A STUDY OF SOME BIOLOGICAL AND SOCIO-ECONOMIC FACTORS IN LOW BIRTH WEIGHT

ABSTRACT: Bjerre, I. and Värendh, G. (Department of Paediatrics, Malmö General Hospital, Malmö, Sweden). A study of some biological and socio-economic factors in low birth weight. Acta Paediatr Scand, 64:605, 1975.–of 3841 children born alive in Malmo in Sweden in 1966, 188, 4.9 % had a birthweight of ≤2 500 g. We studied these children with their families and a control group in order to form an opinion on the role played by certain social and biological factors in the aetiology of LBW in a country with a relatively high average standard of living. Biological factors were analysed, such as the mother's age, parity, stature, and weight, as well as purely socio-economic factors such as the mother's civil status, the social group of the mother and father, income, mother's allowance in case of illness, social help or investigations regarding one or more members of the family, as well as the frequency of immigrants. The combined effect of various socio-economic factors was judged by help of a "social score". The results were analysed for 3 different groups of low birth weight, appropriate for gestational age, small for gestational age and multiple births. Judging from our investigation, biological factors probably play the greatest role in the question of LBW but these factors are difficult to distinguish from socio-economic factors which probably still play a certain role in the group preterm children, appropriate for gestational age.     

INHIBITED GROWTH AND DEVELOPMENT AS PERMANENT FEATURES OF LOW BIRTH WEIGHT

ABSTRACT. A 10-year assessment of ocular function eye size and other anthropometric parameters indicated a negative influence of low birth weight (LBW). The sample consisted of 302 children with BW <2000 g and 237 full-term controls. The former had smaller eyes and there were deficits regarding height, head circumference, interpupillary distance and exophthalmometry readings. Based on an 18-year follow-up study comprising 137 of the above 539, the various LBW deficits have proven to be permanent, and due not only to delayed development around the age of 10. The menarche appeared later in LBW girls (13 ½ years of age) than in controls (13 years). Exophthalmometry readings have led to rejection of one of the presumed classical permanent stigmata of prematurity: ocular protrusion. The findings indicate that low birth weight is an impediment to the overall development of the individual. It also seems to interfere with some of the usual correlations between growth parameters. In addition, the results confirm the well-known feature: that males have a more marked growth spurt at puberty than females.     

NEUROLOGICAL INVESTIGATION OF 5-YEAR-OLD CHILDREN WITH LOW BIRTHWEIGHT

ABSTRACT: Bjerre, I. (Department of Paediatrics, Malmo General Hospital, Malmo, Sweden). Neurological investigation of 5-year-old children with low birthweight. Acta Paediatr Scand, 64: 859, 1975.–139 children with a low birthweight (LBW), i.e. not more than 2500 g, were examined at 5 years of age in respect of their neurological status, with special reference to motor coordination according to Touwen & Prechtl. 5 (3.6%) children had cerebral palsy; 13 (9.4%), minimal brain dysfunction; 38 (27.3%), delayed motor maturation; and 83 (59.7%), normal motor development and normal neurological status. Impairment of hearing and of vision, epilepsy and mental retardation were more common in children with cerebral palsy and MBD, Children with MBD and delayed motor maturation had a lower IQ, as judged from the draw-a-mantest according to Goodenough than children with normal neurological status. Cerebral palsy was found in children with a very low birthweight and short gestational age. Other findings were equally distributed among groups classified by weight and duration of gestation.     

IMMUNOGLOBULIN LEVELS IN INFANTS WITH LOW BIRTH WEIGHTS

The different immunoglobulins G, M, A and D were studied in 65 infants with birth weights less than 2500 g, during their first weeks of life. The initial IgG concentration was very well correlated to gestational age, but by no means so well correlated to birth weight. Infants of low gestational age had, on the average, low IgG concentrations at birth and in the course of their first months of life there was a tendency towards more or less pronounced hypogammaglobulinaemia. Infants with low birth weights had, as a rule, a good capacity for early IgM synthesis but the increase in IgM levels during the first few weeks of life was, however, considerably less rapid in infants of very low gestational age. This may be due to the fact that such infants are less exposed to infections, owing to incubator care and various kinds of precautions. It may also, however, be an expression of an inferior capacity for IgM synthesis in these infants. As regards immunoglobulins A and D in infants with low birth weights, no pronounced differences were found on comparison with previous findings in full-term infants.     

POSSIBLE EFFECTS OF KANAMYCIN AND INCUBATION IN NEWBORN CHILDREN WITH LOW BIRTH WEIGHT

ABSTRACT: In an acoustico-vestibular follow-up investigation of 91 four- to six-year-old children with birth weight below 2 000 g, the same incidence of sensorineural hearing loss (19 %) was found in 54 children treated with kanamycin in the neonatal period as in a group of 37 infants not treated with kanamycin. When comparing a group of children treated with both kanamycin and incubator (54 children) with a group treated with incubator only (16 children), no definite signs of synergism between incubator noise and kanamycin were found. However, the 5 cases of moderate or severe hearing loss all belonged to the group treated with both incubator and kanamycin. These 5 children had more severe neonatal complications, especially apnea, cyanotic spells and hyperbilirubinemia, which may increase the severity of the hearing loss.
Among 56 incubator treated children with normal hearing (ISO standards) 52% had an audiogram pattern suggesting minor noise-provoked cochlear lesions. Among 18 non-incubator treated children with normal hearing only one child (6%) had a similar pattern. It should be stressed, however, that these children had no clinical symptoms of hearing loss.     

The effect of perinatal risk factors on growth in very preterm infants at 2 years of age: the Leiden Follow-Up Project on Prematurity

OBJECTIVE: To describe growth in infants <32 weeks GA. To assess the relationship between growth and perinatal factors (like intrauterine growth retardation and the postnatal use of dexamethasone) and neurodevelopmental outcome. DESIGN: Regional, prospective study in two health regions in the Netherlands. Part of the Leiden Follow-Up Project on Prematurity (LFUPP). PATIENTS: 196 live born infants with GA <32 weeks. METHODS: At two years corrected age length, weight and head circumference of 160 of 196 surviving infants (82%) were evaluated. Standard Deviation Scores were calculated and means were compared to Dutch growth references. Mean SDS for length was corrected for the mean SDS for target height. Birth weight (BW)-SDS for gestational age (GA) was calculated according to Swedish references. RESULTS: Length, weight and weight-for-length were equally impaired in both sexes at two years in premature infants compared to Dutch growth charts. Catch-up in length and weight occurred mostly in the first year of life. Intrauterine growth retardation was associated with impairment of all growth parameters. The use of postnatal dexamethasone was associated with shorter length, lower weight, lower weight for length and smaller head circumference; this effect remained after correction for GA, BW and BW-SDS. Growth retardation (length and weight) was associated with an abnormal neurologic examination; smaller head circumference also with mental and psychomotor delay. CONCLUSION: Growth at two years corrected age in children born <32 weeks is impaired. Postnatal dexamethasone is associated with impairment of all growth parameters including head circumference, which may be a significant contributing factor for abnormal neurodevelopmental outcome.