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1.
Purpose
Gastric perforation is a rare condition with high mortality rates in preterm infants. The aim of this retrospective study was to define the risk factors and prognosis in very low birth weight (VLBW) infants with gastric perforations.Methods
VLBW infants with a diagnosis of gastric perforation between 2012 and 2016 were included. The data including birth weight, gestational age, gender, risk factors, time and location of the perforation and prognosis were recorded.Results
A total of eight infants were identified. The median gestational age and birth weight of the infants were 26 weeks and 860 g, respectively. Five were male and 6 (75%) had a diagnosis of hemodynamically significant patent ductus arteriosus (PDA), early sepsis, persistent hypotension, and drug administration (paracetamol, ibuprofen). The main clinical finding was abdominal distension and pneumoperitoneum was detected in all infants. The median diagnosis was 6 days of life. The median perforation size was 2.5 cm and curvature major and anterior wall were the most common locations. The mortality rate was 62.5%.Conclusion
Male gender, chorioamnionitis, early sepsis, asphyxia, hemodynamic PDA, persistent hypotension, ibuprofen and paracetamol usage, and orogastric catheter administration were the main risk factors for gastric perforations in VLBW infants.2.
Masaya Yamoto Yusuke Nakazawa Koji Fukumoto Hiromu Miyake Hideaki Nakajima Akinori Sekioka Akiyoshi Nomura Kei Ooyama Yutaka Yamada Katsushi Nogami Yuko Van Chisako Furuta Reiji Nakano Yasuhiko Tanaka Naoto Urushihara 《Pediatric surgery international》2016,32(9):887-893
Purpose
Surgical intestinal disorders (SID), such as necrotizing enterocolitis (NEC), focal intestinal perforation (FIP), and meconium-related ileus (MRI), are serious morbidities in extremely low birth weight (ELBW, birth weight <1000 g) infants. From 2010, we performed enteral antifungal prophylaxis (EAP) in ELBWI to prevent for SID. The aim of this study was to identify disease-specific risk factors and to evaluate the efficacy of prevention for SID in ELBW infants.Methods
A retrospective chart review of all consecutive patients between January 2006 and March 2015, which included 323 ELBW infants who were admitted to Shizuoka Children’s Hospital, was conducted.Results
The number of infants with NEC, FIP, and MRI was 9, 12, and 13, respectively; 28 in 323 ELBW infants died. The control group defined the cases were not SID. In-hospital mortality was higher in infants with NEC relative to those in the control group. On logistic regression analysis, low gestational age and cardiac malformations were associated with increased risk of NEC. IUGR were associated with increased risk of MRI. EAP decreased risk of NEC and FIP. Low gestational weight and NEC were associated with increased risk of death.Conclusion
Survival to hospital discharge after operation for NEC in ELBW infants remains poor. EAP decreased risk of NEC and FIP in ELBW infants.3.
Antonio Di Mauro Manuela Capozza Sergio Cotugno Silvio Tafuri Francesco Paolo Bianchi Federico Schettini Raffaella Panza Nicola Laforgia 《Italian journal of pediatrics》2017,43(1):116
Background
Pulmonary disorders and respiratory failure represent one of the most common morbidities of preterm newborns admitted to neonatal intensive care units (NICUs). The use of nasal high-flow therapy (nHFT) has been more recently introduced into the NICUs as a non-invasive respiratory (NIV) support.Methods
We performed a retrospective study to evaluate safety and effectiveness of nHFT as primary support for infants born <?29 weeks of gestation and/or VLBW presenting with mild Respiratory Distress Syndrome (RDS).The main outcome was the percentage of patients that did not need mechanical ventilation. Secondary outcomes were rate of bronchopulmonary dysplasia (BDP), air leaks, nasal injury, late onset sepsis (LOS), intraventricular hemorrhage (IVH), retinopathy (ROP), necrotizing enterocolitis (NEC), hemodynamically-significant patent ductus arteriosus (PDA) and death.Results
Sixty-four preterm newborns were enrolled. Overall, 93% of enrolled patients did not need mechanical ventilation. In a subgroup analysis, 88.5% of infants <?29 weeks and 86.7% of infants ELBW (<?1000 g BW) did not need mechanical ventilation.BPD was diagnosed in 26.6% of preterms enrolled (Mild 20%, Moderate 4.5%, Severe 1.5%). In subgroup analysis, BPD was diagnosed in 53.9% of newborns with GA <?29 weeks, in 53.3% of ELBW newborns and in 11.1% of small for gestational age (SGA) newborns.Neither air leaks nor nasal injury were recorded as well as no exitus occurred. LOS, IVH, ROP, NEC and PDA occurred respectively in 16.1%, 0%, 7.8%, and 1.6% of newborns.Conclusions
According to our results, n-HFT seems to be effective as first respiratory support in preterm newborns with mild RDS. Further studies in a larger number of preterm newborns are required to confirm nHFT effectiveness in the acute phase of RDS.4.
