New assessment of the effects of birth order and socioeconomic status on birth weight

A survey of the 20 698 singleton births occurring in one year to women resident in the Greater Dublin area provided information on birth weight, birth order, and social class. Low (less than or equal to 2500 g), suboptimal (less than or equal to 3000 g), and optimal (3001-4499 g) birth weights all showed a linear relation with social class. The incidence of low and suboptimal birth weight was highest in first, fifth, and subsequent births, and conversely optimal weight was commonest in second, third, and fourth births. Analysis indicated that a major part of the birth-order effect was attributable to social class. Birthweight categories give information which may be distorted when using mean weight alone. The ue of suboptimal and optimal weight offers the possibility of more accurate assessment of trends in performance, particularly in small samples, than does the conventional sole use of low birth weight. Low and suboptimal birth weights are uncommon in Dublin.     

Anthropometric measurements in the detection of low birth weight infants in Lagos

The present study was undertaken to determine the anthropometric risk indicators in the detection of infants with low birth weight. A total of 788 consecutive, singleton, live born infants had anthropometric measurements determined within 24 hours of life using standard methods. There were 389 (49.37%) males and 399 (50.63%) females; 136 (17.56%) of the infants were of low birth weight (LBW). Birthweight was significantly correlated with occipitofrontal circumference (OFC; r = 0.66), length (r = 0.86), mid-arm circumference (MAC; r = 0.88) and maximum thigh circumference (MTC; r = 0.95) (p < 0.001). Furthermore, OFC of 33.6 cm and 32.3 cm, length of 47.7 cm and 45.5 cm, MAC of 9.6 cm and 9.1 cm, and MTC values of 15.5 cm and 14.9 cm were the corresponding cut-off values with the best combination of sensitivity, specificity and predictive values (p < 0.001) for identifying infants with birth weights of < 2500 g and < 2000 g respectively. The use of these risk indicators would help to identify newborns for close supervision and care, as well as prevent mortality and postnatal developmental retardation.     

Predictors of mortality in very low birth weight neonates in India

INTRODUCTION: Very low birth weight (VLBW) neonates constitute approximately 4-7 percent of all live births and their mortality is very high. The objective of the present study was to determine the predictors of mortality in VLBW neonates. METHODS: A retrospective cohort of VLBW neonates admitted over three years was studied. Exclusion criteria were: (1) neonates weighing less than 500 g and with gestational age less than 26 weeks; (2) presence of lethal congenital malformations; and (3) death in the delivery room or within 12 hours of life. The outcome measure was in-hospital death. Medical records were reviewed and data was analysed. Univariate analysis and logistic regression analysis were done to determine the predictors of mortality. RESULTS: A total of 260 cases were enrolled, of which a total of 96 (36.9 percent) babies died. The survival rate was found to increase with the increase in birth weight and gestational age. Univariate analysis showed maternal per vaginal bleeding, failure to administer steroid antenatally, Apgar score less than or equal to 5 at one minute, apnoea, gestational age, neonatal septicaemia and shock are the factors directly responsible for neonatal mortality. Logistic regression equation showed maternal bleed (1.326), apnoea (3.159), birth weight (0.037), gestational age (0.063), hypothermia (1.132) and shock (3.49) predicted 65 percent of mortality in VLBW babies. CONCLUSION: Common antenatal and perinatal predictors of mortality in VLBW infants in India include maternal bleed, failure to administer antenatal steroids, low Apgar score, apnoea, extreme prematurity, neonatal septicaemia and shock.     

Sociobiologic factors influencing low birth weight at a rural project hospital

The incidence of low birth weight (less than or equal to 2500 g) was 38.9% among 2292 singleton live births at a rural project hospital in Haryana. Only 7.0% of the newborns weighed 2000 g or less. Female babies had a higher incidence of low birth weight. Other factors considered were maternal age, parity and literacy and father's literacy. Young mothers (less than 20 years) had a higher incidence of low birth weight. Similarly parents who were illiterate or educated to below the primary grade also had a higher incidence of low birth weight. The maximum percentage of low birth weight was seen in the primiparous mothers. An increase of low birth weight was also seen after the 4th parity. The best outcome was at para 4.     

