Gestational age, birth weight, and the risk of hyperkinetic disorder.

AIMS: To study the association between gestational age and birth weight and the risk of clinically verified hyperkinetic disorder. METHODS: Nested case-control study of 834 cases and 20 100 controls with incidence density sampling. RESULTS: Compared with children born at term, children born with gestational ages of 34-36 completed weeks had a 70% increased risk of hyperkinetic disorder (rate ratio (RR) 1.7, 95% confidence interval (CI) 1.2 to 2.5). Children with gestational ages below 34 completed weeks had an almost threefold increased risk (RR 2.7, 95% CI 1.8 to 4.1). Children born at term with birth weights of 1500-2499 g had a 90% increased risk of hyperkinetic disorder (RR 1.9, 95% CI 1.2 to 2.9), and children with birth weights of 2500-2999 g had a 50% increased risk (RR 1.5, 95% CI 1.2 to 1.8) compared with children born at term with birth weights above 2999 g. The results were adjusted for socioeconomic status of the parents, family history of psychiatric disorders, conduct disorders, comorbidity, and maternal smoking during pregnancy. Results related to birth weight were unchanged after adjusting for differences in gestational age. CONCLUSIONS: Children born preterm, also close to term, and children born at term with low birth weights (1500-2499 g) have an increased risk of clinically verified hyperkinetic disorder. These findings have important public health perspectives because the majority of preterm babies are born close to term.     

Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study

OBJECTIVE: We examined the effect of intrauterine growth restriction on mortality and morbidity in the Israel cohort of very low birth weight premature infants. METHODS: The study population included 2764 singleton very low birth weight infants without congenital malformations born from 24 to 31 weeks of gestation during 1995 to 1999. Four hundred six (15%) were born small for gestational age (SGA). The effect of SGA on death, bronchopulmonary dysplasia, and retinopathy of prematurity was assessed using multiple logistic regression analysis. RESULTS: After adjustment for perinatal risk factors, SGA infants had a 4.52-fold risk for death (95% CI, 3.24-6.33), a 3.42-fold risk for bronchopulmonary dysplasia (95% CI, 2.29-5.13), and a 2.06-fold risk for grade 3 to 4 retinopathy of prematurity (95% CI, 1.15-3.66). CONCLUSIONS: SGA premature infants had an increased risk for death, and major morbidity among survivors was increased.     

The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania

Objectives were to examine the growth patterns of preterm and growth‐restricted infants and to evaluate the associations of prematurity and intrauterine growth restriction (IUGR) with risk of stunting, wasting and underweight. Data from a cohort of HIV‐negative pregnant women–infant pairs were collected prospectively in Tanzania. Small for gestational age [SGA, birthweight (BW) <10th percentile] was used as proxy for IUGR. Anthropometry was measured monthly until 18 months. Length‐for‐age (LAZ), weight‐for‐length (WLZ), and weight‐for‐age (WAZ) z‐scores were calculated using the 2006 World Health Organization (WHO) Child Growth Standards. Stunting, wasting and underweight were defined as binary outcomes using a cut‐off of z‐scores. Multivariate Cox proportional hazard models were used to assess the associations between preterm and SGA to time to stunting, wasting and underweight. The study included 6664 singletons. Preterm and appropriate for gestational age (AGA) infants had slightly better nutritional status than term‐SGA infants and despite some catch‐up growth, preterm‐SGA infants had the poorest nutritional status. The gap in LAZ and WAZ z‐scores among the groups remained similar throughout the follow‐up. Compared with term‐AGA babies, relative risk (RR) of stunting among preterm‐AGA babies was 2.13 (95% confidence interval (CI) 1.93–2.36), RR among term‐SGA was 2.21 (95% CI 2.02–2.41) and the highest risk was among the babies who were both preterm and SGA (RR = 7.58, 95% CI 5.41–10.64). Similar magnitude of RR of underweight was observed among the three groups. Preterm and SGA infants should be closely monitored for growth failure. Intervention to reduce preterm and SGA birth may lower risk of undernutrition in resource‐limited settings.     

