Mid-arm and chest circumferences at birth as predictors of low birth weight and neonatal mortality in the community

In developing countries, where about three quarters of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. A study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight and those at risk. A study of 520 hospital births showed a strong correlation (p less than 0.001) between other anthropometric variables and birth weight, but the correlation was maximum for chest circumference (r = 0.8696) and mid-arm circumference (r = 0.8110). A mid-arm circumference of less than or equal to 8.7 cm and a chest circumference of less than or equal to 30 cm had the best sensitivity and specificity for identifying neonates with a birth weight of 2500 g or less. Measurements on 501 consecutive live births in the community were recorded and the infants followed up at specified ages. Mid-arm circumference was again significantly correlated to birth weight (r = 0.6918). Neonatal mortality showed an inverse relation but postneonatal mortality an inconsistent relation with mid-arm circumference. A mid-arm circumference of less than or equal to 8.7 cm and a birth weight of less than or equal to 2500 g were equally useful in predicting neonatal outcome. Mid-arm and chest circumferences are simple, practicable, quick, and reliable indicators for predicting low birth weight and neonatal outcome in the community and can be easily measured by paramedical workers in developing nations.     

Increments in whole body bone mineral content associated with weight and length in pre-term and full-term infants during the first 6 months of life.

BACKGROUND: The objective of the present study was to assess bone mineral content (BMC) of the whole skeleton in pre-term and full-term healthy infants and the factors influencing BMC, such as bone area, birth weight, birth length, current weight, current length, gender, and gestational age. METHODS: Forty-eight healthy full-term infants and 34 healthy premature infants fed predominantly with intact human milk were studied. BMC was measured monthly with dual energy X-ray absorptiometry (DEXA). At the same time, length and weight were measured and registered. Pre-term infants were studied at 60-day intervals. RESULTS: For both full-term and pre-term infants, BMC increased during the first months of life. However, the values of pre-term infants never reached the values of full-term infants, even after correcting for age and weight. For both full-term and pre-term infants, BMC was significantly correlated at the second month with birth weight (r = 0.901), birth length (r = 0.860), gestational age (r = 0.803), bone area (r = 0.960), current weight (r = 0.920), and current length (r = 0.840, p <0.001 for all correlation coefficients). Multivariate analysis revealed that bone area was the most important factor in predicting BMC. CONCLUSIONS: Pre-term children have lower BMC than full-term children. The main factor explaining this apparent osteopenia is bone area. Pre-term children have a higher daily mineralization rate than full-term children, but this catch-up mineralization is not enough to reach BMC levels seen in full-term children.     

B超测量胎儿腹围、股骨长预测新生儿体重的临床研究

目的:探讨足月分娩前不同B超测量径线对新生儿出生体重和巨大儿的预测价值,为指导临床实践提供科学依据。方法:对3 971名孕妇,在分娩前3天内超声测量胎儿双顶径、头围、胸径、腹围、股骨长、肱骨长,追踪胎儿的出生体重,使用SPSS10.0软件包分析胎儿各径线长与出生体重的关系。结果:B超测量胎儿的双顶径、头围、胸径、腹围、股骨长、肱骨长与新生儿出生时体重相关性均有统计学意义(均P<0.001)。腹围和股骨长是巨大儿重要影响指标(P值均<0.001)。"新生儿出生体重(g)=13.6×腹围(mm)+41.4×股骨长(mm)-4 182"模型对预测新生儿出生体重具有一定价值,但对巨大儿预测价值相对较低(假阴性率为79.8%)。ROC曲线胎儿腹围、股骨长预测巨大儿的最佳临界值分别为357.5mm和71.5 mm,该界值预测巨大儿的灵敏度分别为67.4%和75.6%,特异度分别为83.0%和60.5%。结论:足月分娩前超测量胎儿胸围和股骨长是预测新生儿出生体重的较好指标,腹围大于357.5mm、股骨长大于71.5mm对预测巨大儿具有一定临床价值。     