Yuan-Jian Sheng Shan-Shan Xu Xue-Jing Li Jin-Ling Liu Xi-Ling Wu Xue-Feng Xu 《BMC pediatrics》2017,17(1):205
Background
To evaluate the role of serum cytokines in the pathogenesis of respiratory syncytial virus (RSV) infection in infants with low birth weight (LBW).Methods
A prospective observational study was performed, and hospitalized children with lower respiratory tract infection (LRTI) were recruited. Three hundred fifty-eight patients <?1 year met the inclusion criteria: 116 patients had only RSV infection (RSV group); 242 patients had no RSV or other specific pathogen (non-RSV group). Serum interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α), and interferon-γ (IFN-γ) were detected through flow cytometry.Results
No significant differences in serum IL-2, 4, 6, 10, and IFN-γ levels were observed between the RSV and non-RSV groups. For RSV infected infants with or without wheezing, delivery mode had no obvious effect on the changes of serum cytokine levels. However, the level of IL-6 in the RSV-infected infants with LBW was significantly higher than that in infants with normal birth weight.Conclusions
Serum IL-6 level was significantly increased in RSV infected infants with LBW. It is likely that the specific serum cytokine pattern will contribute to our understanding of the pathogenesis of RSV infections, especially in RSV-infected infants with LBW.5.
Objective
To assess the safety and immunogenicity of pneumococcal conjugate vaccine (PCVs) in preterm infants.Methods
In accordance with the PRISM (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement (as of May 2015), a meta-analysis was conducted to evaluate the safety and immunogenicity of PCVs in preterm infants.Results
Ten thousand nine hundred sixty full-term infants and 2131 preterm infants with 344 preterm infants of <2500 g birth weight [low-birth weight (LBW)] were included, and all the subjects were immunized with either PCV-7, PCV-10 or PCV-13 in this random-effects meta-analysis. For safety, the range of risk ratio (RRs) for local reaction was from 0.88 to 1.02 and from 0.94 to 1.24 for systematic reaction respectively. For immunogenicity, either post-primary or booster vaccination with PCV-7, PCV-10 or PCV-13, genomic mean concentration (GMC) of serotypes 4, 6B, 9 V, 19F and 23F was always less in preterm infants than in full-term infants, in which huge comparison of GMC was found in serotype 19F(SMD = ?0.393, 95%CI:-0.612 ~ 0.175). After primary vaccination, the combined risk ratio (RRs) of immune response against seven common serotypes and additional serotype 1 was approximated to 1.00 with narrow 95 % confidence interval (CI) between preterm infants and full-term infants, and at least 91 % sero-conversion of two additional serotypes, 5 and 7F in two cohorts was observed. Furthermore, between very-low-birth-weight (VLBW) infants of <1500 g and 1501 ~ 2500 g, overall RRs of immune response to PCV-7 administration was 0.98 (95%CI: 0.96 ~ 1.00).Conclusions
Preterm infants have a great tolerance to PCV-7, PCV-10 or PCV-13 vaccination. PCV-7 could elicit optimal immune response post vaccination in preterm infants, even in VLBW infants.6.
Sudha Chaudhari Madhumati Otiv Bharati Khairnar Anand Pandit Mahendra Hoge Mehmood Sayyad 《Indian pediatrics》2012,49(9):727-732
Objective
To assess the growth, adiposity and blood pressure of non-handicapped low birthweight children at 18 years.Design
Prospective cohort study.Setting
Infants born between 1987-1989 with birthweight less than 2000g, discharged from a neonatal special care unit of a referral hospital and followed up till the age of 18 years.Methods
The height, weight, and head circumference were measured. Measurements for adiposity, blood pressure, parental height and weight were recorded.Results
The cohort of 161 low birth weight (LBW) infants was divided into three groups according to their gestation — preterm SGA (n=61), full term SGA (n=30) and preterm AGA (n=70). 71 full term AGA infants served as controls. Preterm SGA males had height of 164.5 cms (162–166.9, 95% CI) which was significantly less (mean deficit = 5.7 cms) than that of controls (P=0.02). However, PTSGA children were short inspite of normal midparental height. Preterm SGA and AGA children had smaller head circumference. There was no evidence of adiposity and no child had hypertension. Mid-parental height was an important determinant of height in LBW children. Both parentss’ weight and BMI were important determinants of weight and BMI, respectively in all LBW children.Conclusion
Preterm SGA males were short, but there was no difference in the weight of the LBW group and controls. Preterms had smaller head circumference. There was no evidence of adiposity or hypertension.7.
