A model to predict motor performance in preterm infants at 5 years

Background

Approximately 60% of preterm infants who are assessed at 5 years for motor performance in a standardized multidisciplinary follow-up program are found to have normal results, indicating that, for these children, routine motor assessment at this age is unnecessary.

Aim

To improve the efficiency of our follow-up practice for motor assessment by developing a model to predict motor performance of preterm infants at 5 years with a maximal sensitivity (≥90%).

Study design

Longitudinal design.

Subjects

We included preterm infants (n = 371) with a gestational age of ≤32 weeks; children with severe disabilities were excluded.

Outcome measures

The Movement Assessment Battery for Children (M-ABC) at 5 years with ‘delayed’ motor performance (<15 percentile) was the dependent variable. As factors in the model, we used twenty neonatal risk factors, the maternal education level, the Motor Scale and the Behavior Rating Scale (BRS) of the Bayley Scales of Infant Development, 2nd edition, at 2½ years.

Results

Binary logistic regression analysis revealed that the prediction model (n = 345) reached a sensitivity of 94%. Five factors contributed significantly (p < 0.05) to the model: a Motor Scale PDI <90 and a BRS ‘motor quality’ <26 percentile, and the neonatal risk factors gestational age <30 weeks, male gender and intra-ventricular hemorrhage.

Conclusion

The prediction model can improve the efficiency of follow-up practice for motor assessment by 37% at 5 years. Applying this model, we would not have assessed 129 children and would have missed six children.     

Inter- and intra-modal matching in very low birth weight and small for gestational age adolescents

Background

Motor problems in low birth weight children may be related to problems in sensorimotor integration processes. Specific tests of inter- and intra-modal matching have not been used in low birth weight populations.

Aim

Examine whether low birth weight adolescents have poorer performance in inter- and intra-modal matching than normal birth weight adolescents.

Study design

A population based follow up study of very low birth weight and small for gestational age children at 14 years of age.

Subjects

Fifty-three very low birth weight adolescents (VLBW: birth weight ≤ 1500 g), 59 term small for gestational age (SGA: birth weight < 10th centile) and 82 adolescents with birth weight ≥ 10th centile at term (reference group).

Outcome measures

Inter- and intra-modal matching was assessed by a manual matching task and results were presented for the preferred and the non-preferred hand in the visual (inter-modal) and proprioceptive (intra-modal) condition.

Results

VLBW adolescents performed poorer in inter- and intra-modal matching compared with the reference group. However, the results were mainly due to a higher number of adolescents with cerebral palsy (CP) and a low estimated intelligence quotient (IQ_est) in the VLBW group. SGA adolescents showed poorer performance with their non-preferred hand compared with their preferred hand in both inter- and intra-modal matching, whereas adolescents in the reference group and VLBW adolescents with normal IQ_est and without CP performed equally well with both hands.

Conclusion

VLBW adolescents with normal IQ_est and without CP do not have major problems in inter- and intra-modal matching. The poorer performance with the non-preferred hand in the SGA group may suggest a specific effect of intrauterine growth retardation.     

Low birth weight and psychiatric morbidity; stability and change between adolescence and young adulthood

Background

Being born with low birth weight is a risk factor for psychiatric morbidity.Few longitudinal studies have included diagnostic assessment and followed subjects into adulthood.

Aim

To assess stability and change in psychiatric morbidity between adolescence and young adulthood in low birth weight subjects, and explore whether screening in adolescence can predict subsequent psychopathology in these groups.

Study design

Prospective geographically based follow-up study of two low birth weight groups and a control group born between 1986 and 1988, assessed at 14 (T1) and 20 (T2) years of age.

Subjects

Thirty eight subjects born preterm with very low birth weight (VLBW: ≤ 1500 g), 43 born at term but small for gestational age (SGA: < 10th percentile) and 64 controls with normal birth weight participated.

Outcome measures

Mental health was assessed using diagnostic psychiatric interview at both study points supplemented with the Achenbach System of Empirically Based Assessment and Children's Global Assessment Scale at T1.

Results

There was a trend towards increasing morbidity from T1 among VLBW (p = 0.086) and a significant increase among SGA (p = 0.003) participants. Supplementary assessment at T1 discriminated satisfactory between persons with and without psychiatric disorders at T2 (area under ROC curve: 0.66 to 0.89), but was most effective in the VLBW group.