Screening for intrauterine growth retardation using ratio of mid-arm circumference to occipitofrontal circumference

Uncritical application of standard weight percentile charts, derived from white infants, to infants from different ethnic groups may result in an overestimate of the incidence of intrauterine growth retardation in those groups. The ratio of mid-arm circumference to occipitofrontal circumference was studied in 194 babies (49 Asian, 58 black, and 87 white). In contrast with birth weight the ratio did not vary among the ethnic groups; it was also independent of sex. In a prospective study of 64 neonates whose weight was below the 10th percentile on standard charts the ratio of mid-arm circumference to occipitofrontal circumference was a more accurate predictor than weight of those infants who would develop symptoms associated with intrauterine growth retardation. The ratio of mid-arm circumference to occipitofrontal circumference therefore provides a simple, accurate, and cheap way of assessing intrauterine growth retardation in areas with a large multiethnic population, where birth weight varies greatly.     

Differing influences on Aboriginal and non-Aboriginal neonatal phenotypes: a prospective study.

OBJECTIVE: To understand the differences, if any, in major influences on birth phenotype between Aboriginal and non-Aboriginal neonates. DESIGN: Prospective study of a cohort of pregnant Aboriginal women presenting for antenatal care before 20 weeks' gestation (ultrasound proven), and a reference cohort of pregnant non-Aboriginal women. Comparison of the phenotypic and demographic characteristics of the women, their pregnancies and their babies. PARTICIPANTS: 96 Aboriginal and 96 non-Aboriginal women with no known medical factors affecting fetal growth or gestation. SETTING: Four remote far north Queensland communities served by the Far North Regional Obstetric and Gynaecological Service (FROGS) and the antenatal clinic at Cairns Base Hospital. MAIN OUTCOME MEASURES: Neonatal birth weight, length, head circumference, abdominal circumference, mid-arm circumference and triceps skinfold thickness, and derived ponderal index (weight/length3), head:abdomen circumference ratio and head:mid-arm circumference ratio. RESULTS: The Aboriginal neonates were on average almost 450 g lighter than their non-Aboriginal counterparts. They were also slightly shorter, with smaller head, abdomen and mid-arm circumferences and lower mean ponderal indices and triceps skinfold thickness. The gestational characteristics of the two groups were not significantly different. Neonatal phenotype was significantly associated with maternal body mass index and maternal age in both groups. Alcohol use in pregnancy was associated with a significant reduction in Aboriginal neonatal size, while tobacco use was significantly associated with size reductions in non-Aboriginal babies. CONCLUSIONS: Culturally appropriate antenatal care programs targeting the effects of poor nutrition and excessive alcohol use are needed if the excess incidence of low birthweight in Aboriginal people is to be reduced.     

低体重新生儿急腹症的外科治疗

目的评价低体重新生儿危重急腹症外科治疗的效果。方法回顾分析2000年1月至2006年1月南京医科大学附属南京儿童医院新生儿外科治疗的228例体重低于2500g的新生儿危重急腹症的临床资料,比较胎龄、出生体重及诊治改进与预后的关系。结果患儿入院年龄1h-7d,平均（4．1±0．7）d;早产儿141例,足月小样儿87例;出生体重≤2000g者26例,2000—2500g者202例;2000年1月至2003年1月（前3年组）83例,2003年1月至2006年1月（后3年组）145例。治愈202例。死亡26例（11．4％）。早产儿组,≤2000g组,前3年组死亡率[14．89％（21／141）、53．84％（14／26）、18．07％（15／83）]远高于足月小样儿组,2000-2500g组和后3年组（χ^2=4．455、P〈0．05,χ^2=52．324、P〈0．01,χ^2=5．745、P〈0．05）。生存患儿随访4—48个月,体重身高达到正常标准。结论早产、出生体重低与新生儿急腹症死亡关系密切;随着新生儿外科手术、产前诊断和围手术期处理水平的提高,低体重新生儿危重急腹症治疗的成功率正在提高。     

Rates of perinatal mortality and low birth weight among 3367 consecutive births in south of Beirut

