Parental and perinatal factors affecting childhood anthropometry of very-low-birth-weight premature infants: a population-based survey

Background: The perinatal–neonatal course of very-low-birth-weight (VLBW) infants might affect their childhood growth. We evaluated the effect of parental anthropometry and perinatal and neonatal morbidity of VLBW neonates on their childhood growth.
Methods: We obtained parental anthropometry, height and weight at age 6–10.5 years of 334 children born as VLBW infants. Parental, perinatal and neonatal data of these children were tested for association with childhood anthropometry.
Results: (1) Maternal and paternal weight standard deviation score (SDS) and discharge weight (DW) SDS were associated with childhood weight SDS (R²= 0.111, p < 0.00001); (2) Maternal and paternal height SDS, corrected gestational age (GA) at discharge, maternal assisted reproduction and SGA status were associated with childhood height SDS (R²= 0.208, p < 0.00001); (3) paternal weight SDS, DW SDS and surfactant therapy were associated with childhood body mass index (BMI) SDS (R²= 0.096, p < 0.00001). 31.1% of VLBW infants had DW SDS < −1.88, and are to be considered small for gestational age ('SGA'). One quarter of these infants did not catch up by age 6–10.5 years.
Conclusion: Childhood anthropometry of VLBW infants depends on parental anthropometry, postnatal respiratory morbidity and growth parameters at birth and at discharge. Almost one-third of VLBW premature infants had growth restriction at discharge from neonatal intensive care unit (NICU), a quarter of whom did not catch up by age 6–10.5 years.     

早产儿及小于胎龄儿喂养困难研究进展

早产儿及小于胎龄儿喂养困难是普遍存在的问题,发病率高。影响早产儿及小于胎龄儿喂养困难的因素有很多,包括窒息、原发疾病、胎龄、开奶时间、孕期因素、环境因素、激素水平等,该文就早产儿及小于胎龄儿喂养困难病因、治疗进行综述,旨在为早产儿及小于胎龄儿喂养困难的防治及进一步研究提供基础。     

Childhood pregnancy (10-14 years old) and risk of stillbirth in singletons and twins

OBJECTIVE: To clarify the association between childhood pregnancy and risk of stillbirth. STUDY DESIGN: We analyzed singleton and twin pregnancies that occurred in children (10-14 years old) in the United States from 1989 to 2000. We estimated the absolute and relative risks of stillbirth by using 15- to19-year-old and 20- to 24-year-old mothers as comparison groups. RESULTS: The analysis involved 17.8 million singletons and 337,904 individual twins. The rate of stillbirth was highest in pediatric mothers for both singletons (12.8/1000) and twins (56/1000) compared with adolescent (6.8/1000 in singletons and 29/1000 in twins) and mature (5.5/1000 in singletons and 20/1000 in twins) mothers. After adjusting for confounding characteristics, pediatric mothers continued to exhibit significantly elevated risk for stillbirth in both singletons (odds ratio, 1.57; 95%CI, 1.49-1.66) and twins (odds ratio, 1.97; 95%CI, 1.42-2.73). Preterm birth rather than small size for gestational age was revealed by means of sequential modeling to account for the excess risk of stillbirth observed in pediatric gravidas. CONCLUSION: Pregnancy in childhood is a risk factor for stillbirth; shortened gestation rather than reduction in fetal growth is the mediating pathway.     

Ghrelin levels from fetal life through early adulthood: relationship with endocrine and metabolic and anthropometric measures

OBJECTIVE: To establish mean plasma ghrelin levels during fetal life and childhood.Study design Cord blood was obtained at birth from premature (n=29) and full-term newborns (n=124). Fasting blood samples were taken from 224 normal subjects divided according to Tanner stage and sex. Ponderal index or body mass index was determined. Ghrelin; insulin-like growth factor (IGF)-I; IGF-II; IGF binding proteins 1, 2, and 3; insulin; glucose; and leptin levels were measured. RESULTS: Ghrelin levels did not differ between preterm and full-term newborns. Ghrelin increased significantly after birth, peaking during the first 2 years of life, then decreasing until the end of puberty. Ghrelin levels correlated negatively with anthropometric variables in full-term newborns and postnatally, but not in preterm newborns. A positive correlation between ghrelin and IGF binding protein 1 was found. CONCLUSIONS: Ghrelin changes significantly throughout development, correlating with anthropometric and metabolic parameters during extrauterine life. The highest levels of ghrelin are found during early postnatal life, when growth hormone begins to exert its effects on growth and important changes in food intake occur, suggesting that this hormone may participate in these processes.     

