Preschool children born moderately preterm have increased waist circumference at two years of age despite low body mass index

Aim: To investigate the development of waist circumference (WC) in preschool children born preterm compared with a population‐based reference. Background: Children born preterm are reported to be insulin resistant, despite being lean during early childhood. We hypothesize that the mechanism is through increased visceral adiposity. Methods: Data from 4446 preschool children (2169 girls/2277 boys) born in 2001–2006 from a population‐based study were compared with longitudinal measurements of body mass index (BMI) and WC from a cohort of 152 children (64 girls/88 boys) born moderately preterm in 2002–2004 (gestational age, 32–37 weeks). Results: In the preterm children, the mean WC was 2.8 cm larger compared with the reference group (p < 0.001) at 2 years of age but not at 5 years of age. There was no significant difference in the mean BMI at 2 years of age. The preterm group was significantly leaner at 5 years of age, with a mean BMI of 15.13 compared with 15.98 in the reference group (p < 0.001). Conclusion: Children born moderately preterm present as lean during early childhood but have an increased waist circumference in infancy, pointing towards a change in fat distribution with more abdominal fat. This may have implications for their metabolic status.     

中国三城市25 254例不同出生胎龄儿童神经行为发育水平研究

目的 探讨出生胎龄对学龄前儿童神经行为发育水平的影响。方法 来自安徽马鞍山市、浙江台州市、江苏扬州市的25 254例学龄前儿童纳入研究。根据所纳入儿童的出生胎龄,分为早产儿组（2 760例,胎龄28~36⁺⁶周）、早期儿组（6 005例,胎龄37~38⁺⁶周）、完全足月儿组（16 489例,胎龄≥39周）。采用年龄与发育进程问卷对儿童进行神经行为发育水平的评估。结果 早产儿组的沟通、粗大运动、精细运动、解决问题和个人-社会等5个能区的神经行为得分较完全足月儿组低（均P < 0.05）;早产儿组沟通、粗大运动、精细运动、解决问题4个能区神经行为得分较早期儿组低（均P < 0.05）;早期儿组各能区的平均分值与完全足月儿组相比,差异无统计学意义（均P > 0.05）。多元线性回归分析显示,校正了性别、年龄、体重指数、父母亲教育程度等混杂因素后,胎龄与5个发育能区（沟通、粗大运动、精细运动、解决问题和个人-社会）的得分呈显著正相关（P < 0.01）。结论 出生为早产儿的儿童神经行为发育水平较出生为完全足月儿和早期儿的儿童低,而出生为早期儿的儿童神经行为发育水平与出生为完全足月儿的儿童无明显差异。胎龄是神经行为发育水平的独立影响因素。     

Cholesterol metabolism in 8 to 12-year-old children born preterm or at term

Studies in animals have indicated that cholesterol metabolism is susceptible to manipulation by diet and growth in early life. In humans, low birthweight has been associated with increased risk of coronary heart disease. AIM: To establish whether plasma lipids and indicators of cholesterol absorption, synthesis and breakdown differ in children born preterm and at term. METHODS: Plasma total cholesterol, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, triacylglycerols, apolipoprotein A1, apolipoprotein B, lathosterol (indicator of cholesterol synthesis), campesterol (indicator of cholesterol absorption), 7-alpha hydroxycholesterol (indicator of cholesterol breakdown) were measured in up to 407 children born preterm and 36 children born at term. RESULTS: Children born preterm had lower cholesterol synthesis (p = 0.002) and lower cholesterol breakdown (p < 0.001) than those born at term, but their plasma cholesterol concentration was not significantly different. After adjusting for current size, birthweight and gestational age were significantly related to plasma lathosterol and 7-alpha hydroxycholesterol. However, when both birthweight and gestational age were adjusted, only gestational age remained significant. There were no significant differences in plasma campesterol between the two groups. CONCLUSION: Being born preterm may have a long-term effect on cholesterol metabolism in children 8-12 y later. Those born prematurely had lower cholesterol synthesis and breakdown, but their plasma cholesterol concentration was similar at this age. These parameters need to be studied in older cohorts.     

