Aberrant adiposity and ectopic lipid deposition characterize the adult phenotype of the preterm infant

Our investigation addresses the hypothesis that disruption of third trimester development by preterm birth alters multiple biological pathways affecting metabolic health in adult life. We compared healthy adult volunteers aged 18-27 y born at ≤ 33 wk gestation or at term. We used whole-body MRI, (1)H magnetic resonance spectroscopy (MRS) of liver and muscle, metabonomic profiling of blood and urine, and anthropometric and blood pressure measurements. Preterm subjects had greater (mean difference (95% CI)) total [2.21 L (0.3, 4.1), p = 0.03] and abdominal adipose tissue [internal 0.51 (0.1, 0.9), p = 0.007]; blood pressure [systolic 6.5 mm Hg (2.2, 10.8), p = 0.004; diastolic 5.9 (1.8, 10.1), p = 0.006]; and ectopic lipid (ratio (95% CI)), intrahepatocellular lipid (IHCL) 3.01 (1.78, 5.28) p < 0.001, and tibialis-intramyocellular lipid (T-IMCL) [1.31 (1.02, 1.69) p = 0.04]. In preterm, compared with term men, there was greater internal adipose tissue [mean (SD); men: preterm 4.0 (1.6), term 2.7 (1.1) liters; women: preterm 2.6 (0.9); term 2.6 (0.5); gender-gestation interaction p = 0.048] and significant differences in the urinary metabolome (elevated methylamines and acetyl-glycoproteins, lower hippurate). We have identified multiple premorbid biomarkers in ex-preterm young adults, which are most marked in men and indicative of risks to later wellbeing. These data offer insight into biological trajectories affected by preterm birth and/or neonatal care.     

Cerebral pressure autoregulation and vasoreactivity in the newborn rat

Perinatal brain injury has been associated with impaired cerebral blood flow (CBF) pressure autoregulation. The brain of 3- to 5-d-old rat pups is immature and similar to that of a preterm infant, and therefore we tested cerebral vasoreactivity in that animal. CBF pressure autoregulation was tested in 20 Wistar pups during normocapnia and hypercapnia, respectively. Hypotension was induced by hemorrhage and cerebral perfusion was monitored with laser Doppler flowmetry and near-infrared spectroscopy. Systolic blood pressure was measured noninvasively from the tail. During normocapnia, the autoregulatory plateau was narrow. Resting systolic blood pressure (SBP) was 39.2 mm Hg and CBF remained constant until SBP decreased below 36.0 mm Hg (SE 0.8). Below the lower limit, CBF declined by a mean of 2.7% per mm Hg [95% confidence interval (CI), 2.4-3.0%], and hemoglobin difference (HbD) and total hemoglobin (HbT) changed proportionally to CBF. After inhalation of carbon dioxide, CBF increased significantly by a mean of 17.7% (95% CI, 13.7-22.8%). The CBF-CO2 reactivity was estimated to 13.4% per kPa (95% CI, 2-24.8%), p=0.026. Over the range of SBP (6-54 mm Hg), a linear relationship between CBF and SBP was found during hypercapnia, indicating abolished pressure autoregulation. A linear correlation between CBF and HbD was found (r=0.80). CBF pressure autoregulation and reactivity to CO2 operate in the newborn rat. This model may be useful for future investigations concerning perinatal pathophysiology in the immature brain.     

Placental weight, birth measurements, and blood pressure at age 8 years

OBJECTIVE: To examine relationships between blood pressure during childhood and both placental weight and body size at birth, in an Australian population. DESIGN: A follow up study of a birth cohort, undertaken when cohort members were aged 8 years. SETTING: Adelaide, South Australia. SUBJECTS: 830 children born in the Queen Victoria Hospital in Adelaide, South Australia, during 1975-6. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure measured when the children were aged 8 years. RESULTS: Blood pressure at 8 years was positively related to placental weight and inversely related to birth weight, after adjusting for the child's current weight. For diastolic pressure there was a decrease of 1.0 mm Hg for each 1 kg increase in birth weight (95% confidence interval (CI) = -0.4 to 2.4) and an increase of 0.7 mm Hg for each 100 g increase in placental weight (95% CI = 0.1 to 1.3). Diastolic pressure was also inversely related to chest circumference at birth, independently of placental weight, with a decrease of 0.3 mm Hg for each 1 cm increase in chest circumference (95% CI = 0.2 to 0.5). CONCLUSIONS: These findings are further evidence that birth characteristics, indicative of fetal growth patterns, are related to blood pressure in later life.     