探讨胎儿腹围在预测巨大儿评估中的临床价值

目的 评估胎儿腹围在预测巨大儿评估中的临床价值。方法 对2017年3月至2019年2月在陕西省第二人民医院产科妊娠37～42周分娩的1107例孕妇病例资料进行回顾性分析,判断超声检测胎儿生长发育指标与新生儿出生体重之间的相关性,观察胎儿腹围在预测巨大儿评估中的临床价值,并比较以胎儿腹围及Hadlock公式预测巨大儿的统计学意义。结果 胎儿腹围、双顶径及股骨长度与新生儿出生体重呈正相关。其中胎儿腹围与新生儿出生体重的相关性最大(r=0.93,P＜0.001),其次为股骨长及双顶径(r=0.73,P＜0.001,r=0.72,P＜0.001)。胎儿腹围预测巨大儿的临床最佳临界值为35.8 cm(约登指数为0.79)。通过测量胎儿腹围或Hadlock公式的方式预测巨大儿,差异无统计学意义。结论 采用超声检测判断胎儿腹围,可实现对巨大儿风险的预测。较Hadlock公式相比,超声检测相对便利,操作简单,临床应用价值显著。     

脐血瘦素水平与几个胎儿宫内生长发育指标的相关性探讨

目的：评估脐血瘦素水平与新生儿生长发育指标的关系,探讨脐血瘦素水平与胎儿宫内生长发育的相关性。方法：90例健康新生儿在夹闭脐带后分别采集脐静脉血2～4ml,采用ELISA法测定新生儿脐血瘦素水平。记录新生儿出生体重、出生身长、头围、计算体重指数（BMI）、胎龄。结果：脐血瘦素水平与出生体重（r=0．513,P〈0．0001）、头围（r=0．413,P〈0．01）、出生身长（r=0．308,P〈0．0001）、BMI（r=0．238,P〈0．0001）、胎龄（r=0．220,P〈0．01）新生儿生长发育指标有显著相关性。结论：脐血瘦素水平与胎儿生长发育有关,瘦素水平出现异常可能是引起胎儿宫内生长受限的因素之一。     

Maternal and cord blood levels of insulin-like growth factors--I and--II and insulin-like growth factor binding protein-1: correlation with birth weight and maternal anthropometric indices

OBJECTIVES: To study the correlation of maternal and cord blood insulin like growth factor (IGF)-I and -II and IGF binding protein (IGFBP)-1 levels with birth weight and maternal anthropometric indices. DESIGN: Longitudinal prospective study. SETTING: Academic Institutions and a Tertiary Care Maternity Hospital. PARTICIPANTS: Women with uncomplicated singleton pregnancy (N = 35) and their newborns. MEASUREMENTS: Maternal weight, height, symphysiofundal height and serum levels of IGF-I, IGF-II, IGFBP-1 were measured thrice during the antenatal period, within 24 h of delivery and at 6 weeks and 6 months postpartum. Newborn anthropometric indices were recorded at birth, and at 6 weeks and 6 months of age. Cord blood levels of IGF-1, IGF-II, IGFBP-1, paternal height and weight, and placental weight measured. RESULTS: Maternal and cord blood IGF-I levels were lower than values reported for Caucasians. All newborns showed adequate growth at birth, and up to 6 months of age. Cord blood IGF-1 positively correlated with chest circumference (r = 0.4532, P = 0.0262), IGFBP-1, negatively with birth weight (r = -0.4024, P = 0.0461) and IGF-II had no effect. Cord blood IGF-I positively correlated with maternal levels at 28 +/- 2 (r = 0.4571, P = 0.0247) and 36 +/- 2 (r = 0.4291, P = 0.0364) weeks of amenorrhoea, whereas IGF-II and IGFBP-1 did not correlate with maternal values. Maternal IGF-I, IGF-II and IGFBP-1 did not correlate with newborn or maternal anthropometric indices. Placental weight correlated significantly with birth weight (r = 0.5299, P = 0.0348) and head circumference (r = 0.5031, P = 0.0470). CONCLUSIONS: Cord blood IGFBP-1 and placental weight appear to be determinants of birth weight variation even among appropriately grown for gestational age newborns.     

