A study of growth prediction of low-birth-weight infants

To predict the time required for low-birth-weight (LBW) infants to catch-up with standard weight, the growth curves for weight in 156 LBW infants with no medical abnormalities were examined. The proportion of infants who caught-up with standard weight by 1.5 years of age was significantly higher in appropriate-for-dates (AFD) infants than in small-for-dates (SFD) infants (93% vs. 70%). The age of catch-up with standard weight had a significant inverse correlation with birth weight in AFD infants, and not in SFD infants. The age of catch-up standard weight of AFD infants, as predicted by the regression analysis was 4-8 months for 2,000 g of birth weight, 8-12 months for 1,500 g, and 12-15 months for 1,000 g, with about 80% accuracy. This prediction may be valuable in providing health advice to mothers with LBW infants.     

Follow-up study related to raising low-birth-weight infants relationship among physical growth, mental development and child-rearing anxiety

OBJECTIVE: In order to clarify relationship among physical growth, mental development of low-birth-weight (LBW) infants and child-rearing anxiety of mothers, a follow-up study was accomplished for LBW cases from birth to three years of age in a regional group. METHODS: A self-administered questionnaire survey was conducted for mothers whose premature infants were born from April 1992 through March 1993 and whose existence was confirmed from April 1995 through March 1996 in Fukui prefecture. A control group was selected from mature infants whose gestation was 37 weeks or more, who were born in the same year and in the same region. The questionnaire was focused on fetal and child growth, as well as child-rearing anxiety. RESULTS: Of the subjects, while including only 6% very LBW infants, the percentage of full-term LBW infants was 55.3% and that of pre-term LBW infants was 44.7%. In the former group, the mean birth weight (MBW) was 2,319 g, the percentage of females was 63.3%, firstborn children was 59.2%, and light-for-dates (LFD) infants due to intrauterine growth retardation 76.9%. In the latter group, the MBW was 1,983 g, the percentage of females was 52.9%, that of firstborn children was 44.5%, and LFD infants was 14.3%. The growth of the LBW infants through the age of three fell into the same category of growth as the upper portion (1,250-1,499 g) of the very LBW infants rather than that of the mature infants. While the growth of appropriate-for-dates (AFD) infants at full-term were normal, that of LFD infants and pre-term infants was insufficient, and the percentage of those demonstrating catch-up of mature infants was less than 80%. The group of pre-term infants was retarded in the gross motor skills, but not language understanding and pronunciation of two-word sentences. The child-rearing anxiety in mothers who delivered pre-term infants was extremely severe after child birth. As the child grew older, however, the feeling of uneasiness was reduced. Mothers who were delivered of full-term LBW infants did not exhibit any fluctuation in child-rearing anxiety during the first three years. CONCLUSION: Fetal size affects growth progress of children. The prognosis of LBW infants is not satisfactory and mothers who deliver full-term LBW infants continue to worry about their child's growth.     

Mineral requirements of low-birth-weight infants.

The minerals calcium (Ca), magnesium (Mg), and phosphorus (P) are essential for tissue structure and function. Recent studies have resulted in a more rational approach to the management of mineral intake in preterm infants receiving parenteral nutrition (PN) and enteral nutrition (EN). For preterm infants requiring PN, the use of PN solutions with a Ca content of 1.25-1.5 mmol/dl (50-60 mg/dl), a P content of 1.29-1.45 mmol/dl (40-45 mg/dl), and an Mg content of 0.2-0.3 mmol/dl (5-7 mg/dl) is supported by studies of mineral homeostasis with serial chemical and calciotropic hormone measurements, standard balance studies, and improved radiographic indices of bone mineralization. For infants requiring EN, an intake of approximately 4 mmol (200 mg) of Ca, 3.2 mmol (100 mg) of P, and 0.33 mmol (8 mg) of Mg/kg/day based on an average retention rate of 64% for Ca, 71% for P, and 50% for Mg should be sufficient to meet the requirements of preterm infants in early infancy. This level of intake is supported by data from balance studies using standard and stable isotope techniques, changes in bone mineral content (BMC) measurements, and calciotropic hormone data. Based on the timing of development of fractures and rickets, changes in BMC, and skeletal growth data, the increased Ca and P intake should continue for at least 3 months after birth or until reaching a body weight of about 3.5 kg. In addition, nonnutritional factors may have the potential to increase mineral loss and disturb mineral homeostasis; chronic diuretic therapy increases mineral loss, and aluminum contamination of nutrients theoretically may compound any skeletal disorder. Thus, attention to the level of mineral intake and factors important in mineral loss and mineral metabolism should optimize mineral retention in small preterm infants.     

