SGA subtypes and mortality risk among singleton births

OBJECTIVES: To determine whether early mortality (first year of life) risks among small for gestational age (SGA) neonates were similar regardless of SGA subtype based on three chronological classifications (term, preterm and post-term). STUDY DESIGN: Retrospective cohort study on all singleton live births in the United States from 1995 to 1999 inclusive. Adjusted risk estimates were computed from logistic regression models using non-SGA infants as the referent. RESULTS: When SGA infants were compared as a homogeneous entity to non-SGA infants, the risks for infant, neonatal and post-neonatal mortality were significantly greater in SGA infants [AOR (adjusted odds ratio)=3.0, 95% CI (confidence interval)=2.9-3.0 for infant mortality; AOR=3.2, 95% CI=3.1-3.2 for neonatal mortality; and AOR=2.6, 95% CI=2.6-2.7 for post-neonatal mortality]. However, heterogeneity existed in terms of mortality risk thresholds across SGA babies. The most remarkable risk magnitude was observed among preterm SGA infants [infant mortality AOR=13.8, 95% CI=13.6-14.1; neonatal death AOR=17.4, 95% CI=17.0-17.7; and post-neonatal death AOR=7.4, 95% CI=7.1-7.6]. The adjusted odds ratio for term and post-term SGA infants were comparable regardless of the period during infancy, and were much less than those observed for preterm SGA infants. CONCLUSIONS: SGA is a heterogeneous disease in terms of prognosis for survival. Preterm SGA infants bear an extremely high risk for mortality during infancy, and counseling of affected parents should reflect this risk divergence.     

Risk factors for small-for-gestational-age babies: The Auckland Birthweight Collaborative Study

OBJECTIVE: This case-control study determined whether internationally recognized risk factors for small-for-gestational-age (SGA) term babies were applicable in New Zealand. METHODOLOGY: All babies were born at 37 or more completed weeks of gestation in one of three hospitals in Auckland. Cases weighed less than the sex specific 10th percentile for gestational age at birth, and controls (appropriate-for-gestational-age (AGA)) were a random selection of heavier babies. Information was collected by maternal interview and from obstetric databases. RESULTS: Information from 1714 completed interviews (844 SGA and 870 AGA) was available for analysis. Computerized obstetric records were available for 1691 of the 1701 women who consented to such access. In a multivariate analysis allowing for sex, gestational age at birth, social class and other potential confounders, mothers who smoked had a significantly increased risk of an SGA baby (adjusted OR 2.41; 95% CI 1.78-3.28), as did primiparous mothers (adjusted OR 1.34; 95% CI 1.03-1.73), mothers of Indian ethnicity (adjusted OR 3.22; 95% CI 1.95-5.30), women with pre-eclamptic toxaemia (adjusted OR 2.42; 95% CI 1.08-5.40) and those with pre-existing hypertension toxaemia (adjusted OR 5.49; 95% CI 1.81-16.71). Mothers of SGA infants were shorter (P < 0.001) and reported lower prepregnancy body weights (P < 0.001) than mothers of AGA infants. The population attributable fraction for smoking suggests that up to 18% of SGA infants born in the ABC Study could be related to maternal smoking. CONCLUSIONS: Risk factors associated with SGA births in other countries are also important in New Zealand. Smoking in pregnancy is an important and potentially modifiable behaviour, and efforts to decrease the number of women who smoke during pregnancy should be encouraged.     

Diet in pregnancy and risk of small for gestational age birth: results from a retrospective case-control study in Italy

This study aims to analyse the association between selected dietary indicators during pregnancy and the risk of small for gestational age (SGA) births in a South European population. This is a case-control study. Cases were 555 women who delivered SGA babies at the Luigi Mangiagalli Clinic of Milan and the Obstetric and Gynecology Clinic of the University of Verona. The controls were women who gave birth at term (≥37 weeks of gestation) to healthy infants with normal weight in the same clinics. Dietary information was collected with a food frequency questionnaire. Women with SGA babies reported a more frequent consumption of meat and olive oil, and a less frequent consumption of fish and eggs. Women with high consumption of olive oil had an increased risk of delivering an SGA baby [odds ratio (OR) 1.6, 95% confidence interval (CI) 1.0-2.5]. The multivariate OR for high meat consumption was 1.4 (95% CI 1.1-1.9); for fish 0.8 (95% CI 0.6-1.0, χ2 for trend 4.0, P = 0.045 ) and for egg 0.7 (95% CI 0.5-0.9). After allowing for factors generally known to be associated with SGA, we have shown that eating more fish and eggs, and less meat and possibly olive oil, are associated with a lower risk of delivering an SGA baby.     