Risk factors for bronchopulmonary dysplasia in very low birth weight newborns treated with mechanical ventilation in the first week of life

The purpose of this study was to identify the risk factors for bronchopulmonary dysplasia (BPD) in a population of very low birth weight (BW) newborns treated with mechanical ventilation in the first week of life who survived the 28 days. The effects of antenatal steroids, sepsis, patent ductus arteriosus (PDA), fluid management and ventilator support strategies were investigated. This was a prospective study of a cohort of 86 newborns with BW below 1500 g who were born alive between the period of September 2000 to November 2002, treated at the University Hospital of Medical School Campinas, Brazil. The BPD was defined as the oxygen dependence in the 28 days, with consistent radiology findings. A logistic regression analysis was realized to identify the risk factors associated to BPD. Among the very low BW newborns, 45 developed BPD. The univariate analysis showed that besides BW and gestational age (GA), other factors such as FiO(2) > or = 0.60 (RR : 2.03; 95% CI: 1.4-2.94), PIP > or = 21 cm H(2)O (RR : 1.73; 95% CI: 1.12-2.65), surfactant therapy (RR : 1.68; 95% CI: 1.14-2.48), fluid volume on day 7 >131 ml/kg/day (RR : 1.81; 95% CI: 1.18-2.78), presence of PDA (RR : 1.95; 95% CI: 1.36-2.8) and pneumothorax (RR : 1.71; 95% CI: 1.18-2.45) were associated to an increase in the risk of BPD. When the variables were analysed concomitantly, using the multivariate logistic regression model, the most important risk factors for the development of BPD were GA < or = 30 weeks (RR : 2.76; 95% CI: 1.23-6.19), PIP > or = 21 cm H(2)O (RR : 1.92; 95% CI: 1.04-3.54), fluid volume on day 7 >131 ml/kg/day (RR : 2.09; 95% CI: 1.14-3.85) and presence of PDA (RR : 1.94; 95% CI : 1.03-3.65). The risk for BPD due to the association of these four factors was 96.4%. Finally, it was observed that the most important risk factors for BPD were prematurity, PDA and elevated levels of PIP as well as fluid volume.     

Prenatal predictors of mortality in very preterm infants cared for in the Australian and New Zealand Neonatal Network

AIM: To identify antenatal and perinatal risk factors for in-hospital mortality of babies born within the Australian and New Zealand Neonatal Network (ANZNN). METHODS: Data were collected prospectively as part of the ongoing audit of high-risk infants (birth weight <1500 g or gestation <32 weeks) admitted to all level III neonatal units in Australia and New Zealand. Antenatal and intrapartum factors to 1 min of age were examined in 11 498 infants with gestational age >24 weeks. Risk and protective factors for mortality were derived from logistic regression models fitted to 1998-9 data and validated on 2000-1 data. RESULTS: For the whole cohort of infants born between 1998 and 2001, prematurity was the dominant risk factor, infants born at 25 weeks having 32 times greater odds of death than infants born at 31 weeks. Low birth weight for gestational age also had a dose-response effect: the more growth restricted the infant the greater the risk of mortality; infants below the 3rd centile had eight times greater odds of death than those between the 25th and 75th centiles. Male sex was also a significant risk factor (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.31 to 1.82). Maternal hypertension in pregnancy was protective (OR 0.46, 95% CI 0.36 to 0.50). The predictive model for mortality had an area under the receiver operating characteristic curve of 0.82. CONCLUSIONS: Risk of mortality can be predicted with good accuracy with factors up to the 1 min Apgar score. By using gestation rather than birth weight as the main indicator of maturity, these data confirm that weight for gestational age is an independent risk factor for mortality.     

Underlying maternal and pregnancy‐related conditions account for a substantial proportion of neonatal morbidity in late preterm infants

Aim

We studied the impact of maternal and pregnancy‐related conditions and the effect of gestational age itself, on the health of infants born late preterm.

