The postnatal growth of children who were small-for-dates or large-for-dates at birth

Nutritional status of patients with cystic fibrosis with meconium ileus: a comparison with patients without meconium ileus and diagnosed early through neonatal screening

OBJECTIVE

This study was pursued as an extension of a randomized clinical investigation of neonatal screening for cystic fibrosis (CF). The objective was to determine if CF patients with meconium ileus (MI) were more likely to be malnourished compared with those without MI who were diagnosed during early infancy through neonatal screening.

METHODOLOGY

Nutritional status was evaluated from early infancy to 13 years of age based on anthropometric, biochemical, and dietary assessments.

RESULTS

MI patients (n = 32) were smaller at birth (3117 g compared with 3413 g) and were shorter (22nd percentile compared with 48th percentile) and thinner (24th percentile compared with 49th percentile) compared with non-MI early diagnosed patients (n = 50) up to 13 years of age. Poor growth was particularly evident in 26 MI patients who required surgery for MI (height and weight at the 20th percentile), whereas those treated without surgery (n = 6) showed better height (45th percentile) and weight (37th percentile). Abnormal essential fatty acid profiles were significantly more prevalent in MI compared with non-MI early-diagnosed patients before 3 years of age. Daily intakes of calorie (130% compared with 111% recommended dietary allowances) and protein (339% compared with 279% recommended dietary allowances) were higher but the percentage of fat (37% compared with 38%) and linoleic acid (4.5% compared with 4.7%) in the diet were similar between the two groups.

CONCLUSIONS

These results demonstrated a clear association of MI with malnutrition in CF. The observed poor growth among our MI patients was not because of poor dietary intakes, but was related to surgical treatment for MI and poor essential fatty acid status. These findings present new challenges regarding the optimal medical treatment and nutritional intervention for CF patients with MI.

Neurological follow-up of small-for-gestational age newborn infants. A study of risk factors related to prognosis at one year of age

To examine the relative importance of some risk factors and neurological prognosis in the first year of life, 37 small-for-gestational age newborns were followed prospectively to 1 year of conceptional age. An abnormal neurological examination was found in 51.3% of the newborns and, at 12 months, 32.5% were still considered abnormal. Only 8.1% of the group had severe neurological sequelae at 1 year of corrected age. The developmental tests showed little changes during the first year, with abnormality rates varying from 16.1 to 25%. The following risk factors were analyzed concerning their relation to neurological and developmental abnormalities: high-risk pregnancy, maternal hypertension, social class, pre-term birth, neonatal asphyxia and weight and height less than 2.5 percentile at the age of 1 year. The statistical analysis showed a high correlation between subnormal weight gain and neurological (p = 0.0001) and developmental (p = 0.001) abnormalities at 1 year. None of the other risk factors were statistically related to neurological prognosis at 1 year.

Growth in the first four years: II. Diversity within groups of small-for-dates and large-for-dates babies

238 small-for-dates (SFD), 246 average-for-dates (AFD) and 241 large-for-dates (LFD) infants were personally examined at birth, and measured thereafter in their own homes at the ages of 2, 6, 12 and 18 months, 2, 3 and 4 years. At each age weight, length or height, and head circumference measures in the SFD and LFD groups were distributed around the appropriate sex AFD mean values. In both extreme groups major shifts towards the mean occurred in the first six months for all three measures. From one year onwards only small within group fluctuations were seen. Correlations between one and four year values for weight, height and head circumference were high. At four years about 50% SFD children were within 1 S.D. of the mean, and 10% were still very small. Slightly more LFD children (55-60%) were near to the mean at this age, particularly for their head circumference values (70%), and only about 8% LFD children had very large heads. Trajectories of individual SFD and LFD children illustrate the great diversity of growth patterns within and between groups.

The prognostic significance of postnatal growth in very low--birth weight infants

To examine the relative importance of intrauterine growth failure, extrauterine growth failure before or after term, and the prognostic significance of catch-up growth, 192 very low--birth weight infants (less than 1.5 kg) were followed prospectively to 8 months corrected age. One hundred fifty-four appropriate--for--gestational age (AGA) and 38 small--for--gestational age (SGA) infants were categorized into normal and subnormal (less than -2 SD) weight for age groups at term (40 weeks) and at 8 months corrected age. By term, 71 AGA infants had subnormal weight; 41 of these caught up by 8 months, and an additional 13 AGA infants failed to thrive between term and 8 months. Of the SGA infants, three caught up in weight by term, and an additional 16 caught up by 8 months. Significant correlates of subnormal weight included neonatal risk score, incidence of chronic disease, and extended hospitalization. The AGA and SGA infants who failed to thrive or failed to catch up in weight by 8 months had lower mean Bayley developmental quotients (p less than 0.005), smaller head circumferences (p less than 0.005), and a higher rate of neurosensory impairment (p less than 0.01) than the AGA infants with normal fetal and postnatal growth. Intrauterine and/or postnatal growth failure prior to term was not of sinister prognostic significance if catch up occurred thereafter.