Prenatal predictors of chronic lung disease in very preterm infants

OBJECTIVE: To identify prenatal risk factors for chronic lung disease (CLD) at 36 weeks postmenstrual age in very preterm infants. POPULATION: Data were collected prospectively as part of the ongoing audit of the Australian and New Zealand Neonatal Network (ANZNN) of all infants born at less than 32 weeks gestation admitted to all tertiary neonatal intensive care units in Australia and New Zealand. METHODS: Prenatal factors up to 1 minute of age were examined in the subset of infants born at gestational ages 22-31 weeks during 1998-2001, and who survived to 36 weeks postmenstrual age (n = 11 453). Factors that were significantly associated with CLD at 36 weeks were entered into a multivariate logistic regression model. RESULTS: After adjustment, low gestational age was the dominant risk factor, with an approximate doubling of the odds with each week of decreasing gestational age from 31 to less than 25 weeks (trend p<0.0001). Birth weight for gestational age also had a dose-response effect: the lower the birth weight for gestational age, the greater the risk, with infants below the third centile having 5.67 times greater odds of CLD than those between the 25th and 75th centile (trend p<0.0001). There was also a significantly increased risk for male infants (odds ratio 1.51 (95% confidence interval 1.36 to 1.68), p<0.0001). CONCLUSIONS: These population based data show that the prenatal factors low gestational age, low birth weight for gestational age, and male sex significantly predict the development of chronic respiratory insufficiency in very preterm infants and may assist clinical decision about delivery.     

Maternal pre-pregnancy underweight and fetal growth in relation to institute of medicine recommendations for gestational weight gain

Purpose

Maternal nutritional status is one of the most important factors of fetal growth and development. Consequently, the currently increasing prevalence of underweight women worldwide has come in the focus of interest of perinatal medicine. The aim of the study was to assess the effect of low pre-pregnancy body mass index (BMI) on fetal growth.

Materials and methods

Data on 4678 pregnant women and their neonates were retrospectively analyzed. Pre-pregnancy BMI of study women was categorized according to the WHO standards. Fetal growth was assessed by birth weight and birth length, birth weight for gestational age, and ponderal index.

Results

Study group included 351 (7.6%) women with pregestational BMI < 18.5 kg/m², while all women with pregestational BMI 18.5–25 kg/m² (n = 3688; 78.8%) served as a control group. The mean birth weight and birth length of neonates born to underweight mothers were by 167 g and 0.8 cm lower in comparison with the neonates born to mothers of normal nutritional status, respectively (P < 0.001 both). The prevalence of small for gestational age (SGA) births was twofold that found in the control group of mothers of normal nutritional status (9.7% vs. 4.9%; P < 0.001). The inappropriately low gestational weight gain additionally increased the rate of SGA infants in the group of mothers with low pre-pregnancy BMI (21.4% vs. 10.4%; P = 0.02). Pre-pregnancy BMI category did not influence neonatal growth symmetry.

Conclusion

Low maternal pregestational BMI is associated with fetal growth assessment. Improvement of the maternal nutritional status before pregnancy can increase the likelihood of perinatal outcome.     

Catch-up growth of supine length/height of very low birth weight, small for gestational age preterm infants to adulthood

OBJECTIVE: To analyze linear growth of very low birth weight (VLBW), small for gestational age (SGA; < 10th percentile) preterm infants from birth as to catch-up or no catch-up growth. STUDY DESIGN: VLBW SGA preterm infants (n = 46) with primarily symmetric intrauterine growth restriction from the Bonn Longitudinal Study were compared with 62 appropriate for gestational age (AGA) VLBW preterm and 73 term infants and with their parents. RESULTS: Forty-six percent of VLBW SGA (21 of 46) had complete height catch-up by adult age, and most became taller than target height (TH) (15 of 21; 71%). The others did not catch up; most of them remained shorter than TH (18 of 25; 72%) after initial catch-up followed by catch-down growth. Mean adult height z-score was lower than that for birth length. Mean body mass index was similar in the catch-up and no catch-up groups (21.8 and 21.3, respectively) and lower than in the controls (23.2). Approximately 1/2 of the head circumference (HC) catch-up children achieved height catch-up as well. CONCLUSIONS: Height catch-up extended beyond age 6 years, independent of HC growth. We could not predict height catch-down or successful catch-up.