3367 consecutive births were reviewed prospectively. Population belongs mainly to a community with relatively underprivileged living conditions. Perinatal mortality was found at a rate of 22.4/1000 B. Early neonatal mortality formed 6.66/1000 B and stillbirth formed 15.83/1000 B. Low birth weight rate was 5.43% of live birth. Analysis of our findings suggests the need to improve follow-up during gestation to avoid complications resulting in macerated stillbirths, and to review the routine of follow-up and care in the immediate period before delivery, during delivery, in the immediate post partum period including resuscitation procedures, and care in the ICN. The aim is to prevent and appropriately treat intrauterine asphyxia, fetal distress, obstetric complications, and in the post partum period to appropriately resuscitate the newborn and improve ICN procedures. These measures are expected to reduce fresh stillbirth and early neonatal mortality and consequently infant mortality. Lowering rate of low birth weight is of less urgent nature in this population as it is relatively not high, but because a larger portion of early neonatal mortality is among low birth weight infants, with weights below 2000 gms, improving ICN care provided to these neonates is expected to sharply reduce neonatal mortality. In Lebanon we have a growing number of ICN units with wide variability of the quality of medical supervision and facilities. Insufficient number of neonatologists and nurses who are specialized in neonatal intensive care is leaving the chance for sick neonates to be attended by general pediatricians and insufficiently trained nurses. Our medical schools are called to encourage pediatricians to specialize in neonatal intensive care and to create more opportunities for this specialty to meet the national requirement. It is suggested, too, to subject ICN units in Lebanon to standardized requirements concerning attendance and facilities before obtaining official recognition. Centralization of care given to severely sick neonates and to women with high risk pregnancy in optimal conditions is most needed.     

Size-at-birth standards for an urban Canadian population

By random sampling of all births occurring in Hamilton, Ont. over an 18-month period the percentile distributions of the newborn infants' weight, length, and head and chest circumferences were determined. The resulting standards may be used in the clinical evaluation of size for gestational age. The smoothed 50th percentile values for newborns of 40 weeks gestational age were as follows for boys and girls respectively: birth weight 3530 and 3355 g, crown-heel length 52.0 and 51.3 cm, head circumference 35.2 and 34.4 cm, and chest circumference 33.4 and 32.8 cm. The mother's height averaged 160.8 +/- 6.1 cm and her weight before the pregnancy 59.2 +/- 10.5 kg. The prevalence of cigarette smoking during pregnancy was 34.8%.     

Preterm birth prevention in a rural practice

A program for the prevention of preterm births was developed for use in small, nonurban communities. In contrast to other programs, increased emphasis was placed on education and reassessment of "low-risk" women. Potentially preventable preterm births were identified and studied. The potentially preventable preterm birth rate decreased from 3.2% in the 3-year control period to 1.3% during the 2-year study period, a 60% reduction. The preterm neonates who were born during the study period were older, had a greater average birth weight, and had fewer admissions to the neonatal intensive care unit. The percentage of women in preterm labor who presented early enough to receive tocolysis increased from 51% to 98%, and those in preterm labor who delivered at term increased from 56% to 96%. Requiring primarily education and increased awareness, this preterm birth prevention program was successful and inexpensive and may be applicable to similar rural primary care practices.     

Risk factors for perinatal mortality in Canada

A population-based computer record-linkage study of infant births and deaths in 1978 and 1979 in eight Canadian provinces (Quebec and Newfoundland were excluded) was undertaken to permit analysis of perinatal mortality in relation to maternal and infant characteristics. Perinatal mortality rates were significantly higher in nonurban than in urban areas (p < 0.05). A logistic regression model was used to assess the effects on perinatal mortality of variables reported on birth and stillbirth records. This model included length of gestation, infant's birth weight and sex, number of previous births and number of previous stillbirths as well as an interaction term for length of gestation and birth weight. For early-neonatal mortality, odds ratios over 8 were observed for birth weight less than 2500 g or gestation less than 35 weeks. About 75% of early-neonatal mortality was attributable to low birth weight or fetal immaturity. Greater emphasis should be placed on the prevention of low birth weight.     

