Behavior problems of 9-16 year old preterm children: biological, sociodemographic, and intellectual contributions

Background

Preterm children are at risk for behavior problems. Studies examining contributions of intellectual and environmental factors to behavior outcomes in preterm children are mixed.

Aims

(1) To identify the nature of maladaptive behaviors in preterm children age 9 to 16 years born across the spectrum of gestational age and birth weight (BW). (2) To examine contributions of BW as a biological factor, socioeconomic status as an environmental factor, and intelligence quotient (IQ) as indicative of intellectual ability to behavior outcomes.

Method

Using the Child Behavior Checklist, parent reports of behavior for 63 preterm children (gestational age 24 to < 36 weeks) were compared to 29 full term children of similar age, gender and socioeconomic status. Multiple regression models evaluated effects of prematurity, socioeconomic status, and intellectual ability on behavioral symptom scores.

Results

Preterm children had higher total and internalizing problem scores compared to full term children. They also had lower IQ. BW was a significant predictor of total and internalizing behavior problems. Among the syndrome scales, anxious/depressed and attention problems were elevated. Socioeconomic status did not contribute to behavior scores. IQ contributed to total, but not to internalizing or externalizing, scores. IQ contributed to attention problems, but not to anxious/depressed scores.

Conclusion

Preterm children had increased behavior problems, especially symptoms of inattention and anxiety. Lower BW predicted more behavior problems. IQ acted as a mediator between BW and attention scores, but not anxiety scores. These findings alert health care providers to assess anxiety in all preterm children regardless of intellectual ability and additional study on the influence of intellectual ability on behavioral outcomes in preterm children is needed.     

The quality of fetal arm movements as indicators of fetal stress

Background

Although a number of studies have found that maternal stress affects the fetus, it is unclear whether jerky fetal movements observed on ultrasound scans are indicative of fetal stress, or whether they are part of normal development.

Aims

The present study was designed to examine the relationship between jerky fetal arm movements in relation to fetal age and stress.

Methods

Video recordings were made of routine ultrasound scans of 57 fetuses (age range 8 to 33 weeks) classified into three age groups: 1st trimester (8-12 weeks, N = 9), 2nd trimester (13-24 weeks, N = 38), and 3rd trimester (26-33 weeks, N = 10). Following previous research on stress behaviour in neonates, a fetal index of stress was derived from frequency of hiccup, back arch and rhythmical mouthing.

Results

Results indicated that while stress level was unrelated to fetal age, jerkiness of arm movements was significantly associated with the fetal stress index but not age.

Conclusions

Our findings suggest that jerky arm movements in fetuses are suggestive of fetal stress.     

Conductive hearing loss in children with bronchopulmonary dysplasia: A longitudinal follow-up study in children aged between 6 and 24 months

Aims

To determine the occurrence of isolated and recurrent episodes of conductive hearing loss (CHL) during the first two years of life in very low birth weight (VLBW) infants with and without bronchopulmonary dysplasia (BPD).

Study design, subjects and outcome measures

In a longitudinal clinical study, 187 children were evaluated at 6, 9, 12, 15 18 and 24 months of age by visual reinforcement audiometry, tympanometry and auditory brain response system.

Results

Of the children with BPD, 54.5% presented with episodes of CHL, as opposed to 34.7% of the children without BPD. This difference was found to be statistically significant. The recurrent or persistent episodes were more frequent among children with BPD (25.7%) than among those without BPD (8.3%). The independent variables that contributed to this finding were small for gestational age and a 5 min Apgar score.

Conclusions

Recurrent CHL episodes are more frequent among VLBW infants with BPD than among VLBW infants without BPD.     

Association of maternal communicative behavior with child vocabulary at 18-24 months for children with congenital hearing loss

Objectives

To identify important maternal and child factors associated with development of vocabulary in a cohort of children with and without permanent hearing loss (HL).

Methods

Children with HL and typical hearing were enrolled after the newborn hearing screen. Mother-child dyads were evaluated at 18-24 months of age. Mothers completed the MacArthur-Bates Communicative Development Inventory (MCDI). Maternal communicative effectiveness was scored using the Parent/Caregiver Involvement Scale (PCIS) from a 10 min play session. Correlations and regression models were run to identify the important predictors of number of child words produced.