Aklilu Endalamaw Eshetu Haileselassie Engeda Daniale Tekelia Ekubagewargies Getaneh Mulualem Belay Mekuriaw Alemayehu Tefera 《Italian journal of pediatrics》2018,44(1):141
Background
Different primary studies in Ethiopia showed the burden of low birth weight. However, variation among those studies was seen. This study was aimed to estimate the national prevalence and associated factors of low birth weight in Ethiopia.Methods
PubMed, Web of Science, Cochrane library, and Google Scholar were searched. A funnel plot and Egger’s regression test were used to see publication bias. I-squared statistic was applied to check heterogeneity of studies. A weighted inverse variance random-effects model was applied to estimate the national prevalence and the effect size of associated factors. The subgroup analysis was conducted by region, study design, and year of publication.Result
A total of 30 studies with 55,085 participants were used for prevalence estimation. The pooled prevalence of LBW was 17.3% (95% CI: 14.1–20.4). Maternal age?<?20?years (AOR?=?1.7; 95% CI:1.5–2.0), pregnancy interval?<?24?months (AOR?=?2.8; 95%CI: 1.4–4.2), BMI?<?18.5?kg/m2 (AOR?=?5.6; 95% CI: 1.7–9.4), and gestational age?<?37?weeks at birth (AOR?=?6.4; 95% CI: 2.5–10.3) were identified factors of LBW.Conclusions
The prevalence of low birth weight in Ethiopia remains high. This review may help policy-makers and program officers to design low birth weight preventive interventions.8.
Purpose
The purpose of this study was to investigate the comparison of AR and AUS in predicting prognosis in infants with necrotizing enterocolitis.Methods
All patients were diagnosed as NEC at the department of general surgery and neonatal surgery, Qilu children’s hospital between 1st, Jun, 2010 and 30th, Dec, 2016. The logistic regression analysis and the area under ROC curve (AUC)s were also used to compare the prognostic values of radiograph and sonograph for NEC.Results
Throughout the study period, 86 preterm neonates were hospitalized with diagnosis of definite NEC. Among these patients, 39 infants (45.3%) required surgical treatment. After adjusting for competing sonographic factors, we identified that thick bowel wall (more than 2.5 mm) (p?=?0.001, HR: 1.849), intramural gas (pneumatosis intestinalis) (p?=?0.017, HR: 1.265), portal venous gas (p?=?0.002, HR: 1.824), and reduced peristalsis (p?=?0.021, HR: 1.544) were independent prognostic factors associated with NEC. After adjusting for competing radiographic factors, we identified that free peritoneal gas (p?=?0.007, HR: 1.472), portal venous gas (p?=?0.012, HR: 1.649), and dilatation and elongation (p?=?0.025, HR: 1.327). Moreover, we found that the AUROC for AR logistic model was 0.745 (95% CI 0.629–0.812), which was significant lower than the AUS logistic model (AUROC: 0.857, 95% CI 0.802–0.946) for predicting prognosis of NEC.Conclusions
In conclusion, we found that several radiographic and sonographic parameters were associated with the prognosis of patients with NEC. The AUS model based on the logistic regression analysis was significant superior to the AR model in the prognostic prediction of NEC.9.
