Influence of folic acid on birthweight and growth of the erythroblastotic infant. I. Birthweight.

The birthweights of 100 infants with erythroblastosis were carefully matched as to sex, gestational age, and parity with the birthweights of 200 control infants born during the same period. At all gestational ages the average birthweight of the affected infants was below that of the controls, the average reduction being 227 g. The more severely affected infants tended to be at a lower centile for birthweight than were the mildly affected ones. The relationships between maternal serum folate, cord blood serum folate, and centile for birthweight among affected infants were also studied. There was a strong correlation between low maternal serum folate and the incidence of small-for-dates babies among the affected infants. There was also a strong correlation between maternal and cord blood serum folate values. There was a lack of correlation between maternal serum folate and cord blood haemoglobin. It is concluded that infants with erythroblastosis are lighter than controls and that the reason for this may be a shortage of folic acid available for fetal growth.     

Influence of folic acid on birthweight and growth of the erythroblastotic infant. II. Growth during the first year.

The growth of 73 erythroblastotic infants (18 mild, 19 moderate, and 36 severe) was followed. In all three grups the average centiles for weight rose during the first half of the year. There was a fall in centiles during the second half of the year in 35 of 55 infants, 17 of them dropping below their birth centiles. Throughout the first year of life there was a strong correlation between serum folate of 8 mug/1 or more and rising weight centiles, and 5 mug/1 or less and falling centiles. None of the infants had macrocytic anaemia and their haemoglobin level rose even when their weight gain fell below the expected rate. It is suggested that in some erythroblastotic infants a shortage of folic acid may be a limiting factor for a normal growth rate.     

Maternal folic acid supplementation and infant birthweight in low‐ and middle‐income countries: A systematic review

The relationship between maternal folic acid supplementation in pregnancy and infant birthweight has not been well described in low‐ and middle‐income countries. We conducted a systematic review and meta‐analysis of the current evidence of the association between folic acid supplementation in pregnancy on three primary outcomes: the incidence of low birthweight, small for gestational age, and mean birthweight. Seventeen studies were identified, which satisfied the inclusion criteria, covering a total of 275,421 women from 13 cohort studies and four randomized controlled trials. For the primary outcome of mean birthweight (n = 9), the pooled mean difference between folic acid and control groups was 0.37 kg (95% confidence interval [CI]: 0.24 to 0.50), and this effect was larger in the randomized controlled trials (0.56, 95% CI: 0.15 to 0.97, n = 3). The pooled odds ratio was 0.59 for low birthweight (95% CI: 0.47 to 0.74, n = 10) among folic acid supplementation versus control. The pooled odds ratio for the association with small for gestational age was 0.63 (95% CI: 0.39 to 1.01, n = 5). Maternal folic acid supplementation in low‐ and middle‐income countries was associated with an increased mean birthweight of infants and decreases in the incidence of low birthweight and small for gestational age.     

Effect of food supplementation during pregnancy on birthweight.

The high prevalence of low-birthweight (less than or equal to 2,500 gm) babies in many poor communities is a major public health problem. Studies in humans in situations of acute starvation suggest an effect of maternal nutrition on birthweight, but less clear results appear under situations of moderate maternal malnutrition. We studied the effects of food supplementation during pregnancy on birthweight in four rural villages of Guatemala, in which two types of supplements were distributed: protein-caloric and caloric. The caloric supplementation increased the total caloric intake during pregnancy. In both supplements, the amount of calories supplemented during pregnancy showed a consistent association with birthweight. In the combined sample the proportion of low-birthweight babies in the high-supplement group (G greater than or equal to 20,000 supplemented calories during pregnancy) was 9% compared with 19% in the low-supplement group (less than 20,000 supplemented calories during pregnancy). The relationship between caloric supplementation and birthweight (29 gm of birthweight per 10,000 supplemented calories) was basically unchanged after controlling for the maternal home diet, height, head circumference, parity, gestational age, duration of disease during pregnancy, socioeconomic status, and different rates of missing data. Moreover, a similar association was found in consecutive pregnancies of the same mother. We concluded that caloric supplementation during pregnancy produced the observed increase in birthweight.     

Effect of folic acid supplementation on small-for-gestational-age infants born at term

The effect of 250 g folic acid (FA)/day or placebo given to 21 small-for-gestational-age infants born at term was studied during the first 3 months of life. The design of the study was double blind with random allocation. No randomization was performed in respect of breast-feeding or formula-feeding with a folate content of 60–70 g/l. No significant differences were observed in haemoglobin concentration, haematocrit, weight and length between FA-supplemented and non-supplemented infants. A negative correlation was demonstrated between gestational age and erythrocyte folate (E-folate) concentration at 1 week. E-folate content was higher when no supplement was given in breast-fed than in formula-fed infants.     