失效模式与效果分析模型在极低出生体重儿脐静脉置管中的术后应用价值

目的 探讨失效模式与效果分析模型在极低出生体重儿脐静脉置管中的术后应用价值.方法 对江西省宜春市妇幼保健院2018年1月至2020年5月收治的65例极低出生体重患儿相关资料予以回顾性分析,以2019年3月为界限,2018年1月至2019年3月收治30例患儿接受常规风险干预,作为常规组,2019年4月至2020年5月35...     

Prediction of Abdominal Visceral Obesity From Body Mass Index, Waist Circumference and Waist-hip Ratio in Chinese Adults： Receiver Operating Characteristic Curves Analysis

Objective To evaluate the sensitivity and specificity of body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) measurements in diagnosing abdominal visceral obesity. Methods BMI, WC, and WHR were assessed in 690 Chinese adults (305 men and 385 women) and compared with magnetic resonance imaging (MRI) measurements of abdominal visceral adipose tissue (VA). Receiver operating characteristic (ROC) curves were generated and used to determine the threshold point for each anthropometric parameter. Results 1) MRI showed that 61.7% of overweight/obese individuals (BMI≥25 kg/m2) and 14.2% of normal weight (BMI<25 kg/m2) individuals had abdominal visceral obesity (VA≥100 cm2). 2) VA was positively correlated with each anthropometric variable, of which WC showed the highest correlation (r=0.73-0.77, P<0.001). 3) The best cut-off points for assessing abdominal visceral obesity were as followed: BMI of 26 kg/m2, WC of 90 cm, and WHR of 0.93, with WC being the most sensitive and specific fact     

脐静脉血清IGF-2水平与巨大儿发生的关系

目的：探讨脐静脉血清胰岛素样生长因子-2（IGF-2）水平与巨大儿（MAC）的关系。方法：选择2018 年1月至2019 年12月出生于温州医科大学附属第一医院的足月MAC和正常出生体质量儿（NBW）分别61例和60 例。检测脐静脉血血清IGF-2 水平,并采用Pearson或Spearman相关分析法分析其与新生儿生长发 育指标的相关性。结果：MAC和NBW组的脐静脉血清IGF-2水平分别为（221.92±29.97）ng/mL和（169.69±14.53）ng/mL,2组间差异有统计学意义（P ＜0.001）;在MAC和NBW组中,母亲合并妊娠期糖尿病（GDM）新生儿的脐静脉血清IGF-2水平高于母亲无GDM者（GDM-MAC组 vs. nGDM-MAC组为229.71 ng/mL vs. 214.18 ng/mL,P =0.046;GDM-NBW组 vs. nGDM-NBW组为175.69 ng/mL vs. 161.48 ng/mL,P ＜0.001）。相关性分析显示脐静 脉血清IGF-2水平与新生儿出生体质量、身长和重量指数呈正相关（r =0.678、0.566、0.600,均P ＜0.001）。IGF-2水平也与胎龄相关（r =0.273,P =0.002）,但与新生儿性别、母亲年龄、高学历和初产无关（P ＞0.05）。结论：新生儿脐静脉血清IGF-2水平受母亲GDM和胎龄影响;IGF-2可反映胎儿生长发育状况,高水平IGF-2与巨大儿发生有关。     