Placental weight,birth measurements,and blood pressure at age 8 years.

OBJECTIVE: To examine relationships between blood pressure during childhood and both placental weight and body size at birth, in an Australian population. DESIGN: A follow up study of a birth cohort, undertaken when cohort members were aged 8 years. SETTING: Adelaide, South Australia. SUBJECTS: 830 children born in the Queen Victoria Hospital in Adelaide, South Australia, during 1975-6. MAIN OUTCOME MEASURES: Systolic and diastolic blood pressure measured when the children were aged 8 years. RESULTS: Blood pressure at 8 years was positively related to placental weight and inversely related to birth weight, after adjusting for the child''s current weight. For diastolic pressure there was a decrease of 1.0 mm Hg for each 1 kg increase in birth weight (95% confidence interval (CI) = -0.4 to 2.4) and an increase of 0.7 mm Hg for each 100 g increase in placental weight (95% CI = 0.1 to 1.3). Diastolic pressure was also inversely related to chest circumference at birth, independently of placental weight, with a decrease of 0.3 mm Hg for each 1 cm increase in chest circumference (95% CI = 0.2 to 0.5). CONCLUSIONS: These findings are further evidence that birth characteristics, indicative of fetal growth patterns, are related to blood pressure in later life.     

Infant feeding and components of the metabolic syndrome: findings from the European Youth Heart Study.

AIMS: To assess the associations of type and duration of infant feeding with components of the metabolic syndrome in children aged 9 and 15. METHODS: A total of 2192 randomly selected schoolchildren aged 9 and 15 years from Estonia (n = 1174) and Denmark (n = 1018) were studied. Insulin resistance (homoeostasis model assessment), triglyceride levels, high density lipoprotein cholesterol, and systolic blood pressure were measured. RESULTS: Children who had ever been exclusively breast fed had lower systolic blood pressures than those who were not. With full adjustment for age, sex, country, birth weight, pubertal stage, body mass index, height, maternal and paternal education, income, smoking, and body mass index the mean systolic blood pressure of children who had ever been breast fed was 1.7 mm Hg (95% CI -3.0 to -0.5) lower than those who had never been exclusively breast fed. There was a dose-response in this association with decreasing mean systolic blood pressure across categories from never exclusively breast fed to breast fed for more than six months. Exclusive breast feeding was not associated with other components of the metabolic syndrome. Results were similar when examined separately in each country. CONCLUSIONS: The magnitude of the association, its independence of important confounding factors, and the dose-response suggest that exclusive breast feeding is causally associated with reduced systolic blood pressure. The magnitude of the effect we found with blood pressure is comparable to the published effects of salt restriction and physical activity on blood pressure in adult populations, suggesting that it is of public health importance.     

Upper- vs lower-limb systolic blood pressure in full-term normal newborns

The difference between upper- vs lower-limb systolic blood pressure (BP) was investigated in 100 normal full-term newborns younger than 24 hours of age by the oscillometric method. The mean systolic BP of both upper limbs was 72.3 +/- 7.6 mm Hg (mean +/- SD). The mean +/- SD systolic BP of both lower limbs was 71.3 +/- 8.2 mm Hg. Systolic BP in the upper limb was greater than that in the lower limb in 66% of newborns by as much as 20 mm Hg (mean +/- SD, 3.5 +/- 3.1). Systolic upper-limb BP was lower than systolic lower-limb BP in 28% of newborns by as much as 21 mm Hg (mean +/- SD, 5.1 +/- 5.1). Systolic BP did not correlate with birth weight. Follow-up evaluation of BP in 25 of the infants up to 3 years of age revealed higher systolic BP in the lower extremities in 24 of the 25 infants. We conclude that (1) it is normal to have a higher systolic BP in either the upper limb or the lower limb in newborns younger than 24 hours of age, and (2) there is no correlation of systolic BP with birth weight in full-term normal neonates younger than 24 hours of age.     