Results

Results from 40 children with typical hearing and 31 children with HL are reported. Words produced (134 ± 135 vs. 71 ± 112) and words produced percentile (33 ± 42 vs. 17 ± 23) scores on the MCDI were significantly higher for children with hearing compared to children with HL. Greater maternal stress was associated with decreased verbal involvement, positive regard, availability, and enjoyment. Regression analysis revealed HL, stay in a Neonatal Intensive Care Unit (NICU), and maternal stress were associated with fewer words produced whereas more optimal maternal atmosphere and quality of control and directiveness were associated with more words produced.

Conclusions

Maternal communicative behaviors, maternal stress, child HL, and child stay in the NICU were all associated with number of words produced at 18-24 months.     

Declining cognitive development from 8 to 18 months in preterm children predicts persisting higher parenting stress

Background

Higher parenting stress in mothers of children born very preterm may be in part a response to poorer neurobehavioral development, reflecting realistic concerns in addition to adaptation to the trauma of preterm delivery. To our knowledge, there are few longitudinal studies of parenting stress that have addressed child cognitive competence.

Aims

To examine parenting stress in preterm and full-term children at 8 and 18 months corrected chronological age (CCA), in relation to child cognitive development and behavior.

Subjects

Participants were N = 152 children (98 preterm born ≤ 32 weeks gestation, and 54 full-term) seen at 8 and 18 months CCA, and the primary caregiver parent.

Study design/Outcome measures

The Parenting Stress Index questionnaire was completed by a parent, child interactive behavior was videotaped, and the Bayley Scales of Infant Development (BSID II, Mental Development Index; MDI) were administered at both ages.

Results

Total Parenting Stress was higher in preterm than full-term children at 8 and 18 months CCA (p < .02), accounted for primarily by the Child domain. Hierarchical regression showed (after controlling for neonatal risk, number of children in the home, child interactive behavior and maternal education) that decreasing Bayley MDI scores from 8 to 18 months CCA predicted higher parenting stress for preterm children. For full-term children, number of children in the home and child interactive behavior predicted parental stress at 18 months.

Conclusion

Higher parenting stress persisting to 18 months CCA in preterm children may partly reflect realistic parental concerns with their child's development.     

Predictive value of early motor evaluation in preterm very low birth weight and term small for gestational age children

Background

Motor problems are common in children born preterm or small for gestational age.

Aim

To study the predictive value of early motor assessments for later motor skills.

Subjects

Twenty-eight children born preterm with very low birth weight (VLBW: birth weight ≤ 1500 g), 57 children born small for gestational age (SGA: birth weight < 10th centile) at term and 77 term-born controls with normal birth weight.

Methods

The psychomotor development index (PDI) of the Bayley Scales of Infant Development was used as a measure of motor skills at age one, the Peabody Developmental Motor Scales (PDMS) at age five and the Movement Assessment Battery for Children (Movement ABC) at age 14. Low/borderline low scores were defined as < − 2SD/− 1SD (PDI) or < 5th/15th centile (PDMS; Movement ABC).

Results

In the VLBW group, motor problems in adolescence were identified both by low PDI (sensitivity: 0.80; 95%CI:0.38-0.96) and PDMS scores (sensitivity: 0.83; 95%CI:0.44-0.97). In the SGA and the control group sensitivity was poor for low PDI and moderate for low PDMS scores. However, in the SGA group, sensitivity increased when borderline low PDMS scores were used as cut-off (sensitivity: 0.75; 95%CI:0.41-0.93). Specificity of PDI and PDMS was high in all three groups.

Conclusions

Both PDI and PDMS may be valuable tools for early identification of motor problems in VLBW children, whereas PDMS best predicted motor problems in the two other groups. In all three groups, a normal motor examination at 1 and 5 years was highly predictive of normal motor skills at age 14.     

Effect of ibuprofen on bilirubin-albumin binding in vitro at concentrations observed during treatment of patent ductus arteriosus

Background

In vitro studies have shown that ibuprofen (IBU) may interfere with bilirubin-albumin binding at concentrations of 100 µg/mL and above.

