Postural development in very low birth weight and normal birth weight infants

In this study the seven postural responses selected by Vojta to evaluate neuromotor development were applied to 68 very low birth weight (VLBW) (greater than 1500 g) infants and to 28 healthy infants of normal birth weight (less than 2500 g). Of the 68 VLBW infants, 41 were small for gestational age and 27 appropriate for gestational age. All infants were examined between 37 and 40 weeks postmenstrual age. They were all later assessed on the Griffiths Mental Developmental Scale at 12 and 18 months. There were significant differences in postural reactions between the two groups which confirmed the lower tone and greater extension previously described in very low birth weight infants. An important finding in the study was that poor head and trunk righting noted at four months corrected age in very low birth weight infants, was associated with less developed locomotion at 12 and 18 months as assessed by the Griffiths Mental Developmental Scale. Thus, a delay in maturation in very low birth weight infants which was apparent from the assessment of postural responses in early infancy was still identifiable on the locomotor subscales at 12 and 18 months. Five of Vojta's responses were shown to be useful as part of the neurological assessment of high risk infants.     

早期干预对早产儿和低出生体重儿在婴儿期行为发育的影响

目的：探讨早期干预早产儿和低出生体重儿在婴儿期行为发育的作用。方法：采用自行设计的早期干预方法，通过指导家长对实验组实施，另设对照组，用Gesell婴幼儿发育检查表测两组在3，6，9，12个月时的行为发育商（DQ），并作比较，结果：实验组在适应性，大运动，精细动作、语言和社会交往5个能区的DQ均值在各月龄段均高于对照组，且从3个月开始在精细动作和社会交往能区与对照组比较，存在统计学差异，在9．12个月龄阶段两组各能区的DQ经统计学检验，除大运动能区存在差异（P＜0．05）外，其他能区DQ均存在极显著性差异（P＜0．01），结论：早期干预对早产儿和低出生体重儿在婴儿期就有良好的促进作用，早期干预应该越早越好。     

Long-chain polyunsaturated fatty acid status and early growth of low birth weight infants

We correlated arachidonic acid (AA) and docosahexaenoic acid (DHA) status with anthropometric measures and growth rates in a group of low birth weight infants (≤2500 g; gestational ages 30–41 weeks; n = 143). AA and DHA status were measured in erythrocytes (RBC) and plasma cholesterol esters (CE) during days 10 to 42. Infants received preterm formula without long-chain polyunsaturated fatty acids (LCP; n = 81), with LCP (n = 29) or maternal milk (n = 33). RBC AA contents on day 10 were correlated (P < 0.05) with birth weight in breast-fed infants and all formula-fed infants, with on day 10 a standard deviation score (SDS) for weight, length and occipito-frontal circumference in all formula-fed infants, and with on day 10 an SDS for length in breast-fed infants. Brain weight was related to RBC DHA and CE DHA contents on both day 10 and day 42 in formula-fed infants. Of the variances of brain growth parameters on day 42, 21–34% were explained by DHA status on day 42 and protein intake from days 10–42. Conclusion We conclude that parameters of early neonatal AA status are related to intra-uterine rather than to post-natal growth. Parameters of post-natal brain growth are related to RBC DHA and CE DHA contents on day 42, and to dietary protein intake. These results point to the importance of dietary DHA for brain growth in the first 6 post-natal weeks. Received: 23 July 1996 / Received in revised form and accepted: 18 June 1997     

Copper status of very low birth weight infants during the first 12 months of infancy.

The Cu intake and status of 106 very low birth weight (VLBW) infants (birth weight 1152 +/- 251 g, gestational age 29 +/- 3 wk, mean +/- SD) were determined approximately 1 mo before hospital discharge, at discharge (time 0), and at 3, 6, 9, and 12 mo +/- 3 wk corrected for gestational age. Infants were fed either formula plus supplemental Zn/Cu (SUPPL, n = 29); formula plus placebo (PLAC, n = 26); or a low birth weight formula (LBWF, n = 26) or were breast-fed (BRMLK, n = 25). Plasma Cu levels in the formula-fed infants increased significantly at each time period with no significant differences between feeding groups. Hair Cu was significantly higher in the SUPPL group compared to the PLAC, LBWF, and BRMLK groups at 3 and 6 mo. Erythrocyte Cu,Zn-superoxide dismutase (CuZnSOD) activity was lowest in the PLAC group. Cu intake was positively correlated with both hair Cu (r = 0.291, p less than 0.0001) and erythrocyte CuZnSOD activity (r = 0.281, p less than 0.001) but not with plasma Cu. An increasing number of formula-fed infants had very low CuZnSOD activity (less than 2 SD below mean) with increasing age (n = 1, 2, 8, 11, and 13 infants at times 0, 3, 6, 9, and 12 mo, respectively). At 12 mo, approximately one third of the formula-fed VLBW infants in this study had low Cu status as assessed by CuZnSOD activity. Infants with the lowest CuZnSOD activity were those with the largest weight gains from 0 to 6 mo and were observed in all formula-fed groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

