Psychological development in children born with very low birth weight after severe intrauterine growth retardation: a 10-year follow-up study

Children born small for gestational age (SGA) and children having very low birth weight, less than 1500 g, are claimed to be at risk of developmental problems, even when obvious pathology and disability are absent. In this study, sensorimotor and cognitive development of 14 medically healthy, very-low-birth-weight and small-for-gestational-age children were investigated. The children were born at the Karolinska Hospital between 1979 and 1981. At the time of the assessment, the children were aged 8.7-11.2 years. The assessment instruments included the Wechsler Intelligence Scale for Children, a modified version of the Bruininks-Oseretsky Test of Motor Proficiency, as well as selected subtests from the Halstead-Reitan Neuropsychological Battery and from the Southern California Tests of Sensory Integration. Information was also obtained from obstetric, neonatal and pediatric records, which included early developmental assessments. As a control group, 14 children were recruited and matched for age, sex and socio-economic background. The very-low-birth-weight-small-for-gestational-age group scored significantly lower on measures of visuospatial ability, non-verbal reasoning, strategy formation and gross-motor coordination. The group differences were largely attributable to the subnormal performance of eight of the very-low-birth-weight-small-for-gestational-age children. These children, who also tended to be born earliest (less than 33 weeks), had a high incidence of behavioral and educational problems. These findings are consistent with the view that the very preterm infant develops a different neurobehavioral organization than a full-term infant. Developmental deficits may become increasingly evident in the early school years.     

The growth of low-birth-weight children

The growth of 171 seven-year-old children, free from major disability, with a birth weight of 2000 g or less was examined and compared with that of their own parents and of normal-birth-weight peers. Measurements included height, weight, occipitofrontal circumference, biparietal, occipitofrontal and bi-iliac diameters, triceps and subscapular skinfold thickness. Low-birth-weight children were shorter than their parents whereas those of normal birth weight were taller. For all parameters, particularly weight, the low-birth-weight children were significantly less well grown. There was no significant relationship between occipitofrontal circumference and intellectual ability.     

香港地区3～18岁儿童青少年肥胖发生率调查

１９９３年香港对０～１８岁儿童进行了全面的生长发育调查，制定了各项生长标准。本研究采用身高标准体重中位数的１２０％作为判定肥胖的标准，发现香港３～１８岁儿童青少年的肥胖发生率为１０．０８％（男１１．２８％，女８．９３％），比内地及香港以往报道的数值都高。调查结果显示儿童从６岁开始肥胖发生率逐渐增高，女孩８岁、男孩１１岁时出现１个高峰。同时说明香港地区随着经济飞跃发展，出现儿童营养过多的现象，需尽早采取预防措施。     

The effect of recurrent tonsillitis and tonsillectomy on growth in childhood

The aim of this study was to determine if children with recurrent tonsillitis are smaller than expected before tonsillectomy and if they have an altered height or weight gain 1 year post-operatively. All (204) children attending the hospital for tonsillectomy with or without adenoidectomy had their height and weight measured pre-operatively and 1 year after operation. The results of 2204 children in local schools were used as a control population. Analysis was by comparison of each population with the Tanner charts. This study suggests that our population of children listed for tonsillectomy were not lighter or smaller than expected before operation but that one year after tonsillectomy, there was an increase in their weight gain. The height gain was no different than expected after operation. Overweight seems to be a medium term complication of tonsillectomy. It may be necessary to redefine the indications for tonsillectomy in children who are already obese.     

The effect of passing an "anti-immigrant" ballot proposition on the use of prenatal care by foreign-born mothers in California

This study examines whether the passage of California's Proposition 187, a proposition designed to restrict undocumented immigrants from using public services, had a negative effect on the use of prenatal care and birth outcomes. Comparisons of prenatal care use and birth outcomes before and after the passage of the proposition are made between low-education foreign-born and U.S.-born mothers using California's Birth Public Use files. Multivariate linear and logistic regressions were used to control for regional and maternal characteristics. We find a significant but small decline in the use of prenatal care by low-education foreign-born women after Proposition 187 passed; however, there was no detectable deterioration of birth outcomes. Whether future reductions in the availability of prenatal care would damage the health of children is unclear.     

Explaining the birth weight paradox: Latina immigrants' perceptions of resilience and risk

In the US, prenatal care is positively associated with improved birth outcomes. However, among Mexican-born Latinos, rates of low birth weight are lower than those of US-born counterparts despite the fact that recently arrived Latino immigrants are less likely to have received adequate prenatal care. The birth weight paradox, identified through analysis of the HHANES, appears to hold constant across variations in age, marital status or educational attainment. The authors explore Latina immigrant's perceptions of resilience factors related to these better birth outcomes through focused group interviews, photonarratives, and documentation of local kin networks. The women's responses are grouped into five resilience factors and one risk complex that have the potential to further explain the HHANES findings. Women's responses, the stories of their photographs, and kin networks are presented. Knowledge of these protective and risk factors can be useful to health professionals and Latino advocacy groups in the design of community-based interventions that protect health status and promote the practice of protective health behaviors within immigrant families and communities.     

