Abstract 17071: Growth Asymmetry, Head Circumference and Neurodevelopmental Outcomes in Infants with Single Ventricles

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Thomas A Miller ◽  
Victor Zak ◽  
Peter Shrader ◽  
Chitra Ravishankar ◽  
Victoria L Pemberton ◽  
...  
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Single Ventricle ◽  
Univariate Analysis ◽  
Somatic Growth ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Head Growth ◽  
Developmental Index ◽  
Asymmetric Growth

Poor somatic growth is common in infants with single ventricle (SV) physiology and has been linked to increased morbidity and impaired neurodevelopment. Asymmetry in somatic growth, a potential brain-sparing adaptation, is important in predicting outcomes in premature and small for gestational age (SGA) infants. Objectives: To assess variability in growth asymmetry and its associations with neurodevelopment in infants with SV. Methods: We analyzed growth asymmetry (weight for age z-score (WAZ) minus head circumference for age z-score (HCAZ)), relative head growth (change in cm/change in kg), HCAZ, and change in HCAZ from baseline to pre-Glenn in subjects prospectively enrolled in the Pediatric Heart Network Infant Single Ventricle (ISV) trial. Associations between these indices and results of the Psychomotor Developmental Index (PDI) and Mental Developmental Index (MDI) of the Bayley Scales of Infant Development-II (BSID) at 14 months were assessed. Results: Of the 230 patients enrolled in ISV, complete biometric data and BSID results were available in 168 (73%). For this cohort, age at enrollment was 21±9 days, age at pre-Glenn was 167±52 days, gestational age was 38.3±1.4 weeks, and 71% were male. Growth asymmetry varied across the cohort at enrollment (0.43 ±1.02, range -2.85 to 4.84) and the pre-Glenn visit (-0.23 ±1.21, range -4.45 to 3.00) as did the relative head growth (2.40±0.86, range 0.50 to 8.00). BSID scores were not associated with indices of growth asymmetry. In univariate analysis, larger pre-Glenn HCAZ correlated with higher MDI (r=0.21, p=0.006) and PDI (r=0.38, p<0.001) and greater increase in HCAZ from enrollment to pre-Glenn was associated with higher PDI (r=0.15, p=0.049). In multivariable modeling adjusting for site, serious adverse events, stage 1 length of stay, and height at 14 months, pre-Glenn HCAZ was an independent predictor of PDI (p=0.03), but not MDI. For each one unit Z-score increase in pre-Glenn HCAZ, the predicted PDI score increased by 2.5 points. Conclusions: In infants with SV, BSID scores were associated with pre-Glenn HCAZ but not with the degree of asymmetric growth. Future studies should explore why asymmetric growth that seems important in premature and SGA infants appears less relevant in infants with SV.

Pattern of head circumference growth following bidirectional Glenn in infants with single ventricle heart disease

2020 ◽  
pp. 1-8
Author(s):  
Stephanie Y Tseng ◽  
Julia Anixt ◽  
Jareen Meinzen-Derr ◽  
Cameron Thomas ◽  
David S Cooper ◽  
...  
Keyword(s):  
Heart Disease ◽  
Motor Development ◽  
Head Circumference ◽  
Single Ventricle ◽  
Developmental Outcomes ◽  
Z Score ◽  
Head Growth ◽  
Bidirectional Glenn ◽  
Post Surgery ◽  
Developmental Index

Abstract Background: Infants with single ventricle congenital heart disease demonstrate increasing head growth after bidirectional Glenn; however, the expected growth trajectory has not been well described. Aims: 1) We will describe the pattern of head circumference growth in the first year after bidirectional Glenn. 2) We will determine if head growth correlates with motor developmental outcomes approximately 12 months after bidirectional Glenn. Methods: Sixty-nine single ventricle patients underwent bidirectional Glenn between 2010 and 2016. Patients with structural brain abnormalities, grade III–IV intra-ventricular haemorrhage, significant stroke, or obstructive hydrocephalus were excluded. Head circumference and body weight measurements from clinical encounters were evaluated. Motor development was measured with Psychomotor Developmental Index of the Bayley Scales of Infant Development, Third Edition. Generalised estimating equations assessed change in head circumference z-scores from baseline (time of bidirectional Glenn) to 12 months post-surgery. Results: Mean age at bidirectional Glenn was 4.7 (2.3) months and mean head circumference z-score based on population-normed data was −1.13 (95% CI −1.63, −0.63). Head circumference z-score increased to 0.35 (95% CI −0.20, 0.90) (p < 0.0001) 12 months post-surgery. Accelerated head growth, defined as an increase in z-score of >1 from baseline to 12 months post-surgery, was present in 46/69 (66.7%) patients. There was no difference in motor Psychomotor Developmental Index scores between patients with and without accelerated head growth. Conclusion: Single ventricle patients demonstrated a significant increase in head circumference after bidirectional Glenn until 10–12 months post-surgery, at which time growth stabilised. Accelerated head growth did not predict sub-sequent motor developmental outcomes.

scholarly journals Head growth during neonatal intensive care unit stay is related to neurodevelopmental outcome in preterm infants born small for gestational age

2020 ◽  
Author(s):  
Hannah Cho ◽  
Ee-Kyung Kim ◽  
In Gyu Song ◽  
Ju Sun Heo ◽  
Seung Han Shin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Preterm Infants ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Neurodevelopmental Outcome ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Head Growth ◽  
Catch Up