Objectives

The present study evaluates the in vitro bilirubin displacement over the range of IBU plasma concentrations observed in vivo during curative treatment of patent ductus arteriosus in preterm infants.

Methods

Considering that individual plasma concentrations obtained during the clinical development of IBU in preterm infants were ranging between 10 and 70 µg/mL and exceptionally above 100 µg/mL, we used the modified peroxidase method to determine total and unbound bilirubin concentrations without IBU and with IBU over this specific concentration range.

Results

Total bilirubin and albumin concentrations were respectively 6.6 mg/dL and 2.87 g/dL in pooled newborn plasma. No displacement of bilirubin from its albumin binding sites by IBU was observed over a range of concentrations from 10 to 100 µg/mL. Only a concentration of 200 µg/mL significantly increased the unbound bilirubin by 1.5-fold (p = 0.0008).

Conclusions

This in vitro study confirms displacement of bilirubin by a high IBU concentration of 200 µg/mL, however it retrieves no significant displacement over a range of concentrations up to and including 100 µg/mL, i.e. within the range of in vivo concentrations at the recommended dose regimen.     

Circulating adipocyte fatty acid binding protein levels in healthy preterm infants: Positive correlation with weight gain and total-cholesterol levels

Background

Adipocyte fatty acid binding protein (a-FABP) has been suggested to play an important role in the pathogenesis of metabolic syndrome. Preterm infants are at risk for the later development of insulin resistance, and, possibly, other components of metabolic syndrome.

Aim

To determine circulating levels of a-FABP in preterm infants and examine possible associations of a-FABP with metabolic indices (serum lipids, glucose, and insulin levels, and homeostasis model assessment index of insulin resistance [HOMA-IR]), levels of leptin and adiponectin, anthropometric parameters and weight gain.

Study design

Prospective cohort study.

Subjects

55 healthy preterm (mean [SD] gestational age 32.8 [1.8] weeks) and 23 fullterm infants (reference group).

Outcome measures

Serum a-FABP, lipids, glucose, insulin, leptin and adiponectin levels at 31.9 [10.4] days of life.

Results

Serum a-FABP levels did not differ significantly between preterm and fullterm infants. A-FABP levels correlated positively with total-cholesterol [total-C] in both preterm and fullterm infants (β = 0.33; p = 0.01 and β = 0.33; p = 0.04, respectively). In addition to total-C, weight gain correlated independently with a-FABP levels in preterm infants (β = 0.36, p = 0.01).

Conclusions

An association between a-FABP levels and indices of insulin resistance was not present in infants studied. As the development of insulin resistance in children born prematurely is possibly associated with weight gain in early postnatal life, follow-up of our study population is necessary to demonstrate whether a-FABP levels, shown to correlate with weight gain in preterm infants, are a predictive marker for the later development of insulin resistance in these infants.     

Family functioning, burden and parenting stress 2 years after very preterm birth

Background

Examining rates of difficulties in family functioning following very preterm birth has been a relatively neglected area of research.

Aims

To examine family functioning, burden and parenting stress in families with very preterm compared with term born children, and investigate influences of parental mental health problems and child neurodevelopmental disability on family outcomes in families with preterm children.

Study design

Participants were 184 very preterm and 71 term children and their parents. Parents completed the Family Assessment Device, Parenting Stress Index and Impact on Family questionnaires when their children were 2 years old (corrected for prematurity). Parental mental health and social risk information were also collected. Children were assessed for neurodevelopmental disability.

Results

Families with very preterm children reported poorer family functioning (p = .03) compared with families with term born children, with less evidence for differences between families with very preterm and term born children in parenting stress and family burden. Within very preterm families, parental mental health problems were associated with higher levels of parenting stress (p = .001), and parents of children with a neurodevelopmental disability were more likely to report higher family burden (p = .04).

Conclusions

For families with very preterm children, parental mental health symptoms and child neurodevelopmental disability may identify families at risk of greater stress and burden who may benefit from additional support.     

General movements in the perinatal period and its relation to echogenicity changes in the brain

Background

In preterm born infants abnormal general movements (GMs) generally normalize before three months post term, but may persist when perinatal brain injury is present.