STUDY OF LOW BIRTH WEIGHT NEONATES

Low birth weight neonates with 2000g or less birth weight constitute about 10% of live births with perinatal mortality as high as 32.4%. Perinatal morbidity is 19.3% with asphyxia neonatorum and neonatal jaundice heading the list. Epidemiological maternal factors include extremes of age and parity, lack of antenatal care, low socioeconomic status, illiteracy and underweight short women. Etiologic factors are obstetric complications, hypertensive disorders, systemic diseases or idiopathic. The scope of preventive measures include improvement of economic status and education about health and safe pregnancy. Proper antenatal care for early detection of high risk cases, adequate and timely management of complications and adequate facilities for neonatal care can reduce the perinatal morbidity and mortality.KEY WORDS: Low birth weight neonates, Perinatal mortality     

孕妇体内血红蛋白水平与新生儿出生体重的关系

目的探讨孕妇体内血红蛋白水平与新生儿出生体重的关系。方法采用问卷调查法对研究对象进行基本情况调查,检测孕妇在不同妊娠期的血红蛋白值;根据新生儿出生体重情况将孕妇分组,比较各组孕妇的产前血红蛋白水平。结果在孕早期、孕中期和孕末期的血红蛋白水平分别为（123.20±11.86）g/L、（110.28±13.92）g/L、（105.46±8.43）g/L,两两比较均有显著统计学差异（P〈0.01）;新生儿出生体重2500～3000 g组孕妇血红蛋白低于3000～3500 g组和〉3500 g组（P〈0.01）。孕妇体内血红蛋白水平与新生儿出生体重的相关系数为r=0.849（P〈0.01）。结论孕妇的血红蛋白水平随着孕期的增加而下降;孕妇血红蛋白水平与新生儿的出生体重有关。     

孕前体重、孕期增重与新生儿出生体重的关系

目的探讨孕前体重和孕期增重对新生儿出生体重及身长等的影响,为降低巨大儿发生率、减少妊娠并发症提供临床资料。方法用自编问卷调查929例足月单胎产妇的孕前体重和孕期增重,随访至分娩。记录新生儿出生体重、身长、头围、胸径等体检数据,运用SPSS软件分析孕前体重、孕期增重与新生儿出生体重等的关系。结果①孕前低体重组新生儿出生体重、身长、头围、胸径、巨大儿发生率均明显低于理想体重组和超重组(P<0.05)。②孕期增重过多组巨大儿发生率、头围、胸径均明显大于增重不足和增重正常组(P<0.01),而3组间新生儿出生体重,身长两两比较差异均有统计学意义(P<0.01,P<0.05),即孕期增重越多新生儿出生体重越大,身长越长。③孕前低体重和正常体重的孕妇随着孕期增重过多,其新生儿出生体重、身长、头围、胸径明显增大。结论孕前体重,孕期增重均与新生儿出生体重及身长等发育指标有关。孕妇应根据自身条件注意调整孕期的增重范围,以便获得良好的妊娠结局。     

新生儿EPHX1和GSTT1基因多态性与低出生体重的关系

目的:探讨微粒体环氧化物水解酶基因(microsomal epoxide hydrolase gene,EPHX1)139位点多态性和谷胱甘肽转硫酶theta1基因(the glutathione S-transferase theta1 gene,GSTT1)多态性对新生儿低出生体重的影响.方法:采用病例对照调查方法,使用统一设计的调查问卷,由经过培训的调查员于1998年至1999年在安徽省安庆市各县级医院对入院分娩孕妇及其单胎、活产的低出生体重儿和正常出生体重的对照新生儿进行调查,共得到246个母亲-新生儿对,其中低出生体重组73对, 正常出生体重对照组173对,用PCR-RFLP方法确定基因型.结果:EPHX1 His139His纯合子基因型与His139Arg杂合子基因/Arg139Arg纯合子基因型比较, GSTT1缺失基因型与存在基因型比较,多因素Logistic回归模型在经混杂因素(母亲年龄、文化程度、生育史、新生儿性别、孕周)调整前后,均未见导致低出生体重的危险性有显著性增加.进一步分析EPHX1139位点多态性和GSTT1位点多态性之间对低出生体重的影响,结果显示GSTT1缺失基因型和EPHX1His139His纯合子基因型之间有明显联合作用,导致低出生体重的危险因素增加(OR＝3.46, P=0.035).结论:基因EPHX1 139位点多态性和GSTT1位点多态性对低出生体重的影响有明显联合作用.     