Background
Enteral feeding of very low birth weight (VLBW) infants is a challenge, since metabolic demands are high and administration of enteral nutrition is limited by immaturity of the gastrointestinal tract. The amino acid glutamine plays an important role in maintaining functional integrity of the gut. In addition, glutamine is utilised at a high rate by cells of the immune system. In critically ill patients, glutamine is considered a conditionally essential amino acid. VLBW infants may be especially susceptible to glutamine depletion as nutritional supply of glutamine is limited in the first weeks after birth. Glutamine depletion has negative effects on functional integrity of the gut and leads to immunosuppression. This double-blind randomised controlled trial is designed to investigate the effect of glutamine-enriched enteral nutrition on feeding tolerance, infectious morbidity and short-term outcome in VLBW infants. Furthermore, an attempt is made to elucidate the role of glutamine in postnatal adaptation of the gut and modulation of the immune response.Methods
VLBW infants (gestational age <32 weeks and/or birth weight <1500 g) are randomly allocated to receive enteral glutamine supplementation (0.3 g/kg/day) or isonitrogenous placebo supplementation between day 3 and 30 of life. Primary outcome is time to full enteral feeding (defined as a feeding volume ≥ 120 mL/kg/day). Furthermore, incidence of serious infections and short-term outcome are evaluated. The effect of glutamine on postnatal adaptation of the gut is investigated by measuring intestinal permeability and determining faecal microflora. The role of glutamine in modulation of the immune response is investigated by determining plasma Th1/Th2 cytokine concentrations following in vitro whole blood stimulation.10.
Objective
To investigate the correlation between the initial prophylactic antibiotic use and the subsequent NEC in high-risk premature infants.Methods
We performed a literature search of PubMed, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Web of Science, and nine studies with a total of 5207 infants were selected for inclusion in this study.Results
The pooled estimate for the seven studies combined indicating that prophylactic antibiotic usage was associated with a non-significant trend toward increased incidence of NEC [odds ratio (OR) 0.75; 95% confidence interval (CI) 0.26–2.17], and prolonged exposure to prophylactic antibiotics, compared with limited prophylactic antibiotic use, was associated with a significant trend toward the risk of increasing incidence of NEC (OR 1.31; 95% CI 1.08–1.59).Conclusion
Current evidence does not support the use of prophylactic antibiotics to reduce the incidence of NEC for high-risk premature infants.11.
Background
To investigate strategies used for the management of respiratory distress syndrome (RDS) and bronchopulmonary dysplasia (BPD) in extremely low birth weight (ELBW) infants.Methods
A survey of neonatal specialists working in US academic institutions with fellowship training programs.Results
Eighty percent (72/89) of the identified academic institutions had at least one physician who responded to the survey. Among respondents, 85% (171/201) agreed or strongly agreed to use continuous positive airway pressure (CPAP) initially for the management of RDS, and the majority agreed or strongly agreed to use a fraction of inspired oxygen (FiO2) ≥0.4 and a mean airway pressure (MAP) ≥10 cm H2O as a criteria for surfactant therapy; and 73% (146/200) sometimes or always used caffeine to prevent BPD. Only 25% (50/202) sometimes or almost always used steroids to prevent or treat BPD. Identified indications to use steroids were 3 or more extubation failures or inability to extubate beyond 8 weeks of age.Conclusions
Variability in treatment strategies of ELBW is common among neonatal specialists. However, the majority of the respondents agreed or strongly agreed to use early CPAP for the management of RDS, consider a FiO2 ≥0.4 and a MAP ≥10 cm H2O as criteria for surfactant therapy, and sometimes or almost always used caffeine to prevent BPD. Steroids continue to have a role in the management of BPD in infants who are difficult to extubate.12.
Maheswari Ekambaram Matilde Irigoyen Johelin DeFreitas Sharina Rajbhandari Jessica Lynn Geaney Leonard Edward Braitman 《World journal of pediatrics : WJP》2018,14(4):357-363
Background
In adolescents, there is limited evidence on the independent and additive effect of prepregnancy body mass index (BMI) and gestational weight gain on infant birth weight. Data also show that this effect may vary by race. We sought to examine the impact of maternal prepregnancy BMI and gestational weight gain on birth weight and risk of large for gestational age (LGA) in term newborns of minority adolescent mothers.Methods
This was a retrospective cohort study of 411 singleton live term infants born to mothers ≤ 18 years. Data were abstracted from electronic medical records.Results
Gestational weight gain was related to infant birth weight (ρ = 0.36, P < 0.0001), but BMI was not (ρ = 0.025, P = 0.61). On regression analysis, gestational weight gain, gestational age and Hispanic ethnicity were independent predictors of birth weight, controlling for maternal age, BMI, parity, tobacco/drug use and preeclampsia. The probability of having an LGA infant increased with weight gain [adjusted odds ratio (aOR) 1.14, 95% confidence interval (CI) 1.07–1.21] but not with BMI. Mothers who gained weight in excess of 2009 Institute of Medicine (IOM) recommendations had a greater risk of having an LGA infant compared to those who gained within recommendations (aOR 5.7, 95% CI 1.6–19.5).Conclusions
Minority adolescents with greater gestational weight gain had infants with higher birth weight and greater risk of LGA; BMI was not associated with either outcome. Further studies are needed to examine the applicability of the 2009 BMI-specific IOM gestational weight gain recommendations to adolescents in minority populations.13.