Excess mortality and morbidity among small-for-gestational-age premature infants: a population-based study

OBJECTIVE: We examined the effect of intrauterine growth restriction on mortality and morbidity in the Israel cohort of very low birth weight premature infants. METHODS: The study population included 2764 singleton very low birth weight infants without congenital malformations born from 24 to 31 weeks of gestation during 1995 to 1999. Four hundred six (15%) were born small for gestational age (SGA). The effect of SGA on death, bronchopulmonary dysplasia, and retinopathy of prematurity was assessed using multiple logistic regression analysis. RESULTS: After adjustment for perinatal risk factors, SGA infants had a 4.52-fold risk for death (95% CI, 3.24-6.33), a 3.42-fold risk for bronchopulmonary dysplasia (95% CI, 2.29-5.13), and a 2.06-fold risk for grade 3 to 4 retinopathy of prematurity (95% CI, 1.15-3.66). CONCLUSIONS: SGA premature infants had an increased risk for death, and major morbidity among survivors was increased.     

Customised birthweight standards accurately predict perinatal morbidity

OBJECTIVE: Fetal growth restriction is associated with adverse perinatal outcome but is often not recognised antenatally, and low birthweight centiles based on population norms are used as a proxy instead. This study compared the association between neonatal morbidity and fetal growth status at birth as determined by customised birthweight centiles and currently used centiles based on population standards. DESIGN: Retrospective cohort study. SETTING: Referral hospital, Barcelona, Spain. PATIENTS: A cohort of 13 661 non-malformed singleton deliveries. INTERVENTIONS: Both population-based and customised standards for birth weight were applied to the study cohort. Customised weight centiles were calculated by adjusting for maternal height, booking weight, parity, ethnic origin, gestational age at delivery and fetal sex. MAIN OUTCOME MEASURES: Newborn morbidity and perinatal death. RESULTS: The association between smallness for gestational age (SGA) and perinatal morbidity was stronger when birthweight limits were customised, and resulted in an additional 4.1% (n=565) neonates being classified as SGA. Compared with non-SGA neonates, this newly identified group had an increased risk of perinatal mortality (OR 3.2; 95% CI 1.6 to 6.2), neurological morbidity (OR 3.2; 95% CI 1.7 to 6.1) and non-neurological morbidity (OR 8; 95% CI 4.8 to 13.6). CONCLUSION: Customised standards improve the prediction of adverse neonatal outcome. The association between SGA and adverse outcome is independent of the gestational age at delivery.     

The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania

Objectives were to examine the growth patterns of preterm and growth‐restricted infants and to evaluate the associations of prematurity and intrauterine growth restriction (IUGR) with risk of stunting, wasting and underweight. Data from a cohort of HIV‐negative pregnant women–infant pairs were collected prospectively in Tanzania. Small for gestational age [SGA, birthweight (BW) <10th percentile] was used as proxy for IUGR. Anthropometry was measured monthly until 18 months. Length‐for‐age (LAZ), weight‐for‐length (WLZ), and weight‐for‐age (WAZ) z‐scores were calculated using the 2006 World Health Organization (WHO) Child Growth Standards. Stunting, wasting and underweight were defined as binary outcomes using a cut‐off of z‐scores. Multivariate Cox proportional hazard models were used to assess the associations between preterm and SGA to time to stunting, wasting and underweight. The study included 6664 singletons. Preterm and appropriate for gestational age (AGA) infants had slightly better nutritional status than term‐SGA infants and despite some catch‐up growth, preterm‐SGA infants had the poorest nutritional status. The gap in LAZ and WAZ z‐scores among the groups remained similar throughout the follow‐up. Compared with term‐AGA babies, relative risk (RR) of stunting among preterm‐AGA babies was 2.13 (95% confidence interval (CI) 1.93–2.36), RR among term‐SGA was 2.21 (95% CI 2.02–2.41) and the highest risk was among the babies who were both preterm and SGA (RR = 7.58, 95% CI 5.41–10.64). Similar magnitude of RR of underweight was observed among the three groups. Preterm and SGA infants should be closely monitored for growth failure. Intervention to reduce preterm and SGA birth may lower risk of undernutrition in resource‐limited settings.     