Change in cognitive abilities over time during preschool age in low risk preterm children

Background

More information is needed on ‘low-risk’ preterm infants' neurological outcome so that they can be included in follow-up programs at least until school age.

Objective

To examine the neuropsychological outcome in a group of low-risk low birth weight (LBW) children without neurological impairment followed from birth to 5 years of age.

Patients

26 intellectually normal children born preterm (30–34 weeks gestation) without major neurological disabilities and 23 control children born at term and matched for age, sex, and parental educational and occupational status.

Methods

Subjects already evaluated at 3 years of age underwent assessment again at 5 years using as neuropsychological outcome measures a wide range of tests including perceptual and visual–motor function, language comprehension and expression, and attention skills.

Results

When tested at 5 years, children born preterm still obtained significantly lower mean scores than controls on visual motor integration test (57 vs 64, p = 0.01), visual perception test (41 vs 43, p = 0.002) and a trend toward a lower score in the picture vocabulary test (81 vs 85.5, p = 0.07). The group of premature infants and controls improved their performance over time in the neuropsychological abilities investigated and, in some skills such as visual perception. Children born preterm took longer than those born at term to reach similar performance levels, 5 versus 3 years.

Conclusion

Ex low-risk children born preterm achieve lower scores over time in visual–motor and perceptual ability scales and in some language tests than children born at term. Like high-risk premature infants even those at low risk deserve regular follow-up with long-term programs.     

Comparison of Non Verbal Learning Difficulties in Preschoolers Born Preterm with the Term Born Peers

Objectives

To identify the incidence and pattern of specific areas of non verbal learning deficits (NVLD) associated with preterm and term born peers and also to evaluate influence of gestational age on cognition, motor, language and behavior in preterm and term infants.

Methods

Children were screened for prematurity by giving parents a comprehensive questionnaire covering the family details, birth history, medical history and school performance. After finding their suitability, the children were picked randomly using the lottery method. Hundred children born moderately preterm were allocated in Group B and 100 term born children were recruited in Group A. Participants of both the groups were evaluated using the First STEP- screening test to evaluate preschoolers.

Results

This study revealed that there was significant difference between both the preterm and the control group in all the domains of First STEP and there was 10 % incidence of NVLD in preterm born preschoolers.

Conclusions

Thus, the gestational age influences the cognitive, motor, behavior and academic performance in the preschoolers, thereby increasing the incidence of NVLD in preterm than the term born peers.     

中国三城市25 254例不同出生胎龄儿童神经行为发育水平研究

目的 探讨出生胎龄对学龄前儿童神经行为发育水平的影响。方法 来自安徽马鞍山市、浙江台州市、江苏扬州市的25 254例学龄前儿童纳入研究。根据所纳入儿童的出生胎龄,分为早产儿组（2 760例,胎龄28~36⁺⁶周）、早期儿组（6 005例,胎龄37~38⁺⁶周）、完全足月儿组（16 489例,胎龄≥39周）。采用年龄与发育进程问卷对儿童进行神经行为发育水平的评估。结果 早产儿组的沟通、粗大运动、精细运动、解决问题和个人-社会等5个能区的神经行为得分较完全足月儿组低（均P < 0.05）;早产儿组沟通、粗大运动、精细运动、解决问题4个能区神经行为得分较早期儿组低（均P < 0.05）;早期儿组各能区的平均分值与完全足月儿组相比,差异无统计学意义（均P > 0.05）。多元线性回归分析显示,校正了性别、年龄、体重指数、父母亲教育程度等混杂因素后,胎龄与5个发育能区（沟通、粗大运动、精细运动、解决问题和个人-社会）的得分呈显著正相关（P < 0.01）。结论 出生为早产儿的儿童神经行为发育水平较出生为完全足月儿和早期儿的儿童低,而出生为早期儿的儿童神经行为发育水平与出生为完全足月儿的儿童无明显差异。胎龄是神经行为发育水平的独立影响因素。     

Cognitive development and attention performances at school age of "normal" prematurely born children]

