in Tororo, Uganda. Blood spots were collected by finger-prick onto filter paper at routine visits, and G6PD activity was determined by both tests. Performance of the WST8/1-methoxy PMS test under various temperature, light, and storage conditions was evaluated. RESULTS The WST8/1-methoxy PMS assay was found to have 72% sensitivity and 98% specificity when compared to the commercial enzymatic assay and the AUC was 0.904, suggesting good agreement. Misclassifications were at borderline values of G6PD activity between mild and normal levels, or related to outlier haemoglobin values (<8.0 gHb/dl or >14 gHb/dl) associated with ongoing anaemia or recent haemolytic crises. Although severe G6PD deficiency was not found in the area, the test enabled identification of low G6PD activity. The assay was found to be highly robust for field use; showing less light sensitivity, good performance over a wide temperature range, and good capacity for medium-to-long term storage. CONCLUSIONS The WST8/1-methoxy PMS assay was comparable to the currently used standard enzymatic test, and offers advantages in terms of cost, storage, portability and use in resource-limited settings. Such features make this test a potential key tool for deployment in the field for point of care assessment prior to primaquine administration in malaria-endemic areas. As with other G6PD tests, outlier haemoglobin levels may confound G6PD level estimation.

Estimation of reference curves for the urinary steroid metabolome in the first year of life in healthy children: tracing the complexity of human postnatal steroidogenesis

CONTEXT Complex steroid disorders such as P450 oxidoreductase deficiency or apparent cortisone reductase deficiency may be recognized by steroid profiling using chromatographic mass spectrometric methods. These methods are highly specific and sensitive, and provide a complete spectrum of steroid metabolites in a single measurement of one sample which makes them superior to immunoassays. The steroid metabolome during the fetal-neonatal transition is characterized by a) the metabolites of the fetal-placental unit at birth, b) the fetal adrenal androgens until its involution 3-6 months postnatally, and c) the steroid metabolites produced by the developing endocrine organs. All these developmental events change the steroid metabolome in an age- and sex-dependent manner during the first year of life. OBJECTIVE The aim of this study was to provide normative values for the urinary steroid metabolome of healthy newborns at short time intervals in the first year of life. METHODS We conducted a prospective, longitudinal study to measure 67 urinary steroid metabolites in 21 male and 22 female term healthy newborn infants at 13 time-points from week 1 to week 49 of life. Urine samples were collected from newborn infants before discharge from hospital and from healthy infants at home. Steroid metabolites were measured by gas chromatography-mass spectrometry (GC-MS) and steroid concentrations corrected for urinary creatinine excretion were calculated. RESULTS 61 steroids showed age and 15 steroids sex specificity. Highest urinary steroid concentrations were found in both sexes for progesterone derivatives, in particular 20α-DH-5α-DH-progesterone, and for highly polar 6α-hydroxylated glucocorticoids. The steroids peaked at week 3 and decreased by ∼80% at week 25 in both sexes. The decline of progestins, androgens and estrogens was more pronounced than of glucocorticoids whereas the excretion of corticosterone and its metabolites and of mineralocorticoids remained constant during the first year of life. CONCLUSION The urinary steroid profile changes dramatically during the first year of life and correlates with the physiologic developmental changes during the fetal-neonatal transition. Thus detailed normative data during this time period permit the use of steroid profiling as a powerful diagnostic tool.

Immobilisation dose rates and photogrammetry based mass calculations for southern elephant seals during expedition JUB2010

Immobilization and anaesthesia of adult male southern elephant seals (Mirounga leonina) is potentially risky for animals and scientists. A tiletamine/zolazepam injection is considered the most appropriate drug combination for field application in this species. Since appropriate dosages are difficult to assess due to uncertainties in weight estimation, we used photogrammetry-derived weight estimates to ensure precise post hoc calculations of dosages. We report on 15 intramuscular tiletamine/zolazepam immobilizations of post-moult males of the upper weight class at King George Island/Isla 25 de Mayo, in April 2010. Initial injections were made using blowpipe syringes. Mean tiletamine/zolazepam combined dosages of 0.71 mg/kg (SD ± 0.16) ranged between 0.46 and 1.01 mg/kg. In four cases, ketamine was added in dosages between 0.96 and 2.61 mg/kg. Mean induction period was 23 min (± 15), and the mean duration of the procedures from first injection to release of the animals required 96 min (± 51). Four seals exhibited periods of apnoea, and one case of an extended, repetitive, and potentially critical apnoea (> 25 and 8 min) required intervention in order to successfully re-initiate spontaneous respiration. All procedures resulted in proper immobilizations allowing for the deployment of the satellite tags on the seals' heads. The fact that even substantial deviations between the initial weight estimates and the photogrammetry-derived weight estimates had no apparent effect on the course of the immobilization underlines the drugs' wide safety margin in this species.