Conclusion

High psychiatric morbidity continued into young adulthood in the VLBW group and increased significantly in the SGA group. Screening in adolescence can be used to detect individuals at risk especially among those born at very low birth weight.     

Postnatal growth of preterm born children ≤ 750g at birth

Background

Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development.

Aims

To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5.

Study design

Retrospective cohort study.

Subjects

One hundred one children with a BW ≤ 750 g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands.

Outcome measures

Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years.Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥−1), mildly delayed (−2 ≤ Z-score <−1) or severely delayed (Z-score <−2). AGA (Ht, Wt or OFC at birth ≥−2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <−2 SDS) infants.

Results

Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥−2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%).

Conclusions

Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥−2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.     

Neurodevelopmental outcome after COX inhibitor treatment for patent ductus arteriosus

Aim

To compare neurodevelopmental results in very low birth weight (VLBW) infants two years after successful or failed cyclooxygenase inhibitor treatment with either indomethacin or ibuprofen for a haemodynamically significant patent ductus arteriosus (hsPDA).

Methods

We retrospectively evaluated closure rates and outcome parameters of VLBW infants with hsPDA 89 of whom were treated with indomethacin and 93 with ibuprofen.

Results

Indomethacin and ibuprofen therapy groups did not differ in their baseline clinical profile (median gestational age 26.0 and 26.2 wks d) in early (median CRIB 6 and 5, respiratory distress > 2° in 36 and 34 infants) and late morbidities (intraventricular hemorrhage > 2° in 9 and 10 infants, bronchopulmonary dysplasia in 31 and 27 infants, 80 and 85 survivors), PDA closure rates (63 and 58%) or neurodevelopmental outcome. The therapy failure group (54 infants) was characterized by lower median gestational age (25.0 wks d) and higher mortality (17%). No differences were found in the neurodevelopmental outcome of the surviving infants with ligation as compared to the survivors with successful pharmacological closure of the PDA at 24 months corrected age.

Conclusion

Use of either ibuprofen or indomethacin for closure of a hsPDA did not influence two year neurodevelopmental outcomes in VLBW infants.     

The effects of maternal stress and child language ability on behavioral outcomes of children with congenital hearing loss at 18-24months

Background

Prior studies have shown that children with congenital hearing loss have increased rates of behavior disorders. Child hearing loss has also been reported to be associated with increased maternal stress. Little is known about the behavior or the predictors of behavioral outcomes of children with hearing loss identified early and receiving Early Intervention services.

Aim

The objective of this study was to identify the behavioral outcomes in early identified children with hearing loss and control hearing children at 18-24 months of age and to examine the impact of stress on early behavior development. It was hypothesized that children with hearing loss will have more behavior problems, and maternal stress will be associated with child behavior problems.

Study design

Prospective observational.

Subjects

Children with and without congenital hearing loss and their mothers.

Outcome measures

The Parenting Stress Index and the Child Behavior Checklist.

Results

Children with hearing loss had increased scores for withdrawn and internalizing behavior. In multivariate analyses after adjusting for hearing loss, Neonatal Intensive Care Unit stay, and socioeconomic status, maternal stress independently contributed to higher scores for internalizing behavior, externalizing behavior, and total behavior problems.

Conclusion

Maternal stress is an important correlate of behavior problems for children with hearing loss and should be considered by Early Intervention providers.     

Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: Pilot study

Background

Heel stick is the most common painful procedure for preterm infants in neonatal intensive care units. Resultant pain causes adverse physiological effects in major organ systems. Kangaroo Care (KC), involving mother-infant skin-to-skin contact is a promising analgesic for infant pain; however, the effect of KC on the autonomic nervous system's response to pain is unknown.

Aim

To determine if KC results in improved balance in autonomic responses to heel stick pain than the standard method where infants remain in an incubator care (IC) for the heel stick.

Study design

A randomized cross-over trial.

Subjects

Fourteen preterm infants, 30-32 weeks gestational age and less than 9 days postnatal age.

Outcome measures

Infant behavioral state, heart rate, heart rate variability (HRV) indices including low frequency (LF) and high frequency (HF) power, and the LF/HF ratio measured over Baseline, Heel Warming, Heel Stick, and Recovery periods in KC and IC conditions.