Psychosocial intervention improves the development of term low-birth-weight infants

It is estimated that 11% of births in developing counties are term low-birth-weight (LBW); however, there is limited information on the development of these infants. Our objectives were to determine the effect of psychosocial intervention on the development of LBW infants and to compare term LBW and normal-birth-weight (NBW) infants. Term LBW (n = 140) and NBW infants (n = 94) were enrolled from the main maternity hospital in Kingston, Jamaica. The LBW infants were randomly assigned to control or intervention comprising weekly home visits from birth to 8 wk and from 7 to 24 mo of age. Development was assessed at 15 and 24 mo with the Griffiths Scales. The intervention benefited the infants' developmental quotient (DQ, P < 0.05) and performance subscale at 15 mo (P < 0.02), the hand and eye (P < 0.05) and performance subscales (P < 0.02) at 24 mo, and home environment at 12 mo. The effect of the intervention on development was mediated in part by the improvement in the home environment. The control LBW infants had significantly lower scores than the NBW in DQ and several subscales, whereas there were no significant differences between the NBW and the LBW infants after intervention. In conclusion, term LBW was associated with developmental delays, which were reduced with psychosocial intervention.     

广西地区低出生体重儿危险因素分析

目的 分析广西地区低出生体重的危险因素,为制定低出生体重干预措施提供依据.方法 本研究为多中心横断面回顾性统计分析研究,以2018年广西大部分地区新生儿为研究对象,病例组共纳入37010例(占总数91.31％)低出生体重活产儿,对照组随机抽取54677例正常出生体重活产儿,采用孕产妇个案调查表收集相关孕产妇数据及新生儿...     

Mineral requirements of low-birth-weight infants

The minerals calcium (Ca), magnesium (Mg), and phosphorus (P) are essential for tissue structure and function. Recent studies have resulted in a more rational approach to the management of mineral intake in preterm infants receiving parenteral nutrition (PN) and enteral nutrition (EN). For preterm infants requiring PN, the use of PN solutions with a Ca content of 1.25-1.5 mmol/dl (50-60 mg/dl), a P content of 1.29-1.45 mmol/dl (40-45 mg/dl), and an Mg content of 0.2-0.3 mmol/dl (5-7 mg/dl) is supported by studies of mineral homeostasis with serial chemical and calciotropic hormone measurements, standard balance studies, and improved radiographic indices of bone mineralization. For infants requiring EN, an intake of approximately 4 mmol (200 mg) of Ca, 3.2 mmol (100 mg) of P, and 0.33 mmol (8 mg) of Mg/kg/day based on an average retention rate of 64% for Ca, 71% for P, and 50% for Mg should be sufficient to meet the requirements of preterm infants in early infancy. This level of intake is supported by data from balance studies using standard and stable isotope techniques, changes in bone mineral content (BMC) measurements, and calciotropic hormone data. Based on the timing of development of fractures and rickets, changes in BMC, and skeletal growth data, the increased Ca and P intake should continue for at least 3 months after birth or until reaching a body weight of about 3.5 kg. In addition, nonnutritional factors may have the potential to increase mineral loss and disturb mineral homeostasis; chronic diuretic therapy increases mineral loss, and aluminum contamination of nutrients theoretically may compound any skeletal disorder. Thus, attention to the level of mineral intake and factors important in mineral loss and mineral metabolism should optimize mineral retention in small preterm infants.     

Outcomes of early nutrition support in extremely low-birth-weight infants.

BACKGROUND: Early nutrition intervention, both parenteral and enteral, is becoming a standard of care for the extremely low-birth-weight infant (ELBW; <1,000 g) in many neonatal intensive care units (NICU) across the United States. However, there are no published or widely accepted guidelines regarding nutrition support strategies for this population. Most NICU clinicians have developed their own guidelines, so nutrition practices vary widely. In an effort to standardize our practice, we implemented nutrition support guidelines for ELBW infants, initiating both parenteral nutrition (PN) and minimal enteral feedings (MEFs) within the first 24 hours of life, whenever possible. The purpose of this study was 2-fold: (1) to evaluate the adherence to the nutrition guidelines and (2) to compare pre- and postguideline outcomes such as time to regain birth weight, time to reach full enteral feedings, and average daily weight gains. METHODS: The study was conducted at a level III NICU from January 2002 until February 2003. Charts of 70 infants with a birth weight 相似文献   

