Failure to thrive in Lebanon. IV. Longitudinal health and growth data

Intrauterine growth standards in a developing country: a study of singleton livebirths at 28-42 weeks' gestation

This study aimed to develop fetal growth charts for the population of Greater Beirut, Lebanon, and compare them with previously established references. A survey of consecutive singleton livebirths admitted to normal nurseries and neonatal intensive care units of major hospitals, through the database project of the National Collaborative Perinatal Neonatal Network was used as a design. The study was conducted in nine major healthcare institutions serving the population of Beirut and its suburbs. A total of 24 767 singleton livebirths delivered between 28 and 42 weeks' gestation, with known data on gender, gestational age and anthropometric characteristics were recorded between 1 April 1999 and 31 March 2002. Growth charts were developed by plotting birthweight, length and head circumference percentiles against gestational age for male and female infants separately. Overall, 1348 (5.4%) pregnancies were delivered before 37 weeks' gestation and 1227 (4.9%) were low birthweight. Male infants were delivered slightly earlier than their female counterparts and the mean birthweight, length and head circumference were consistently higher in males. A total of 2247 (9.1%) infants were small-for-gestational-age, with a male-to-female sex ratio of 1.03. Using previously established growth references that overestimated small-for-gestational-age prevalence resulted in a greater proportion of false positives. The opposite was true for growth references that underestimated small-for-gestational-age prevalence. The current growth charts present useful tools for assessing the general health status of newborn infants delivered at sea level in the urban areas of Lebanon and other East Mediterranean countries.

The home environment of the malnourished-deprived child

The extent of childhood malnutrition-deprivation throughout the world is indicated and its nature and the forms it takes are described. An account is given of several studies carried out by the author and his colleagues in Lebanon. An investigation of failure to thrive in young children revealed that in an apparently homogeneous low socioeconomic group there was a wide spectrum of physical growth which correlated closely with a number of home environment variables. Another study of the mental development of some of these children carried out over several years showed that children with even mild growth failure had a statistically significant impairment of mental development as compared with their apparently healthy siblings, also living in a home environment characterized by deprivation. The far reaching consequences are emphasized. In a third study which investigated the formal education of mothers, their nutritional knowledge and practices and the growth of their children, the indices were found to be interrelated to some extent. Finally, a small study gave some indication, perhaps contrary to general belief, that the rapid social change undergone by families who migrate from the country to an urban slum may be associated with an improvement in nutrition of the children.

Weight/length classification of nutritional status

The use of somatic measurements for the assessment of nutritional status is briefly reviewed. Two classifications using weight and length being advocated at present--those of McLaren and Read (1972) and Waterlow and Rutishauser (1974)--were applied to data from three sets of children surveyed in hospital and field studies. The results obtained differed considerably. The system of Waterlow and Rutishauser tended to underestimate the problem. A simple chart has been devised to aid the practical application of the classification of McLaren and Read.