Cognitive development in preterm infants: birth to 8 years

This report summarizes the outcome at age 8 of a group of preterm infants followed intensively from birth. The study was designed primarily to follow the processes of interaction between biological and environmental factors in determining the childhood outcome of infants born preterm rather than to report the incidence of particular types of outcomes for special subgroups of infants. A high percentage of the children were performing within the normal range. Social factors played a major role in determining the outcome regardless of neonatal complications. Functional assessment of newborn visual attention and sleep organization showed a modest relation to outcome. A subgroup of preterm infants from Spanish-speaking families, for cultural and language integration reasons, followed a somewhat different course from infancy to childhood outcome than did the group from English-speaking families. The results suggest that in longitudinal studies of preterm infants, different cultural and language groups should be analyzed separately so that one may understand the developmental processes and outcomes.     

Growth trajectories of extremely low birth weight infants from birth to young adulthood: a longitudinal, population-based study

We compared sex-specific growth attainment of a population-based cohort of 147/166 (89%) extremely low birthweight (ELBW < 1000 g) and 131/145 (90%) sociodemographically comparable normal birthweight (NBW) cohort at young adulthood, and examined the pattern of growth trajectories and correlates of growth at ages 1, 2, 3, and 8 y, and teen and young adulthood (mean age, 23.3 versus 23.6 y). The proportion considered small for gestational age was ELBW 25% versus NBW 3%; and 26% versus 2% had neurosensory impairments. Weight for age z-scores for ELBW showed substantial decline to age 3 y, with subsequent significant catch-up to adolescence and smaller gains to adulthood. Height for age z-scores showed both sexes of ELBW were disadvantaged at every age compared with NBW and their expected mid-parental height. The BMI z-scores for ELBW showed a sustained incline from age 3 to adulthood, where both sexes normalized to above zero, and were comparable to their peers. ELBW children showed growth failure during infancy, followed by accelerated weight gain and crossing of BMI percentiles at adolescence, a pattern that may increase the risk of insulin resistance and coronary heart disease. However, normalization of BMI for both sexes at adulthood suggests that final growth was proportionate.     

Growth in extremely low birth weight infants up to three years

OBJECTIVE: To evaluate postnatal growth of extremely low birth weight infants (ELBW, <1,000 g) until 36 months of corrected age (CA), and to relate growth outcome to anthropometric parameters at birth, sex, fetal growth status (small or appropriate for gestational age--SGA/AGA), period of admission and major perinatal events. STUDY DESIGN/METHOD: Weight (Wt), height (Ht) and head circumference (HC) were assessed in 159 ELBW infants. Data were standardized with Z-scores following Usher and McLean and Sempe growth curves. Uni- and multivariate statistical analysis were performed. RESULTS: The mean birth weight was 851.2+/-116.5 g. Z-scores decreased from birth to term, at a deeper rate for AGA than for SGA infants (p<0.005 for Ht, Wt, and HC). Between term and 36 months, growth was better in SGA compared with AGA infants (p=0.003 for Ht). Multivariate analysis showed that anthropometric parameters at birth were positive determinants for Wt, Ht and HC at term, and also for Wt and Ht at 36 months CA (Z-scores). Oxygen therapy after 36 weeks of post-conceptional age was a negative determinant influencing growth at 36 months CA (Z-scores). CONCLUSIONS: Significant catch-up growth took place between birth and 36 months, which was greater for SGA than for AGA infants. Anthropometric parameters at birth and oxygen therapy at 36 weeks post-conceptional age are the main predictive factors for growth at 36 months CA.     

Endotracheal resuscitation of preterm infants at birth.

The adequacy of initial ventilation in 21 preterm babies (25-36 weeks'' gestation), who required endotracheal intubation and positive pressure ventilation, were studied. Pressure and flow were measured at the proximal end of the endotracheal intubation tube and expiratory volume calculated from the flow trace. The results were compared with those from a group of 26 term infants who also required resuscitation. Five of 21 preterm babies (24%) had adequate tidal ventilation with the first inflation. This rose to seven of 21 (33%) by the third inflation. This was significantly less than the results in the term infants (chi 2 = 4.38 p less than 0.05). Respiratory reflex responses to resuscitation were seen in 41% of inflations in preterm and 56% of inflations in term infants. There was a significant correlation between reflex activity and adequate ventilation in the preterm group (chi 2 = 11.83, p less than 0.001) but not in the term group (chi 2 = 0.212, p = NS). No correlation was seen between initial ventilation and outcome.     

住院早产儿并发症12年回顾性分析

目的住院早产儿并发症回顾性分析12年的变化。方法对本院1994年1月-2005年12月期间住院的1378例早产儿的临床资料进行回顾性病例分析。结果前后6年比较，后6年住院早产儿中低胎龄（6．7％，13．6％）、低出生体重（11．3％，14．9％）早产儿比例增加；本组早产儿死亡74例，病死率为5．4％，后6年病死率较前6年下降（8．5％，3．6％）。住院早产儿并发症前后6年比较，湿肺（2．8％，5．2％）、酸中毒（1％，3．7％）、咽下综合征（3．0％，4．5％）和低血糖（10．5％，14．2％）的发生率升高，而肺炎（18．9％，10．8％）、硬肿症（4、5％，1．1％）、肺出血（4．9％，1．8％）和缺氧缺血性脑病（4．5％，2．3％）的发生率下降。结论经前后6年比较，我院住院早产儿中低胎龄、低出生体重的比例增加，病死率下降；部分早产儿严重并发症发生率下降。     