OBJECTIVE: A preterm birth can exert an influence on cognitive development. The aim of this study was to determine whether preterm birth may impact on attention executive processes, at school age, in children without neurological sequelae. DESIGN AND METHODS: Prematurely born children admitted in the level III NICU of the Maternité régionale of Nancy between 1992 and 1994, underwent at 8 to 10 years 8 subtests of the mental processing scales of the K-ABC, which assess process categories involved in learning. The children were also submitted to 3 tests that evaluate attention mechanisms efficiency (category fluency task, backward digits span, Tower of London). The controls were children born at term recruted in schools of the same area. RESULTS: The 124 children were born with birth weight appropriate for gestational age, and were in the school grades expected for their ages, in 3rd, 4rth, and 5fth grades. Fifty-three children were born at term, 29 were prematurely born (33-36 w), and 42 were very prematurely born (28-32 w). Birth term was significantly correlated (P < 0.001) with scores at sequential processing scale, at simultaneous processing scale and at the mental processing composite scale. At this scale, the children born at term obtained a median score of 112, the children prematurely born of 101, and the children very prematurely born of 98.5. For 40 third grade children (18 born at term, 10 prematurely born, and 12 very prematurely born), birth term was significantly correlated with performances at the 3 tests of attention. In all cases, preterm was inversely correlated with performances. CONCLUSION: The results are consistent with a lower efficiency in attention executive processes which may be related to the higher frequency of learning disabilities associated with prematurity.     

Learning disabilities in a population-based group of children with hydrocephalus

AIM: To assess cognitive functions in a population-based group of children with hydrocephalus and to analyse differences between children with and without myelomeningocoele (MMC); with hydrocephalus already present at birth and those who developed it later; children born at full term and those born preterm. METHODS: Of 103 children with hydrocephalus born in the western-Swedish region in 1989-1993, 73 were assessed using the Wechsler Intelligence Scales or the Griffith Developmental Scales. RESULTS: One-third of the children were normally gifted (IQ >85), another 30% had a low average IQ of 70-84 and 37% had learning disabilities with an IQ of <70. The median IQ was 75, verbal IQ 90 and performance IQ 76 (p<0.001). An IQ of <70 was found in 19 of 45 (42%) children without MMC and in 8 of 28 (29%) of those with MMC. Children born preterm had a lower IQ of 68 than those born at full term with an IQ of 76, while children with hydrocephalus present at birth but without MMC had a lower IQ of 60 than the others with an IQ of 77. Children with cerebral palsy and/or epilepsy (n=22) had a lower IQ of 66 than the IQ of 78 in those without these impairments (p<0.01). CONCLUSION: Cognitive functions in children with hydrocephalus need to be carefully assessed before school age to ensure adequate support and education. Even the one-third near normally gifted children with an IQ of 70-85 require special attention, due to the profile of relatively well-preserved verbal functions but greatly impaired perceptual and non-verbal abilities.     

Growth impairment in the very preterm and cognitive and motor performance at 7 years

Background: Infants born of low birth weight often have poor subsequent growth (especially if they were born very preterm), which has been shown to relate to later motor and cognitive development. Aims: To assess a cohort of preterm infants at the age of 7 years for growth, motor, and cognitive measures, and investigate the effects of growth impairment on school performance. Methods: A cohort of 280 children born before 32 completed weeks of gestation were tested, together with 210 term controls. Results: Pretem children were significantly lighter and shorter than term controls and had smaller heads and lower body mass index (BMI). Median centiles for weight, height, head circumference, and BMI were 25, 25, 9, and 50 for boys and 50, 25, 9, and 50 for girls compared with 50, 50, 50, and 75 for controls. They performed significantly less well on all tests with a mean score of 91 (9.2) on the Developmental Test of Visual-Motor Integration, 89 (14.5) on the Wechsler-III IQ test, and 30.7% scoring at or below the 5th centile on the Movement Assessment Battery for Children. In boys, short stature and small heads were the best predictors of poor performance; in girls, a small head alone was a predictor for poor motor and cognitive performance. Conclusion: Poor postnatal growth in preterm infants, especially of the head, is associated with increased levels of motor and cognitive impairment at 7 years of age. This growth restriction appears to occur largely in the postnatal rather than antenatal period and may be amenable to intervention and subsequent improvement in outcome.     

Growth impairment in the very preterm and cognitive and motor performance at 7 years.