Aims

To assess the continuity of GM quality from fetal to early neonatal period and its relation to brain echogenicity changes.

Study design

Prospective study examining GMs and three vulnerable brain areas before and 7 days after birth. The quality of GMs was classified as normal or abnormal by Gestalt-perception. The brain was examined for moderate echogenicity changes (periventricular: brighter than choroid plexus, intraventricular: filling equal or more than 50% of the ventricle, and locally increased basal ganglia/thalami).

Subjects

94 fetuses from pregnancies complicated by preterm hypertensive disorders or labour at a gestational age between 26 and 34 weeks.

Outcomes measures

Correlations of fetal GMs, echogenicity changes, and clinical parameters (e.g. gestational age, parity, hypertensive disorders or preterm labour, oligohydramnios and fetal growth restriction) with neonatal GMs.

Results

Fetal GMs were abnormal in 64%, normalizing in 68% within 7 days after birth. Fetal GMs were significantly related to postnatal GMs (p = 0.045). Moderate fetal brain echogenicity changes and clinical parameters were not significantly related to neonatal GM.

Conclusions

In this population of pregnancies compromised by hypertensive disorders or preterm labour fetal GMs correlated with neonatal GMs. Presence of moderate echogenicity changes in the fetal brain was not related to neonatal GMs.     

Use of the ages and stages questionnaire in young children who are deaf/hard of hearing as a screening for additional disabilities

Background

Children with sensorineural hearing loss have a high rate of additional disabilities beyond those expected by the impact of hearing loss on language and are identified later than children without hearing loss. Identifying these developmental delays and allowing earlier implementation of interventions specific to these concerns would improve care.

Aims

To determine whether the Ages and Stages Questionnaire© (ASQ) can identify unmet needs or unidentified developmental delays among young children with bilateral sensorineural hearing loss.

Subjects

Fifty children with any degree of bilateral sensorineural hearing loss, 6 months to 36 months of age recruited from a tertiary referral center and regional early intervention programs for children who are deaf/hard of hearing.

Outcome measures

The ASQ and comprehensive developmental evaluations with the Revised Gesell Developmental Schedules.

Study design

Sensitivities and specificities of the ASQ were calculated.

Results

While 32% of our population had a developmental delay outside the domain of communication, the ASQ had poor sensitivity on the overall score without the communication domain as well as for fine motor, cognitive, personal–social domains. It had good sensitivity for the domains of communication and gross motor skills and good specificity (ranging 83–85%) on specific domains as well as for the overall score (70%).

Conclusions

The ASQ does not provide an effective mean for identifying additional developmental concerns in young children with bilateral sensorineural hearing loss. Further studies are needed to determine how to identify additional disabilities in a timely manner among young children with hearing loss.     

Estimating the relative contributions of maternal genetic, paternal genetic and intrauterine factors to offspring birth weight and head circumference

Background

Genetic factors and the prenatal environment contribute to birth weight. However, very few types of study design can disentangle their relative contribution.

Aims

To examine maternal genetic and intrauterine contributions to offspring birth weight and head circumference. To compare the contribution of maternal and paternal genetic effects.

Study design

Mothers and fathers were either genetically related or unrelated to their offspring who had been conceived by in vitro fertilization.

Subjects

423 singleton full term offspring, of whom 262 were conceived via homologous IVF (both parents related), 66 via sperm donation (mother only related) and 95 via egg donation (father only related).

Measures

Maternal weight at antenatal booking, current weight and maternal height. Paternal current weight and height were all predictors. Infant birth weight and head circumference were outcomes.

Results

Genetic relatedness was the main contributing factor between measures of parental weight and offspring birth weight as correlations were only significant when the parent was related to the child. However, there was a contribution of the intrauterine environment to the association between maternal height and both infant birth weight and infant head circumference as these were significant even when mothers were unrelated to their child.

Conclusions

Both maternal and paternal genes made contributions to infant birth weight. Maternal height appeared to index a contribution of the intrauterine environment to infant growth and gestational age. Results suggested a possible biological interaction between the intrauterine environment and maternal inherited characteristics which suppresses the influence of paternal genes.     