Risk factors for small for gestational age

BACKGROUND: The purpose of the paper was to determine the risk factors for small-for-gestational-age (SGA) infants at full term, in Japan. METHODS: The study was conducted at four hospitals and clinics in the Tokyo metropolitan area. A retrospective review of 2972 mothers and their infants born from singleton pregnancies at any time during the years 2002 and 2003 was conducted. RESULTS: Of these women, 8.4% gave birth to SGA infants. The proportion of SGA infants was significantly higher among heavy smokers (>10 cigarettes/day; 13.7%, P < 0.01). The odds ratio (OR) for SGA decreased significantly in proportion to the pregnancy body mass index (OR, 0.89; 95% confidence interval [CI]: 0.84-0.94, P < 0.001). The OR of SGA for stratified maternal weight gain was 1.79 (95%CI: 1.24-2.58, P 12 kg. CONCLUSION: The present study clearly confirms the detrimental effect of a low prepregnancy body mass index, low maternal weight gain and maternal smoking during pregnancy on the incidence of SGA infants.     

胎龄≤32周早产儿低血糖的危险因素分析

目的 探讨胎龄≤32周早产儿出生后发生低血糖的危险因素。方法 回顾性纳入2017年1月至2020年6月入住新生儿重症监护病房的86例胎龄≤32周低血糖早产儿作为低血糖组,随机选取同期住院监测血糖正常的早产儿172例为对照组。采用单因素分析与多因素logistic回归分析筛选早产儿低血糖的危险因素。结果 研究期间早产儿共计515例,其中低血糖86例（16.7%）。低血糖组小于胎龄儿（SGA）、剖宫产出生、孕母高血压、产前使用激素的比例均高于对照组（P < 0.05）,而出生体重及血糖检测前已静脉使用葡萄糖的比例均低于对照组（P < 0.05）。SGA（OR=4.311,95% CI：1.285~14.462）、孕母高血压（OR=2.469,95% CI：1.310~4.652）和产前使用激素（OR=6.337,95% CI：1.430~28.095）为早产儿低血糖的危险因素（P < 0.05）,静脉使用葡萄糖（OR=0.318,95% CI：0.171~0.591）为早产儿低血糖的保护因素（P < 0.05）。结论 SGA、孕母高血压和产前使用激素可增加胎龄≤32周早产儿早期发生低血糖的风险;对胎龄≤32周早产儿,建议生后尽早静脉使用葡萄糖,以减少低血糖的发生。     

Risk factors associated with wheezing in infants

Objectiveto identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil.Methodsthis was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI).Resultsthe written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46).Conclusionsthe study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.     

Bedsharing, roomsharing, and sudden infant death syndrome in Scotland: a case-control study

OBJECTIVE: To examine the hypothesis that bedsharing with an infant is associated with an increased risk of sudden infant death syndrome (SIDS). STUDY DESIGN: A 1:2, case:control study in Scotland UK, population 5.1 million, including 123 infants who died of SIDS between January 1, 1996 and May 31, 2000, and 263 controls. The main outcome measure was sharing a sleep surface during last sleep. RESULTS: Sharing a sleep surface was associated with SIDS (multivariate OR 2.89, 95% CI 1.40, 5.97). The largest risk was associated with couch sharing (OR 66.9, 95% CI 2.8, 1597). Of 46 SIDS infants who bedshared during their last sleep, 40 (87%) were found in the parents' bed. Sharing a bed when <11 weeks (OR 10.20, 95% CI 2.99, 34.8) was associated with a greater risk, P = .010, compared with sharing when older (OR 1.07, 95% CI 0.32, 3.56). The association remained if mother did not smoke (OR 8.01, 95% CI 1.20, 53.3) or the infant was breastfed (OR 13.10, 95% CI 1.29, 133). CONCLUSIONS: Bedsharing is associated with an increased risk of SIDS for infants <11 weeks of age. Sharing a couch for sleep should be strongly discouraged at any age.     

