A practical approach to the assessment of faltering growth in the infant and toddler

Faltering growth, previously called failure to thrive, in infants and toddlers is a common primary care presentation and reason for paediatric referral. This article suggests an approach to selection of cases for referral, the assessment and investigation required in secondary care and the identification of the less than 5% of cases with an underlying organic disease. A framework is suggested to aid advice to be given to parents with a child who has faltering growth due to inadequate nutritional intake for their energy requirements.     

Effectiveness of an educational intervention to improve child feeding practices and growth in rural China: updated results at 18 months of age

Inappropriate complementary feeding practices have led to, in part, significant disparities in growth and nutritional status between rural and urban children in China. A cluster‐randomised, controlled trial was implemented in Laishui, China to assess the effectiveness of an educational intervention on caregivers' feeding practices and children's growth. Eight townships were randomly assigned to the intervention or control. Five hundred ninety‐nine healthy infants were enrolled at 2–4 months old, and were followed up at ages 6, 9, 12, 15 and 18 months. The intervention group received information on enhanced home‐prepared recipes and food preparation and hygiene through group training, counselling and home visit. Key outcomes were children's physical growth, caregivers' knowledge and behaviours on complementary feeding, and the infant and child feeding index (ICFI). Analysis was by intention to treat. The intervention group achieved better knowledge and practices related to complementary feeding, and significantly higher ICFI scores at each follow‐up point. Children in the intervention group achieved higher z‐scores for weight‐for‐age (WAZ) and weight‐for‐height (WHZ) than the control (0.18 vs. 0.01 and 0.49 vs. 0.19, respectively) at 18 months old, and were less likely to have stunted growth (odds ratio = 0.71, 95% confidence interval: 0.53–0.94). Mixed model showed that the intervention group achieved significantly better linear growth over time, including WAZ (P = 0.016), WHZ (P = 0.030) and HAZ (P = 0.078). These results indicated that an educational intervention delivered through local health services can enhance caregivers' knowledge and practices of complementary feeding and ultimately improve children's growth.     

Preterm infants fed nutrient‐enriched formula until 6 months show improved growth and development

Background: The purpose of the present study was to determine the effect of feeding nutrient‐enriched preterm formula to preterm infants until 6 months' corrected age (CA) on growth and development in the first 18 months of life. Methods: Very low‐birthweight preterm infants were fed preterm formula until term (40 weeks CA). Infants were then assigned to one of three groups and were fed term formula until 6 months' CA (group 1, n= 29); preterm formula to 3 months' CA and then term formula to 6 months' CA (group 2, n= 30); or preterm formula until 6 months' CA (group 3, n= 31). Anthropometry was performed at term, 3, 6, 9, 12, 15, and at s18 months' CA. Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 months' CA. Results: Although body weight, length, head circumference and z score for CA at term in group 3 were significantly lower than those of groups 1 and 2, growth rates of these parameters were significantly higher in group 3 up to 18 months CA', as compared to groups 1 and 2. The mental developmental index and psychomotor developmental index of the Bayley test were not significantly different between the three groups. Conclusions: Very low‐birthweight preterm infants fed nutrient‐enriched preterm formula until 6 months' CA demonstrated significantly improved growth rates for bodyweight, length and head circumference, and comparable mental and psychomotor development throughout the first 18 months of life.     

Maternal depression and infant growth: a review of recent evidence

Depressive disorder occurring during pregnancy and the post-natal period (maternal depression) is common in both developed and developing countries. It can cause functional impairment at a time when the mother is performing tasks vital to her infant's growth and development. This article reviews recent research investigating whether there is an association between maternal depression and infant growth impairment. A search was made using Medline for articles published in the last 10 years, and the results were scrutinized for relevance and quality. Eight studies from developing countries, and three from the UK, are described. Cohort studies from both India and Pakistan provide evidence that maternal depression is an independent risk factor for poor infant growth. However, studies from other developing countries are limited and conflicting in their findings. The UK-based research suggests that such an association occurs in mothers/infants living in conditions of socio-economic deprivation. This review discusses the potential mechanisms by which the relationship between maternal depression and infant growth outcomes may be explained: the effect of infant growth 'failure' upon maternal mood; the impact of maternal depression upon health-seeking behaviours, breastfeeding and mother-child interaction; the relationship between antenatal depression and low infant birthweight; and economic, socio-cultural and confounding factors that may explain the variation between results from different settings.     