合肥市区婴儿生长发育指标的调查分析

目的:了解合肥市活产新生儿出生时体格发育状况及婴儿阶段体格发育水平。方法:选取合肥市2007~2008年分娩新生儿进行婴儿期体格发育检测。新生儿出生时体格测量指标采用出生身长、出生体重、出生头围等。婴儿期体格发育监测资料包括3个月、6个月、9个月和12个月分别进行身长、体重、头围等体格发育指标的测量。结果:合肥市2007~2008年活产新生儿平均出生体重(3 370±451)g、出生身长(50.26±1.67)cm,出生头围(34.09±1.37)cm,出生后3个月、6个月、9个月和12个月的平均体重分别为(6.751±0.798)kg、(8.469±1.002)kg、(9.518±1.123)kg和(10.275±1.163)kg,平均身长分别为(62.18±2.20)cm、(68.54±2.36)cm、(73.02±2.53)cm和(76.77±2.57)cm,各月龄的男童体重、身长、头围水平均高于女童,且无论男童还是女童,6个月前(特别是3个月前)各体格指标增长水平明显高于6个月以后。合肥市市区婴儿各月龄组身高、体重均高于WHO推荐标准(2006版,下同);而体重男婴和女婴各有2个月龄高于全国9城市标准(2009版,下同),身高男婴有1个、女婴有2个月龄组高于全国9城市标准,头围符合全国9城市标准。结论:合肥市婴儿出生时和婴儿期内的体格发育总体上处于较好水平。WHO推荐的身高和体重标准已难以适应现阶段合肥市婴儿生长发育的评价。而全国9城市标准可以作为合肥市市区婴儿生长发育的评价标准。     

不同喂养方式对早产低出生体重儿生后1～3个月生长指标增长值的影响

目的探讨早产儿出院后配方奶与母乳、足月儿配方奶、混合喂养等不同喂养方式对早产低出生体重儿生后1～3个月阶段的体重、身长、头围等生长指标增长值的影响。方法广州市与佛山市10家医院新生儿科出院的早产低出生体重儿(胎龄不足37周且出生体重小于2 500 g)489例,分为早产儿出院后配方奶喂养组(PDF组,n=323)、母乳喂养组(BM组,n=38)、足月儿配方奶喂养组(TF组,n=76)、早产儿出院后配方奶联合母乳喂养组(PDF/BM组,n=28)和足月儿配方奶联合母乳喂养组(TF/BM组,n=24),观察及比较各组在出生后1、2、3个月时体重、身长、头围增长值的差异。结果 PDF组在1、2、3个月时的体重增长值均大于BM组(P<0.05),1、3个月时的身长增长值大于BM组(P<0.05),2、3个月时的头围增长值大于BM组(P<0.05)。PDF组在1、2、3个月时的体重、身长、头围增长值均大于TF组(P<0.05)。结论出院后应用配方奶喂养能使早产低出生体重儿在生后1～3个月阶段的体重、身长、头围快速增长,从而帮助早产低出生体重儿实现追赶性生长,避免或减少宫外发育迟缓的发生。     

Body fat at birth and cord blood levels of insulin, adiponectin, leptin, and insulin-like growth factor-I in small-for-gestational-age infants

BACKGROUND: Low birthweight has been associated with an increased risk of obesity, insulin resistance, and diabetes in adulthood. The aim of this study was to evaluate IGF-I, adiponectin, insulin levels, and body fat in small-for-gestational-age (SGA) infants at birth. METHODS: We performed a transverse comparative study in SGA and appropriate-for-gestational-age (AGA) infants. The study was conducted at the Hospital of Gynecology and Obstetrics in Leon, Mexico. Weight, length, and percent of body fat were evaluated during the first 48 h of birth. Glucose, insulin, leptin, adiponectin, and IGF-I levels in cord blood were measured. RESULTS: We studied 100 infants (50 SGA and 50 AGA). A history of diabetes in a second-degree relative was higher in SGA infants than in AGA infants (48.0 vs. 30.0%, respectively; p = 0.03). Glucose, adiponectin, insulin and IGF-I levels were similar between the groups. Leptin levels and percentage of body fat were lower in SGA than AGA (15.3 vs. 23.4 ng/mL; p = 0.003, 11.1 vs. 12.7%; p <0.001, respectively). Logistic regression analysis showed that length, percentage of body fat, and leptin levels were positively associated with birthweight. However, leptin levels were not independent of percentage of body fat. CONCLUSIONS: Low body fat and leptin levels, but no evidence of increased metabolic risk at birth, were found in SGA infants.     