Methods

Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995–2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses.

Results

Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7–13.6) for neonatal admission to 2.3 (95% CI: 1.8–2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity.

Conclusion

Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.     

Trends in outcomes for very preterm infants in the southern region of Sweden over a 10-year period

Aim: To investigate trends in mortality and morbidity in very preterm infants.
Methods: Population-based perinatal register; liveborn infants 22 + 0 to 31 + 6 gestational weeks were investigated (time period 1995–2004). Time trends for mortality and common morbidities were explored using logistic regression analyses.
Results: Data from 1614 liveborn infants were included. There was an increase in live born infants below 25 gestational weeks, annual odds ratio (OR) 1.15 (95% CI: 1.08–1.23) and a decrease in mortality annual OR 0.82 (95% CI: 0.69–0.98). The rates of bronchopulmonary dysplasia (BPD) and sepsis increased during the study period, annual ORs of 1.10 (95% CI: 1.04–1.17) and 1.09 (95% CI: 1.03–1.16). The duration of mechanical ventilation increased for surviving infants <25 gestational weeks (p = 0.003), while the duration of continuous positive airway pressure (CPAP) increased for infants <28 gestational weeks (p = <0.001). There were no changes in the rates of intraventricular haemorrhages (IVH, 3–4), retinopathy of prematurity (ROP, 3–5), seizures or necrotizing enterocolitis (NEC).
Conclusion: During the 10-year period changes in mortality and morbidity were most pronounced for infants with GA <28 gestational weeks. The increasing rate of sepsis was present in infants <28 gestational weeks, whereas the increase in BPD was demonstrated in the whole study population <32 gestational weeks.     

Temperament in infants born prematurely

The temperament of infants born prematurely was studied to examine further the notion that prematurity may be a risk factor for an infant's subsequent social interaction. The Infant Temperament Questionnaire of Carey and McDevitt was revised and revalidated for an Australian population and sent to mothers of infants who had been born prematurely (36 weeks or less) and who were aged 4 to 8 months (corrected for prematurity). Two hundred and twenty-six questionnaires were distributed and 110 (49%) returned. There were no differences between respondents and nonrespondents with respect to gestational age, birth weight, method of delivery, Apgar scores, or perinatal complications. When compared to a control group (N = 240) of infants born at term and who came from families with similar demographic characteristics, infants born prematurely did not differ significantly on any of the nine temperament dimensions. Both groups had similar proportions of "easy," "difficult," and "slow to warm up" infants, and there were no significant differences in maternal global ratings of temperament between the two groups. Comparisons of infants of less than 33 weeks gestation gave results similar to those reported above. These data indicate that infants born prematurely have temperament profiles at 4 to 8 months similar to infants born at term.     

Mortality in out‐of‐hospital premature births

Aim: To determine whether the mortality for out‐of‐hospital (OOH) premature births was higher than for in‐hospital premature births and identify additional risk factors. Patients and Methods: A historical cohort study of a consecutive series of live‐born, OOH, births of 24–35 weeks gestation cared for by two Transport Teams working in and around Paris, France 1994–2005. Matching with in‐hospital births was according to gestational age, antenatal steroid use, the mode of delivery and nearest year of birth. Results: Eighty‐five OOH premature births were identified, of whom 83 met inclusion criteria, and 132 matching in‐hospital premature births were selected. There was 18% mortality in the OOH group compared with 8% for the in‐hospital group [p = 0.04, OR 2.9, (CI 95% 1.0–8.4)]. Variables significantly associated (p < 0.05) with the OOH birth were HIV infection, lower maternal age and endo‐tracheal intubation, lack of medical follow‐up during pregnancy, low temperature and low birth weight. Conclusions: Mortality was more than twice as high in out‐of‐hospital deliveries than for in‐hospital matched controls. Hypothermia was an important associated risk factor. Measures such as oxygen administration to maintain an appropriate saturation for gestational age, the provision of polyethylene plastic wraps and skin‐to‐skin contact are recommended.     