不同喂养方式对极低/超低出生体重儿生长发育的影响

目的 探讨极低/超低出生体重（VLBW/ELBW）早产儿纠正年龄6个月内生长发育情况及不同喂养方式对其生长发育的影响。方法 对2016年1月至2017年4月出院并按时完成随访的VLBW/ELBW早产儿109例进行纠正年龄6个月内的生长发育监测。采用Z评分法评价体格指标,并分析不同喂养方式（母乳喂养组：母乳+母乳强化剂;混合喂养组：母乳+早产儿配方奶;人工喂养组：早产儿配方奶）对其生长发育的影响。结果 年龄别体重Z积分、年龄别身长Z积分、身长别体重Z积分、体重指数Z积分的追赶高峰发生于纠正年龄3个月内;年龄别头围Z积分的追赶高峰发生于纠正年龄5个月。VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内。母乳喂养组体重、身长、头围的生长在纠正年龄3个月时均优于混合喂养组和/或人工喂养组（P < 0.05）;母乳喂养组头围、身长的生长在纠正年龄6个月时均优于混合喂养组和/或人工喂养组（P < 0.05）。结论 VLBW/ELBW早产儿的生长偏离多发生于纠正年龄1~3个月内,提示应加强早期个体化随访及营养指导以减少生长偏离的发生。亲母母乳喂养并添加母乳强化剂是VLBW/ELBW早产儿的最佳喂养方式。     

Retarded heart growth in the victims of sudden infant death: possible implications for lethal mechanisms

The study was aimed to compare the weight of the heart at death in infants who died of sudden infant death (SID) and in control infants under 1 year old. The study included 227 infants who died in St. Petersburg in 1983 to 1990 and who met the criteria of SID. One hundred and thirty-eight infants who died within 24 h out of hospital of defined respiratory infections within the same period of time constituted a control group. Infants with signs of malformations, tumours, and intrauterine infections were excluded from the study. A linear regression model was used in data analysis. No statistically significant association was found between the weight of the heart by the time of death and the following variables: gender, birth weight and length, ponderal index at birth, gestational age, calendar age at death, and length at death. Two variables which significantly influenced the heart weight and entered the linear regression model were infant's weight by the time of death and the cause of death (whether SID or not). No statistically significant interaction was found for these two parameters. It was found that each increase in total body weight by 1000 g brought with in an increase in the heart weight by 4 g (95% CI=3.6–4.4); for the SID babies, the weight of the heart was less than for the control ones by 1.6 g (95% CI=0.3–2.9 g).Conclusion Retarded heart growth may lead to functional disturbances and may contribute to possible mechanisms in some SID cases.     

早产小于胎龄儿和适于胎龄儿生长发育状况随访分析

目的观察早产小于胎龄儿(SGA)和适于胎龄儿(AGA)出院后体格生长及智能发育状况。方法选择2009年2月至2012年12月出院的早产儿220例,根据出生时状况分为SGA组和AGA组,在矫正月龄7个月内定期测量身长、体质量、身长,头围,并由专职人员进行发育商测试,比较两组间差异。结果纠正1~6月龄SGA组体质量Z值均小于AGA组,差异有统计学意义(P0.05);纠正7月龄差异无统计学意义(P0.05);纠正1~5月龄SGA组身长Z值均小于AGA组,差异有统计学意义(P0.05),纠正6月龄之后差异消失;纠正1~7月龄SGA组头围Z值均小于AGA组,差异有统计学意义(P0.05)。SGA组及AGA组在纠正5~7月龄发育商分别为96.7±9.2及102.9±9.9,差异有统计学意义(P0.05);SGA组大运动、认知及语言能区得分均低于AGA组,差异有统计学意义(P0.05)。结论 SGA早产儿在纠正7月龄内体质量追赶性生长较好,但身长追赶性生长则相对较差,头围追赶最差;SGA早产儿纠正5~7月龄智能发育水平总体落后于AGA早产儿,尤以大运动、认知和语言能区落后较明显。     

