SERUM CHOLESTEROL CONCENTRATIONS IN EARLY INFANCY

Abstract. Ginsburg, B.-E. and Zetterstrom, R. (Department of Paediatrics, Karolinska Institute, St. Goran's Children's Hospital, Stockholm, Sweden). Serum cholesterol concentrations in early infancy. Acta Paediatr Scand, 69: 581, 1980.—Sixteen healthy term infants were followed from birth to the age of 3–6 months. Total cholesterol, VLDL-LDL-cholesterol and HDL-cholesterol were determined in cord serum, in serum obtained 3–10 days after birth (mean age 4.6 days) and at the age of 3–6 months (mean 4.1 months). Mean total cholesterol increased by 1.5 mmol/l during the first 3–10 days and by an additional 1.1 mmol/l during the following 3–6 months. Mean VLDL-LDL-cholesterol increased by 1.0 mmol/l and 0.9 mmol/l, respectively, and mean HDL-cholesterol by 0.4 mmol/l and 0.3 mmol/l, respectively, during the same periods. The HDL-cholesterol: VLDL-LDL-cholesterol ratio thus fell from 1.5 at birth to 0.8 at the age of 3–10 days and to 0.6 at 3–6 months. In eight breast-fed infants, the mean total cholesterol level increased by 2.9 mmol/l from birth to the age of 3–6 months. This increase was significantly higher than the increase found in eight infants who received a cow's milk formula—i.e. 2.3 mmol/l. Free and esterified cholesterol were determined in 10 infants. Free cholesterol accounted for about one-third of the total cholesterol from birth to the age of 3–6 months.     

A Management Strategy for Mild Valvar Pulmonary Stenosis

Pulmonary valve stenosis (PVS) is a common congenital cardiac lesion, 1/1000 live-births, the majority of patients having mild transvalvar gradients. In the present study, we sought to determine the outcome of mild PVS diagnosed by echocardiography and to propose a management algorithm that would identify patients at risk for progression of PVS, yet reduce health care expenditures. In this single-center retrospective study, we included all patients who met the following criteria: first diagnosed with PVS at <10 years of age, an initial peak systolic Doppler gradient of ≤40 mm Hg, no additional congenital heart lesions, and at least two clinical evaluations. There were 146 subjects who met these criteria. The median age at initial diagnosis was 3.9 months, with a range of 1 day to 9.9 years. The average initial peak systolic gradient (PSG) was 23.3 mm Hg (±7.8) and final PSG 17.1 mm Hg (±10.3). Over a mean length of follow-up of 4.0 years, 107/146 (73%) were later reported to have very mild PVS (PSG ≤ 25 mm Hg, no clinical change or resolution of murmur). Only 3 of 146 subjects progressed to have a PSG above 40 mm Hg, with 1 undergoing a balloon valvuloplasty. In conclusion, mild PVS diagnosed in early childhood is a benign lesion, with most children essentially demonstrating resolution in the first years of life. Mild PVS identified in infancy requires a brief period of close observation. Based on these data, our management recommendations are that infants be followed closely within the first year of life. Young infants diagnosed at birth that maintain a PSG ≤ 25 mm Hg at more than 6 months of age as well as those who are older than 1 year of age with a PSG ≤ 40 mm Hg have a benign course and the utility of ongoing cardiology follow-up is questionable.     

Early introduction of fish decreases the risk of eczema in infants

BACKGROUND: Atopic eczema in infants has increased in western societies. Environmental factors and the introduction of food may affect the risk of eczema. AIMS: To investigate the prevalence of eczema among infants in western Sweden, describe patterns of food introduction and assess risk factors for eczema at 1 year of age. METHODS: Data were obtained from a prospective, longitudinal cohort study of infants born in western Sweden in 2003; 8176 families were randomly selected and, 6 months after the infant's birth, were invited to participate and received questionnaires. A second questionnaire was sent out when the infants were 12 months old. Both questionnaires were completed and medical birth register data were obtained for 4921 infants (60.2% of the selected population). RESULTS: At 1 year of age, 20.9% of the infants had previous or current eczema. Median age at onset was 4 months. In multivariable analysis, familial occurrence of eczema, especially in siblings (OR 1.87; 95% confidence interval (CI) 1.50 to 2.33) or the mother (OR 1.54; 95% CI 1.30 to 1.84), remained an independent risk factor. Introducing fish before 9 months of age (OR 0.76; 95% CI 0.62 to 0.94) and having a bird in the home (OR 0.35; 95% CI 0.17 to 0.75) were beneficial. CONCLUSIONS: One in five infants suffer from eczema during the first year of life. Familial eczema increased the risk, while early fish introduction and bird keeping decreased it. Breast feeding and time of milk and egg introduction did not affect the risk.     