Growth in the first year of life: effects of sex and weight for gestational age at birth

Fifty-five small-for-dates (SFD), 56 average-for-dates (AFD) and 55 large-for-dates (LFD) babies were weighed and measured at regular intervals from birth to 12 months. Within the SFD and AFD groups weight gain was greater for boys than for girls so that by one year there were highly significant differences between the two sexes. Within the LFD group the sex difference was slight at all ages. Gain in length was similar to that for weight within each group; but head circumference showed a different pattern. Absolute increase in head circumference respectively for boys and girls between birth and one year was greatest in the SFD group and least in the LFD group. Within all three groups it was greater for boys than girls. By the age of six months AFD boys had larger heads than LFD girls and SFD boys had larger heads than AFD girls. At 12 months the head-circumference values for LFD girls and SFD boys did not significantly differ.

Growth in the first year of life: how early can one predict size at twelve months among small-for-dates and large-for-dates babies?

Within groups of small-for-dates (SFD) and large-for-dates (LFD) babies there is great diversity in their postnatal growth patterns. We analysed our data to find out how soon, and for which dimensions, could predictions of size at one year be reasonably made. Among LFD babies a strong correlation (r=0.644) was found between head circumference at birth and 12 months. Comparable values for weight and length were present by 3 months. In the SFD group, correlations of the same order were achieved for all three dimensions at the age of 4 months.

[Head circumference and brain development. Growth retardation during intrauterine malnutrition and catch-up growth mechanisms (author's transl)]

Today the close correlation between head circumference growth and brain development in the last weeks of gestation and in the first two years of life is no longer disputed. A recently developed formula even allows for calculations of brain weight based upon head circumference data. Between the ages of 32 postmenstrual weeks and six months after expected date of delivery there is a period of very rapid brain growth in which the weight of the brain quadruples. During this growth spurt there exists an increased vulnerability by unfavorable environmental conditions, such as malnutrition and psychosocial deprivation. The erroneous belief still being prevalent that the brain of the fetus and young infant is spared by malnutrition, can be looked upon as disproved by new research results. Severe malnutrition during the brain growth spurt is thought to be a very important non-genetic factor influencing the development of the central nervous system (CNS) and therewith intellectual performance. In the past a permanent growth retardation of head circumference and a reduced intellectual capacity usually was observed in small-for-gestational age infants (SGA). Nowadays, however, there can be found also proofs of successful catch-up growth of head circumference and normal intellectual development after early and high-energy postnatal feeding of SGA infants. The development of SGA infants of even very low birth weight can be supported in such a way that it takes a normal course by providing good environmental conditions, such as appropriate nutrition - especially during the early growth period - and a stimulating environment with abundant attention by the mother.

Ultrasound characterization of fetal growth

Fetal weight is estimated in vivo from ultrasound image measurements. Serial study of weight growth defines a trajectory which has physiologic and clinical significance. Low order polynomial fits to these data provide a functional description of the growth process which may be used for recognition and characterization of distinct growth patterns.

Growth graphs for the clinical assessment of infants of varying gestational age

Two graphs are presented showing means and 1 and 2 SD for growth in weight, length, and head circumference: (1) a fetal-infant graph with lines of growth from 26 weeks of gestational age until one year of age after ""term'' has been reached: and (2) a similarly constructed graph for children ages one through ten years. The standards of growth were obtained from published data in which the subjects received optimal health care. The graphs allow comparisons of infants of varying gestational age with standards for that age. Normal and abnormal deviations in growth are easily identified. Some examples of common variations in physical growth are described.

Influence of maternal obesity on subcutaneous fat in the newborn

Skinfold thickness measurements were made at biceps, triceps, subscapular, and suprailiac sites on both sides on 265 full-term newborn infants. The mothers were classified as thin (25), normal (179), or obese (61) on the basis of their triceps skinfold thicknesses. At all skinfold sites the babies of the obese mothers were significantly fatter than the babies of normal mothers, and the babies of the normal mothers were significantly fatter than those of the thin mothers. There was a highly significant positive correlation between maternal triceps thickness and the baby's sum of skinfold thicknesses. Hypertension was common during the pregnancies of the obese mothers and was associated with a significant reduction in the babies' skinfold thicknesses. When each of the 61 obese mothers were matched for parity, blood pressure, and smoking habit with 61 non-obese mothers the babies of the obese mothers still had significantly greater skinfold thicknesses than the babies of non-obese mothers.

The relationship of the rate of intrauterine growth of low-birth-weight infants to later growth

The relationship of the rate of intrauterine growth of low-birth-weight infants (1,501 to 2,500 gm) to their postnatal growth up to 10 years of age was investigated. Each child was assigned to one of four gestation quartiles which have identical birth weight distributions but differ widely in their length of gestation. The mean heights and weights of the children in each of the four quartiles were compared with similar data of a control group of children who had birth weights above 2,500 gm. Only infants in the long gestation quartile failed to catch up in height and weight to the control group by the end of the 10-year period. The same results that were obtained for the total cohort were also found separately for white and black children and for boys and girls. The data relate to 488 single white and black low-birth-weight infants and 488 normal-birth-weight infants.

The normal short child. Community study of children in Newcastle upon Tyne

This paper describes a community study of children who were born in 1960, 1961, and 1962, and who at the age of 10 years were of short stature but without evidence of organic disease. There was a tendency for the children to have low birthweights and delayed skeletal development, and most of their parents were short. In addition, the children scored poorly in tests of mental ability and attainment. Many of the children had been reared in poor social conditions and it is suggested that this played an important role in causing the short stature of at least one-third of the children.