Comparison of different growth curves in the assessment of extrauterine growth restriction in very low birth weight preterm infants

BackgroundPreterm infants are at risk of extrauterine growth restriction (EUGR) and associated complications in the long term. Growth curves are important in assessing postnatal growth in these infants. The aim of this study was to determine the prevalence of EUGR in preterm infants and the factors associated with EUGR using two different growth curves.MethodsWe retrospectively evaluated 596 preterm infants with birth weight ≤1500 g. Small for gestational age (SGA) was defined as birth weight <10th percentile for gestational age. EUGR was defined as discharge weight z score <?2. All z scores were determined using both the Fenton 2013 and Intergrowth-21st (IG-21) growth curves.ResultsThe infants’ median gestational age was 28 weeks (27–29) and median birth weight was 1080 g (900–1243). The prevalence of SGA was 9.2% with IG-21 curves and 5% with Fenton curves (p < 0.001). The median discharge weight was 2060 g (1860–2363). The prevalence of EUGR was significantly higher with the Fenton curves than with the IG-21 curves (38% vs. 31.7%, p < 0.001). The mean discharge weight z score was ?1.82±1.29 with Fenton and ?1.44±1.49 with IG-21 curves. In multivariate analysis, significant risk factors for EUGR according to the Fenton curves were SGA (odds ratio [OR]: 19.15, 95% confidence interval [CI]: 4.4–82.59), respiratory distress syndrome (RDS) (OR 1.64, 95% CI 1.12–2.4), late neonatal sepsis (LNS) (OR: 2.27, 95% CI: 1.5–3.44), and >16 days to full enteral feeding (OR: 1.8, 95% CI: 1.22–2.68). Similarly, independent risk factors for EUGR according to the IG-21 curve were SGA (OR: 16.3, 95% CI: 7.23–36.9), RDS (OR: 1.81, 95% CI: 1.16–2.83), LNS (OR: 2.29, 95% CI: 1.43–3.68), and >16 days to full enteral feeding (OR: 2.11, 95% CI: 1.38–3.23).ConclusionThe growth curves used for diagnosis may lead to differences in EUGR rates in intensive care units and the factors identified as associated with EUGR. At-risk infants should be evaluated for EUGR and their weight and nutritional support should be monitored carefully. Comparisons of long-term outcomes are needed to assess the suitability of growth curves used for EUGR follow-up.     

Smoking,nicotine and tar and risk of small for gestational age babies

AIMS: To assess the effect of maternal smoking and environmental tobacco smoke (ETS) on risk of small for gestational age infants (SGA). METHODS: Case-control study of 844 cases and 870 controls. RESULTS: Maternal smoking in pregnancy was associated with an increased risk of SGA (adjusted odds ratio (OR)= 2.41; 95% confidence interval (CI) = 1.78, 3.28). We could not detect an increased risk of SGA with paternal smoking, or with other household smokers when the mother was a non-smoker, but did find an increased risk with exposure to ETS in the workplace or while socializing. Infants of mothers who ceased smoking during pregnancy were not at increased risk of SGA, but those who decreased but did not stop remained at risk of SGA. There was no evidence that the concentration of nicotine and tar in the cigarettes influenced the risk of SGA. CONCLUSIONS: Maternal smoking in pregnancy is a major risk factor for SGA. This study suggests that mothers should be advised to cease smoking completely during pregnancy, and that a reduction in the number of cigarettes smoked or smoking low tar or nicotine concentration cigarettes does not reduce the risk of SGA.     