极低及超低出生体重儿的预后因素分析

目的 分析极低及超低出生体重儿（出生体重≤ 1 200 g）的临床资料,为其预后及临床干预提供预警指标。方法 回顾性分析108 例极低及超低出生体重儿的母孕期病史、新生儿出生时情况、诊治经过及预后,采用非条件logistic 回归分析筛选预后的影响因素。结果 108 例极低及超低出生体重儿,出生体重范围在结论 极低及超低出生体重儿的病死率较高,且随着日龄的增加,影响早产儿生存的预后因素不同,临床上应针对这些因素制定合理的管理方案,提高早产儿生存率。     

Predictors of one-year developmental status in low birth weight infants

The purpose of the present study was to describe the relations among various perinatal, environmental, and demographic measures in a sample of low birth weight infants and to relate those measures to 1-year developmental status. Perinatal variables included birth weight, gestational age, Apgar scores, and summary measures of respiratory distress and morbidity. Home visits provided ratings of the infants' environment at 7 and 12 months corrected age. The Bayley Scales of Infant Development were given at the 12-month home visit. A principal components factor analysis revealed four factors. The first factor was labeled an immaturity-illness factor, since it was primarily composed of gestational age, birth weight, and the respiratory distress and morbidity summary scores. Ratings of the infant's home environment loaded on the second factor, the demographic variables on the third factor, and the 1- and 5-minute Apgar scores comprised the fourth factor. The four factor scores together with the number of delays on the Denver Developmental Screening Test, given at 7 months corrected age, were entered as independent variables in four multiple regression analyses with the corrected and uncorrected mental development index index (MDI) and psychomotor development index (PDI) Bayley scores as the dependent variables. These regression analyses indicated that 1-year developmental status is a reflection of the infant's immaturity and neonatal morbidity, the quality of his or her home environment, and freedom from sensorimotor delays.     

Crying behaviour in early infancy is associated with developmental outcome at two years of age in very low birth weight infants

AIM: To evaluate the association between infant fussing and crying and developmental outcome in very low birth weight (VLBW) infants. METHODS: Hundred and seventeen VLBW infants were followed up to 24 months of corrected age. The duration of fussing and crying and frequency of fuss/cry bouts were measured at term 6 weeks and 5 months of corrected age. Cognitive and motor development was assessed at 24 months of corrected age. RESULTS: The increased duration of combined fuss/cry at term associated with lower psychomotor developmental index (PDI), [regression coefficient (b)=-0.83, p=0.025]. Crying at term associated negatively with mental developmental index (MDI) (b=-0.91, p=0.040) and PDI (b=-1.10, p=0.015). The associations between fuss/cry and PDI, and crying and PDI persisted in multiple regression analysis (b=-0.89, p=0.030 and b=-1.23, p=0.018, respectively). Excessive fuss/cry (>or=180 min/day) at term associated with lower PDI (p=0.005) and at 6 weeks with lower MDI (p=0.024) and PDI (p=0.012). Increase in the frequency of fuss/cry bouts at 5 months associated with higher PDI in both simple (b=2.90, p=0.045) and in multiple regression analysis (b=3.60, p=0.019). CONCLUSIONS: In VLBW infants, longer duration of fussing and crying in very early infancy, but not at 5 months, is associated with less optimal development at 24 months of age.     

Urinary neutrophil gelatinase-associated lipocalin at birth predicts early renal function in very low birth weight infants