新生儿病房肺炎克雷伯菌医院感染的危险因素及防控分析

目的 调查分析新生儿病房肺炎克雷伯菌医院感染的危险因素,为预防和控制新生儿医院感染提供依据。方法 调查2012年2~9月发生医院感染新生儿的出生胎龄、体质量、入院诊断,采样监测病区物品表面、医务人员手及咽试子,分析感染的危险因素。结果 832例新生儿中,发生医院感染21例,感染率为2.52%。主要感染部位为血流感染,占71.43%;以早产儿为主,占47.62%;胎龄<37周、出生体质量≤1500 g是新生儿发生医院感染的危险因素(P<0.05);在婴儿床、备用医疗用品及洗澡间的婴儿用品表面均检出与患儿感染一致的病原菌。结论 改善医疗环境,严格卫生消毒,对胎龄小、出生体质量低等高危患儿采取必要的预防干预措施,能有效降低医院感染的发生。     

基于移动终端开展中国新生儿出生特征研究

目的:描述中国新生儿出生特征,并评价应用移动终端采集妇幼健康基础信息和开展相关流行病学研究的可行性。方法:2016年6月至2017年1月,在全国23个省份166家助产机构募集孕产妇,应用手机终端自填式问卷采集分娩方式、孕周和出生体质量等基础信息,描述剖宫产、早产、出生体质量、身长和头围等常用妇幼健康指标的发生率或平均水平。与2005年中国7岁以下儿童生长发育标准、2006年世界卫生组织儿童生长发育标准以及2014年中国不同胎龄新生儿出生体质量标准比较,评价数据的可信性。结果:调查产妇9 986名,其中35岁及以上者占11.7%,大专及以上学历者占70.2%。剖宫产、早产、低出生体重儿和巨大儿的发生率依次为38.1%、4.5%、2.2%和7.8%;新生儿平均出生体质量(3.33±0.44) kg [男(3.36±0.44) kg,女(3.29±0.43) kg],身长(50.97±2.32) cm [男(51.04±2.32) cm,女(50.89±2.32) cm],头围(33.99±1.56) cm [男(34.01±1.57) cm,女(33.97±1.55) cm]。与不同时期全国数据比较显示,剖宫产率和足月儿胎龄别出生体质量接近2014年全国水平,平均出生体质量和身长高于2005年中国生长发育标准、也高于2006年世界卫生组织生长发育标准。结论:男、女婴出生体质量较10年前的全国数据分别增加40 g和80 g,身长分别增加0.6 cm和1.3 cm,头围则与10年前相近,提示10年来我国新生儿体质状况明显改善,同时,信息化的发展可能为流行病学研究提供新途径。     

叶酸代谢基因多态性及Hcy水平与新生儿早产、出生体重的关系

目的探究叶酸代谢基因多态性及同型半胱氨酸(Hcy)水平与新生儿早产、出生体重的关系。方法选取我院2018年11月~2019年3月收治的80例孕妇进行研究,于孕早期采集口腔黏膜标本予以检测,以检测结果为标准,将叶酸代谢障碍遗传风险分为无/低风险(39例)和中/高风险(41例);同时检测孕妇的Hcy水平,并详细记录。分析不同基因型及Hcy水平与新生儿早产、出生体重的相关性。结果Hcy水平与新生儿出生体重呈正相关(r=0.168,P=0.002),MTRR A66G基因型与新生儿早产呈正相关(r=0.174,P=0.001),基因型总风险与新生儿早产呈正相关(r=0.159,P=0.004)。中/高风险孕妇早产率为20.51%(8/39),无/低风险孕妇早产率为4.88%(2/41),中/高风险孕妇早产率高于无/低风险组,差异有统计学意义(P<0.05)。分娩巨大儿孕妇Hcy水平为(5.76±0.73)μmol/L,分娩正常体重儿孕妇Hcy水平为(4.23±0.59)μmol/L,分娩极低体重儿孕妇Hcy水平为(4.01±0.56)μmol/L,分娩巨大儿孕妇Hcy水平高于分娩正常体重儿孕妇和分娩极低体重儿孕妇HCY水平,差异有统计学意义(P<0.05)。叶酸代谢障碍不同风险程度出生体重分布相比,差异无统计学意义(P>0.05)。结论叶酸代谢能力与早产具有相关性,叶酸代谢障碍越严重,早产儿的发生率越高;孕妇Hcy水平与新出生儿体重具有相关性,孕妇Hcy水平越高,新生儿出生体重越重。     