Serum insulin-like growth factor 1 and serum growth-promoting activity during the first postnatal year in infants with intrauterine growth retardation

Follow-up from birth to age 12 months was obtained in 21 infants born with intrauterine growth retardation. Serum insulin-like growth factor 1 was measured by radioimmunoassay. The bioassayable growth-promoting activity of the serum was measured as the "thymidine activity" on lectin-activated lymphocytes at 5 days and 1, 3, 6, 9, and 12 months, and was compared with control values. Depending on their length at age 12 months, the intrauterine growth retardation infants were divided into three groups: at or above the average (n = 8, group A), between the mean and -2 SD (n = 7, group B), or less than -2 SD (n = 6, group C). No differences in nutritional indexes or in head circumference were found between the three groups. Insulin-like growth factor 1 was significantly lower at age 5 days in intrauterine growth retardation than in control infants. It increased slowly in groups A and B to reach the control values at age 9 and 12 months. In group C it remained significantly subnormal at 1 yr of age. Thymidine activity was also significantly lower at age 5 days in intrauterine growth retardation compared with control infants. It increased sharply at age 1-3 months in groups A and B but remained significantly lower in group C up to 1 yr of age. Although individual values of insulin-like growth factor 1 and thymidine activity were closely correlated, the increase of length during the first postnatal year correlated significantly with the thymidine activity levels at 1 and 3 months but not with the insulin-like growth factor 1 levels at 1, 3, and 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effect of breast feeding on the plasma cholesterol and growth of infants

The effect of breast-feeding on plasma cholesterol, body weight, and body length was studied longitudinally in a large free-living cohort of infants (n = 512) from birth until the age of 1 year. Of the cohort, 21.4% were exclusively breast-fed for at least 3 months, 39.3% received bottle-feeding, and 39.3% received a combination of breast- and bottle-feeding. At birth the plasma cholesterol was similar in the three groups. After 3 months the mean plasma cholesterol and proportion of hypercholesterolemic infants in the breast-fed group were significantly (p less than 0.001) higher than that of the other two groups. These differences had disappeared at the age of 1 year. Breast-fed infants weighed less at 3 and 12 months, but body length was similar to those of the other groups. These results suggest that breast-feeding elevates plasma cholesterol by a direct mechanism and that the effect persists only as long as the breast-feeding is continued.     

61例极低出生体重早产儿生后第一年生长发育的随访

目的 探讨极低出生体重早产儿生后第一年生长发育情况及相关影响因素。方法 对61例极低出生体重早产儿进行出生后第一年的生长发育监测。采用Z评分法评价体格指标、丹佛发育筛查测验(DDST)进行发育筛查。结果 61例中小于胎龄儿(SGA)27例(44.3%),适于胎龄儿(AGA)34例(55.7%)。随访1年,年龄别体重(WAZ)、年龄别身长(HAZ)、年龄别头围(HCZ)、身长别体重(WHZ)的Z积分中位数均>-1 SD;年龄别体质指数(BMI)的Z积分(BAZ)以及WHZ的高峰在纠正年龄1个月。纠正胎龄40周时,低体重、生长迟缓、消瘦、小头畸形、超重和肥胖等的生长偏离发生率最高,分别为15%、16%、11%、13%、20%和10%。与纠正胎龄40周比,纠正年龄6个月及9~12个月的超重发生率(3%,3%)明显降低(P P 结论 极低出生体重早产儿在纠正龄3个月以内生长偏离明显。生后第一年DDST筛查异常的比例较高。     