Psychiatric morbidity in two low birth weight groups assessed by diagnostic interview in young adulthood

Aim: To study the prevalence and characteristics of psychiatric symptoms and disorders in young adults born with low birth weight. Methods: At 20 years of age 44 very low birth weight (VLBW: birth weight ≤1500 g), 55 term born small for gestational age (SGA: birth weight <10th percentile) and 75 control subjects born 1986–1988 were assessed using the interview Schedule for Affective Disorders and Schizophrenia for School‐age children and Structured Clinical Interview for DSM‐IV Personality Disorders, Children’s Global Assessment Scale and Attention deficit hyperactivity disorder (ADHD) Rating Scale IV; self‐report and parent report. Results: Fourteen (33%) VLBW versus six (8%) control participants had a definite psychiatric disorder: OR = 5.6 (1.9–15.9). In the term SGA group, 14 (26%) had a disorder: OR = 3.9 (1.4–11.0) vs controls. Anxiety disorders and ADHD were the most frequent diagnoses. The differences were not explained by gender, assessment age or parental socioeconomic status. ADHD Rating Scale mean scores were higher in parent reports in the VLBW group and in self‐reports in the term SGA group compared with the control group. Conclusion: Children born with low birth weight whether caused by preterm birth or by growth retardation at term seem to be at increased risk for psychiatric disorders as young adults.     

A case–control study to examine the association between breastfeeding during late pregnancy and risk of a small‐for‐gestational‐age birth in Lima,Peru

Excessive demands on maternal nutritional status may be a risk factor for poor birth outcomes. This study examined the association between breastfeeding during late pregnancy (≥28 weeks) and the risk of having a small‐for‐gestational‐age (SGA) newborn, using a matched case–control design (78 SGA cases: birthweight <10th percentile for gestational age; 150 non‐SGA controls: 50th percentile <birthweight <90th percentile for gestational age). Between March 2006 and April 2007, project midwives visited daily three government hospitals in Lima, Peru and identified cases and matched controls based on hospital, gestational age, and inter‐gestational period. Mothers were interviewed and clinical chart extractions were completed. Factors associated with risk of SGA were assessed by their adjusted odds ratios (aOR) from conditional logistic regression. Exposure to an overlap of breastfeeding during late pregnancy was not associated with an increased risk of having a SGA newborn [aOR = 0.58, 95% confidence interval (CI): 0.10–3.30]. However, increased risk was associated with having a previous low‐birthweight birth (aOR = 6.53; 95% CI: 1.43–29.70) and a low intake of animal source foods (<25th percentile; aOR = 2.26; 95% CI: 1.01–5.04), and tended to be associated with being short (<150 cm; aOR = 2.05; 95% CI: 0.92–4.54). This study found no evidence to support the hypothesis that breastfeeding during late pregnancy increases the risk for SGA; however, studies with greater statistical power are needed to definitively examine this possible association and clarify whether there are other risks to the new baby, the toddler and the pregnant woman.     

Risk for birth defects among premature infants: a population-based study

OBJECTIVE: To investigate the relationship between prematurity and birth defects. STUDY DESIGN: In a population-based cohort study, infants with birth defects were ascertained through the Metropolitan Atlanta Congenital Defects Program, a surveillance system with active methods of ascertainment. Gestational age data were obtained from birth certificates of liveborn, singleton infants with and without birth defects born in the 5-county metropolitan Atlanta area. RESULTS: Among 264,392 infants with known gestational ages born between 1989 and 1995, 7738 were identified as having birth defects (2.93%). Premature infants (<37 weeks' gestation) were more than two times as likely to have birth defects than term infants (37-41 weeks) (risk ratio = 2.43; 95% CI 2.30-2.56). This relationship was evident for several categories of birth defects. The rate of birth defects varied by gestational age categories, with the highest risk in the 29- to 32-week gestational age category (risk ratio = 3.37). CONCLUSIONS: The risk for birth defects is increased in premature infants. Awareness of this relationship is important for clinicians caring for premature infants. The morbidity and mortality associated with a particular defect may be significantly altered by the presence of prematurity. Further study of this association may provide insight into the etiology of these relatively common problems.     