BACKGROUND: Infants born of low birth weight often have poor subsequent growth (especially if they were born very preterm), which has been shown to relate to later motor and cognitive development. AIMS: To assess a cohort of preterm infants at the age of 7 years for growth, motor, and cognitive measures, and investigate the effects of growth impairment on school performance. METHODS: A cohort of 280 children born before 32 completed weeks of gestation were tested, together with 210 term controls. RESULTS: Preterm children were significantly lighter and shorter than term controls and had smaller heads and lower body mass index (BMI). Median centiles for weight, height, head circumference, and BMI were 25, 25, 9, and 50 for boys and 50, 25, 9, and 50 for girls compared with 50, 50, 50, and 75 for controls. They performed significantly less well on all tests with a mean score of 91 (9.2) on the Developmental Test of Visual-Motor Integration, 89 (14.5) on the Wechsler-III IQ test, and 30.7% scoring at or below the 5th centile on the Movement Assessment Battery for Children. In boys, short stature and small heads were the best predictors of poor performance; in girls, a small head alone was a predictor for poor motor and cognitive performance. CONCLUSION: Poor postnatal growth in preterm infants, especially of the head, is associated with increased levels of motor and cognitive impairment at 7 years of age. This growth restriction appears to occur largely in the postnatal rather than antenatal period and may be amenable to intervention and subsequent improvement in outcome.     

Body composition in newborn infants: 5-year experience in an Italian neonatal intensive care unit

The aim of nutrition in neonatology is to achieve a healthy growth that mimics, both in terms of growth rates and quality of growth, that of a normal fetus of the same gestational age. In addition, providing an optimal amount and quality of nutrients significantly contributes to the attainment of a neurodevelopment similar to that of an infant born at term. Yet, a high risk of developing metabolic syndrome in relation to aggressive nutrition and accelerated postnatal growth velocity has been reported in former preterm infants. Considering the strict interrelationship that exists between early nutrition, growth, and subsequent health, the development of body composition in early infancy, in terms of fat mass, may contribute to the long-term "programming" process. Hence, accurate and non-invasive measurement of infant body composition, which evaluates the quality in addition to the amount of weight gain, represents a useful tool for gaining further insight into the relationship between birth weight or time in utero and future development. Preterm infants, including those born small for gestational age, have been reported to develop an increased and/or aberrant adiposity, in addition to postnatal growth retardation, when assessed at term-corrected age. However, within the first 5 months, preterm infants, either born adequate or small for gestational age, show a recovery of fat mass, and attain fat mass values comparable to those of full-term infants assessed at birth. The metabolic consequences of these findings on the long-term health need to be further clarified.     

Is term newborn body composition being achieved postnatally in preterm infants?

Background

The American Academy of Pediatrics (AAP) recommends that preterm infants' growth duplicates fetal growth rates and that body composition replicates in utero body composition.

Aims

To compare the total body fat mass between preterm infants assessed at term corrected age and full-term newborns, and to investigate the effects of gestational age, gender, weight increase, being breast fed on total adiposity.

Study design

Prospective observational study.

Subjects

One hundred and ten preterm infants [mean (SD) gestational age: 29.9 (2.3) weeks; birth weight: 1118 (274) g], and 87 full term [mean (SD) 38.6 (1.21) weeks, 3203 (385) g], breastfed infants.

Outcome measures

Growth and body composition by means of a pediatric air displacement system were assessed at term corrected age in preterm infants and on day 3 of life in full term infants.

Results

Weight, length and head circumference were smaller in the preterm group as compared to the term group. Mean (SD) percentage of fat mass in preterm infants was significantly higher as compared to term infants [14.8 (4.4) vs 8.59 (3.71), P < 0.0001]. Fat mass was negatively correlated with gestational age (P < 0.001), and positively associated with weight increase (P < 0.05).

Conclusions

Our data suggest that body composition, in terms of fat mass, in preterm infants at term corrected age is different from that of full term newborns.     