Neonatal mortality of low-birth-weight infants in Bangladesh

OBJECTIVE: To ascertain the role of low birth weight (LBW) in neonatal mortality in a periurban setting in Bangladesh. METHODS: LBW neonates were recruited prospectively and followed up at one month of age. The cohort of neonates were recruited after delivery in a hospital in Dhaka, Bangladesh, and 776 were successfully followed up either at home or, in the event of early death, in hospital. FINDINGS: The neonatal mortality rate (NMR) for these infants was 133 per 1000 live births (95% confidence interval: 110-159). The corresponding NMRs (and confidence intervals) for early and late neonates were 112 (91-136) and 21 (12-33) per thousand live births, respectively. The NMR for infants born after fewer than 32 weeks of gestation was 769 (563-910); and was 780 (640-885) for infants whose birth weights were under 1500 g. Eighty-four per cent of neonatal deaths occurred in the first seven days; half within 48 hours. Preterm delivery was implicated in three-quarters of neonatal deaths, but was associated with only one-third of LBW neonates. CONCLUSION: Policy-relevant findings were: that LBW approximately doubles the NMR in a periurban setting in Bangladesh; that neonatal mortality tends to occur early; and that preterm delivery is the most important contributor to the NMR. The group of infants most likely to benefit from improvements in low-cost essential care for the newborn accounted for almost 61% of neonatal mortalities in the cohort.     

早产儿体格智能发育随访及预后相关因素分析

【目的】了解早产儿婴幼儿期体格智能发育的情况，并对影响其智能发育和预后的因素进行分析。【方法】对中山大学附属第一医院1996～2000年出生的291例早产儿在婴幼儿期进行体格智能发育测试，并对所有小儿作常规体格检查；采用婴幼儿智能发育测验手册(CDCC)进行智能和运动测试，得出智能发育指数(MDI)及运动发育指数(PDI)；并分析各种相关因素。【结果】研究对象中体格发育及智能运动发育落后率较高，且发生脑瘫等残疾率高；脑瘫患儿在围生期均有引起脑缺氧损伤的严重疾患；多因素分析结果显示围生期疾患的严重程度、胎龄、父母文化程度以及早期干预与MDI和PDI有相关关系。【结论】早产儿婴幼儿期智能运动发育落后的比例较高且致残率高，与围生期损伤神经系统的高危因素密切相关，早期干预可促进智能及运动发育。应重视早产儿智能和运动发育的观察，做好定期随访工作，及早进行干预康复治疗，提高此群体的远期生存质量。     

Nitrogen balance and protein turnover during the growth failure in newly born low-birth-weight infants

Weight gain, nitrogen balance, protein turnover, and energy and protein intakes were measured during the first week of life of 14 low-birth-weight (LBW) infants, 5 small-for-gestational-age (SGA) infants and 9 appropriate-for-gestational-age (AGA) infants enterally fed at rates determined by the infants ability to assimilate feed. Mean gross intakes were 334 KJ and 1.75 g/kg protein; 4 infants were increasing and 10 were losing weight at rates proportional to gross energy and protein intakes and to nitrogen balance (0.031 g protein balance/g wt gain). Rates of protein synthesis and degradation measured by an intragastric infusion of [1-13C]leucine, averaged 14.5 and 15.9 g protein.kg-1.d-1, some 50% higher than previously reported in older preterm infants and not correlated with nitrogen balance. The growth failure of these infants was not associated with inadequate overall rates of protein turnover, but appeared to reflect an influence of the insufficient energy and protein intakes on the high rates of protein turnover, inducing changes in protein balance in either direction through relatively small changes in protein synthesis and/or degradation.     

Molybdenum requirements in low-birth-weight infants receiving parenteral and enteral nutrition.

BACKGROUND: Molybdenum (Mo) is an essential trace element required by three enzymatic systems, yet there are no reports of Mo deficiency in infants. Low-birth-weight infants (LBW) might be at risk for Mo deficiency because they are born before adequate stores for Mo can be acquired, they have rapid growth requiring increased intakes, and they frequently receive supplemental parenteral nutrition (SPN) and total parenteral nutrition (TPN) unsupplemented with molybdenum. METHODS: To investigate Mo requirements of LBW infants (n = 16; birth weight, 1336+/-351 g; gestational age, 29.8+/-2.5 weeks; M+/-SD), the authors collected all feeds, urine, and feces prior to TPN (baseline, n = 16, collections = 16), during TPN (n = 9, collections = 19), during SPN (n = 13, collections = 17), and after one week of full oral feeds (FOFs) of formula or human milk (FOF, n = 16, collections = 16). RESULTS: Infant weights at collection times were: 1.3+/-0.3 g, 1.27+/-0.4 g, 1.4+/-0.3 g, and 1.7+/-0.5 g, respectively. Mo intake was 0.03+/-0.1 microg/d, 0.34+/-0.1 microg/d, 1.25+/-1.7 microg/d, and 6.1+/-2.5 microg/d. Mo output was 0.64+/-0.6, 0.34+/-0.5, 0.68+/-0.8, and 4.1+/-2.5 microg/d. Mo balance at these times was -0.60+/-0.5, -0.001+/-0.5, 0.57+/-1.9, and 2.0+/-2.9 microg/d. Mo balance increased with time, yet some infants were always in negative balance, even though Mo intakes exceeded recommendations. CONCLUSIONS: The authors speculate that an intravenous intake of 1 microg/kg/d (10 nmol/kg/d) and an oral intake of 4-6 microg/kg/d (40-60 nmol/kg/d) would be adequate for the LBW infant.     