Maternal and fetal influences on blood pressure.

To study maternal and fetal influences on blood pressure in childhood 405 children aged 4 years who were born and still resident in the Salisbury health district were visited at home for blood pressure and growth measurements. Information on the pregnancy, delivery, and baby was abstracted from the routine obstetric notes. Similar to recent findings in adults, the child's systolic pressure was inversely related to birth weight and positively related to placental weight. Systolic pressure at 4 years increased by 1.2 mm Hg for every SD decrease in the ratio of head circumference to length at birth, and by 1.1 mm Hg for every SD decrease in ponderal index at birth. Mothers whose haemoglobin concentrations fell below 100g/l during pregnancy had children whose systolic pressures were on average 2.9 mm Hg higher than the children of mothers with higher haemoglobin concentrations. Patterns of placental weight, birth weight, head circumference, and length that are associated with high blood pressure in adults are also associated with higher blood pressure in 4 year old children. Identification of the intrauterine influences that lead to these patterns of fetal growth could lead to the primary prevention of hypertension.     

Early cardiovascular effects of corticotherapy for bronchopulmonary dysplasia]

OBJECTIVES: The aim of this study was to analyze the time course of cardiovascular effects in glucocorticoid-treated premature infants with bronchopulmonary dysplasia (BPD). METHODS: In a retrospective case study, 63 ventilator-dependent very-low-birth-weight neonates (mean gestational age = 27.9 +/- 2 weeks and mean birth weight = 920 +/- 275 g) treated with dexamethasone (52%) or betamethasone (48%) were studied. The average value for each study day was calculated for systolic arterial blood pressure and heart rate. RESULTS: At initiation of treatment, blood pressures increased significantly from pre-treatment to day 1 and continued to increase during the first week: as a percentage of pre-treatment baseline the mean increase for systolic arterial blood pressure was 19% (95% confidence interval [CI] = 16, 22) on day 2 (P < 0.001). The maximum amplitude of variation was observed before day 2 for 75% of the study group. As a group as a whole, the heart rate value significantly decreased on day 1 (mean difference = -14.6 beats/min; 95% CI = -16.5, -12.6; P < 0.001), and then reached pre-treatment value within one week. Cardiovascular response was independent of gestational age, birth weight and postnatal age at the beginning of treatment. CONCLUSION: During postnatal steroid therapy a rise in blood pressure is a common side effect, but bradycardia is mentioned very occasionally. The present study shows a marked increase in blood pressure during the first 48 hours concomitant with a decrease in heart rate. The inverse relationship between systolic arterial blood pressure and heart rate suggests a baroreflex response.     

The safety of etomidate for emergency rapid sequence intubation of pediatric patients

OBJECTIVE: To determine whether pediatric patients given etomidate for rapid sequence intubation (RSI) in the ED develop clinically important hypotension or adrenal insufficiency. METHODS: Retrospective review of 100 consecutive patients younger than age 10 years given etomidate for RSI in the ED at two academic medical centers. Data were abstracted from ED and in-patient medical records. Clinically important hypotension was defined as a decrease in systolic blood pressure (BP) measurement to below one standard deviation (SD) of mean normal for age. Clinically important adrenal insufficiency was defined as the need for exogenous corticosteroid replacement for suspected adrenal insufficiency at any time during hospitalization. RESULTS: BP measurements before and within 20 minutes after etomidate administration for RSI were recorded on 84 intubations (84%). The mean change in BP between pre-intubation and post-intubation measurements was a decrease of 1 mmHg (95% CI: -6 mm Hg to +7 mm Hg, P = 0.83). When expressed as a percentage of normal BP for age, the mean change in BP was a decrease of 1% (95% CI: -7% to +6%, P = 0.82). Four patients (4.8%; 95% CI: 1.3-11.7%) had a systolic BP decrease to below one SD of mean normal for age. Fourteen patients received corticosteroids during hospitalization, but none (0/99, 95% CI: 0-3.7%) for suspected adrenal insufficiency. CONCLUSIONS: We found no evidence of clinically important adrenocorticoid suppression and a low incidence of clinically important hypotension when using etomidate for emergent pediatric RSI. Because other induction agents may also result in hypotension, prospective comparison studies are needed to further evaluate the safety of etomidate in this patient population.     