School-age developmental needs in children born preterm

Children born preterm are at risk of developing neurodevelopmental, cognitive and mental health needs. There is an inverse correlation between gestational age and those needs. Difficulties with communication and language, executive function, learning, coordination, behaviour, and mental health tend to become more obvious as the social and academic demand increases in later childhood. By school age, children born preterm without severe neurodisability have often been discharged from neonatal follow-up programmes and opportunities for early recognition are missed. Long term follow-up with enhanced developmental surveillance as well as raising awareness of the consequences of prematurity in school are essential in identifying the needs of children born preterm, so that timely interventions can be implemented. In this article, we draw attention to the school-age developmental needs of children born preterm and the implications for clinical care for this population.     

Assessment of somatic development and body composition in the 7th year of life in children born as extremely low birth weight infants (≤1000g); a multi-centre cross-sectional study of a cohort born between 2002 and 2004 in the Malopolska voivodship

Children born with extremely low birth weight often present delayed growth in the first years of their lives: they remain shorter and weigh less than their peers. Current reports published worldwide state that later in life these children are at an increased risk of cardiac and vascular diseases, diabetes and obesity. Abnormal distribution and the excess of fat tissue predispose them to develop the metabolic syndrome. The aim of the study was to evaluate the somatic development of seven-year-old children born with birth-weight ≤1000 g (ELBW) in the Malopolska voivodship and to estimate the content and distribution of fat tissue. Moreover, the risk factors of disturbed somatic development were evaluated. Materials and methods: Two hundred and four live newborns with birth weight ≤1000 g were born in the Malopolska voivodship between 1.09.2002 and 31.08.2004. One hundred and fifteen of these children (56%) died in early infancy. The study included 81 children in the 7th year of life out of the 89 surviving ones. Their mean gestational age at birth was 27.3 weeks. (SD: 2.1 weeks) and their mean birth-weight was 840 g (SD: 130 g). All the children underwent anthropometric measurements and the thickness of the skin fold over the triceps was measured. Body mass index (BMI) was calculated and the body composition was assessed by multifrequency bioimpedance. The control group consisted of 39 children born at term chosen randomly from the general population and matched with regard to age and sex. Results: The ELBW children in the 7th year of life were shorter (z-score: -1.06±1.4 p<0.001), had lower body mass (z-score: -0.57±0.9; p=0.01), smaller head circumference (z-score: -1.2±1.3; p<0.001), lower BMI (z-score: -0.99±1.6; p<0.001) as compared to their peers. Fat tissue mass was lower in the ELBW group than in the control group (11% vs 16%; p<0.01). The most retarded somatic development was observed in the group of children suffering from cerebral palsy. Conclusions: 1. Children born with ELBW, at 7 years of life, present significantly retarded somatic development as compared with their full-term peers. 2. The most important risk factor of somatic development disturbances is cerebral palsy. 3. Children born with low birth weight and ELBW, need long term follow up.     

Maternal infant-feeding style and children's adiposity at 5 years of age

OBJECTIVES: To examine the relationship between maternal infant-feeding style and adiposity in childhood and to determine whether feeding style explains any of the association between maternal obesity and childhood adiposity. DESIGN: Prospective cohort study. SETTING: Cincinnati metropolitan area. PARTICIPANTS: A total of 313 preschool children; 80% were white and 20% were black. MAIN OUTCOME MEASURES: Seven factors describing maternal infant-feeding style derived from the Infant Feeding Questionnaire administered at age 3 years; maternal obesity, defined as a body mass index of 30 or higher before pregnancy; and adiposity at 5 years of age as assessed by dual-energy x-ray absorptiometry. RESULTS: The mean +/- SD fat mass was 4.55 +/- 1.64 kg. Seventeen percent of the mothers were obese before pregnancy. Children whose mothers had high concern about the infant overeating or becoming overweight (the highest tertile of the "overeating" factor) had 0.67 kg (95% confidence interval, 0.31-1.03 kg) higher fat mass than children whose mothers did not have high concern (the other 2 tertiles). None of the other 6 feeding factors were related to childhood adiposity. Children of obese mothers had 0.54 kg (95% confidence interval, 0.10-0.98 kg) higher fat mass than children of nonobese mothers. High concern about the infant overeating, which was more common in obese mothers, accounted for 15% of this 0.54-kg difference. CONCLUSION: High maternal concern about an infant overeating or becoming overweight was associated with higher adiposity at 5 years of age and explained some of the association between maternal obesity and child adiposity.     