Growth in the first year in children following IAP Policy on Infant Feeding

OBJECTIVE:To study the growth pattern in the first year in children fed according to recommendations of IAP Policy on Infant Feeding. DESIGN: Longitudinal. SETTING: Department of Pediatrics, S.C.B. Medical College Hospital, Cuttack, Orissa. SUBJECTS AND METHODS: 114 infants (68 boys and 46 girls) with birth weight greater than or equal to 2500g from upper and middle S-E status were regularly followed up from birth to 12 mo of age and fed according to recommendations of IAP Policy on Infant Feeding. Mean and standard deviations of weight for age (W/A) and length for age (L/A) and mean Z scores for W/A, L/A and W/L (weight for length) were calculated separately for boys and girls with reference to NCHS-WHO and BFDS data. OBSERVATIONS: Mean Z scores for W/A with reference to NCHS-WHO data showed a positive trend from birth upto the age of 3 to 4 months, subsequently declining upto one year. The Z scores for L/A showed only a minimal downward trend. The W/L Z score remained above the baseline value up to 3 months in boys and 7 months in girls. When BFDS was taken as the reference, W/A Z scores showed consistent positive increments, from birth in girls and 1 mo in boys. L/A Z scores increased from 3 months in boys and 11 months in girls. Using NCHS data as the reference, the percentage of infants below -2SD for weight was 0 to 7% during first 6 months and 14% at 12 months. Ten% were below -2SD for length at 12 months. With BFDS as the reference, the percentage of infants below -2SD for weight was 25% at birth, 5% at 6 months and 12% at 1 yr. For length, it was 12% at birth and 8% at 1 year. The increments in weight and length closely followed BFDS upto 12 mo age. CONCLUSION: The IAP Policy on Infant Feeding results in adequate growth of non low birth weight infants in the first year of life.     

The prone sleeping position impairs arousability in term infants

OBJECTIVE: To investigate whether the prone sleeping position impaired arousal from sleep in healthy infants and whether this impairment was related to cardiorespiratory variables, temperature, or age.Study design: Healthy term infants (n = 24) were studied with daytime polysomnography on 3 occasions: 2 to 3 weeks after birth, 2 to 3 months after birth, and 5 to 6 months after birth. Multiple measurements of arousal threshold (cm H(2)O) in response to air-jet stimulation applied alternately to the nares were made in both active sleep and quiet sleep when infants slept both prone and supine. RESULTS: Arousal thresholds were significantly higher in both active sleep and quiet sleep when infants slept prone at 2 to 3 weeks and 2 to 3 months, but not at 5 to 6 months. These increases were independent of any sleep position-related change in either rectal or abdominal skin temperature, respiratory rate, oxygen saturation, or heart rate. CONCLUSIONS: The prone position significantly impairs arousal from both active sleep and quiet sleep in healthy term infants. This impairment in arousability occurred with no clinically significant changes in cardiorespiratory variables or body temperature. Decreased arousability from sleep in the prone position provides an important insight into its role as a risk factor for sudden infant death syndrome.     

1~24月婴幼儿胰岛素样生长因子-1水平及与生长发育的关系

目的：分析1~24月龄婴幼儿血清胰岛素样生长因子-1（IGF-1）水平及其与生长发育的关系。方法：525名健康婴幼儿入选本研究（早产儿125名,足月儿400名）,测量体重/身长,酶联免疫吸附法检测血清IGF-1水平。结果：早产组婴儿期血清IGF-1水平在生后1.5月为最低（86±60 ng/mL）,此后一直维持较高水平,生后4~12月显著高于足月组。足月组婴儿期血清IGF-1水平在生后1.5月为最高(116±52 ng/mL),此后缓慢下降,生后8月时降至最低（69±58 ng/mL）。不论是早产儿还是足月儿体重/身长SDS与血清IGF-I水平均存在着正相关关系。结论：血清IGF-1水平均与婴幼儿期生长发育速度密切相关。［中国当代儿科杂志,2010,12（6）：459-461］     

Hypocapnia and other ventilation-related risk factors for cerebral palsy in low birth weight infants.