Preterm infants are exposed to conditions that can impair renal function. We evaluated the ability of serum and urinary neutrophil gelatinase-associated lipocalin (sNGAL and uNGAL) to predict renal function in the first weeks of life. From September 2008 to July 2009, infants weighing ≤1500 g at birth with no major congenital anomalies or sepsis were eligible. We measured sNGAL and uNGAL levels at birth. To evaluate renal function, we determined changes in serum creatinine (sCreat) and estimated GFR (eGFR) from birth to d 21. Forty neonates (mean GA, 27 ± 2 wk) completed the study. Renal function improved in 32 of 40 (80%) infants (normal renal function, NRF group) (sCreat, from 0.97 ± 0.2 to 0.53 ± 0.13 mg/dL; eGFR, from 15.3 ± 4.1 to 28.6 ± 7.9 mL/min), whereas renal function worsened in 8 of 40 (20%) infants (impaired renal function, IRF group) (sCreat, from 0.71 ± 0.27 to 0.98 ± 0.43 mg/dL; eGFR from 23 ± 14.7 to 16.4 ± 9.1 mL/min). The uNGAL/urinary creatinine (uCreat) ratio at birth was higher in the IRF group (31.05 ng/mg) than the NRF group (6.0 ng/mg), and uNGAL was significantly higher in IRF group, detecting IRF with a cutoff of 100 ng/mL. uNGAL levels at birth may have a predictive role in very LBW (VLBW) infants.     

Carnitine status and blood ammonium levels in low birth weight infants

Forty-three low birth weight infants appropriate for gestational age (AGA) were monitored to evaluate carnitine status in relation to blood ammonium levels. The infants were grouped into three depending on blood ammonium level on postnatal day 7: 62.9 +/- 3.8 mumol/L in group 1 (N = 13), 38.9 +/- 8.4 mumol/L in group 2 (N = 23), and 24.5 +/- 2.9 mumol/L in group 3 (N = 9). Plasma free carnitine levels decreased in all three groups (p less than 0.001) and plasma short chain acylcarnitine increased only in group 1 (p less than 0.002), compared to findings in normal infants. The blood ammonium level positively and negatively correlated to plasma short chain acylcarnitine (p less than 0.002) and plasma free carnitine levels (p less than 0.002), respectively. The reabsorption rate of free carnitine in renal tubules (RRFC) was decreased at rates of 37.5, 27.5, and 25% of infants in groups 1, 2, and 3, respectively. The acylcarnitine/free carnitine clearance ratio (RAFCC) was decreased in groups 1 (p less than 0.01) and 2 (p less than 0.05) compared with group 3. Thus, an accumulation of short chain acyl moieties and insufficiency in renal absorption of free carnitine are putative causes of lowered plasma free carnitine in infants with higher blood levels of ammonium. The possibility that the carnitine status regulates blood ammonium levels in low birth weight infants warrants continued investigation.     

The vitamin status of low birth weight infants and their mothers

The levels of vitamins A, E, B1, B2, folate, and B12 were measured in maternal blood, cord blood, and in 5-day neonate capillary blood samples. Twenty-six infants and their mothers served as controls and were compared with 32 low birth weight (LBW) infants. LBW infants showed significantly lower levels of vitamins A, E, B2, and folate than the controls. The folate status of mothers of LBW infants was significantly lower (7 +/- 1.8 ng/ml) than that of control mothers (21 +/- 0.8 ng/ml).     

Neurodevelopmental, functional and growth status of term low birth weight infants at eighteen months

This study was done to evaluate the neurodevelopmental, functional and growth status of term infants weighing 2000 g or less at 18 months, and to analyze major medical and social factors associated with an adverse neurodevelopmental and/or functional outcome. All infants were assessed for growth, audio-visual, neurological impairment, and motor and mental development using Indian modification of Bayley Scales of infant development. A detailed history was also taken. Term infants with birth weight of >2500 g without any antenatal or neonatal complications served as controls. Fifty low birth weight (LBW) term infants and 30 controls were evaluated. The mean mental development Quotient for LBW infants [91.51(16.97)] was significantly lower than that of Controls [102.02(8.4)]; the mean motor development Quotient however was comparable. The LBW infants were significantly lagging in terms of weight, length and head circumference at assessment. Neonatal complications were associated with an abnormal motor outcome while lower Socio-economic status and maternal education were related to adverse mental status. We concluded that Term LBW infants are at a significant disadvantage in terms of growth and mental scores at 18 months.     

Iron status in low birth weight infants on breast and formula feeding

Iron status in 15 low birth weight infants, 1000–2499 g, on breast feeding was studied longitudinally for the first 6 months of age, and the findings compared to those of 30 low birth weight infants receiving a proprietary iron-fortified formula. The two groups received no iron supplement until they developed iron deficiency. The incidence of iron deficiency at 6 months was significantly greater in the breast-fed group than in the formula-fed group (86% v 33%). The breast-fed group had significantly lower serum ferritin and hemoglobin values after 4 months of age. The findings indicate that breast-fed low birth weight infants have a higher risk of developing iron deficiency and should receive iron supplementation from 2 months of age.Abbreviations TIBC total iron-binding capacity - MCV mean corpuscular volume