Chronic lung disease of prematurity and early childhood wheezing: Is foetal inflammatory response syndrome to blame?

BackgroundLong-lasting respiratory symptoms have a huge impact on the quality of life in prematurely born children.AimsWe aimed to investigate the perinatal and maternal risk factors involved in the development of chronic respiratory morbidity in preterm infants, with an emphasis on the importance of Foetal Inflammatory Response Syndrome (FIRS).Study designProspective cohort study.SubjectsDemographic, antenatal, delivery and outcomes data were collected from 262 infants with less than 32 completed weeks of gestational age, over a 10-year period.Outcome measuresPresence of chronic lung disease of prematurity and early childhood wheezing.ResultsIn multivariate logistic regression analysis the presence of FIRS appears to be the most important risk factor for both, chronic lung disease of prematurity (OR 31.05, 95% CI 10.7–87.75, p < 0.001) and early childhood wheezing (OR 5.63, 95% CI 2.42–13.05, p = 0.01). In the alternative regression model for early childhood wheezing, with chronic lung disease included as a variable, the statistical significance of FIRS completely vanished (OR 1.15, 95% CI 0.39–3.34, p = 0.79), whilst chronic lung disease became the most important risk factor (OR 23.45, 95% CI 8.5–63.25, p < 0.001).ConclusionsPrenatal and early neonatal events are of utmost importance in the development of chronic respiratory symptoms in children. The influence of FIRS on the development of chronic respiratory symptoms goes far beyond its impact on gestational age and may be related to direct inflammation-mediated lung tissue damage. CLD appears to be an intermittent step on the way from FIRS to ECW.     

Risk factors for bronchopulmonary dysplasia in neonates born at ≤1500 g (1999–2009)

Background: Advances in perinatal care have improved the survival rate for very low‐birthweight (VLBW) infants in China. The incidence of bronchopulmonary dysplasia (BPD), however, has not been reduced. The objective of the present study was to identify the perinatal risk factors for BPD in neonates born at ≤1500 g. Methods: A retrospective analysis of data for neonates born at ≤1500 g between 1999 and 2009 in the neonatal intensive care unit (NICU) of Second Affiliated Hospital of Sun Yat‐Sen University, Guangzhou city, China, was carried out. Results: Out of a total of 11 506 live births, 3538 infants were admitted to level II nursery and NICU (level III nursery). Among 149 preterm infants born at ≤1500 g, 77.8% survived until day 28, and the incidence of BPD was 48.3%. Logistic regression analysis showed that gestational age (GA) ≤30 weeks (odds ratio [OR], 9.507; 95% confidence intervals [95%CI]: 2.604–34.707), maternal chorioamnionitis (OR, 41.987; 95%CI: 6.048–291.492), ventilation‐associated pneumonia (OR, 11.600; 95%CI: 2.847–47.268), and more than three blood transfusions (OR, 10.214; 95%CI: 2.191–47.623) were associated with the development of BPD. Conclusion: Clinical evidence has been provided for possibly significant risk factors associated with BPD in neonates born at ≤1500 g, which can provide useful information for further research to improve survival of VLBW infants and decrease the incidence of BPD.     