Results

HRV differences between KC and IC were that LF was higher in KC at Baseline (p < .01) and at Heel Stick (p < .001), and HF was higher in KC at Baseline than in the IC condition (p < .05). The LF/HF ratio had less fluctuation across the periods in KC than in IC condition and was significantly lower during Recovery in KC than in IC (p < .001).

Conclusions

Infants experienced better balance in response in KC than IC condition as shown by more autonomic stability during heel stick. KC may be helpful in mediating physiologic response to painful procedures in preterm infants.     

Effects of preterm birth and fetal growth retardation on cardiovascular risk factors in young adulthood

Background

The association between low birth weight (LBW) and increased risk of obesity, hypertension and cardiovascular disease later in life is well documented in epidemiological studies. However, clinical follow-up studies of LBW populations have only partly supported this.

Aims

Evaluate associations between LBW and body fat, blood pressure (BP), lung and endothelial function, and maximal oxygen uptake (VO_2max) in 18 year old young adults.

Subjects

Thirty-seven subjects born prematurely with birth weight < 1501 g (VLBW group), 47 born at term with low weight (< 10th centile) for gestational age (SGA group) and 63 controls with normal birth weight participated in the study.

Outcome measures

Anthropometric measurements, BP, endothelial function, lung function and VO_2max were recorded.

Results

Both LBW groups were shorter, lighter, had smaller head circumference and higher subscapular-to-triceps skinfold-ratio than controls. Systolic and mean arterial BP was higher in the VLBW compared with the control group, whereas there were no differences between the groups in endothelial function. The VLBW group had reduced dynamic lung volumes lower carbon monoxide transfer factor and lower VO_2max compared with controls. In particular young adults born VLBW who were also growth retarded in utero had higher indices of central body fat, higher BP and lower VO_2max.

Conclusion

We found that very preterm birth, but not growth retardation at term, was associated with higher BP and a less favourable fat distribution. In particular, the young adults born VLBW who were also growth retarded in utero had less favourable outcomes.     

Distinguishing pathological from constitutional small for gestational age births in population-based studies

Background

Small for gestational age (SGA) can occur following a pathological process or may represent constitutionally small fetuses. However, distinguishing these processes is often difficult, especially in large studies, where the term SGA is often used as a proxy for restricted fetal growth. Since biologic variation in fetal size is largely a third trimester phenomenon, we hypothesized that the definition of SGA at term may include a sizeable proportion of constitutionally small fetuses. In contrast, since biologic variation in fetal size is not fully expressed in (early) preterm gestations, it is plausible that SGA in early preterm gestations would comprise a large proportion of growth restricted fetuses.

Aim

We compared mortality and morbidity rates between SGA and appropriate for gestational age (AGA) babies.

Subjects

A population-based study of over 19 million non-malformed, singleton births (1995-04) in the United States was performed. Gestational age (24-44 weeks) was based on a clinical estimate. SGA and AGA were defined as sex-specific birthweight < 10th and 25-74th centiles, respectively, for gestational age. All analyses were adjusted for a variety of confounding factors.

Outcome measures

Excess mortality risk in SGA and AGA babies.

Results

On an additive scale, stillbirth and neonatal mortality rates were higher at every preterm gestation among SGA than AGA births, and similar at term gestations. An inverse relationship between gestational age and excess deaths between SGA and AGA babies delivered at < 37 weeks was evident.

Conclusions

In early preterm gestations, the definition of SGA may well be justified as a proxy for IUGR. In contrast, SGA babies that are delivered at term are likely to be constitutionally small.     

Persistent maternal anxiety affects the interaction between mothers and their very low birthweight children at 24 months

Background

Parental distress following the birth of a premature infant diminishes the parent's ability to be sensitive to the infant's cues, and this may affect infant developmental outcomes.

Aims

The present study examined the effects of maternal anxiety during infant hospitalization in the Neonatal Intensive Care Unit (NICU) on the interactive behavior of mothers with their very low birthweight (VLBW) children in toddlerhood.

Subjects

A sample of 56 mothers and their VLBW infants were recruited in the NICU.

Study design

During the infant's NICU stay, mothers completed a self-report measure of trait anxiety. These mothers and their infants were followed when the infants were 24 months corrected age, when mothers and their children were videotaped during free play at home. These videotapes were then coded using the Emotional Availability Scales.