住院早产儿并发症12年回顾性分析

目的住院早产儿并发症回顾性分析12年的变化。方法对本院1994年1月~2005年12月期间住院的1378例早产儿的临床资料进行回顾性病例分析。结果前后6年比较,后6年住院早产儿中低胎龄(6·7%,13·6%)、低出生体重(11·3%,14·9%)早产儿比例增加;本组早产儿死亡74例,病死率为5·4%,后6年病死率较前6年下降(8·5%,3·6%)。住院早产儿并发症前后6年比较,湿肺(2·8%,5·2%)、酸中毒(1%,3·7%)、咽下综合征(3·0%,4·5%)和低血糖(10·5%,14·2%)的发生率升高,而肺炎(18·9%,10·8%)、硬肿症(4·5%,1·1%)、肺出血(4·9%,1·8%)和缺氧缺血性脑病(4·5%,2·3%)的发生率下降。结论经前后6年比较,我院住院早产儿中低胎龄、低出生体重的比例增加,病死率下降;部分早产儿严重并发症发生率下降。     

Growth of preterm infants

A hundred-forty-one infants born from 26 to 36 weeks, appropriate-for-gestational-age, were followed from birth until the corrected postmenstrual age of 42 weeks. Weight, height and cephalic perimeter were measured on a weekly basis. Based on the average values and percentiles of these measurements it was adjusted a third degree polynomial function. The growth curves obtained, when compared with the so-called intra-uterine growth curves, showed that during the 40th and 42nd postmenstrual weeks the averages and medians are similar. It was observed that the growth dynamics of the preterm infants showed a catch-up pattern in the immediate postnatal period.     

Growth from birth to 2 years of North African infants born in France

North African people living in France have low socio-economic standing and high birth rates. Growth in weight and height of 359 North African infants born in France was followed during their first 2 years of life. Comparisons were made with standard growth curves for French infants and with the growth of 143 French infants living in similar conditions. Growth in height was similar in each group but at 6 to 9 months of age North African girls were heavier (p less than 0.05). In order to standardize the data for each infant, cubic polynomial interpolation method was used.     

Respiratory strategies for preterm infants at birth

Neonatologists treating extremely premature infants in the delivery room are faced with many dilemmas, not least how best to support their breathing. A balance must be struck between helping those infants who need it and not applying potentially harmful treatments to infants who might not need them. Crucial to this process is being able to identify infants who might benefit.     

Growth curves for preterm infants

The commonly used growth curves for preterm infants are four decades old and may not be suitable for the current population. Uncertainty exists regarding the most suitable curves for monitoring the growth of preterm infants. While intrauterine growth rate appears to be the ideal growth that needs to be attained by the preterm infants, it may not be feasible given the limitations set by the morbidities of prematurity. Babson and Benda's chart has been updated using recent data from large samples of preterm infants making it useful for monitoring growth of infants in the preterm period. Once a corrected age of 40 weeks is reached, the recently released WHO growth curves can be used to monitor their ongoing growth. While aiming for achieving intrauterine growth velocities in postnatal life, one should not lose sight of the potential short term adverse effects of aggressive nutrition and long term adverse effects of excessive catch up growth.     

Growth of children with Down's syndrome: birth to age 3 years.

A sample of 90 children with Down's syndrome were measured for recumbent length and weight from birth to age 36 months at the Children's Hospital Medical Center in Boston. At birth, means for both length and weight were reduced by about 0.5 SDs from the control group means. By 36 months, mean recumbent length was greater than 2 SDs below that for the control group, while the mean for weight was reduced by about 1.5 SDs from the control group mean. Growth velocity for both length and weight was most deficient within the first two years of life. About 30% of the sample demonstrated excess weight for length relations by 36 months. Children with moderate or severe heart disease were significantly smaller than those without or with mild cardiac problems at all times after birth. Measurements of a subsample of children at 4, 5, and 6 years of age suggested that growth velocity after 3 years of age may be within the range of normal. Assessment of growth of the child with Down's syndrome may be carried out with reference to charts plotting tenth to 90th percentiles based on these data.     

早产/低出生体重儿喂养建议

早产/低出生体重儿是指出生胎龄小于37周、出生体重低于2500 g的新生儿,是需要特殊关注的群体,合理的营养支持是提高其存活率的关键环节之一,不仅关系到近期生长和疾病转归,而且直接影响远期预后,充足均衡的营养是保证早产/低出生体重儿健康成长的物质基础.     

早产/低出生体重儿喂养建议

早产/低出生体重儿是指出生胎龄小于37周、出生体重低于2500 g的新生儿,是需要特殊关注的群体,合理的营养支持是提高其存活率的关键环节之一,不仅关系到近期生长和疾病转归,而且直接影响远期预后,充足均衡的营养是保证早产/低出生体重儿健康成长的物质基础.     

早产/低出生体重儿喂养建议

早产/低出生体重儿是指出生胎龄小于37周、出生体重低于2500 g的新生儿,是需要特殊关注的群体,合理的营养支持是提高其存活率的关键环节之一,不仅关系到近期生长和疾病转归,而且直接影响远期预后,充足均衡的营养是保证早产/低出生体重儿健康成长的物质基础.     

早产/低出生体重儿喂养建议

早产/低出生体重儿是指出生胎龄小于37周、出生体重低于2500 g的新生儿,是需要特殊关注的群体,合理的营养支持是提高其存活率的关键环节之一,不仅关系到近期生长和疾病转归,而且直接影响远期预后,充足均衡的营养是保证早产/低出生体重儿健康成长的物质基础.     

早产/低出生体重儿喂养建议

早产/低出生体重儿是指出生胎龄小于37周、出生体重低于2500 g的新生儿,是需要特殊关注的群体,合理的营养支持是提高其存活率的关键环节之一,不仅关系到近期生长和疾病转归,而且直接影响远期预后,充足均衡的营养是保证早产/低出生体重儿健康成长的物质基础.