Magnesium/Calcium ratios and sea surface temperature estimation for sediments of the Timor Sea

We use a multiproxy approach to monitor changes in the vertical profile of the Indonesian Throughflow as well as monsoonal wind and precipitation patterns in the Timor Sea on glacial-interglacial, precessional, and suborbital timescales. We focus on an interval of extreme climate change and sea level variation: marine isotope (MIS) 6 to MIS 5e. Paleoproductivity fluctuations in the Timor Sea follow a precessional beat related to the intensity of the Australian (NW) monsoon. Paired Mg/Ca and d18O measurements of surface- and thermocline-dwelling planktonic foraminifers (G. ruber and P. obliquiloculata) indicate an increase of >4°C in both surface and thermocline water temperatures during Termination II. Tropical sea surface temperature changed synchronously with ice volume (benthic d18O) during deglaciation, implying a direct coupling of high- and low-latitude climate via atmospheric and/or upper ocean circulation. Substantial cooling and freshening of thermocline waters occurred toward the end of Termination II and during MIS 5e, indicating a change in the vertical profile of the Indonesian Throughflow from surface- to thermocline-dominated flow.

Western Arabian Sea SST estimation

Millennial-scale records of planktonic foraminiferal Mg/Ca, bulk sediment UK37', and planktonic foraminiferal d18O are presented across the last two deglaciations in sediment core NIOP929 from the Arabian Sea. Mg/Ca-derived temperature variability during the penultimate and last deglacial periods falls within the range of modern day Arabian Sea temperatures, which are influenced by monsoon-driven upwelling. The UK37'-derived temperatures in MIS 5e are similar to modern intermonsoon values and are on average 3.5°C higher than the Mg/Ca temperatures in the same period. MIS 5e UK37' and Mg/Ca temperatures are 1.5°C warmer than during the Holocene, while the UK37'-Mg/Ca temperature difference was about twice as large during MIS 5e. This is surprising as, nowadays, both proxy carriers have a very similar seasonal and depth distribution. Partial explanations for the MIS 5e UK37'-Mg/Ca temperature offset include carbonate dissolution, the change in dominant alkenone-producing species, and possibly lateral advection of alkenone-bearing material and a change in seasonal or depth distribution of proxy carriers. Our findings suggest that (1) Mg/Ca of G. ruber documents seawater temperature in the same way during both studied deglaciations as in the present, with respect to, e.g., season and depth, and (2) UK37'-based temperatures from MIS 5 (or older) represent neither upwelling SST nor annual average SST (as it does in the present and the Holocene) but a higher temperature, despite alkenone production mainly occurring in the upwelling season. Further we report that at the onset of the deglacial warming, the Mg/Ca record leads the UK37' record by 4 ka, of which a maximum of 2 ka may be explained by postdepositional processes. Deglacial warming in both temperature records leads the deglacial decrease in the d18O profile, and Mg/Ca-based temperature returns to lower values before d18O has reached minimum interglacial values. This indicates a substantial lead in Arabian Sea warming relative to global ice melting.

Cretaceous stable isotopic record and sea surface temperture estimation for ODP Site 207-1259

The Turonian (93.5 to 89.3 million years ago) was one of the warmest periods of the Phanerozoic eon, with tropical sea surface temperatures over 35°C. High-amplitude sea-level changes and positive d18O excursions in marine limestones suggest that glaciation events may have punctuated this episode of extreme warmth. New d18O data from the tropical Atlantic show synchronous shifts ~91.2 million years ago for both the surface and deep ocean that are consistent with an approximately 200,000-year period of glaciation, with ice sheets of about half the size of the modern Antarctic ice cap. Even the prevailing supergreenhouse climate was not a barrier to the formation of large ice sheets, calling into question the common assumption that the poles were always ice-free during past periods of intense global warming.

Stable isotope ratios of foraminifera and sea surface temperature estimation of sediment core W2804A-14