Results

Maternal anxiety was not found to be related to severity of neonatal illness. Maternal anxiety in the NICU was associated with less sensitivity and less structure in interaction with their toddlers at 24 months corrected age, even controlling for maternal education and child birthweight. Children of mothers with higher anxiety scores in the NICU were less likely to involve their mothers in their play at 24 months corrected age.

Conclusions

Maternal anxiety in the NICU predicted adverse interactive behaviors when the children were 24 months corrected age. Early identification of anxious mothers in the NICU is needed in order to initiate preventive intervention to support the mother-infant relationship.     

Fetal cardiac sympathetic activation is linked with maternal body mass index

Background

Sympathetic over activity has been suggested to impact on the risk of cardiovascular diseases. The origin of abnormalities in the autonomic nervous system is unknown, but it is susceptible to environmental influences during the critical periods of human development.

Aims

To examine the influence of maternal characteristics on fetal cardiac autonomic nervous activation.

Study design

Prospective, observational study.

Subjects

41 fetuses from normal pregnancy born after 36 gestational weeks.

Outcome measures

Maternal characteristics that affect fetal intrauterine well-being intrauterine environmental factors were evaluated, including pre-pregnancy body mass index as well as GHbA1c, blood pressure and 3-day food diaries from each trimester of pregnancy. To assess intrapartum fetal cardiac sympathovagal activation fetal ECG was recorded for 1 h during delivery. Heart rate variability was measured using power spectrum analysis of low-to-high frequency ratio of fetal heart rate variability.

Results

Cardiac sympathetic activation measured during delivery was associated with maternal pre-pregnancy body mass index (r = 0.33, p = 0.03), placental weight (r = 0.4, p = 0.008) and the immaturity of the fetus (r = − 0.3, p < 0.05).

Conclusion

Early intrauterine environmental factors such as maternal pre-pregnancy body mass index are associated with fetal sympathetic activation with a potential for cardiovascular programming.     

The infant behavioral assessment and intervention program in very low birth weight infants; outcome on executive functioning, behaviour and cognition at preschool age

Background

The Infant Behavioral Assessment and Intervention Program (IBAIP©) improved motor function at 24 months, and mental and behavioural development in high risk subgroups of very low birth weight (VLBW) infants.

Aim

To determine IBAIP's effects on executive functioning, behaviour and cognition at preschool age.

Study design

Follow-up of a randomised controlled trial (RCT).

Subjects

At 44 months corrected age, all 176 VLBW infants were invited for follow-up. Forty-one term born children were assessed for comparison.

Outcome measures

Visual Attention Task (VAT), Gift delay, Peabody Picture Vocabulary Test III-NL (PPVT), Visual motor integration tests and Miller assessment for preschoolers. Parents completed Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and Child Behavior Checklist (CBCL).

Results

At preschool age, 76 (88%) children of the intervention group and 75 (83%) children of the control group participated. There were no significant differences between the intervention and the control group. However, positive interaction effects between intervention and infants with bronchopulmonary dysplasia, infants born at gestational age < 28 weeks, and infants of low educated mothers were found on CBCL, CBCL and BRIEF-P, and PPVT respectively. Most interaction effects exceeded 1 standard deviation in favour of the intervention children. The 151 VLBW children performed significantly worse than the term born children on the VAT, BRIEF-P and CBCL.

Conclusion

IBAIP effects in VLBW children did not sustain until preschool age on executive functioning, behaviour and cognition. However, the most vulnerable children had a clinical relevant profit from IBAIP. VLBW children performed worse than the term born children.This study is a follow-up at preschool age of the multi-centre RCT of IBAIP versus usual care in VLBW infants. The RCT was performed in Amsterdam, The Netherlands (IBAIP RCT registered on http://www.controlled-trials.com number ISRCTN65503576).     

The effect of recombinant aminopeptidase A (APA) on hypertension in pregnant spontaneously hypertensive rats (SHRs)

Background

We have tested the effects of aminopeptidase A (APA), MgSO₄ and various conventional antihypertensive drugs on hypertension in pregnant spontaneously hypertensive rats (SHRs) and examined the effects on both fetal heart and kidney.

Methods

We used recombinant human APA, which has been recently shown to work as an antihypertensive agent in SHRs (n = 5). Each drug was administered from gestational day 10 to day 20 and each dose was increased daily up to 10 fold until the end of treatment except for MgSO₄ (n = 5 per each group). Blood pressure (BP) was monitored and fetal kidneys and heart were histologically examined.