Descriptive epidemiology of hemivertebrae, Hawaii, 1986-2002

The intent of this study was to report on the epidemiology of hemivertebrae. Cases were derived from a population-based birth defects registry in Hawaii and comprised all infants and fetuses with hemivertebrae delivered during 1986-2002. Hemivertebrae rates per 10 000 births were determined for selected factors and comparisons made by calculating the rate ratio (RR) and 95% confidence interval (CI). Forty-two cases of hemivertebrae were identified, for a total rate of 1.33. Forty-one of the cases were live births, of which 26.83% expired within one year after delivery. Other major structural birth defects were found in 95.24% of the cases. The most frequent associated defect was scoliosis, affecting 54.76% of the cases. The rate among females was significantly lower than among males (RR 0.48, 95% CI 0.23-0.94). The rate was lower with maternal age > or =35 years (RR 0.50, 95% CI 0.10-1.57) and higher with birth weight < 2500 g (RR 5.96, 95% CI 2.84-11.90) and gestational age < 38 weeks (RR 3.94, 95% CI 2.01-7.64). The majority of hemivertebrae cases had other major structural birth defects. Hemivertebrae occurred predominantly among males and risk was lower with increased maternal age. Rates for hemivertebrae were higher with lower birth weight and gestational age. Further population-based research involving larger study populations are recommended to confirm these observations.     

New insights into the development of retinopathy of prematurity – importance of early weight gain

Evidence is accumulating that one of the strongest predictors of retinopathy of prematurity (ROP), in addition to low gestational age, is poor weight gain during the first weeks of life. In infants born preterm, the retina is not fully vascularised. The more premature the child, the larger is the avascular area. In response to hypoxia, vascular endothelial growth factor (VEGF) is secreted. For appropriate VEGF‐induced vessel growth, sufficient levels of insulin‐like growth factor I (IGF‐I) in serum are necessary. IGF‐I is a peptide, related to nutrition supply, which is essential for both pre‐ and post‐natal general growth as well as for growth of the retinal vasculature. In prematurely born infants, serum levels are closely related to gestational age and are lower in more prematurely born infants. At preterm birth the placental supply of nutrients is lost, growth factors are suddenly reduced and general as well as vascular growth slows down or ceases. In addition, the relative hyperoxia of the extra‐uterine milieu, together with supplemental oxygen, causes a regression of already developed retinal vessels. Postnatal growth retardation is a major problem in very preterm infants. Both poor early weight gain and low serum levels of IGF‐I during the first weeks/months of life have been found to be correlated with severity of ROP. Conclusion: This review will focus on the mechanisms leading to ROP by exploring factors responsible for poor early weight gain and abnormal vascularisation of the eye of the preterm infant.     

Risk for schizophrenia in intercountry adoptees: a Danish population-based cohort study

BACKGROUND: Increasing numbers of intercountry adoptees are reaching adulthood, the age of onset for most serious mental disorders. Little is known about the development of schizophrenia in intercountry adoptees, a group with potentially increased vulnerability. The aim of this study was to investigate the risk of developing schizophrenia in adoptees and in non-adoptees. METHODS: Utilising data from the Danish Civil Registration System, we established a population-based cohort of 1.06 million persons resident in Denmark before the age of 15, whose legal mother lived in Denmark at the child's birth. Intercountry adoptees were identified as children born abroad. Record linkage provided information on psychiatric admissions.RESULTS: Intercountry adoptees had an increased relative risk (RR) (RR = 2.90, 95% CI 2.41-3.50) of developing schizophrenia compared to native Danes. The increased risk was independent of age at onset and age at, or region of, adoption, and was not attributable to mental illness in a foster parent, the foster parent's age, or to urbanisation. The foster mother's own biological offspring had also an increased risk of developing schizophrenia (1.92, 95% CI 1.23-3.02). CONCLUSIONS: Young adult intercountry adoptees are at increased risk for schizophrenia. Although the underlying cause is unknown, a complex interplay of factors presumably may be involved, including heredity, adversity prior to adoption, and post-adoption adjustment difficulties during upbringing.     