足月新生儿7日内血压变化范围及临界值

目的探讨正常足月新生儿7 d内血压的正常值范围及每日变化,研究早期新生儿血压临界值。方法应用美国Omni-TrakTMNVS型监护仪上的DINAMAP测压装置,随机检查50例足月新生儿生后7 d内的血压值。测量右上臂血压,记录收缩压(SBP)、舒张压(DBP)和平均动脉压(MAP)数值。结果1)日龄(X1)对正常足月新生儿SBP、DBP、MAP有非常显著的影响。2)SBP、DBP、MAP与X1、出生体质量(X2)、胎龄(X3)回归方程分别为SBP=32.4 0.7X1 3.7X2 0.6X3(mm Hg),DBP=13.1 0.6X1 2.9X2 0.6X3(mm Hg),MAP=17.3 0.4X1 2.0X2 0.8X3(mm Hg),MAP=DBP 0.45(SBP-DBP)(mm Hg)。3)7 d内不同胎龄、不同出生体质量新生儿DBP、SBP、MAP不同。正常足月新生儿高血压临界值分别为SBP>90 mm Hg,DBP>65 mm Hg,MAP>75 mm Hg。4)低血压临界值分别为:SBP<50 mm Hg,DBP<30 mm Hg,MAP<40 mm Hg。结论明确新生儿7 d内血压范围及血压临界值为新生儿高血压或(和)低血压诊断提供了可靠的依据。     

The association of caffeinated beverages with blood pressure in adolescents

OBJECTIVE: To assess the association between the consumption of caffeinated beverages and blood pressure in African American and white adolescents. DESIGN: This study was part of ongoing research examining stress-induced hemodynamic responses in adolescents. African American and white adolescents (n = 159) selected foods and beverages for a 3-day sodium-controlled diet. Caffeine in these foods was used to stratify participants into 3 categories (0-50 mg/d, >50-100 mg/d, and >100 mg/d). Before menu selection, blood pressure readings were obtained. STATISTICAL ANALYSIS: A general linear model (multiple regression with both categorical and continuous variables) was developed to assess the effects of race, category of caffeine intake, and interaction of race and caffeine intake on systolic and diastolic blood pressure controlling for sex and body mass index (calculated as weight in kilograms divided by height in meters squared). RESULTS: The association between systolic blood pressure and caffeine category varied by race (P =.001). African Americans consuming more than 100 mg/d of caffeine had higher systolic blood pressure readings than the groups consuming 0 to 50 mg/d (mean difference, 6.0 mm Hg; 95% confidence interval [CI], 2.3 to 9.7) or more than 50 to 100 mg/d (mean difference, 7.1 mm Hg; 95% CI, 3.4 to 10.7). The effect on diastolic blood pressure was less pronounced (P =.08). The diastolic blood pressure of the group consuming more than 100 mg/d was 3.7 mm Hg (95% CI, 0.41 to 7.0) higher than the group consuming more than 50 to 100 mg/d and was not statistically different from the group consuming 0 to 50 mg/d (mean difference, 2.4 mm Hg; 95% CI, -0.9 to 5.8). There was no evidence that the association between diastolic blood pressure and caffeine intake varied by race (P =.80). CONCLUSIONS: For adolescents, especially African American adolescents, caffeine intake may increase blood pressure and thereby increase the risk of hypertension. Alternatively, caffeinated drink consumption may be a marker for dietary and lifestyle practices that together influence blood pressure. Additional research is needed owing to rising rates of adolescent hypertension and soft drink consumption.     