Results

The antihypertensive effects of the drugs were in the following order: hydralazine > aminopeptidase A and angiotensin receptor blockers (ARBs), candesartan > MgSO₄ and methyldopa. Microscopic examination showed that fetal exposure to candesartan is associated with poor proximal tubular differentiation in the kidney and that to MgSO₄ is associated with poor blood vessel formation in the heart, respectively.

Conclusions

Our present study showed that APA is one of the candidates for antihypertensive agents in hypertension during pregnancy.     

Preconception risk factors and SGA babies: Papilloma virus, omega 3 and fat soluble vitamin deficiencies

Background

Small for gestational date (SGA) babies have a poor ‘whole of life’ prognosis and major factors affecting SGA may be present prior to conception.

Aims

To discover whether lifestyle risk factors can be identified in women planning a pregnancy.

Study design

Prospective study of women who were planning a pregnancy, who agreed to answer a detailed 250 question questionnaire prior to commencing to try to conceive, to being monitored, and within 7 days of a positive pregnancy test having a vaginal ultrasound scan and answering further questions about the events since the last menstrual period. Details of all outcomes were recorded.

Subjects

585 couples completed the study.

Outcome measures

The relationships between birth weights and questionnaire data was analysed using SPSS and parametric statistical analysis.

Results and conclusions

401 women (67.9% of all participants) had live births. Eleven babies (2.7%) were less than the 3rd percentile in weight and a further 22 babies (5.4%) were between the 3rd and 10th weight percentiles. Mothers of SGA babies had a lower than average education, diets that were low in meat, fish, dairy foods and nuts or seeds and were more likely to conceive in the winter. Mothers of SGA babies were significantly more likely to have had a recent abnormal Pap smear test. Air travel in the month of conception was a risk factor in having a baby less than 10th percentile.

Conclusion

The quality of lifestyle prior to conception is critical: prenatal counselling needs to be undertaken prior to conception.     

High plasma cytokine levels, white matter injury and neurodevelopment of high risk preterm infants: assessment at two years

Background

Controversy exists regarding association of high levels of proinflammatory cytokines, neonatal morbidities and poor neurodevelopment outcome in very low birth weight infants.

Objective

To determine association between severity of early inflammatory response and neurodevelopment outcome in high risk very low birth weight infants.

Methods

Sixty-two very preterm infants with high risk for early-onset sepsis were followed up to 24 months corrected age. Blood sample was collected for IL-6, IL-8, IL-10, IL-1β, and TNF-α analysis. Neurodevelopment outcome by Bayley Scales of Infant Development II was assessed at 22 to 24 months. Magnetic Resonance Image was performed at least once during the first 12 months.

Results

In 24 (38.7%) MDI was < 85, and 16 (25.8%) had PDI < 85. Low birth weight was significantly associated with low MDI, and birth weight and periventricular leukomalacia were significantly associated with low PDI by multiple regression analysis. After controlling for birth weight and gestational age, none of the studied variables was associated with low MDI, and only periventricular leukomalacia with low PDI. Each additional 100 g in the birth weight reduced the probability of low MDI and PDI scores in 14%.

Conclusions

There was no association of high cytokines plasma levels with poor neurodevelopment outcome at 22 to 24 months' corrected age, suggesting that elevations of plasma proinflammatory cytokines early in life do not play an important role in pathophysiology of brain injury in high risk preterm infants.     

Parental bilingualism is associated with slower cognitive development in very low birth weight infants

Background

Speech development is frequently impaired in very low birth weight (VLBW) infants. Few and controversial data have been published on concepts regarding the influence of bilingual education.

Aims

The objectives of the current study were to assess the influence of parental bilingualism on speech development and neurodevelopmental outcome in low risk VLBW infants.

Study design

Monocentric prospective controlled cohort study with standardized follow-up.

Subjects

We recruited 50 singleton VLBW infants each from monolingual and bilingual families as well as 90 term control infants. The infants were free of disease and congenital malformation.

Outcome measures

Griffiths scales of infant development at the corrected ages of 6 and 12 months, Bayley Scales of Infant Development II (BSID II) with 22 months.