Mortality in 504 infants weighing less than 1501 g at birth and treated in four neonatal intensive care units of South-Belgium between 1976 and 1980

Mortality was studied in 504 infants weighing less than 1501 g at birth and treated in four neonatal intensive care units of South-Belgium between 1976 and 1980. Two hundred and twenty-one babies died during their stay at the hospital, a mortality rate of 438 per 1000 live births. The neonatal mortality rate (mortality during the first 28 days of life) was 373 per 1000 live-births. Thirty-three infants died after the neonatal period, which is 15% of the total number of deaths. Twothirds of these post-neonatal deaths were related to complications of diseases associated with pre-term delivery. Mortality rates were higher in infants of less than 1001 g than in those of 1001–1250 g or 1251–1500 birth weight. In each birth weight category, patients born in their own obstetrical departments and referred infants had similar mortality rates. Longitudinal analysis showed improving mortality rates between 1976 and 1977 in the total population of VLBW infants, between 1977 and 1978 in infants of <1001 g and in 1980 compared to 1976 in the 1251–1500 g group. There were higher incidences of need for ventilatory assistance, patent ductus arteriosus, necrotising enterocolitis and septicaemia in referred patients of <1001 g than in patients born in their own obstetrical departments with comparable birth weight. Artification ventilation was more often required in referred infants of 1251–1500 g. This study confirms the importance of considering at least the complete hospital stay when analysing mortality in VLBW infants. Infants of <1001 g had high mortality, particularly after the neonatal period. This phenomenon was asscciated with complications of morbid conditions related to extreme prematurity.Abbreviations VLBW very low birth weight - PDA patent ductus areeriosus - NEC necrotising enterocolitis     

The “Critical volume tolerance method” for estimating the limits of dose escalation during three-dimensional conformal radiotherapy for prostate cancer

: To describe the “Critical Volume Tolerance” (CVT) method for defining normal tissue tolerance during 3D-based dose escalation studies for prostate cancer.

: The CVT method predicts the tolerance to radiation for “in series”-type functional units based on the assumption that tolerance depends on a critical threshold “low-volume high-dose region.” The data used for describing this model were generated from 3D analysis of randomly selected patients with prostate cancer. Commonly used coplanar frou- and six-field conformal (SFC) techniques were chosen as the comparison techniques. For purposes of comparison, rectal tolerance was assumed to be reached following whole pelvic irradiation using a four-field box technique to 50 Gy, followed by a conedown boost to 70 Gy using bilateral 9 × 9 cm 120 degree arcs as popularized by investigators from Stanford University (SUH).

: Based on the average dose volume histograms for the patients studied, the maximum safe increase in dose for the SFC technique compared to the SUH technique, would be 10% if 30% of the rectal volume was the critical dose limiting volume (CVT = 30%), 5%if the CVT = 10%, or greater than 20% if the CVT = 40%. Commonly used four-field conformal techniques would not be expected to allow significant escalation of the dose without increasing the risk of complications.

: The CVT method is relatively simple, and data general based on it can be used to support normal tissue complication probability equations. The CVT method can be verified or modified as partial tolerance data become available. Based on the CVT model, sophisticated treatment techniques should allow a modest increase in the total dose of radiation delivered to the prostate without an increase in late complications.     

Body fluid compartment changes following cardiopulmonary bypass in dogs

To investigate whether pulsatile perfusion affects postoperative edema, we examined weight, total body water (TBW), and extracellular fluid (ECF) following cardiopulmonary bypass (CPB) in dogs using three different perfusion systems. Fourteen dogs were divided into three groups differing only in the perfusion system used: Sarns nonpulsatile and pulsatile roller pumps and a University of Texas pulsatile pump. Weight, TBW, and ECF were measured preoperatively and on postoperative days (POD) 1, 3, and 7. No significant differences were seen in body weight, TBW, or ECF between groups. Body TBW (percent of body weight) rose significantly (P=0.005) to 72% on POD 3 and 7. ECF (percent of body weight) rose to 58% by POD 7 (P=0.008). These three perfusion systems produced no differences in the pattern of postoperative body fluid distribution after CPB, suggesting that there is no advantage to pulsatile perfusion for the purpose of decreasing postoperative edema.