Ventilatory management patterns in very low birth weight newborns, particularly iatrogenic hypocapnia, have occasionally been implicated in perinatal brain damage. However, such relationships have not been explored in large representative populations. To examine the risk of disabling cerebral palsy in mechanically ventilated very low birth weight infants in relation to hypocapnia and other ventilation-related variables, we conducted a population-based prospective cohort study of 1105 newborns with birth weights of 500-2000 g born in New Jersey from mid-1984 through 1987, among whom 777 of 902 survivors (86%) had at least one neurodevelopmental assessment at age 2 y or older. Six hundred fifty-seven of 777 assessed survivors (85%), of whom 400 had been mechanically ventilated, had blood gases obtained during the neonatal period. Hypocapnia was defined as the highest quintile of cumulative exposure to arterial PCO(2) levels <35 mm Hg during the neonatal period. Disabling cerebral palsy was diagnosed in six of 257 unventilated newborns (2.3%), 30 of 320 ventilated newborns without hypocapnia (9.4%), and 22 of 80 ventilated newborns with hypocapnia (27.5%). Two additional ventilatory risk factors for disabling cerebral palsy were found-hyperoxia and prolonged duration of ventilation. In a multivariate analysis, each of the three ventilatory variables independently contributed a 2- to 3-fold increase in risk of disabling cerebral palsy. These risks were additive. Although duration of mechanical ventilation in very low birth weight newborns likely represents severity of illness, both hypocapnia and hyperoxia are largely controlled by ventilatory practice. Avoidance of arterial PCO(2) levels <35 mm Hg and arterial PO(2) levels >60 mm Hg in mechanically ventilated very low birth weight infants would seem prudent.     

早产儿胼胝体生长率与运动发育迟滞关系的研究

目的：研究早产儿胼胝体生长率与神经运动发育之间的关系。方法：2007年3～8月入住新生儿重症监护病区胎龄小于34周早产儿50例,于生后0~6周接受经前囟门矢状位颅脑超声探查，胼胝体长度测量为从膝部至压部。所有早产儿于校正胎龄3月时接受52项神经运动检查, 分析胼胝体生长率与神经运动检查结果之间的关系。结果：早产儿出生时的胼胝体平均长度为39.16 mm，生后头6周，胼胝体生长率平均1.05 mm/周；神经运动检查异常组早产儿(n=14)和神经运动检查正常组早产儿(n=36)0～2周胼胝体生长率差异无显著性意义，P>0.05, 但神经运动检查异常组早产儿2～3周和4～5周胼胝体生长率（0.68 mm/周和0.86 mm/周）慢于正常组早产儿（1.17 mm/周和1.12 mm/周），差异有显著性意义（P<0.05），合并2～6周总的生长率，异常组仍然慢于正常组（0.91 mm/周比1.15 mm/周），差异有显著性意义（P<0.01）。结论：床旁超声监测早产儿胼胝体生长发育切实可行，早产儿于校正胎龄3月时神经运动发育迟滞可能与2～6周龄时胼胝体生长率低下有关。     

住院早产儿校正年龄1岁时体格和神经心理发育情况及影响因素分析

目的 分析住院早产儿校正年龄1岁时体格和神经心理发育情况及追赶生长的影响因素.方法 选择2017年1月1日至2019年6月30日于北京市朝阳区妇幼保健院出生的450例住院早产儿及200例健康足月儿为研究对象,比较两组幼儿1岁时体格和神经心理发育情况.将早产儿按照发育情况分为体质量追赶生长满意组(360例)和不满意组(9...     