Jayasree Chandramati Abdul Majeed Ashwin Prabhu Sasidharan Ponthenkandath 《Indian pediatrics》2018,55(10):905-906
Background
Intractable obstructive apneas requiring multiple intubations are rare in newborns.Case characteristics
We report a pair of twins born at 29 weeks gestation who had severe obstructive apneas due to Paradoxical Vocal Cord Motion (PVCM).Outcome
The symptoms resolved promptly with ipratropium nebulization. Follow-up at 12 months of age revealed normal development.Message
PVCM should be considered in the differential diagnosis of intractable obstructive apneas in very low birth weight preterm infants.14.
Purpose
To evaluate whether plasma white blood cell count (WBC), platelet count (PLT), and C-reactive protein level (CRP) can be used to differentiate surgical necrotizing enterocolitis (NEC) from medical NEC.Methods
Preterm infants admitted between January 1, 2011 and July 31, 2015 were stratified by the need of surgery as surgical NEC (n?=?41) and medical NEC (n?=?43). The values of WBC, PLT and CRP were collected at time before NEC occurred (T0), at onset of NEC (T1) and when surgical assessment was required (T2). Patients admitted between August 1, 2015 and March 1, 2018 (n?=?53) were collected for further verification.Results
Variables identified in logistic regression analysis predicting surgical NEC were WBC and PLT at T2 (WBC2 and PLT2). The predictive probability of surgery (P) could be calculated by the equation \(\ln (P/(1 - P))=2.801 - 0.207{\text{WB}}{{\text{C}}_{\text{2}}} - 0.008{\text{PL}}{{\text{T}}_{\text{2}}}\). The area under curve of P was 0.84 and the ideal cutoff value was 0.55, with sensitivity and specificity of 85 and 81%, respectively. This cutoff value got an sensitivity of 80% and specificity of 79% in the verification group.Conclusion
Combination of WBC and PLT can effectively differentiate surgical NEC from medical NEC infants when surgical assessment was required.15.
Aim
To investigate the effectiveness of IgM-enriched immunoglobulins (IgM-eIVIG) in reducing short-term mortality of neonates with proven late-onset sepsis.Methods
All VLBW infants from January 2008 to December 2012 with positive blood culture beyond 72 hours of life were enrolled in a retrospective cohort study. Newborns born after June 2010 were treated with IgM-eIVIG, 250 mg/kg/day iv for three days in addition to standard antibiotic regimen and compared to an historical cohort born before June 2010, receiving antimicrobial regimen alone. Short-term mortality (i.e. death within 7 and 21 days from treatment) was the primary outcome. Secondary outcomes were: total mortality, intraventricular hemorrhage, necrotizing enterocolitis, periventricular leukomalacia, bronchopulmonary dysplasia at discharge.Results
79 neonates (40 cases) were enrolled. No difference in birth weight, gestational age or SNAP II score (disease severity score) were found. Significantly reduced short-term mortality was found in treated infants (22% vs 46%; p?=?0.005) considering all microbial aetiologies and the subgroup affected by Candida spp. Secondary outcomes were not different between groups.Conclusion
This hypothesis-generator study shows that IgM-eIVIG is an effective adjuvant therapy in VLBW infants with proven sepsis. Randomized controlled trials are warranted to confirm this pilot observation.16.