Risk factors for the different types of chronic lung diseases of prematurity according to the preceding respiratory distress syndrome

BACKGROUND: Recently, atypical chronic lung disease (CLD) of prematurity that develops in the absence of preceding respiratory distress syndrome (RDS) have been observed frequently. The specific risk factors for atypical CLD that are presumed to be different from those for classical CLD that develops following RDS were assessed. METHODS: Prospective cohort analysis was done from 115 very low-birthweight infants who were born in Seoul National University Hospital, Seoul, Korea, and survived more than 36 weeks postmenstrual age or 28 days of life. All subjects were classified into either a preceding RDS group (n = 35) or a non-RDS group (n = 80). Logistic regression analysis was done for the multivariate assessment of specific risk factors for CLD in both groups. RESULTS: The analysis showed that short gestational age (GA; relative risk [RR], 3.1 per 1 week decrement; 95% confidence intervals [CI], 2.7-3.4), of the male gender (RR, 9.8; CI, 0.9-112), and poor response to surfactant (RR, 14; CI, 1.2-156) were significant risk factors for CLD in the preceding RDS group. In the non-RDS group, chorioamnionitis was one of the significant risk factors for CLD (RR, 4.8; CI, 1.1-21) along with short GA and high mean airway pressure (MAP) during the first 3 days of life. CONCLUSION: Chorioamnionitis was a risk factor for atypical CLD in addition to short GA and high MAP during the early postnatal period, and poor response to surfactant was a risk factor for classical CLD in addition to short GA and being male. Therefore, CLD is considered to have type-specific risk factors.     

Periconceptional folic acid fortification for the risk of gestational hypertension and pre‐eclampsia: a meta‐analysis of prospective studies

Published literatures report controversial results about the association of folic acid–containing multivitamins with gestational hypertension and pre‐eclampsia. A comprehensive search was performed to identify related prospective studies to assess the effect of folic acid fortification on gestational hypertension and pre‐eclampsia. The Q test and I² statistic were used to examine between‐study heterogeneity. Fixed or random effects models were selected based on study heterogeneity. A funnel plot and modified Egger linear regression test were used to estimate publication bias. Eleven studies conformed to the criteria. Pooled results indicated that folic acid fortification alone was not associated with the occurrence of gestational hypertension [relative risk (RR) = 1.03, 95% confidence interval (CI): 0.98–1.09, P = 0.267] and pre‐eclampsia (RR = 0.99, 95% CI: 0.90–1.08, P = 0.738). However, supplementation of multivitamins containing folic acid could prevent gestational hypertension (RR = 0.57, 95% CI: 0.43–0.76, P < 0.001) and pre‐eclampsia (RR = 0.64, 95% CI: 0.48–0.84, P = 0.001). The difference between folic acid fortification alone and multivitamins containing folic acid was significant. This meta‐analysis suggests that periconceptional multivitamin supplementation with appropriate dose, not folic acid alone, is an appropriate recommendation for pregnant women. The effect should be further confirmed by conducting large‐scale randomised controlled trials.     

Precocious pubarche is associated with SGA, prematurity, weight gain, and obesity

Background: Perinatal stress is thought to underlie the Barker sequelae of low birth weight, of which precocious pubarche may be a manifestation. Aims: To explore whether prematurity as well as smallness for gestational age (SGA) predisposes to precocious pubarche, and the potential role of excess weight gain during childhood. Methods: Retrospective chart review of 89 children (79 girls) with precocious pubarche. Results: Sixty five per cent were overweight/obese at diagnosis, compared with 19–24% of Australian children. Thirty five per cent had a history of SGA and 24% of prematurity. Weight SDS increased from birth to diagnosis in 91% of children. The mean change in weight SDS from birth to diagnosis was greater in those who were SGA (2.8, 95% CI 2.2 to 3.4) versus AGA (1.7, 95% CI 1.3 to 2.2), with no difference in the incidence of overweight/obesity. The latter was lower among children born premature (40% versus 72% term) but was associated with a mean increase in weight of 1.3 SDS during childhood. Nine out of ten girls and boys with precocious pubarche had at least one of the three risk factors studied. Conclusions: Both prematurity and SGA were associated with precocious pubarche, as was overweight/obesity, irrespective of size or gestation at birth. Excess weight gain in childhood may predispose to precocious pubarche in susceptible individuals.