Use of folic acid supplementation and risk for dizygotic twinning

BACKGROUND: An increase in dizygotic twinning rate after folic acid supplementation has previously been described, but in a recent study from China, no such effect was seen. AIMS: To further investigate the association between use of folic acid supplement and dizygotic twinning. STUDY DESIGN: Using the Swedish Medical Birth Registry, the rate of dizygotic twinning among infants of women who reported the use of folic acid was studied, taking a number of confounders into consideration. Comparisons were made with all women recorded in the register. OUTCOME MEASURE: Unlike-sexed twin pairs were used as representatives of dizygotic twinning. RESULTS: A number of confounders for the association between folic acid use and twinning were identified and taken into consideration. Women who were immigrants (who used less folic acid and had slightly lower twinning rates than women born in Sweden) and women who reported subfertility problems or treatment for subfertility (who had a high use of folic acid and a high twinning rate) were excluded, and adjustment was then made for year of birth, maternal age, parity, and smoking in early pregnancy. Folic acid use and twinning risk increased with maternal age and decreased with parity. Smokers used less folic acid than nonsmokers. Concomitant use of other drugs was no important confounder except for those used at subfertility. The odds ratio (OR) for dizygotic twinning after folic acid supplementation was then 1.71 (95%CI=1.21-2.42) and for the years 2000-2001 even 2.09 (95%CI=1.39-3.12). CONCLUSION: There is an increase in twinning rate after folic acid supplementation in a Western population which should be taken into consideration when folic acid supplementation or food fortification is recommended.     

Weekly vs daily iron and folic acid supplementation in adolescent Nepalese girls

OBJECTIVE: To compare the effectiveness of weekly vs daily iron and folic acid supplementation for control of anemia in adolescent Nepalese girls. DESIGN: Randomized controlled trial. SETTING: A Government Girl School in Dharan, Nepal, an urban foothill town that is 305 m above sea level. SUBJECTS: Consecutive healthy adolescent girls (n = 209, median age 15 years) randomized to 3 groups matched for age, anthropometry, and personal and sociodemographic characteristics. Of 209 subjects, 181 completed the trial. Two girls had adverse reactions to treatment and were excluded. INTERVENTION: Group A (n = 70) received a 350-mg ferrous sulfate and 1.5-mg folic acid combination once daily for 90 to 100 days. Group B (n = 67) received the tablet under supervision once a week for 14 weeks. Group C (n = 72) did not receive any drugs. OUTCOME VARIABLE: Presupplementation and postsupplementation differences in prevalence of anemia and change in hematocrit. RESULTS: Prevalence of anemia (defined as hematocrit <36%) declined from 68.6% and 70.1% in groups A and B to 20% and 13.4%, respectively, postsupplementation (P<.001), whereas the prevalence in group C changed little (68.1% to 65.3%, P =.81). There was a significant rise in the mean hematocrit of both supplemented groups (group A, 32.9% +/- 3.5% to 41.0% +/- 5.6%, P<.001; group B, 33.2% +/- 3.6% to 40.4% +/- 4.9%, P<.001) but no appreciable change in controls (34.2% +/- 2.9% to 34.1% +/- 3.3%, P =.91). Net change in mean hematocrit in both the supplementation groups was comparable (P =.57). CONCLUSIONS: The prevalence of anemia in adolescent Nepalese girls is high. Supervised iron and folic acid therapy once a week is an effective alternative to daily administration and helps lower the prevalence of anemia in adolescent girls.     

Rickets in very low birthweight infants. Influence of supplementation with vitamin D, phosphorus and calcium

The influence of extra phosphorus (P) and calcium (Ca) on the incidence of rickets was studied in 40 infants with a birthweight below 1.5 kg. All were fed breastmilk and all received vitamin D 1200 IU/day. Half of the infants were supplemented with P 20 mg/kg/day and Ca 30 mg/kg/day. Rickets, diagnosed with X-ray at 5 to 7 weeks of age, developed in 12 infants, 11 of whom weighed below 1.0 kg. In infants below 1.0 kg rickets was significantly more common in the group not receiving extra P and Ca. After diagnosis all were substituted and radiographic healing occurred in all. Serum Ca concentrations were normal in both groups whereas serum P was significantly lower in non-supplemented patients. Serum alkaline phosphatases (ALP) were normal in all patients at the time of diagnosis demonstrating the risk of using ALP as a diagnostic test for rickets in very low birthweight.     

Incubator temperature control: effects on the very low birthweight infant.