Effects of weaning cereals with different phytate content on growth, development and morbidity: a randomized intervention trial in infants from 6 to 12 months of age

BACKGROUND: Phytate decreases iron and zinc bioavailability and contributes to deficiencies of iron and zinc, potentially causing anaemia, poor psychomotor development, impaired growth and increased risk of diarrhoea and respiratory infections. AIM: To investigate whether a reduced dietary intake of phytate, either via extensively phytate-reduced infant cereals [milk cereal drinks (MCDs) and porridge] or a milk-based infant formula, would improve growth and development and reduce morbidity in infants. DESIGN: Infants (n = 300) were, in a double-blind design, randomized to three diet intervention groups from 6 to 12 mo of age-commercial MCD and porridge (CC group), phytate-reduced MCD and phytate-reduced porridge (PR group), or milkbased infant formula and porridge with regular phytate content (IF group)-then followed until 18 mo. Dietary intake, anthropometry, development (Bayley Scales of Infant Development) and episodes of infectious diseases were registered. Results: There were no significant differences between study groups in growth, development or morbidity until 12 mo of age. The IF group had a 77% higher risk (95% CI: 1.05-2.97) of diarrhoea compared to the PR group during the 12-17-mo period. Infants with haemoglobin concentration (Hb) < 110 g/l at 12 mo had lower attained weight at 18 mo (11.14 kg vs 11.73 kg, p = 0.012). Infants with serum zinc (S-Zn) <10.7 pmol/l at 12 mo had higher risk of respiratory infections (RR = 1.74, 95% CI: 1.19-2.56) compared to controls. CONCLUSION: Phytate reduction had no effect on growth, development or incidence of diarrhoeal or respiratory infections. Infants with low Hb or low S-Zn may be at higher risk of poor growth and respiratory infections, even in this high-income population.     

晚期早产儿与足月小于胎龄儿生长发育状况比较

目的比较均为低出生体质量的晚期早产与足月小于胎龄(SGA)儿童的生长和发育状况。方法随机选取100例出生体质量<2 500 g的3岁儿童,其中50例为晚期早产儿童,50例为足月SGA儿童,对其进行体格测量及盖赛尔(Gesell)发育量表评估。结果晚期早产和足月SGA儿童的出生体质量、出生身长相近,但3岁时晚期早产儿童的身高、体质量、头围明显优于足月SGA儿童,差异有统计学意义(P<0.05);Gesell发育评估显示,晚期早产儿童的动作能、应物能、语言能、应人能均高于足月SGA儿童,差异有统计学意义(P<0.05)。结论同为低出生体质量,晚期早产儿童的长期生长和发育状况优于足月SGA儿童。     

不同抚触方法对新生儿生长发育的影响-多中心临床研究

目的 了解不同的抚触方法对足月与早产新生儿早期生长发育的影响。方法 随机选择４０５例正常与疾病足月与早产新生儿,分别应用国外通用法（ＣＯＴ）、国内改良简易法（ＭＤＳＴ）与国内改良简易经络法（ＭＤＳＴＡＣ）对抚触组按摩１０ｄ,同时对抚触组与对照组于按摩前后及相同时段的生长指标、Ｈｂ、选择性６项新生儿神经行为发育指标进行观察,并作组间与自身比较,同时比较营养素摄入。结果 接受ＣＯＴ与部分ＭＤＳＴＡＣ按     