新生儿胼胝体长度与孕周、出生体重的相关性研究

目的通过超声探测不同孕周、体重的新生儿出生时胼胝体长度,为早期无创、定量评价早产儿脑发育状况奠定基础。方法156例新生儿,男86例,女70例.包括早产儿96例,平均孕周32.45±2.71,平均出生体重（1847.24±512.49）g,于生后当天在静息或睡眠状态下接受经前囟门矢状位颅脑超声探查,胼胝体长度为从膝部至压部。结果随着孕周和体重的增加,胼胝体长度逐步增加,早产儿平均胼胝体长度（40.32±3.07）mm,与同期60例足月儿胼胝体长度（44.13±2.11）mm比较,差异有统计学意义（P〈0.001）;胼胝体长度与出生体重的相关系数为0.73（P〈0.001）。与孕周的相关系数为0.68（P〈0.001）。不同性别之间胼胝体长度差异无统计学意义（P〉0.05）。结论出生时胼胝体长度受出生体重、孕周大小的影响,但不受性别影响。     

早产儿液态配方奶对生长指标的影响

目的：探讨新生儿重症监护病房（NICU）使用早产儿液态配方奶对生长指标的影响。方法选取2012年1月～2013年12月在芜湖市第一人民医院NICU住院且胎龄〈34周的112例早产儿,随机分为对组组和观察组（n=56）,对照组使用早产儿配方奶粉喂养患儿;观察组使用早产儿液态配方奶喂养患儿,比较2组喂养后恢复至出生体质量时间,监测2组纠正胎龄40周时身长、体质量、头围等指标的变化。结果观察组恢复至出生体质量时间（8.16±2.14）d,短于对照组（9.66±3.51）d（P〈0.05）;观察组体质量为（3.8±1.9）kg、身长为（61.0±6.5）cm、头围为（38.5±2.5）cm,均大于对照组体质量为（3.6±1.6）kg、身长为（59.0±8.2）cm、头围为（37.5±3.5）cm （F=5.81,P〈0.05）。观察组56例中有10例发生宫外发育迟缓,和对照组相比差异不显著。结论早产儿液态配方奶能加快患儿恢复至出生时体质量,纠正胎龄40周时早产儿液态奶喂养患儿生长占优势。     

Risk factors associated with chronic lung disease in Malaysian very low birthweight infants

To determine the significant risk factors associated with development of chronic lung disease (CLD) in Malaysian very low birthweight (VLBW, < 1501g) infants. A prospective observational study was carried out at the Sarawak General Hospital (SGH) in Kuching, over a period of 29 months from 1 April 2003 to 31 August 2005. Infants with birthweight between 600g to 1500g admitted to this hospital were recruited. The progress of these infants was followed till discharge. CLD was defined as the persistent need for oxygen therapy to maintain oxygen saturation above 88% at 36 weeks of postmenstrual age. Of the 224 infants recruited, 36 (14.8%) had CLD. Logistic regression analysis showed that lower birth weight (adjusted odds ratio (OR) = 0.996, 95% confidence intervals (CI) = 0.994, 0.998; p = 0.001), male infants (adjusted OR = 3.9, 95% CI = 1.6, 11.7; p = 0.02), chorioamnionitis (adjusted OR = 9.0, 95% CI = 1.6, 50.8; p = 0.01), severe respiratory distress syndrome of grades 3 or 4 (adjusted OR = 4.6, 95% CI =1.6, 13.2; P = 0.005) and patent ductus arteriosus (adjusted OR = 4.3, 95% CI = 1.5, 12.8; p = 0.007) were significant risk factors associated with development of CLD. A number of treatable conditions are associated with development of CLD in Malaysian VLBW infants.     