Birth centre care over a 10-year period: infant morbidity during the first month after birth

Aim: To study morbidity during the first month of life affecting infants of mothers booked for birth centre care during pregnancy. Methods: 3238 live single-born infants whose mothers were admitted to an in-hospital birth centre, located at South Hospital in Stockholm, between 1989 and 2000 were compared with 179 502 infants whose mothers received standard maternity care in the Stockholm region during the same period, and who fulfilled the same medical inclusion criteria as those of the birth centre group. Information on other exposures and outcomes was collected from the Swedish Medical Birth and Hospital Discharge Registers. Logistic regression analyses were performed to calculate the odds ratio (OR), using 95% confidence intervals (95% CI). Results: Compared with infants born in standard care, infants in the birth centre group had a higher risk of respiratory problems (OR 1.39; 95% CI 1.14-1.69), a difference correlated to less serious respiratory diagnoses. However, the difference was not statistically significant if the birth centre group was compared only with infants born in standard care at South Hospital (OR 1.18; 95% CI 0.94-1.47). Birth centre care was associated with a lower risk of fractures (OR 0.40; 95% CI 0.25-0.63).

Conclusion: Birth centre care was not associated with severe infant morbidity and even appeared to reduce the risk of birth trauma, such as clavicle and other fractures.     

Is hypotension a major risk factor for neurological morbidity at term age in very preterm infants?

OBJECTIVE: To investigate the influence of perinatal risk factors, especially hypotension, on neuromotor status at term in surviving preterm infants born before 32 weeks of gestation. METHODS: This study is part of the Leiden Follow-Up Project on Prematurity: a prospective, regional study of 266 live born infants with a gestational age (GA) < 32 weeks born in 1996-1997. Twenty-eight infants died before term age. Two hundred and eleven infants were examined neurologically at term according to Prechtl. The findings were classified as normal (N), mildly abnormal (MA) or definitely abnormal (DA). Hypotension was defined as a mean arterial blood pressure (MABP) < 30 mm Hg on at least two occasions. RESULTS: One hundred and six (50%) infants were classified as neurologically N, 92 (44%) infants were classified as MA and 13 (6%) infants as DA. Hypotension, bronchopulmonary dysplasia (BPD), flaring and cystic periventricular leucomalacia (PVL) were risk factors for neurological morbidity. Of the 68 infants with hypotension, 33 (49%) were classified as MA and 7 (10%) as DA. Of the 141 infants without hypotension, 58 (41%) were MA, and 5 (4%) were DA. The odds ratio of hypotension for neurological morbidity was 1.9 (95% CI 1.06-3.40), adjusted for gestational age, birth weight, small for gestational age (SGA) and gender, it was 1.96 (95% CI 1.02-3.77). The adjusted odds ratio of PVL was 18.6 (4.4-78.5), of flaring was 2.37 (1.18-4.74) and of BPD was 2.44 (1.08-5.5). CONCLUSIONS: Apart from gestational age, periventricular leucomalacia, and bronchopulmonary dysplasia, hypotension in preterm infants is a major risk factor for neurological morbidity at term.     

Population based study on the outcome of small for gestational age newborns

OBJECTIVE: To explore whether and how population based data from a regional quality control programme can be used to investigate the hypothesis that small for gestational age (SGA) very low birthweight infants (VLBW, <1500 g) are at increased risk of death, severe intraventricular haemorrhage (IVH), and periventricular leucomalacia (PVL), but at decreased risk of respiratory distress syndrome (RDS). METHODS: Analyses of population based perinatal/neonatal data (1991-96) from a quality control programme in Lower Saxony, Germany. After assessment of data validity and representativeness, exclusion criteria were defined: birth weight >90th centile, severe malformations, siblings of multiple births, and gestational age (GA) <25 or >29 weeks. Outcomes of interest were death, severe IVH, PVL, and RDS. Multivariable analyses were performed by Cox proportional hazard and logistic regression models. RESULTS: Within the data validation procedure, an increase in proportions of both VLBW (from 0.95% in 1991 to 1.11% in 1996; +17%) and SGA (from 22.7% to 27.4%; +21%) infants became apparent (p<0.05). The study population consisted of 1623 infants (173 SGA). Mortality was 12.1% (n = 196), with an adjusted hazard ratio for SGA infants of 2.54, 95% confidence interval (CI) 1.70 to 3.79. Both groups were at similar risk of severe IVH (adjusted odds ratio 0.93, 95% CI 0.5 to 1.65) and PVL (1.54, 95% CI 0.78 to 2.87), but SGA infants had less RDS (0.57, 95% CI 0.35 to 0.93). Male sex, multiple birth, hypothermia (<35.5 degrees C), and sepsis were associated with IVH and RDS. Infants admitted to hospitals with <36 VLBW admissions/year had increased mortality (adjusted hazard ratio 1.56, 95% CI 1.12 to 2.18). CONCLUSIONS: SGA VLBW infants are at increased risk of death, but not of IVH and PVL, and at decreased risk of RDS. That mortality is higher in smaller hospitals needs further investigation.     