High-resolution computed tomography in young patients with cystic fibrosis: distribution of abnormalities and correlation with pulmonary function tests

Objective

To assess pulmonary abnormalities detected by high-resolution computed tomography (HRCT) in young children with cystic fibrosis (CF) and mild to moderate lung disease.

Study design

High-resolution computed tomography was performed in 60 children, 6 to 10 years old, with mild to moderate lung disease (forced expiratory volume in 1 minute [FEV₁], 52-137; mean, 102; SD, 15% predicted). HRCTs were scored by using a system that evaluates each lobe for severity and extent of CF lung disease. Findings of CF lung disease were tabulated in all subjects and in a subgroup with normal pulmonary function tests. HRCT scores were correlated with FEV₁, forced vital capacity (FVC), and forced expiratory flow between 25% and 75% of expired vital capacity (FEF_25-75) in 57 patients.

Results

Bronchiectasis was present in 35% of subjects, mucous plugging in 15%, and air trapping in 63%. No abnormality was detected in 25%. In 37 subjects with FEV₁, FVC, and FEF_25-75 >85% predicted, bronchiectasis was present in 30%. In 17% of these subjects, bronchiectasis was seen in ≥4 lobes. Correlations between HRCT scores and FEV₁ were significant and showed fair to moderate correlation (r = 0.36-0.46).

Conclusions

High-resolution computed tomography demonstrated a broad range of pulmonary abnormalities in young patients with CF with mild to moderate lung disease. In this study, abnormalities, including bronchiectasis, were common in young children with CF and normal pulmonary function tests.     

Mammary duct ectasia in children: report of a short series and review of the literature

Background

Mammary duct ectasia is uncommon in children, and is usually considered to be an acquired disease in adults. However the occurrence in infants and children suggest it may be developmental.

Aims

To report a case series of mammary duct ectasia, and review the published literature to ascertain the common findings and histological findings in children.

Study design

Case series report and review of the literature.

Results

We report three cases of mammary duct ectasia, an unusual disease in children. The most common presenting features are a bloody nipple discharge; there may also be a palpable mass or general breast enlargement. Two patients in this series presented with large masses simulating other conditions. Summary of all reported cases in children found that symptoms can arise from infancy, but is most common around the age of 3 years (range 2 months to 13 years), with a 5:2 male:female ratio. Histology centres on peri-ductal inflammation and dilation. Haemosiderin laden macrophages were seen commonly in this series; and may represent a histological marker in children. The disease is often self-limiting. Patients may require surgery for persistent nipple discharge or lump.

Conclusions

Duct ectasia should be entertained in small infants and children presenting with both small and large peri-areolar breast masses and/or bleeding. The occurrence of the disease in infants suggests that mammary duct ectasia may represent a developmental anomaly in the paediatric population.     

Neurophysiological evaluation in children with Friedreich's ataxia

Introduction

In children with Friedreich's ataxia (FRDA children), clinical ataxia outcomes are hardly substantiated by underlying neurophysiological parameters. In young FRDA children, some reports (based upon International Cooperative Ataxia Rating Scale scores (ICARS)) mention transient neurological improvement upon idebenone treatment. However, these outcomes are obtained with adult instead of pediatric reference values. It is unknown whether age-related neurophysiological parameters can really substantiate neurologic improvement.

Aim

In young FRDA children, we aimed to determine longitudinal neurophysiological parameters during idebenone treatment.

Methods

During a two-year study period, 6 genetically proven FRDA children with cardiomyopathy (6-18 years) were longitudinally assessed for neurophysiological parameters [sensory evoked potentials (SEPs), F response, peripheral nerve conduction and dynamometry] in association with age-matched ICARS-scores.

Results

In all FRDA children, SEPs remained absent during the two-year study period. Peroneal nerve conduction velocity declined (from − 1SD to − 2SD; p < .05), whereas F responses remained essentially unaltered. Total muscle force and leg muscle force decreased (from − 2 to − 3SD and − 2.5 to − 3.5SD; both p < .05) and age-related ICARS-scores deteriorated (median increase + 41%; p < .05).

Conclusion

In FRDA children, age-related neurophysiological and ataxia parameters deteriorate during idebenone treatment. Although we cannot exclude some (subjective) disease stabilization, age-related neurophysiological parameters do not substantiate neurologic improvement.     