The influence of age and gender on the relationship between birth weight and blood pressure in childhood: a study using 24-hour and casual blood pressure

This study investigates the influence of age and gender on the relationship between birth weight and blood pressure in childhood, using casual and 24-h blood pressure measurements. Casual and 24-h blood pressure were measured on 976 normal schoolchildren (550 girls) aged 6 to 16 years. There was no significant association between birth weight and casual systolic blood pressure (regression coefficient (ss)=-0.30; 95% CI -1.79, 1.19). There was a significant negative correlation between birth weight and mean 24-h systolic blood pressure (ss=-2.13; 95% CI -3.35, -0.90). Subgroup analysis by gender revealed a significant relation for girls (ss=-2.88; 95% CI -4.44, -1.32) but not boys (ss= -1.02; 95% CI -2.99, 0.95). ). Subgroup analysis by age group revealed a significant relation for > or =11 years old (ss= -3.17, 95% CI -4.86, -1.48) but not children <11 years old (ss= -0.88; 95% CI -2.63, 0.88). Interaction tests demonstrated a statistically significant different relationship between birth weight and blood pressure for boys and girls ( P=0.021) and for children <11 and > or = 11 years of age ( P=0.036). CONCLUSION: this study demonstrates that gender and age have an important influence on the relationship between birth weight and blood pressure in childhood. The observed differences between boys and girls and the different age groups remain unexplained.     

Early predictors of hypertension in prematurely born adolescents

Objective: To assess the blood pressure of former preterm and term matched adolescent controls and to identify risk factors associated with blood pressure at 16 years. Design: Observational cohort study. Secondary analysis of a randomized clinical trial. Setting: Three academic centres participating in the Multicenter Indomethacin IVH Prevention Trial. Participants: A total of 296 children born in 1989–1992 with birth weights 600 to <1250 g who participated in the Multicenter Indomethacin IVH Prevention Trial and 95 term controls were evaluated at 16 years. Main outcome measures: Blood pressure and predictors of blood pressure. Results: The adjusted mean difference in blood pressure for preterm adolescents was 5.1 mm Hg; p = 0.002 for systolic and 2.1 mm Hg; p = 0.027 for diastolic blood pressure. Among preterms, the primary predictors of increased systolic blood pressure were weight gain velocity between birth and 36 months (b = 8.54, p < 0.001), pre‐eclampsia (b = 5.67, p = 0.020), non‐white race (b = 3.77, p = 0.04) and male gender (b = 5.09). Predictors of diastolic blood pressure were weight gain velocity between birth and 36 months (b = 4.69, p = 0.001), brain injury (b = 6.51, p = 0.002) and male gender (b = ?2.4, p = 0.02). Conclusions: Early programming secondary to increased early weight gain velocity, intrauterine stress and neonatal brain injury may all contribute to risk of increased blood pressure among former preterm adolescents.     

Birthweight and blood pressure among children in Harare,Zimbabwe

AIM—To determine whether poor uterine growth may be associated with increased blood pressure and subsequent hypertension in adulthood.
METHODS—A retrospective cohort study of 756 schoolchildren (mean age 6.5 years) was carried out in six low income areas in Harare city, Zimbabwe. Indices of intrauterine growth and blood pressure were assessed.
RESULTS—Adjusted for current weight, the children''s systolic blood pressure was inversely related to their birthweight; for each decreasing kg of birthweight, systolic blood pressure rose by 1.73 mm Hg (95% CI; 0.181 to 3.28). After adjustment for current weight, systolic blood pressure was also inversely associated with occipito-frontal circumference, but not with birth length or gestational age. Diastolic blood pressure was not associated with any of the intrauterine indices.
CONCLUSION—Fetal size may be inversely related to systolic blood pressure in childhood in an African population.