Carbon isotopically based estimates of CO2 levels have been generated from a record of the photosynthetic fractionation of 13C (epsilon p) in a central equatorial Pacific sediment core that spans the last ~255 ka. Contents of 13C in phytoplanktonic biomass were determined by analysis of C37 alkadienones. These compounds are exclusive products of Prymnesiophyte algae which at present grow most abundantly at depths of 70-90 m in the central equatorial Pacific. A record of the isotopic compostion of dissolved CO2 was constructed from isotopic analyses of the planktonic foraminifera Neogloboquadrina dutertrei, which calcifies at 70-90 m in the same region. Values of epsilon p, derived by comparison of the organic and inorganic delta values, were transformed to yield concentrations of dissolved CO2 (c e) based on a new, site-specific calibration of the relationship between epsilon p and c e. The calibration was based on reassessment of existing epsilon p versus c e data, which support a physiologically based model in which epsilon p is inversely related to c e. Values of PCO2, the partial pressure of CO2 that would be in equilibrium with the estimated concentrations of dissolved CO2, were calculated using Henry's law and the temperature determined from the alkenone-unsaturation index UK 37. Uncertainties in these values arise mainly from uncertainties about the appropriateness (particularly over time) of the site-specific relationship between epsilon p and 1/c e. These are discussed in detail and it is concluded that the observed record of epsilon p most probably reflects significant variations in Delta pCO2, the ocean-atmosphere disequilibrium, which appears to have ranged from ~110 µatm during glacial intervals (ocean > atmosphere) to ~60 µatm during interglacials. Fluxes of CO2 to the atmosphere would thus have been significantly larger during glacial intervals. If this were characteristic of large areas of the equatorial Pacific, then greater glacial sinks for the equatorially evaded CO2 must have existed elsewhere. Statistical analysis of air-sea pCO2 differences and other parameters revealed significant (p < 0.01) inverse correlations of Delta pCO2 with sea surface temperature and with the mass accumulation rate of opal. The former suggests response to the strength of upwelling, the latter may indicate either drawdown of CO2 by siliceous phytoplankton or variation of [CO2]/[Si(OH)4] ratios in upwelling waters.

Salinity estimation from Gulf of Guinea, sediment core MD03-2707

The isotopic composition of surface seawater is widely used to infer past changes in sea surface salinity using paired foraminiferal Mg/Ca and d18O from marine sediments. At low latitudes, paleosalinity reconstructions using this method have largely been used to document changes in the hydrological cycle. This method usually assumes that the modern seawater d18O (d18Osw)/salinity relationship remained constant through time. Modelling studies have shown that such assumptions may not be valid because large-scale atmospheric circulation patterns linked to global climate changes can alter the seawater d18Osw/salinity relationship locally. Such processes have not been evidenced by paleo-data so far because there is presently no way to reconstruct past changes in the seawater d18Osw/salinity relationship. We have addressed this issue by applying a multi-proxy salinity reconstruction from a marine sediment core collected in the Gulf of Guinea. We measured hydrogen isotopes in C37:2 alkenones (dDa) to estimate changes in seawater dD. We find a smooth, long-term increase of ~10 per mil in dDa between 10 and 3 kyr BP, followed by a rapid decrease of ~10 per mil in dDa between 3 kyr BP and core top to values slightly lighter than during the early Holocene. Those features are inconsistent with published salinity estimations based on d18Osw and foraminiferal Ba/Ca, as well as nearby continental rainfall history derived from pollen analysis. We combined dDa and d18Osw values to reconstruct a Holocene record of salinity and compared it to a Ba/Ca-derived salinity record from the same sedimentary sequence. This combined method provides salinity trends that are in better agreement with both the Ba/Ca-derived salinity and the regional precipitation changes as inferred from pollen records. Our results illustrate that changes in atmospheric circulation can trigger changes in precipitation isotopes in a counter-intuitive manner that ultimately impacts surface salinity estimates based on seawater isotopic values. Our data suggest that the trends in Holocene rainfall isotopic values at low latitudes may not uniquely result from changes in local precipitation associated with the amount effect.

Sea surface temperature estimation for the last 70 ka from IODP Site 306-U1313

During the six Heinrich Events of the last 70 ka episodic calving from the circum-Atlantic ice sheets released large numbers of icebergs into the North Atlantic. These icebergs and associated melt-water flux are hypothesized to have led to a shutdown of Atlantic Meridional Overturning Circulation (AMOC) and severe cooling in large parts of the Northern Hemisphere. However, due to the limited availability of high-resolution records the magnitude sea surface temperature (SST) changes related to the impact of Heinrich Events on the mid-latitude North Atlantic is poorly constrained. Here we present a record of UK37'-based SSTs derived from sediments of Integrated Ocean Drilling Project (IODP) Site U1313, located at the southern end of the ice-rafted debris (IRD)-belt in the mid-latitude North Atlantic (41°N). We demonstrate that all six Heinrich Events are associated with a rapid warming of surface waters by 2 to 4°C in a few thousand years. The presence of IRD leaves no doubt about the simultaneous timing and correlation between rapid surface water warming and Heinrich Events. We argue that this warming in the mid-latitude North Atlantic is related to a northward expansion of the subtropical gyre during Heinrich Events. As a wide-range of studies demonstrated that in the central IRD-belt Heinrich Events are associated with low SSTs, these results thus identify an anti-phased (seesaw) pattern in SSTs during Heinrich Events between the mid-latitude (warm) and northern North Atlantic (cold). This highlights the complex response of surface water characteristics in the North Atlantic to Heinrich Events that is poorly reproduced by fresh water hosing experiments and challenges the widely accepted view that within the IRD-belt of the North Atlantic Heinrich Events coincide with periods of low SSTs.