早产儿出院后追赶生长的随访观察及宫外发育迟缓的影响因素

目的 研究早产儿纠正月龄6个月内追赶生长的情况,并分析宫外发育迟缓（EUGR）的影响因素。方法 选取在新生儿重症监护病房治疗后出院的,并建立序贯化定期随访档案且有完整随访记录的早产儿321例,按2015年“早产儿保健工作规范”出院后分组随访标准分为低危早产儿组（n=69）和高危早产儿组（n=252）。采用Z评分法对体重、身长和头围进行评估,分析早产儿纠正月龄6个月内追赶生长情况。并采用多因素logistic回归分析探讨6月龄EUGR发生的危险因素。结果 低危组和高危组两组早产儿体重、身长和头围的Z值 < -2（未达追赶生长）的百分比均随纠正月龄增加而逐渐下降,其中低危组早产儿纠正月龄6个月时体重、身长和头围未达追赶生长的比例分别降为1.4%（1/69）、2.9%（2/69）和 1.4%（1/69）,高危组早产儿相应的比例为1.2%（3/252）、1.6%（4/252）和3.6%（9/252）。高危组纠正6月龄EUGR发生率高于低危组（28.2% vs 15.9%,P=0.039）。多因素logistic回归分析显示,早产儿纠正6月龄EUGR的危险因素包括多胎（OR=2.68,P=0.010）、出生体重较低（<1 000 g：OR=14.84,P < 0.001;1 000~1 499 g：OR=2.85,P=0.005）、宫内发育迟缓（OR=11.41,P < 0.001）,而出生后营养强化可降低EUGR的风险（OR=0.25,P < 0.001）。结论 早产儿多可在纠正月龄6个月内达追赶生长;高危早产儿6月龄EUGR发生率较高;多胎、低出生体重、宫内发育迟缓为早产儿EUGR的危险因素,而出生后合理营养强化可降低早产儿EUGR的发生。     

Serum cholesterol concentrations in newborn infants with gestational ages of 28-42 weeks

Serum total cholesterol, HDL-cholesterol and VLDL-LDL-cholesterol were determined in 53 newborn infants with gestational ages of 28-42 weeks. In pre-term infants (gestational age less than 37 weeks) the total cholesterol concentration in cord blood was higher than in term infants. Mean values were 2.4 and 1.7 mmol/l, respectively. The HDL-cholesterol/VLDL-LDL-cholesterol ratio was 1.8 in pre-term and term infants. In 11 pre-term and 17 term infants a second determination was made 3-4 days after birth. Total cholesterol had increased more in term than in pre-term infants and the difference found at birth and already levelled out. Mean value was 3.0 mmol/l in pre-term and term infants. The HDL-cholesterol/VLDL-LDL-cholesterol ratio had changed to 0.6 in pre-term and term infants. Six-pre-term infants who received intravenous fluids only were also studied. Their values did not differ from those in pre-term infants fed orally. Free and esterified cholesterol were determined in 26 infants of varying gestational ages. About one-third of the total cholesterol was in the free form in pre-term and term infants at birth and during the first days of life.     

High energy feeding in small for gestation infants.

Seventeen low weight infants with symmetrical growth retardation (no wasting) were entered in a randomised, double-blind comparison of high energy, 3.6 MJ/L (87 kcal/100 ml) v standard energy 2.7 MJ/L (65 kcal/100 ml) feeds given ad libitum during their first three months. Intakes were measured throughout, and energy absorption was determined at home from balance studies at 6 weeks and 3 months of age. Infants on high energy feeds absorbed the same proportion of energy intake but consumed less feed throughout the study. Regulation of feed intake was such that by 2 months of age energy intakes were similar in both groups, though before this time infants on high energy feeds had a higher net energy intake and grew slightly faster. Appetite regulation seems to be present at birth or soon after but is not fully developed for several weeks, and until this time increased energy intake can be imposed by adjusting the energy density of the feed.     

SERUM CHOLESTEROL CONCENTRATIONS IN NEWBORN INFANTS WITH GESTATIONAL AGES OF 28–42 WEEKS

Abstract. Ginsburg, B.-E. and Zetterström, R. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Serum cholesterol concentrations in newborn infants with gestational ages of 28–42 weeks. Acta Paediatr Scand, 69: 587, 1980.—Serum total cholesterol, HDL-cholesterol and VLDL-LDL-cholesterol were determined in 53 newborn infants with gestational ages of 28–42 weeks. In pre-term infants (gestational age < 37 weeks) the total cholesterol concentration in cord blood was higher than in term infants. Mean values were 2.4 and 1.7 mmol/l, respectively. The HDL-cholesterol/ VLDL-LDL-cholesterol ratio was 1.8 in pre-term and term infants. In 11 pre-term and 17 term infants a second determination was made 3–4 days after birth. Total cholesterol had increased more in term than in pre-term infants and the difference found at birth had already levelled out. Mean value was 3.0 mmol/I in pre-term and term infants. The HDL-cholesterol/ VLDL-LDL-cholesterol ratio had changed to 0.6 in pre-term and term infants. Six pre-term infants who received intravenous fluids only were also studied. Their values did not differ from those in pre-term infants fed orally. Free and esteritied cholesterol were determined in 26 infants of varying gestational ages. About one-third of the total cholesterol was in the free form in pre-term and term infants at birth and during the first days of life.     