A 2-year study of neonatal mortality in a large Malaysian hospital

A 2-year study was carried out in the Maternity Hospital, Kuala Lumpur to determine the neonatal mortality rates. This Hospital functions both as the local service centre as well as the national referral centre in Malaysia. Its neonatal services, however, were equipped and manned at those below Level III perinatal centre. During the study period 52, 877 livebirths took place in the Hospital. In 1987 and 1988 respectively, the low birthweight (less than 2500 gm) rates were: 112.8 and 101.9 per 1000 livebirths, very low birthweight (less than 1500 gm) rates: 11.1 and 8.8 per 1000 livebirths, neonatal mortality rates: 12.5 and 10.7 per 1000 livebirths and neonatal mortality risk ratio: 1.15 and 1.27. There was significant difference in mortality rates among the Malay, Chinese and Indian babies born in this hospital: the Indians had the highest and the Chinese the lowest rates. Babies delivered by breech or lower segment Caesarean section (LSCS) also had significantly higher mortality than those delivered by other modes of delivery. Low birthweight neonates constituted less than 45% of the total special care nursery admission but contributed to more than 70% of the total neonatal deaths. The common causes of neonatal deaths were problems of prematurity, infection, asphyxia and congenital malformations. Preterm and low birthweight neonates died primarily from problems of prematurity or infection. Term and larger neonates died mainly from asphyxia. More than 75% of the neonatal deaths occurred before 7 days of life. Improvement of antenatal care in the community and upgrading of perinatal services in this Hospital could help to lower the morbidity and mortality due to preventable causes.     

A 12-month prospective survey of perinatal outcome of liveborn neonates in Julu County, China

Background Population based epidemiologic study on the main diseases and birth status of liveborn neonates remains scarce in China, especially in rural areas where a large number of neonates are born. The aim of this study was to establish an epidemiological basis of live births in Julu County, a representative of the northern and mid-western parts of China in terms of demography, disease pattern and women and children＇s health care infrastructure.Methods The perinatal data of all live births were prospectively collected in three participating county-level hospitals from September 1, 2007 to August 30, 2008.Results There were 5822 live births in these hospitals. Among all live births, 53.7% were male and 4.5% were bornprematurely. Mean （SD） birth weight （BW） was （3348±503） g. The low （〈2500 g） and very low BW （〈1500 g） infants accounted for 3.8% and 0.5% of the total births, with 6.5% as small for gestational age and 2.8% as multi-births.Cesarean section rate was 30.2%, of which 68.6% were elective. There were 745 infants （12.8% of the live births）admitted to local neonatal wards within 7 days of postnatal life, in which 48.3% and 19.3% were due to perinatal asphyxia and prematurity, respectively. The incidences of perinatal aspiration syndrome, transient tachypnea and respiratory distress syndrome were 4.9%, 0.6% and 0.5%, respectively. Neonatal mortality was 7.6%. （44/5822）, with 16 in delivery room and 28 in neonatal ward before discharge.Conclusions This study provided a population-based perinatal data of live births and neonatal mortality in a northern China county with limited resources. Neonatal disorders related to perinatal asphyxia remain a serious clinical problem,which calls for sustained education of advanced neonatal resuscitation and improvement in the quality of perinatal-neonatal care.