     

Association of cord blood cytokine levels with wheezy infants in the first year of life

As antenatal environment may influence the development of atopy-predisposing immune response, cord blood cytokine productions may be an important predictor for wheezing. We investigated cord blood cytokines in a prospective birth cohort, intensively monitored for wheezy infant outcome at 1 yr. Cord blood serum samples from 269 children were assayed for interleukin (IL)-1β, -2, -4 to -8, -10, -12 (p70), -13, and -17, interferon-γ, tumor necrosis factor-α, granulocyte-macrophage colony-stimulating factor, granulocyte colony-stimulating factor (G-CSF), monocyte chemotactic protein-1, and macrophage inflammatory protein-1β. Associations between family histories, antenatal and perinatal factors, cord blood cytokine concentrations, and wheezy infant outcomes (wheezing more than two times) were analyzed. In cord blood sera from 269 children, there were associations between high levels of IL-6, -8 and G-CSF concentrations, and cesarean section. Data at 1 yr were obtained from 213 infants, including 33 wheezy infants. Risk of wheezing was related to gestational age, birth weight, cesarean section, and maternal eczema, but not to bacterial/viral infection during pregnancy, maternal asthma, maternal smoking, or paternal history. High level of cord blood IL-8 concentration had a significant association with wheezy infant outcomes at 1 yr (p = 0.025). By using multivariate logistic regression analysis, birth weight [odds ratio(OR) = 0.998, 95% confidence interval (CI) = 0.997–1.000] and maternal eczema (OR = 5.356, 95% CI = 1.340–21.41), but no other factors, were significant predictors of wheezy infants. Birth weight, gestational age, and maternal history were important risk factors for wheezing in the first year of life. Several cord blood cytokine productions were influenced by cesarean section, and IL-8 may be a predictor for recurrent wheezing at 1 yr.     

Maternal determinants of birth weight of North Indian babies

Birth weight charts of uncomplicated singleton pregnancies (n=3293) were prepared from subjects who delivered between 30 and 42 weeks of gestation. Multiple regression analysis of the data revealed significant effect of maternal age, parity, height, weight and religion upon birth weight. Maternal blood pressure systolic ≥160 mm of Hg and diastolic ≥110 mm of Hg (severe PIH) were associated with significant lowering of birth weight. Male babies weighed more than female babies.     

Systolic blood pressure in babies of less than 32 weeks gestation in the first year of life

AIM—To define the normal range of systolic blood pressure in a non-selective population based sample of babies of low gestation throughout early infancy.METHODS—Daily measurements of systolic blood pressure were made in all the babies of less than 32 weeks gestation born in the North of England in 1990 and 1991 during the first 10 days of life. Additional measurements were obtained from 135 of these babies throughout the first year of life. Systolic pressure was measured by sensing arterial flow with a Doppler ultrasound probe. It was assumed that blood pressure had never been pathologically abnormal in the neonatal period if the child was alive and free from severe disability two years later. Data of adequate quality were available from 398 such children. Additional data were collected, for comparative purposes, from 123 babies of 32, 36, or 40 weeks of gestation.RESULTS—Systolic pressure correlated with weight and gestation at birth, and rose progressively during the first 10 days of life. The coefficient of variation did not vary with gestational or postnatal age (mean value 17%), the relation with gestation being closer than with birthweight. Systolic pressure rose 20% during the first 10 days from an initial mean of 42 mm Hg in babies of 24 weeks gestation, and by 42% from an initial mean of 48 mm Hg in babies of 31 weeks gestation. These findings were not altered by the exclusion of data from 14 babies who had inotropic support during this time. Simultaneous measurements in three centres using an oscillometric technique revealed that this technique tended to overestimate systolic pressure when this was below average. Systolic pressure finally stabilised at a mean of 92 (95% CI 72-112) mm Hg at a postconceptional age of 44-48 weeks irrespective of gestation at birth.CONCLUSION—Systolic blood pressure 4-24 hours after birth was less than gestational age (in weeks) in only 3% of non-disabled long term survivors. Systolic pressure rose with increasing gestation and increasing postnatal age, but stabilised some six weeks after term, regardless of gestation at birth.     