Modeling of the human fetal skull base growth: interest in new volumetrics morphometric tools

Background

Research on the skull base is important to improve our understanding of the growth and development of the modern human skull. To study the growth of the human fetal skull base, we assessed a new geometric morphometric tool, which does not require the use of bone landmarks.

Material and methods

Seven dry fetal skulls of an estimated gestational age ranging from 15 to 27 weeks were studied. Each skull was scanned using a standard CT scan and the image sets were post-processed to extract volumetric data by segmenting the skull base into predefined regions of interest. Our method of analysis was based on the inertial properties of reconstructed volumes.

Results

The volumetric study of the skulls highlighted an asynchronous speed of growth between the pre and post-chordal parts of the skull base whose preferential growth are in the vertical and horizontal planes. We also found different speeds of growth in the pre-chordal part depending on the type of ossification (endochondral or membranous). The overall shape of the skull base bones were preserved during the period studied except for the petrous pyramids. The expansion of bone parts was isometric with reference to a central point that was located at the intrasphenoidal synchondrosis. Finally, the analysis of the basicranial angles corroborated data from the literature in the sagittal plane and allowed their study also in the frontal and horizontal planes.

Conclusions

This three-dimensional volumetric approach is a necessary complement to studies that are performed in the sagittal plane and are based on the identification of landmarks. The geometric morphometric method used by authors permitted to obtain original informations on the growth kinetics and bone tridimensional movements of the human fetal skull base.     

Nutritional and socioeconomic factors in motor development of Santal children of the Purulia district, India

Aims

The aim of this study was to characterize the motor development of 5-12 year-old Santal children of the Purulia district of West Bengal, India. The effect of socioeconomic and nutritional status on motor development was also examined.

Study design

841 (427 boys and 414 girls) Santal children were examined in this cross-sectional study. The nutritional status of each child was assessed by height-for-age z-score based on WHO reference data. Socioeconomic status (SES) was measured by the updated Kuppusswami scale. Motor development was measured using the Bruininks-Oseretsky Test of Motor Proficiency-Second Edition, Short Form (BOT-2).

Results

Sex had a significant (p < 0.05) effect on children's score of running speed and agility, upper-limb coordination and strength with higher scores for boys than girls. Children with a height-for-age z-score of − 2 or less were significantly more likely to have a total BOT-2 z-score of − 2 or less compared with children at a healthier height-for-age range (Χ² = 271.136, p < 0.0001). Well-nourished children scored significantly higher (p < 0.05) than undernourished children in total BOT-2 score and in all individual motor subtests. Regression analysis showed that nutritional status, socioeconomic status and height have a significant impact on total BOT-2 score (p < 0.001). Age and sex were found to be influencing factors in motor development.

Conclusion

Santal children's motor proficiency is around the 1st percentile when compared with normative BOT-2 data. This may be, in part, a result of nutritional and economic disparities between children on who the BOT-2 was normed and Santal children, supporting the role of nutrition in motor development. Additionally, Santal children with lower SES and poorer nutritional status have lower motor proficiency compared with Santal children with comparatively higher SES and nutritional status.     

Antenatal maternal anxiety is associated with problem behaviour at age five

Background

Developmental programming by maternal stress during pregnancy is found to influence behavioural development in the offspring.

Aim

To prospectively investigate the association between antenatal maternal anxiety and children's behaviour rated by their mothers and teachers.

Methods

In a large, community based birth-cohort (the ABCD-study) antenatal maternal state-anxiety (M = 36.7, SD = 9.8) was measured around the 16th week of gestation. Five years later, 3446 mothers and 3520 teachers evaluated 3758 children's overall problem behaviour, emotional symptoms, conduct problems, hyperactivity/inattention problems, peer relationship problems and pro-social behaviour.