维持性血液透析患者血钠水平与营养状态的相关性研究

目的  探讨维持性血液透析患者透析前血清钠水平与营养状况的关系。方法  选取2015年4月- 2015年8月浙江省温州市中心医院终末期肾病接受维持型血液透析治疗患者94例,用标准技术测量患者的肱三头肌皮褶厚度厚度、上臂中部肌周长、上臂中点肌肉周长、握力以及采用改良主观综合评估法评估患者的营养状态,检测透析间期体重增长、干体重、透析前后血压以及实验室指标。其根据血清钠水平分两组：低钠组（Na<137 mmol/L）和对照组（Na≥137mmol/L）,分别比较两组的上述指标。结果  低钠组患者上臂肌围、握力、血清白蛋白水平更低,营养评分、透析间期体重增长占干体重的平均百分数更高,差异有统计学意义（P < 0.05）。两组的肱三头肌皮褶厚度、上臂围、干体重、血透前后血压、前白蛋白、血红蛋白、转铁蛋白、血脂、血钾、血钙及CRP差异无统计学意义（P >0.05）。透析前血清钠浓度与上臂肌围呈正相关（r =0.266,P =0.009）,与握力呈正相关（r =0.401,P =0.001）,与营养评分呈负相关（r =-0.46,P =0.001）,与血清白蛋白水平呈正相关（r = 0.309,P =0.002）,与血CRP和透析间期体重增长占干体重的平均百分数不相关。结论  维持性血液透析患者透析前血钠水平偏低与蛋白质能量消耗和透析间期体重增加有关。

     

新生儿脐血中脑源性神经生长因子含量与营养供给状态的相关性

目的 探讨新生儿脐血中脑源性神经生长因子(BDNF)含量与营养供给状态的相关性。 方法 选择2013年8月—2016年8月湖北医药学院附属东风医院分娩的160例低出生体重儿,所有患儿都给予静脉注射和胃肠道供养的混合方法进行干预,把宫外发育迟缓30例归为观察组,非宫外发育迟缓130例归为对照组;评定新生儿的营养供给状态,同时进行脐血血浆中BDNF含量的测定与一般资料的调查。 结果 出生时2组新生儿胎龄、性别、体重、身长、头围对比差异均无统计学意义(均P>0.05)。观察组新生儿的重症感染、肺透明膜病、颅内出血等并发症发生率为30.0%,对照组为5.4%,观察组明显高于对照组(P<0.05)。观察组与对照组的脐血BDNF含量分别为(2.56±1.21) ng/m L和(3.48±0.99) ng/m L,观察组明显低于对照组(P<0.05)。相关性分析显示低出生体重儿的宫外发育迟缓与脐血中BDNF含量、重症感染、肺透明膜病、出生体重有明显相关性(均P<0.05);Logistic回归分析显示影响低出生体重儿发生宫外发育迟缓的主要危险因素为脐血中BDNF含量低、重症感染、肺透明膜病(均P<0.05)。 结论 低出生体重儿中的营养供给状态多存在不足,有比较高的宫外发育迟缓发生率,脐血中BDNF含量与营养供给状态存在明显的相关性,也是影响宫外发育迟缓发生的危险因素。      

Exclusive Breast Feeding in Low Birth Weight Babies

Background

Human milk is the ideal source of nutrition for full term neonates, but there is controversy regarding its use as a nutrition source for preterm and low birth weight infants. However current data supports the use of human milk for low birth weight infants. This study was undertaken to evaluate the growth of both preterm and term small for gestational age infants nursed on exclusive breast milk from birth to four months of age.

Methods

This was a prospective, longitudinal study carried out in a recognized baby-friendly hospital where exclusive breast-feeding is practiced in all neonates. All consecutive low birth weight neonates irrespective of gestational age, born during the study period of two years were included in the study. Assessment of growth parameters included recording of weight (daily when in the hospital and later weekly), length (weekly) and head circumference (weekly) till the age of four months.

Result

Low birth weight infants, both the preterm and the term small for gestational age, on being exclusively breastfed by their own mothers, gained weight and had an increase in their head circumference and length to the levels almost comparable to the standard fetal- infant growth norms.

Conclusion

Exclusive breast-feeding results in adequate growth in low birth weight babies including preterms.Key Words: Breast feeding, Preterm, Low birth weight, Neonates