Results

In general, both bilingual and monolingual VLBW infants achieved age-specific milestones at the corrected age of 6, 12 and 22 months. However, bilingual VLBW infants achieved significantly lower scores than their monolingual peers in all cognitive subscales. The influence of maternal education on the neurodevelopmental outcome of the preterm infants was not significant; the subscales' correlation with socioeconomic or biological parameters was poor. However, a clear differentiation between social status and bilingual environment importance for speech development was not possible.

Conclusions

In the setting of the present investigation, parental bilingualism is associated with slower neurodevelopment in VLBW infants during the first 2 years of life.     

Entorhinal cortical thinning affects perceptual and cognitive functions in adolescents born preterm with very low birth weight (VLBW)

Background

The entorhinal cortex serves as an important gateway between the cerebral cortex and the hippocampus by receiving afferent information from limbic, modality sensory-specific, and multimodal association fibers from all the brain lobes.

Aim

To investigate whether thinning of entorhinal cortex is associated with reduced perceptual, cognitive and executive skills in very low birth weight (VLBW) adolescents.

Study design

Prospective, geographically based follow-up study of three year cohorts of preterm born VLBW children.

Subjects

Forty-nine VLBW (birth weight ≤ 1500 g) and 58 term-born control adolescents were examined at the age of 14–15 years.

Outcome measures

Perceptual and cognitive functions were assessed with Visual motor integration test, Grooved Pegboard test, Wechsler Intelligence Scale for Children-III and different executive function tests (Wisconsin card sorting test, Trail Making test, Knox cube test). An automated MRI technique at 1.5 T for morphometric analyses of cortical thickness was performed. Areas with cortical thinning in left and right entorhinal cortex in the VLBW group were chosen as regions of interest to look for associations between cortical thickness and clinical findings.

Results

Thinning of the entorhinal cortex was correlated with low performance on perceptual and cognitive scores in the VLBW adolescents, but not in controls. In addition, thinning of the entorhinal cortices correlated with reduced performance on several executive tests, including perceptual speed and aspects of working memory.

Conclusions

Entorhinal cortical thinning is related with low IQ and reduced perceptual and executive functions in VLBW adolescents.     

Is routine TORCH screening and urine CMV culture warranted in small for gestational age neonates?

Background

Congenital infections are associated with a wide variety of clinical symptoms, including small for gestational age (SGA).

Aims

To determine the co-occurrence of SGA and congenital TORCH infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture.

Study design

We performed a retrospective study of all neonates admitted to our neonatal intensive care unit from January 2004 to February 2010 in whom SGA was diagnosed and TORCH serologic tests and/or CMV urine cultures were performed.

Results

TORCH serologic tests (in neonatal or maternal serum) and/or a CMV urine culture were performed in 112 neonates with SGA. None of the neonates tested positive for Toxoplasma gondii, Rubella, and Herpes simplex virus. Positive CMV urine culture was detected in 2% (2/112) of neonates, but their CMV IgM titers were negative.

Conclusions

The co-occurrence of TORCH congenital infection in infants with SGA is rare. Routine TORCH screening in neonates with isolated SGA does not seem warranted and should be limited to CMV urine cultures.     

Longitudinal growth of head circumference in term symmetric and asymmetric small for gestational age infants

Aims

To study longitudinal growth pattern of head circumference of full-term symmetric and asymmetric small for gestational age (SGA) infants of the two sexes during first year of life.

Study Design

Mixed-longitudinal growth research design.

Subjects

Head circumference amongst full-term 100 symmetric, 100 asymmetric as well as 100 appropriate for gestational age (AGA) infants was measured at birth, 1, 3, 6, 9 and 12 months of age using standardized technique and instrument.

Results

The mean head circumference of male symmetric SGA infants measured significantly (p ≤ 0.001) smaller than asymmetric SGA infants while, in female symmetric SGA infants it measured shorter beyond 6 months. As compared to AGA infants, head circumference in symmetric and asymmetric SGA infants measured significantly smaller in size. Growth velocity for head circumference amongst symmetric and asymmetric SGA male infants did not show statistically significant differences. Rate of head circumference growth remained significantly higher amongst female asymmetric SGA infants than the symmetric ones between 3 and 6 months while, a reversal of trend was observed between 9 and 12 months.

Conclusion

The better growth attainments for head circumference of male and female asymmetric SGA infants than their symmetric SGA counterparts during first postnatal year of life may be attributed to the continuation of influence of “head sparing” experienced by asymmetric SGA babies during prenatal life.