Background
Fully understanding the determinants and sequelae of fetal growth requires a continuous measure of birth weight adjusted for gestational age. Published United States reference data, however, provide estimates only of the median and lowest and highest 5th and 10th percentiles for birth weight at each gestational age. The purpose of our analysis was to create more continuous reference measures of birth weight for gestational age for use in epidemiologic analyses.Methods
We used data from the most recent nationwide United States Natality datasets to generate multiple reference percentiles of birth weight at each completed week of gestation from 22 through 44 weeks. Gestational age was determined from last menstrual period. We analyzed data from 6,690,717 singleton infants with recorded birth weight and sex born to United States resident mothers in 1999 and 2000.Results
Birth weight rose with greater gestational age, with increasing slopes during the third trimester and a leveling off beyond 40 weeks. Boys had higher birth weights than girls, later born children higher weights than firstborns, and infants born to non-Hispanic white mothers higher birth weights than those born to non-Hispanic black mothers. These results correspond well with previously published estimates reporting limited percentiles.Conclusions
Our method provides comprehensive reference values of birth weight at 22 through 44 completed weeks of gestation, derived from broadly based nationwide data. Other approaches require assumptions of normality or of a functional relationship between gestational age and birth weight, which may not be appropriate. These data should prove useful for researchers investigating the predictors and outcomes of altered fetal growth.17.
Janet Sharpe Mandy Way Pieter J. Koorts Mark W. Davies 《World journal of pediatrics : WJP》2018,14(5):492-497
Background
To determine whether the introduction of pasteurized donor human milk and probiotics for infants born?<?32 weeks gestational age or?<?1500 g birthweight is associated with a reduction in mortality and the incidence of necrotising enterocolitis (NEC) and sepsis.Methods
We performed a retrospective analysis of two cohorts: before and after the introduction of probiotics and pasteurised donor human milk. Univariate analysis of primary and secondary outcomes was performed; variables impacting outcomes were assessed using multivariate logistic regression.Results
There were 1791 infants: 1334 in the pre-donor milk/probiotic cohort and 457 in the post-donor milk/probiotic cohort. On univariate analysis, mortality (7.6 vs. 2.4%, P?<?0.001) and incidence of sepsis (6.2 vs. 3.5%, P?=?0.028) were statistically significantly lower in the post-donor milk/probiotic group. NEC (2.8 vs. 1.5%, P?=?0.14) and non-NEC associated gastrointestinal perforation (1.6 vs. 0.4%, P?=?0.052) were lower in the post-donor milk/probiotics cohort, but these were not statistically significant. The difference in mortality remained statistically significant on multivariate analysis in the post-donor milk/probiotic cohort compared to those in the pre-donor milk/probiotic cohort (odds ratio 0.31, 95% confidence interval 0.16–0.61). The decrease in the incidence of NEC was consistent with previous observational studies but the difference was not statistically significant.Conclusion
The availability of probiotics and pasteurised donor human milk is associated with a reduction in mortality in very preterm infants.18.
19.
Sudha Chaudhari Madhumati Otiv Mahendra Hoge Anand Pandit Mohammed Sayyed 《Indian pediatrics》2017,54(6):461-466
Objective
To study the early markers of Metabolic syndrome in a cohort of low birth weight (LBW) children followed up since birth, at the age of 22 years.Design
Prospective cohort study.Setting
Tertiary-care hospitalParticipants
Neonates weighing less than 2000 g discharged from a neonatal special care unit were followed up prospectively; 153 cases and 77 controls were assessed at 22 years of age.Methods
Fasting, 30 minute and 120 minute glucose and insulin after a bolus of 75g of glucose was determined. Insulin resistance was calculated. A lipid profile was also done. Anthropometric measurements were taken and abdominal fat was determined by magnetic resonance imaging.Main outcome
Prevalence of the five components of Metabolic Syndrome as described by the International Diabetic Federation (IDF).Results
65.1% of the cohort was born small for gestational age. All three components of Metabolic syndrome were present in only three cases and none of the controls. However, two components were present in 25 (16.4%) cases and 5 (6%) controls (P=0.039). Cases in the lowest quartile of birthweight who became big at 22 years had significantly higher fasting insulin (P=0.001), Homeostatic Model Assessment–Insulin Resistance (Homa-IR) (P=0.001) and higher systolic blood pressure. Sum of skinfold thickness at 4 sites correlated significantly with fasting insulin and HOMA-IR, and was a stronger correlate compared to BMI, waist circumference and MRI fat. There was no difference in the biochemical parameters between appropriate for gestational age and small for gestational age infants.Conclusion
Prevelence of three or more components of Metabolic syndrome was low in LBW children at 22 years, but of two components was high. Those ‘Small at birth and big at 22 years’ had high insulin resistance.20.
A. Shashidhar P. N. Suman Rao Saudamini Nesargi Swarnarekha Bhat B. S. Chandrakala 《Indian pediatrics》2017,54(5):363-367