Bacteriuria in pregnancy and growth and development of the infants

In the framework of a community-oriented programme in a western neighbourhood in Jerusalem, screening for bacteriuria during pregnancy was introduced. Between the years 1972 and 1979, 30 cases were identified, an incidence of 1.7%. All women diagnosed as having bacteriuria received antibiotic treatment according to sensitivity of the organism. This report presents the pregnancy outcome as measured by physical growth and development of the offspring. Cases of bacteriuria were compared with individually matched nonbacteriuric controls. No statistically significant differences were found in mean birth weight, mean weight and length at 1, 3, 6, 9 and 12 months, and development quotient at 2 years. No low birth weight infants were found among the cases. The fact that no differences were found between cases and controls, the feasibility, validity, acceptability and low cost of the screening test, and the health benefits of the programme justify introduction of routine screening and treatment of bacteriuria in the preventive health services.     

Health impact of catch‐up growth in low‐birth weight infants: systematic review,evidence appraisal,and meta‐analysis

This study aimed to systematically review and appraise evidence on the short‐term (e.g. morbidity, mortality) and long‐term (obesity and non‐communicable diseases, NCDs) health consequences of catch‐up growth (vs. no catch‐up growth) in individuals with a history of low birth weight (LBW).We searched MEDLINE, EMBASE, Global Health, CINAHL plus, Cochrane Library, ProQuest Dissertations and Thesis and reference lists. Study quality was assessed using the risk of bias assessment tool from the Agency for Health Care Research and Quality, and the evidence base was assessed using the GRADE tool. Eight studies in seven cohorts (two from high‐income countries, five from low‐middle‐income countries) met the inclusion criteria for short‐term (mean age: 13.4 months) and/or longer‐term (mean age: 11.1 years) health outcomes of catch‐up growth, which had occurred by 24 or 59 months. Of five studies on short‐term health outcomes, three found positive associations between weight catch‐up growth and body mass and/or glucose metabolism; one suggested reduced risk of hospitalisation and mortality with catch‐up growth. Three studies on longer‐term health outcomes found catch‐up growth were associated with higher body mass, BMI or cholesterol. GRADE assessment suggested that evidence quantity and quality were low. Catch‐up growth following LBW may have benefits for the individual with LBW in the short term, and may have adverse population health impacts in the long‐term, but the evidence is limited. Future cohort studies could address the question of the consequences of catch‐up growth following LBW more convincingly, with a view to informing future prevention of obesity and NCDs. © 2016 John Wiley & Sons Ltd     

The relevance of infant observation for early intervention: containment in theory and practice

This paper explores the links between the practice of Infant Observation as a mode of study of early development, and a means of training future clinicians and others, and its potential use in research and early intervention, particularly in respect of risk. Material from an infant observation undertaken as part of a clinical training is quoted before moving on to two illustrations of babies at risk – one of developing autism, and the other, a baby in foster care, observed as part of a research project into what happens to babies taken into care. Both illustrations are observation-based interventions, rather than pure observations, and are seen as providing good evidence for development of the practice to support healthier development in vulnerable infants and to enrich the understanding of social workers and others who take significant decisions about the lives of young children.     

Effects of heavy maternal smoking on intrauterine growth patterns in sudden infant death victims and surviving infants

Sudden infant death (SID) is associated with both intrauterine growth retardation and maternal smoking during pregnancy. Here, we investigated if the statistical association between maternal smoking and SID is direct or mediated through the well- known growth retarding effects of heavy maternal smoking on the fetoplacental unit. We analysed data from a population-based prospective cohort study (181 cases, total newborn population 227,791 births) within the Westphalian Perinatal Inquiry in Germany between 1990 and 1994. SID victims whose mothers did not smoke had a normal mean birth weight (mean 3415.5 vs 3431.5 g), length (mean 51.46 vs 51.66 cm), and body mass index (BMI) (mean 12.8 vs 12.8 kg/m²) when compared to surviving children. In contrast, SID victims of mothers who smoked heavily (>ten cigarettes per day) had a significantly lower birth weight (2911.21 g vs 3148.34 g), length (48.98 vs 50.39 cm), and BMI (11.8 vs 12.4 kg/m²) when compared to surviving children whose mothers smoked heavily. Stratification for gestational age revealed that these differences are mainly caused by preterm SID infants. Conclusion The statistical association between maternal smoking and SID mainly results from effects of tobacco smoke on the fetoplacental unit which, in later SID victims, appears to be more susceptible to the growth retarding effects of cigarette smoking. Received: 26 May 1997 / Accepted in revised form: 10 September 1997     