We studied temperature stability in 22 infants of birthweight less than 1500 g in the first four days of life. Infants were nursed in incubators using either air mode control or skin temperature servo control. Data were collected continuously using a computer linked monitoring system. Skin temperature control resulted in a less stable thermal environment than air mode control. Increased thermal stability in the incubator on air mode control may well be beneficial, particularly to sick, very low birthweight infants.     

上海市单中心儿科门诊特征和医疗服务2009至2018年趋势分析

目的 探索医院信息系统(HIS)医疗大数据处理方法,分析儿童专科医院近10年门诊患儿就诊特征及医疗服务趋势。方法 以复旦大学附属儿科医院(我院)HIS门诊患儿就诊挂号登记表的全样本数据为基础,系统地进行数据清洗(诊断、地址、重复、离群、缺失)、数据集成(数据库链接和匹配)、数据规约、数据脱敏和数据核查,行门诊患儿就诊特征及医疗服务趋势的分析。结果 2009至2018年我院门诊挂号20 775 899人次,依据纳入和剔除标准,18 242 822 人次进入本文分析;男性占57.42%,婴儿占9.57%,幼儿占40.94%,学龄前儿童占24.82%,学龄儿童占24.67%。诊断缺失率为5.92%,地址缺失率为45.31%,接诊医生姓名缺失率为26.81%,行缺失数据人群分析,各年份性别和年龄构成比差别不大。10年间门诊量年平均增长5.22%,2012较2011年增长11.22%,2014较2013年增长10.93%,2015年后环比增长均<2.90%。10年间不同年份各省市门诊量>P₇₅ 和~P₅₀的省市,从华东向西南、西北、华南、中部、东北扩大。10年间门诊医生平均日接诊51人次,初、中和高级职称医生门诊日均接诊分别63、54和45人次;专科门诊从2009年的46个发展为2018年的180个,2018年专科就诊比例达68.12%,专病门诊从2009年的16个发展为2018年的142个。结论 基于国家儿童医学中心之一的我院的门诊数据表明,10年间门诊量先快速增长后平稳增长,患儿来源地区快速从华东地区辐射至全国,门诊医生平均日接诊数量低于全国平均水平,专科门诊和专病门诊成为重要的发展趋势。     

The Bacon Chow study: maternal supplementation and infant growth

The effect of maternal supplementation during both gestation and lactation on infant growth from birth to 12 mth was investigated in the double-blind, randomly allocated control trial conducted in Taiwan by the late Bacon F. Chow. The supplement was a milk-based formula providing 800 kcal and 40 g protein daily. The placebo provided less than 40 kcal per diem but resembled the supplement in appearance. Supplementation was limited to mothers and began after birth of one infant and continued without interruption until weaning of a second infant. Supplement effects were tested by comparing both supplement and placebo groups and first- and second-infant groups with respect to weight, length and head circumference. Both comparisons of growth curves and analyses of variance were carried out. Both strategies agreed in failing to detect differences in growth between supplement and placebo groups. However, differences were found between first and second infants in the supplement group.     

Antenatal iron–folic acid supplementation reduces risk of low birthweight in Pakistan: secondary analysis of Demographic and Health Survey 2006–2007

The aim of the current study was to examine the impact of antenatal iron–folic acid (IFA) supplementation on perceived birth size and birthweight in Pakistan over a 5‐year period from 2002 to 2006. The data source was the Pakistan Demographic and Health Survey (PDHS) 2006–2007. Information from 5692 most recent live‐born infants within 5 years prior to the survey was examined. The primary outcomes were maternal perception of birth size and birthweight, and the main exposure was any use of antenatal IFA supplements. Birthweight was reported for only 10% of the live births in the PDHS 2006–2007. Multivariate logistic regression analysis was adjusted for the cluster sampling design and for 13 potential confounders. The risk of having smaller than average birth size newborn was significantly reduced by 18% (adjusted odds ratio 0.82, 95% confidence interval 0.71, 0.96) for mothers who used any IFA supplements compared with those who did not. A similar (18%), but non‐significant reduction in the risk of low birthweight, was found with the maternal use of IFA supplements. The risk of having smaller than average birth size babies was significantly reduced by 19% in those women who started IFA in the first trimester of pregnancy. About 11% of babies with smaller than average birth size were attributed to non‐use of antenatal IFA supplements. Antenatal IFA supplementation significantly reduces the risk of a newborn of smaller than average birth size in Pakistan. Universal coverage of supplementation would improve birth size.     