缺铁性贫血对婴幼儿智能发育的影响

【目的】 探讨缺铁性贫血对婴幼儿智能发育的影响,为临床治疗提供参考依据。 【方法】 选取42名符合缺铁性贫血诊断标准的婴幼儿为病例组,背景资料相似的无缺铁性贫血病史的42名健康婴幼儿为对照组,使用盖塞尔发展诊断量表评估两组婴幼儿智能发育情况。 【结果】 病例组的适应行为、精细运动DQ值低于对照组,差异有统计学意义(P<0.05);血红蛋白水平与适应行为、精细运动DQ值存在正相关关系,其相关系数分别为0.56和0.38(P均<0.05);血红蛋白水平是适应行为、精细动作发育的独立危险因素,偏回归系数分别为0.385和0.261(P均<0.05)。 【结论】 缺铁性贫血可影响婴幼儿适应行为、精细动作的发育。     

Body composition of low-birth-weight infants determined by using bioelectrical resistance and reactance.

We tested the hypothesis that bioelectrical resistance and reactance are indices of total body water (TBW) and extracellular water (ECW), respectively. Infants less than 2500 g in birth weight were studied while less than 24 h old and at 4-7 d of age. TBW (n = 32) was measured by H2(18)O dilution and ECW (n = 34), by bromide dilution. Measurements were made by using an impedance plethysmograph from each of four electrode pairs. Bioelectrical resistance correlated inversely with TBW (r = -0.683). When body weight and crown-heel length were factored into the equation, the correlation improved (r = 0.953). Bioelectrical reactance correlated inversely with ECW (r = -0.707). When body weight and surface area were factored into the equation the correlation improved (r = 0.882). We conclude that bioelectrical resistance and reactance are good indices of TBW and ECW, respectively. However, the ability to resolve small changes in body-water compartments when confined to the intraluminal or other third spaces remains questionable, particularly for single subjects.     

宫内生长受限胎儿出生后细胞遗传学分析

目的应用外周血染色体培养/核型分析技术对20例有胎儿生长受限(fetal growth restriction,FGR)史的新生儿进行外周血染色体培养及核型分析,寻求与遗传学相关的致病因素。方法收集2012年1月-2014年6月到本院新生儿科初步诊断为FGR的患儿20例,应用外周血常规接种、培养、制片及G带分析。结果 20例FGR胎儿出生后外周血染色体检测共检测出10例染色体异常,其中21-三体5例,18-三体1例,染色体结构异常4例。结论在FGR的致病因素中,染色体结构畸变和数目异常是导致胎儿宫内生长受限的致病因素之一,获得不论有无躯体畸形的发育迟缓的儿童的染色体信息十分必要,可为患儿预后和早期干预提供有效而准确的咨询。     

Impaired fat utilization in parenterally fed low-birth-weight infants suffering from sepsis

Lipid infusion in low-birth-weight infants suffering from sepsis is still controversial. Consequently, we investigated the fat tolerance in six low-birth-weight infants with sepsis and 15 low-birth-weight infants without sepsis. For measurement of fat clearance, we assayed the serum concentrations of triglycerides enzymatically, and of the free fatty acids by colorimetric micromethod. The fatty acid oxidation was analyzed with the [13C]triolein breath test by means of ratio-mass spectrometry. The infants were maintained on continuous parenteral nutrition with various amounts of soybean oil emulsion (1 g, 2 g, and 3 g fat/kg body weight per day). Comparing the lipid infusion of 1 and 2 g fat/kg body weight per day between the two groups, we found triglyceride and free fatty acid values in both groups to be in the normal range. At a dose of 3 g of fat/kg body weight per day, septic low-birth-weight infants showed a significantly higher concentration of triglycerides (2.02 +/- 0.46 mmol/liter) and of free fatty acids (2.06 +/- 0.45 mmol/liter) than the nonseptic low-birth-weight infants (triglycerides: 1.09 +/- 0.43 mmol/liter; free fatty acids: 1.05 +/- 0.41 mmol/liter). The low-birth-weight infants with sepsis showed a reduced fat oxidation rate of 16.0 +/- 1.5% in contrast to that of the low-birth-weight infants without sepsis, whose rate was 38.4 +/- 1.8%. Accordingly, we apply dosages not exceeding 2 g of fat/kg body weight per day to septic low-birth-weight infants.