Results

Hierarchical multiple regression analysis using a large number of potential covariates revealed that children of mothers who reported higher levels of anxiety during their pregnancy showed more overall problem behaviour, hyperactivity/inattention problems, emotional symptoms, peer relationship problems, conduct problems and showed less pro-social behaviour when mothers rated their child's behaviour. When teachers rated child behaviour, children showed more overall problem behaviour and less pro-social behaviour that was related to antenatal anxiety. The child's sex moderated the association between antenatal anxiety with overall problem behaviour and hyperactivity/inattention problems when reported by the mother. In boys, exposure to antenatal anxiety was associated with a stronger increase in overall problem behaviour compared to girls. Furthermore, antenatal anxiety was significantly related to an increase in hyperactivity/inattention problems in boys, while this was not the case in girls.

Conclusions

Exposure to antenatal maternal anxiety is associated with children's problem behaviour, with different outcome patterns for both sexes. Nevertheless, effect sizes in this study were small.     

Parental body size and early weight and height growth velocities in their offspring

Background

Whereas weight or height at a given age are the results of the cumulative growth experience, growth velocities allows the study of factors affecting growth at given ages.

Aim

To study the relationships between parental height and body mass index (BMI) and offspring's height and weight growth during infancy and childhood.

Study design

From the FLVSII population-based study, 235 parent-child trios belonging to 162 families examined in 1999.

Outcome measures

From medical records and previous FLVS examinations, child's height and weight history were reconstructed. Weight and height growth velocities from birth to seven years were estimated from a modelling of individual growth curve and correlated with parent's body size in 1999.

Results

Ponderal index and length at birth were significantly associated with maternal but not paternal BMI and height. In the first six months, height growth velocity was significantly associated with maternal stature (at three months: 0.12 ± 0.05 and 0.02 ± 0.05 cm/month for a 10 cm difference in maternal and paternal height respectively) and weight growth velocity with paternal BMI (at three months: 5.7 ± 2.8 and 1.9 ± 2.3 g/month for a difference of 1 kg/m² in paternal and maternal BMI respectively). Between two and five years, height growth velocity was more significantly associated with paternal height whereas weight growth velocity was more closely associated with maternal BMI.

Conclusions

Early childhood growth is characterised by alternate periods associated specifically with maternal or paternal BMI and height. This novel finding should trigger the search for specific genetic, epigenetic or environmentally shared factors from the mothers and fathers.     

Serial brain MRI and ultrasound findings: relation to gestational age, bilirubin level, neonatal neurologic status and neurodevelopmental outcome in infants at risk of kernicterus

Aims

To describe cranial ultrasound (cUS) and magnetic resonance imaging (MRI) findings in neonates at risk of kernicterus, in relation to gestational age (GA), total serum bilirubin (TSB), age at imaging and neurodevelopmental outcome.

Patients and methods

Neonates with peak TSB > 400 μmol/L and/or signs of bilirubin encephalopathy. Review of neonatal data, cUS, preterm, term and later MRI scans and neurodevelopmental outcome.

Results

11 infants were studied, two < 31, four 34-36 and five 37-40 weeks GA. TSB levels: 235-583 μmol/L (preterms); 423-720 μmol/L (terms). Neonatal neurological examination was abnormal in 8/10. cUS showed increased basal ganglia (BG) in 4/9 infants and white matter (WM) echogenicity, lenticulostriate vasculopathy (LSV) and caudothalamic hyperechogencity/cysts (GLCs) in 5/9 infants. MRI showed abnormal signal intensity (SI) in the globus pallidum (GP) in 1/2 preterm, 8/9 term and 9/11 later scans. Abnormal WM SI occurred in 2 preterm, 7 term and 10/11 later scans. Seven infants developed athetoid/dystonic cerebral palsy (CP) and 6 hearing loss (HL). Adverse outcome was associated with abnormal BG on cUS (3/4 CP, 4/4 HL), with high SI in GP (7/9 CP, 6/9 HL) on late T2-weighted MRI (all GA) and on T1/T2-weighted term MRI, mainly in term-born infants. WM abnormalities, GLCs and LSV did not correlate with outcome.

Conclusions

Severe CP occurred with relatively low TSB levels in preterms but only at high levels in full-terms; HL was difficult to predict. Early scans did not reliably predict motor deficits whilst all children with CP had abnormal central grey matter on later scans. Abnormal WM was seen early suggesting primary involvement rather than change secondary to grey matter damage. Why characteristic central grey matter MRI features of kernicterus are not seen early remains unexplained.