Lung function in children born after foetal growth restriction and very preterm birth

Aims: To assess lung function at early school age in children delivered at very early gestation owing to intrauterine growth restriction and abnormal foetal blood flow (IUGR). Methods: Spirometry was performed at median age 8.4 (range 6.5–10.7) years in 31 children born preterm with IUGR (PT‐IUGR) with a median (range) birth weight (BW) of 650 (395–976) g and median (range) gestational age 27 (24–29) weeks. Control groups were matched for gender and age and had BW appropriate for gestational age (AGA); 31 children born preterm (PT‐AGA) with BW of 1010 (660–1790) g matched for gestational age at birth, and 31 children born at term (T‐AGA) with BW of 3530 (3000–4390) g. Results: The PT‐IUGR group had lower mean (SD) values of z‐scores for FEV₁, FEV₁/FVC and forced mid‐expiratory flow rate (FEF_25–75%) compared to the T‐AGA group, p = 0.003, p = 0.032 and p < 0.001, respectively, but did not differ from the PT‐AGA group. PT‐IUGR children delivered at ≥26 gestational weeks (GW) had lower FEF_25–75% than PT‐AGA children of corresponding GA, p = 0.014. Conclusion: Lung function was reduced in the PT‐IUGR group at early school age compared to controls born at term. The influence of IUGR on later lung function was only apparent in children born preterm after 26 GW.     

Breastfeeding in children born small for gestational age and future nutritional and metabolic outcomes: a systematic review

ObjectiveTo systematically review evidence related to nutritional and cardiometabolic outcomes in children born at term and small for gestational age and the association with breastfeeding.Source of dataTwo independent reviewers searched the MEDLINE, LILACS, SciELO, and Embase databases without time or language restrictions. The PRISMA tool was used, and studies that evaluated infants born at term and small for gestational age, breastfed, and with an evaluation of cardiometabolic outcomes were included. Studies with preterm infants, those that did not have information on breastfeeding, and those with lack of evaluation of the outcome variables were excluded. Also excluded were review articles, editorials, and series of cases.Summary of dataOnly seven articles were found that met the abovementioned criteria. There was a great variability in the type of evaluation, as well as in the age of these children. It was demonstrated that breastfeeding promoted growth without body composition alteration and without increased insulin resistance in children with exclusive breastfeeding, when compared to children receiving a higher calorie formula, except for one article that observed an increase in fat mass in exclusively breastfed children.ConclusionBreastfeeding seems to be a safe feeding practice for infants born at term and small for gestational age, showing no association with deleterious short-term outcomes. Breastfeeding stimulation in these populations seems to be a way of preventing the health problems associated with the high risk of chronic noncommunicable diseases and obesity.     

Die neurologische und kognitive Entwicklung zu klein geborener Kinder

This article aims to provide an overview on the neurological and cognitive outcome of children who were “born too small”. We will discuss the neurodevelopmental prognosis of term born small for gestational age children, and for children born prematurely (appropriate and small for gestational age). The various underlying causes responsible for intrauterine growth retardation (IUGR) and significance for neurodevelopmental outcome will be discussed briefly. Neurodevelopmental outcome of term born children with IUGR due to intrauterine malnutrition and outcome of preterm born small for gestational age (SGA) as well as preterm born appropriate for gestational age (AGA) children will then be discussed in more detail. Children with IUGR represent a heterogeneous group regarding the underlying cause that is responsible for the growth retardation. Neurodevelopmental prognosis very much depends on the specific underlying cause. IUGR caused by intrauterine malnutrition is not necessarily associated with neurodevelopmental problems. However, results of several studies suggest that in term born children with IUGR mild neuromotor problems and lower full scale IQ is more frequent when compared with term born appropriate for gestational age children. Prematurely born children are at high risk for neurodevelopmental impairment. There is no difference in frequency of disabling impairments between AGA and SGA preterm children. However, in preterms with IUGR there seems to be a higher frequency of mild neuromotor problems and cognitive function seems to be poorer than in appropriate for gestational age preterms.