Aerosol total mass concentration and optical depth during IPY 2007-2008 at Maitri and Larsemann Hills Station

The properties of background aerosols and their dependence on meteorological, geographical and human influence are examined using measured spectral aerosol optical depth (AOD), total mass concentration (Mt) and derived number size distribution (NSD) over two distinct coastal locations of Antarctica; Maitri (70°S, 12°E, 123 m m.s.l.) and Larsemann Hills (LH; 69°S, 77°E, 48 m m.s.l.) during southern hemispheric summer of 2007-2008 as a part of the 27th Indian Scientific Expedition to Antarctica (ISEA) during International Polar Year (IPY). Our investigations showed comparable values for the mean columnar AOD at 500 nm over Maitri (0.034±0.005) and LH (0.032±0.006) indicating good spatial homogeneity in the columnar aerosol properties over the coastal Antarctica. Estimation of Angstrom exponent a showed accumulation mode dominance at Maitri (alpha ~1.2±0.3) and coarse mode dominance at LH (0.7±0.2). On the other hand, mass concentration (M(T)) of ambient aerosols showed relatively high values (~8.25±2.87 µg/m**3) at Maitri in comparison to LH (6.03±1.33 µg/m**3).

Sea surface temperature estimation for MIS 16 of IODP Site 306-U1313

Hudson Strait (HS) Heinrich Events, ice-rafting events in the North Atlantic originating from the Laurentide ice sheet (LIS), are among the most dramatic examples of millennial-scale climate variability and have a large influence on global climate. However, it is debated as to whether the occurrence of HS Heinrich Events in the (eastern) North Atlantic in the geological record depends on greater ice discharge, or simply from the longer survival of icebergs in cold waters. Using sediments from Integrated Ocean Drilling Program (IODP) Site U1313 in the North Atlantic spanning the period between 960 and 320 ka, we show that sea surface temperatures (SSTs) did not control the first occurrence of HS Heinrich(-like) Events in the sedimentary record. Using mineralogy and organic geochemistry to determine the characteristics of ice-rafting debris (IRD), we detect the first HS Heinrich(-like) Event in our record around 643 ka (Marine Isotope Stage (MIS) 16), which is similar as previously reported for Site U1308. However, the accompanying high-resolution alkenone-based SST record demonstrates that the first HS Heinrich(-like) Event did not coincide with low SSTs. Thus, the HS Heinrich(-like) Events do indicate enhanced ice discharge from the LIS at the end of the Mid-Pleistocene Transition, not simply the survivability of icebergs due to cold conditions in the North Atlantic.

Sea surface temperature estimation of the South Tasman Rise

The Subtropical Front (STF) marking the northern boundary of the Southern Ocean has a steep gradient in sea surface temperature (SST) of approximately 4°C over 0.5° of latitude. Presently, in the region south of Tasmania, the STF lies nominally at 47°S in the summer and 45°S in the winter. We present here SST reconstructions in a latitudinal transect of cores across the South Tasman Rise, southeast of Australia, during the late Quaternary. SST reconstructions are based on two paleotemperature proxies, alkenones and faunal assemblages, which are used to assess past changes in SST in spring and summer. The north-south alignment in core locations allows reconstruction of movement of the STF over the last 100 ka. Surface water temperatures during the last glaciation in this region were ~4°C colder than today. Additional temperature changes greater in magnitude than 4°C seen in individual cores can be attributed to changes in the water mass overlying the core site caused by the movement of the front across that location. During the penultimate interglacial, SST was ~2°C warmer and the STF was largely positioned south of 47°S. Movement of the STF to the north occurred during cool climate periods such as the last marine isotope stages 3 and 4. In the last glaciation, the front was at its farthest north position, becoming pinned against the Tasmanian landmass. It moved south by 4° latitude to 47°S in summer during the deglaciation but remained north of 45°S in spring throughout the early deglaciation. After 11 ka B.P. inferred invigoration of the East Australia Current appears to have pushed the STF seasonally south of the East Tasman Plateau, until after 6 ka B.P. when it achieved its present configuration.

Temperature and CO2 estimation for the Middle Eocene section of ODP Hole 189-1172A

The long-term warmth of the Eocene (~56 to 34 million years ago) is commonly associated with elevated partial pressure of atmospheric carbon dioxide (pCO2). However, a direct relationship between the two has not been established for short-term climate perturbations. We reconstructed changes in both pCO2 and temperature over an episode of transient global warming called the Middle Eocene Climatic Optimum (MECO; ~40 million years ago). Organic molecular paleothermometry indicates a warming of southwest Pacific sea surface temperatures (SSTs) by 3° to 6°C. Reconstructions of pCO2 indicate a concomitant increase by a factor of 2 to 3. The marked consistency between SST and pCO2 trends during the MECO suggests that elevated pCO2 played a major role in global warming during the MECO.