Metabolic differences between AGA-and SGA-infants of very low birthweight. III. Influence of postnatal age

Seven very low birthweight (VLBW) infants, small for gestational age (SGA), with moderate intrauterine growth retardation and 7 VLBW-infants, appropriate for gestational age (AGA), fed breast milk fortified with 6 g freeze-dried human milk per 100 ml were studied on the 8th, 21st and 42nd days of life. The protein intake on the study days varied between 2.68 and 3.61 g/kg/day in the SGA-and 2.69 and 3.75 g/kg/day in the AGA-infants. Serum concentrations of total bile acids (BA) and the renal excretion of total nitrogen (TN) as well as alpha-amino-nitrogen (AAN) were measured in all infants on each study day. On the 8th day of life a mean protein intake of 3.2 g/kg/day resulted in higher serum concentrations of BA as well as in a higher renal excretion of TN and AAN in the SGA-infants when compared to the AGA-infants. On the 21st day of life these differences were smaller and only the serum concentration of BA and the renal excretion of AAN were still significantly higher in the SGA-infants. On the 42nd day of life only serum concentrations of total BA were elevated in the SGA-infants when compared to that in the AGA-infants. The observed metabolic differences between moderately SGA-and AGA-infants related to protein and bile acid metabolism diminished during the first weeks of life. The present data suggest that when nutritional management of VLBW-infants is planned, differences in metabolic capacities must be considered and protein intake should be increased with caution and in accordance to the individual metabolic situation of the infants during the first weeks of life.     

Folate of pregnant women after a nationwide folic acid supplementation in China

Folate insufficiency during the periconceptional period increases the risk of neural tube defects (NTDs) in offspring, and folic acid supplementation substantially reduces the risk. Widespread large‐scale folic acid supplementation (0.4‐mg folic acid tablet) has been adopted as a main strategy to prevent NTDs in China since 2009. We examined folate concentrations in plasma and red blood cells (RBCs) of pregnant women and the factors associated with blood folate concentrations in a population with a high prevalence of NTDs in northern China. A cross‐sectional survey was conducted in 2014, and 1,107 pregnant women were recruited from 11 county or city maternal and child health centres across Shanxi province. Microbiological assays were used to determine folate concentrations. Factors associated with blood folate insufficiency were identified. The median (25th and 75th percentiles) folate concentrations were 28.4 (17.6, 45.2) nmol L^?1 and 1,001.2 (658.7, 1,402.5) nmol L^?1 in plasma and RBCs, respectively. According to the proposed RBC (906 nmol L^?1) concentrations for optimal NTD prevention, 42.4% participants had RBC folate insufficiency. Rural women had a higher proportion of folate insufficiency than urban women. Folic acid supplementation was the only factor associated with RBC folate insufficiency. A large proportion of women had RBC folate concentrations that are not optimal for the prevention of NTDs despite free access to folic acid supplements. Actions that aim to improve folic acid supplementation compliance are needed to reach the full potential of the nationwide folic acid supplementation programme in terms of NTD prevention.     

Poor weight gain of the low birthweight infant fed nasojejunally.

Forty-four appropriately grown preterm infants of birthweight 1-1.5 kg were allocated to nasojejunal (NJ) or nasogastric (NG) feeding at birth. Infants in the NJ group were transferred to NG feeding as soon as they weighed 1.5 kg. The mean caloric intake of infants in both groups was the same, but mean incremental weight velocity during NJ feeding was significantly less than during NG feeding. At expected date of delivery mean body weight and mean occipitofrontal circumference were significantly smaller in the NJ group. During the 3 months after the expected date of delivery, when all infants were being fed orally, the infants in the NJ group had significantly greater mean weight velocity and mean occipitofrontal circumference velocity than infants in the NG group so that by 3 months after the expected date of delivery there was no significant difference in bodyweight or occipitofrontal circumference between the groups. Low birthweight infants fed by the nasojejunal route from birth should be transferred to nasogastric feeding as soon as possible.     

A decreasing rate of neural tube defects following the recommendations for periconceptional folic acid supplementation

BACKGROUND/AIM: Neural tube defects (NTDs) are the most common birth defects, resulting in severe mortality and morbidity. In 1995, the supplementation of folic acid periconceptionally was officially recommended in Germany. The impact of the recommendations on the rate of NTDs was assessed. METHODS: An active surveillance system was established in the northern Rhine area. From 1996, all departments of obstetrics were asked to report cases of NTDs in all abortions, live births and stillbirths. Compliance with the recommendations was evaluated in a sample of mothers who delivered at the Department of Obstetrics of Düsseldorf University in 2001. RESULTS: From 1996-2003, 520 NTDs were reported. Compared to the rate of NTDs in 1996 (10.5/10,000), the average incidence in the years 1997 to 2003 dropped (6.8/10,000). The intake of folic acid, as recommended, was low among the general population (21.1%).CONCLUSION: Active surveillance data on the rate of NTDs are compatible with the maximum decrease of about 20% to be expected from data on the implementation of the recommendations. A much greater decrease in NTDs should be the challenge for the future.