Motor skills in adolescents with low birth weight

BACKGROUND: Minor motor problems have been reported in low birthweight children, but few studies have assessed motor skills in adolescents. OBJECTIVE: To examine the prevalence of motor problems in adolescents with low birth weight. METHOD: Fifty four very low birthweight (VLBW: birth weight < or = 1500 g), 59 term small for gestational age (SGA: birth weight < 10th centile), and 83 control (birth weight > or = 10th centile at term) children were assessed with the Movement assessment battery for children (Movement ABC) at the age of 14 in a population based study. RESULTS: One in four VLBW children (odds ratio (OR) 9.3, 95% confidence interval (CI) 2.5 to 34.5) and one in six SGA children (OR 4.7, 95%CI 1.2 to 18.4) had motor problems compared with controls (3.7%). There were no sex differences in motor problems in the VLBW group, and the increased risk was consistent across the continuum of the Movement ABC. For SGA children, the increased risk of motor problems was particularly in manual dexterity in boys. CONCLUSION: VLBW and SGA adolescents have increased risk of motor problems compared with control children.     

Infants of diabetic mothers are at increased risk for the oculo-auriculo-vertebral sequence: A case-based and case-control approach

OBJECTIVES: To determine if infants of diabetic mothers (IDM) are at increased risk for dysplastic ears and the oculoauriculo-vertebral spectrum (OAVS). STUDY DESIGN: Cases of IDM with dysplastic external ears seen at Cedars-Sinai Medical Center were combined with case series in medical literature describing similar patients. Data from a large congenital birth defects registry in Spain were analyzed, and odds ratios (OR) for infants born to either a gestational or preconceptionally diabetic mother to have one of the studied malformations were calculated with 95% confidence intervals. RESULTS: Among the 30 patients in the case series, 50.0% (15) had hemifacial microsomia; 46.7% (14) had hearing loss; 33.3% (10) had facial nerve palsy; 33.3% (10) had vertebral anomalies; 36.7% (11) had cardiovascular defects, of which 45% (5) were conotruncal defects; 26.7% (8) had renal anomalies; 13.3% (4) had limb defects (all radial ray hypoplasia); 10% (3) had DiGeorge sequence; 6.7% (2) had laterality defects; and 6.7% (2) had imperforate anus. Within the cases from the birth defects registry, the odds ratio for OAVS in infants of mothers with gestational diabetes mellitus was 2.28 (95% CI, 1.03-4.82, P =.03), and the OR for ear anomalies in these infants was 1.21 (95% CI, 0.94-1.56, P =.13). When infants of mothers with preconceptionally diagnosed type 1 or 2 diabetes were considered, the OR for OAVS was 1.50 (95% CI, 0.08-9.99, P =.49), and the OR for dysplastic ears was 0.94 (95% CI, 0.48-1.81, P =.85). CONCLUSIONS: Our data indicate that OAVS occurs with a higher incidence in IDM than in the general population. Associated problems include hearing loss, athymia, and cardiac, renal, and limb malformations. Therefore, we recommend that an IDM with features consistent with OAVS undergo a workup including hearing evaluation, skeletal survey, echocardiogram, renal ultrasonogram, and immunodeficiency workup if clinically indicated. Furthermore, noting that most of these defects occur in structures of neural crest origin, we hypothesize that poorly controlled maternal diabetes interferes with cephalic neural crest cell migration.     

SIDS risk factors and factors associated with prone sleeping in Sweden.