Effect of neonatal caloric deprivation on head growth and 1-year developmental status in preterm infants

The effects of neonatal illness and caloric intake on head growth velocity and on 1-year developmental outcome were studied in 73 appropriate (AGA) and small for gestational age (SGA) premature infants of (mean +/- SD) 30 +/- 2 weeks gestation who received intensive care during the neonatal period. Head growth from birth to 1 year of corrected age was characterized by a triphasic curve initiated by a period of growth arrest or suboptimal growth followed by a period of catch-up growth and terminated by a period of growth along standard curves. Head growth arrest or suboptimal head growth were directly related to the duration of the initial period of caloric deprivation (less than 85 kcal/kg/day) and to the duration of mechanical ventilation. Catch-up head growth was influenced by the duration of the preceding period of caloric deprivation in all infants and by the caloric intake during that phase only in SGA infants; catch-up growth was unrelated to the duration of mechanical ventilation. Head growth along standard curves occurred in all infants by 3 months of corrected age and persisted up to 1 year of corrected age. Infants calorically deprived the longest (AGA 4 to 6 weeks, SGA 2 to 3 weeks) had head growth along standards at curves below -1 SD on the growth chart; all other groups had this phase of head growth at curves between the mean and -1 SD. Infants calorically deprived for more than 4 weeks had developmental scores below normal ranges by 1 year of corrected age.     

Intraocular pressure in children up to five years of age

We established a value scale (Figure) of IOP for children without glaucoma. Under the age of 4 months the IOP was measured with topical anesthesia; halothane anesthesia was used in children from 4 months to 5 years. In 30 children under the age of 4 months the IOP is 8.4 +/- 0.6 mm Hg. In 44 children from 4 months to 5 years, the IOP measured under halothane general anesthesia is 7.8 +/- 0.4 mm Hg at the age of 1 year, and it gradually increases by about 1 mm Hg per year of age to 11.7 +/- 0.6 mm Hg at the age of 5 years.     

Medicinal iron to low birth weight infants

Serum ferritin concentrations were measured during the first 6 months of life in 28 low birth weight infants (mean birth weight 1820 g range 900-2460; mean gestational age 34 weeks range 29-37) fed a standard formula fortified with ferrous sulphate. Fifteen of the infants received supplementary medicinal iron (ferrous succinate) from 3 weeks of age, and 13 only from 2 months of age. All were given vitamin E from 10 days of age. The serum ferritin values did not differ between the groups at 1-2 days, 8-10 weeks or at 6 months. Furthermore, there were no signs of hyperhaemolysis at 8-10 weeks in the group receiving medicinal iron early. The data indicate that the iron content in the formula is sufficient until 2 months of age, but also that thereis no disadvantage in starting medicinal iron at 3 weeks of age, if the diet is sufficient in vitamin E.     

Clinical pharmacology of netilmicin in preterm and term newborn infants

Sixty-four neonates, with gestational age ranging from 27 1/2 to 40 weeks, postnatal age from 1 to 15 days, and birth weight from 800 to 3400 gm, were given netilmicin 2.5 mg/kg intramuscularly two or three times per day according to postnatal age, for 5 to 14 days. Serum concentrations were measured before and 1 hour after a dose at least twice during treatment. The serum washout profile of the drug was observed in 22 neonates after discontinuation of therapy. Renal function was studied in 37 infants by measuring serum creatinine concentrations and in 27 by urinary excretion of N-acetyl-glucosaminidase during and up to 15 days after therapy. Behavioral and impedance audiometry, and in infants failing those, auditory brainstem evoked response tests, were performed between 6 and 12 months of age. In 23.5% of the neonates, trough serum levels were greater than 3 micrograms/ml. The serum washout followed a multiexponential decay, accounting for distributional, rapid (initial), and slow (tissue) elimination phases. Linear regression analysis performed between each kinetic parameter and gestational age or birth weight showed that initial elimination half-life, steady-state volume of distribution, and total body clearance were significantly correlated with both variables. Netilmicin did not cause detectable renal or auditory damage.