Intact survival of a 280-g infant: an extreme case of growth retardation with normal cognitive development at two years of age

The care of infants born weighing less then 500 g is not only controversial but is also associated with medical uncertainties. We report the management of a growth retarded infant who weighed 280 g at birth after 26.9 weeks'gestation. The child not only survived but appears developmentally normal at two years of age. Although the infant is the smallest survivor reported, the case demonstrates the importance of gestational assessment in deciding delivery room management.     

不同时机应用枸橼酸咖啡因对早产儿结局及神经发育影响的比较研究

目的探讨不同时机应用枸橼酸咖啡因对早产儿结局及神经发育的影响。方法选取2018年1月至6月于我院新生儿重症监护室住院治疗的胎龄小于32周、体重小于1500 g的早产儿共113例为研究对象,按开始使用枸橼酸咖啡因的日龄分为早期治疗组(日龄≤1 d,53例)和晚期治疗组(1 d<日龄≤10 d,60例),回顾性收集并比较两组患儿围生期的基本情况、治疗过程、临床结局,并针对神经发育情况随访至12月龄。结果早期治疗组患儿支气管肺发育不良、动脉导管未闭及脑室内出血/脑室周围白质软化的发生率低于晚期治疗组,差异均有统计学意义(均P<0.05)。早期治疗组纠正胎龄40周时新生儿神经行为测定评分高于晚期治疗组,差异有统计学意义(P<0.05)。早期治疗组纠正胎龄3月龄时智力发育指数高于晚期治疗组,纠正胎龄至12月龄时智力发育指数及运动发育指数均高于晚期治疗组,差异均有统计学意义(均P<0.05)。结论早期应用枸橼酸咖啡因可改善早产儿结局,改善神经系统预后。     

出生3个月内婴儿的碘营养状态及其对早期生长发育的影响

目的了解出生3个月内婴儿的碘营养状态及其对早期生长发育的影响。方法在非碘缺乏地区的上海随机选取122名出生3个月内的婴儿(母乳喂养儿68名,配方乳喂养儿54名)进行观察性研究。分别于婴儿日龄42d和90d时测定其母乳或配方乳及婴儿尿中的碘浓度,并对婴儿进行身长、体重和头围测量,婴儿90d时行Gesell智力发育评估。结果①42d和90d时婴儿尿碘浓度(中位数)分别为161.0μg/L和184.1μg/L;②母乳和配方乳喂养婴儿在42d和90d日龄时的尿碘浓度(中位数)分别为197.9μg/L、115.4μg/L和219.2μg/L、140.1μg/L;尿碘浓度低于100μg/L的比例分别为12.0%、42.4%和4.4%、33.6%;③母乳和配方乳的乳碘浓度(中位数)分别为109.1μg/L和88.9μg/L,均与婴儿尿碘浓度呈正相关(r=0.523,0.696);④出生3个月内不同碘营养状态的婴儿在体格和智能发育方面差异均无统计学意义。结论①部分婴儿存在碘营养不足或过多,应加强对婴儿碘营养状态的监测;②母乳喂养婴儿的碘营养状态优于配方乳喂养的婴儿,积极鼓励母乳喂养;③出生3个月内不同碘营养状态婴儿间的体格和智能发育尚未见明显差异,有待进一步随访观察。