OBJECTIVE: To compare the current prevalence of risk factors for sudden infant death syndrome (SIDS) in Sweden with a decade earlier, and assess factors associated with prone sleeping. METHODS: The results of a cohort study (Infants of Western Sweden) and a population based case-control study (Nordic Epidemiological SIDS Study) were examined. Subjects were 5600 healthy 6 month old infants born in 2003 in the Western Sweden region and 430 healthy Swedish infants born between 1991 and 1995. RESULTS: Prone sleeping decreased from 31.8% to 5.6% and supine sleeping increased from 35.3% to 47.3%. Side or side/supine sleeping increased from 25.2% to 43.8%. Maternal smoking during pregnancy decreased from 23.5% to 9.5%. The risk for prone sleeping increased if the mother was unemployed (OR 2.4, 95% CI 1.5 to 4.0), if she was a heavy smoker in the third trimester (OR 44.1, 95% CI 1.6 to 1199.6), and if the child was irritable (OR 2.5, 95% CI 1.3 to 5.1), shared a bedroom with siblings (OR 2.6, 95% CI 1.0 to 6.6), or never used a dummy (OR 3.2, 95% CI 1.9 to 5.4). CONCLUSIONS: Parents have complied with advice to prevent SIDS given at infant welfare centres for the last 10 years. A change in the preferred sleeping position from side variants to exclusively supine, and reducing the number of pregnant women smoking may be beneficial. Use of a prone sleeping position was associated with maternal employment status, maternal smoking, temperament of the child, dummy use, and sharing a bedroom with siblings.     

Neonatal respiratory morbidity risk and mode of delivery at term: influence of timing of elective caesarean delivery

AIM: To establish whether the timing of delivery between 37 + 0 and 41 + 6 wk gestation influences neonatal respiratory outcome in elective caesarean delivery, following uncomplicated pregnancy, thus providing information that can be used to aid planning of elective delivery at term. METHODS: All pregnant women who were delivered by elective caesarean delivery at term during a 3-y period were identified from a perinatal database and compared retrospectively with pregnant women matched for week of gestation, who were vaginally delivered. Maternal characteristics, neonatal outcome, incidence of respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) were analysed. During this time, 1284 elective caesarean section deliveries occurred at or after 37 + 0 wk of gestation. RESULTS: Neonatal respiratory morbidity risk (odds ratio, OR), including RDS and TTN, was significantly higher in the infant group delivered by elective caesarean delivery compared with vaginal delivery (OR 2.6; 95% CI: 1.35-5.9; p < 0.01). While TTN risk in caesarean delivery was not increased (OR 1.19; 95% CI: 0.58-2.4; p > 0.05), the RDS risk was significantly increased (OR 5.85; 95% CI: 2.27-32.4; p < 0.01). This RDS risk is greatly increased in weeks 37 + 0 to 38 + 6 (OR 12.9; 95% CI: 3.57-35.53; p < 0.01). After 39 + 0 wk, there was no significant difference in RDS risk. CONCLUSIONS: Infants born by elective caesarean delivery at term are at increased risk for developing respiratory disorders compared with those born by vaginal delivery. A significant reduction in neonatal RDS would be obtained if elective caesarean delivery were performed after 39 + 0 gestational weeks of pregnancy.     

Introduction of complementary food to infants within the first six months postpartum in rural Vietnam

Aim: To document the introduction of complementary food and factors influencing the decision to feed infants with solid food within 6 mo postpartum in rural Vietnam. Methods: A longitudinal study of 463 women who gave birth during August-October 2002 was conducted. Results: An early introduction of complementary food was found, which increased from 16.4% at week 1 to 56.5% at week 16 and nearly 100% at week 24. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% of women at weeks 1, 16 and 24, respectively. Logistic regression analysis found that at week 24 postpartum, it was less likely for the infant to be fed with solid food if the mother was a farmer (OR 0.52, 95% CI: 0.18-0.95) and passed secondary school (OR 0.28, 95% CI: 0.10-0.54), whose husband was satisfied with the infant's sex (OR 0.30, 95% CI: 0.17-0.53), her mother-in-law preferred exclusive breastfeeding (OR 0.18, 95% CI: 0.04-0.75), or her friends practised exclusive breastfeeding (OR 0.41, 95% CI: 0.16-1.10). However, infants were likely to be fed with solid food when their parents had higher income and lived independently (OR 1.76, 95% CI: 1.01-3.06).

Conclusion: Community mobilization for sharing the workload with women could help them to cope with employment and breastfeeding.