Coagulation testing in pediatric blunt trauma patients.

OBJECTIVES: To determine the prevalence of abnormal coagulation studies and to identify variables associated with markedly elevated coagulation studies in children with blunt trauma. METHODS: We reviewed the medical records of all patients < 15 years old hospitalized at a Level 1 trauma center for either blunt head or torso trauma over a 4-year period. Data from each patient's emergency department (ED) presentation were abstracted. ED coagulation studies were defined prior to data analysis as elevated if the international normalized ratio (INR) was > or =1.2 or partial thromboplastin time (PTT) was > or =33.0 seconds and markedly elevated if the INR was > or =1.5 or PTT was > or =40 seconds. Variables associated with markedly elevated coagulation studies in a univariate analysis (P < 0.05) were entered into a backward elimination logistic regression analysis to identify variables independently associated with markedly elevated coagulation studies. RESULTS: A total of 1082 patients' records were reviewed, and the 830 (77%) patients with coagulation studies obtained composed the study population. Elevated coagulation studies were detected in 232 (28%) patients, and 49 (6%) of these were found to be markedly elevated. In the multivariate analysis, a GCS < or =13 (odds ratio [OR] 8.7, 95% confidence interval [CI] 4.3, 17.7), low systolic blood pressure (OR 4.0, 95% CI 1.6, 9.9), open/multiple bony fractures (OR 2.9, 95% CI 1.4, 6.2), and major tissue wounds (OR 2.8, 95% CI 1.4, 5.6) were independently associated with markedly elevated coagulation studies. CONCLUSION: Hospitalized pediatric blunt trauma patients frequently have minor elevations in ED coagulation studies. Marked elevations occur infrequently and are independently associated with a GCS < or =13, low systolic blood pressure, open/multiple bony fractures, and major tissue wounds.     

Comparison of body mass index and triceps skinfold at 5 years and young adult body mass index, waist circumference and blood pressure

Aim: To examine which measure of obesity at 5 years, body mass index (BMI) or triceps skinfold thickness, is most strongly associated with 21‐year risk factors for cardiovascular disease (CVD), including BMI, waist circumference (WC), systolic blood pressure (SBP) and diastolic blood pressure (DBP). Methods: Longitudinal birth cohort study with BMI and triceps skinfold measurements at age 5, and BMI, WC and blood pressure at 21 years. Overweight and obesity at 5 years were determined according to Cole‐International Obesity Task Force standards, at 21, by World Health Organization definitions. Triceps skinfold thickness measurements were converted to a z‐score, and cut‐offs for overweight and obesity were chosen to reflect similar proportions to the BMI subgroups. BMI, WC, SBP and DBP were also measured at 21 years. Results: Five‐year BMI and triceps skinfold thickness were both significantly associated with the CVD risk measures at 21 years. For overweight/obesity at 5 years, the adjusted odds ratio (95% confidence interval) for 21‐year overweight/obesity was 5.6 (4.2, 7.4), for 21‐year WC was 1.5 (1.2, 2.0). Mean difference (95% CI) in BMI was 4.4 (3.9, 5.0), in WC 8.3 cm (6.8, 9.8), in SBP 2.4 mm Hg (0.5, 4.3), in DBP 1.1 mm Hg (0.1, 2.2). For skinfold, the similar findings were odds ratio 2.6 (2.0, 3.4) and 1.2 (0.9, 1.6) for 21‐year BMI and WC, and mean differences of 2.6 (2.0, 3.2), WC 4.8 cm (3.3, 6.3), SBP 2.3 mm Hg (0.5, 4.2) and DBP 0.7 mm Hg (?0.4, 1.8). Conclusions: In children with overweight/obesity, BMI rather than triceps skinfold is the preferred epidemiological measure for identifying young adult CVD risk markers of BMI, WC and blood pressure.     

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.