Abstract Background: To investigate postnatal growth patterns and their relationship with neurodevelopment in preterm infants born small for gestational age (SGA).Methods: This study analyzed 90 infants born SGA with birth weight <1,500 g or gestational age <32 weeks. Length, weight, and head circumference (HC) were recorded at birth, 35 weeks postmenstrual age (PMA), 40 weeks PMA, and at 4, 9, and 18 months corrected age (CA). Neurodevelopmental outcomes were assessed using the Bayley-III scales at 18 months CA. Results: Z-score of HC in SGA infants increased from birth to 40 weeks PMA. Failure of head growth catch-up to 10th percentile by 4 months CA and all three parameters by 9 months CA and onwards were associated with worse neurodevelopmental outcomes. Z-score changes in head growth between birth and 35 weeks PMA were significantly associated with neurodevelopmental outcome (p=0.006, adjusted odds ratio 6.964, 95% confidence interval: 1.763-27.506). Conclusions: Head growth during neonatal intensive care unit stay were associated with neurodevelopmental outcomes in preterm SGA infants. Preterm SGA infants are predicted to have optimal neurodevelopment at 18 months CA, if the head growth catch-up is achieved by 4 months CA and length and weight by 9 months CA.

scholarly journals Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yoo Jinie Kim ◽  
Seung Han Shin ◽  
Eun Sun Lee ◽  
Young Hwa Jung ◽  
Young Ah Lee ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Gestational Age ◽  
Growth Velocity ◽  
Postnatal Growth ◽  
School Age ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Neurocognitive Outcomes ◽  
Size At Birth

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

scholarly journals Head circumference trajectory in children with perinatal stroke

2021 ◽  
pp. 088307382199610
Author(s):  
Amanda Leong ◽  
Amalia Floer ◽  
Adam Kirton ◽  
Aleksandra Mineyko
Keyword(s):  
Ischemic Stroke ◽  
Head Circumference ◽  
Developmental Outcomes ◽  
Normal Growth ◽  
Fisher Exact Test ◽  
Arterial Ischemic Stroke ◽  
Neurodevelopmental Outcomes ◽  
Perinatal Stroke ◽  
Head Growth ◽  
Poor Outcome

Background: Perinatal stroke is a leading cause of hemiparetic cerebral palsy and lifelong disability. Neurodevelopmental outcomes are difficult to predict and markers of long-term poor outcome continue to be investigated. Deceleration in growth of head circumference has been associated with worse developmental outcomes in neonatal brain injury. We hypothesized that perinatal stroke would result in decreased rates of head growth during childhood that would be associated with worse developmental outcomes. Methods: Patients with magnetic resonance imaging (MRI)–confirmed neonatal arterial ischemic stroke and arterial presumed perinatal ischemic stroke were identified from a population-based research cohort (Alberta Perinatal Stroke Project). Demographics and occipital-frontal circumference data were collected from medical records. Head growth was compared to typically developing control charts using a 2-tailed t test. The Fisher exact test was used to examine associations between Pediatric Stroke Outcome Measures (PSOM) scores and occipital-frontal head circumference. Results: Three hundred fifteen occipital-frontal head circumference measurements were collected from 102 patients (48 female, 54 male), over a median of 3.2 years (standard deviation = 5.18, range = 0-18.3). After 3 months for female patients and 1 year for male patients, occipital-frontal head circumference deviated and remained below normal growth trajectories ( P < .05) with a large effect size (Cohen d >0.8). Poor outcome (PSOM ≥ 1) was associated with smaller occipital-frontal head circumference ( P < .05). Conclusion: Head growth deceleration is observed in children with perinatal arterial ischemic stroke and is associated with poor outcome. Head circumference may be a tool to alert clinicians to the potential of abnormal neurologic outcome.

scholarly journals Head circumference and anterior fontanel measurements in newborns

2012 ◽  
Vol 52 (3) ◽  
pp. 145 ◽  
Author(s):  
Rizal Agus Tiansyah ◽  
Irawan Mangunatmadja ◽  
Aman Pulungan
Keyword(s):  
Gestational Age ◽  
Head Circumference ◽  
Full Term ◽  
Brain Growth ◽  
Anterior Fontanel ◽  
Term Infants ◽  
Head Growth ◽  
Term Newborns ◽  
Male Subjects ◽  
The Brain

Background Head growth and anterior fontanel (AP) closureare passive processes in response to brain growth. The growthof the brain and skull starts in the third week of intrauterinegestation. roth processes run simultaneously as a part of integralgrowth, along 'With increasing gestational age, until post􀀿birth.Measurement of head circumference (He) and AF in newbornsis done to determine if the brain and skull grew normally duringthe intrauterine period.Objectives To investigate the differences in He and AF sizebetween preterm and full􀀿term infants, and the relationshipbetween gestational age (GA) and birth weight (BW) to Heand AF size.Methods This was a descriptive analytic study on preterm andfull􀀿term newborns. Measurement of HC and AF was conductedin three phases: just after birth, 1x24 and 2x24 hours of age.Analysis of HC and AF size differences between preterm and fullterm subjects was performed, as well as analysis of the correlationbetween GA and BW to HC and AF size.Results Two hundred fifty newborns completed the study. Therewere 180 full􀀿term and 70 preterm subjects. Median HC in full􀀿term and preterm male subjects were 34 cm (range 31􀀿37 cm)and 31 cm (27􀀿34 cm), respectively. Median HC in full􀀿termand preterm female subjects were 33 cm (31􀀿36 cm) and 32 cm(27􀀿3S.S cm), respectively. Median AF in full􀀿term and pretermmale subjects were 2.17 cm (1.0SA.6 cm) and 2.22 cm (1.3SA.Scm), respectively, and in full􀀿term and preterm female subjectswere 2.02 cm (lA.1S cm) and 2.22 cm (0.7SA cm), respectively.The HC of preterms were significantly lower than the fullterms(P<O.OOl), however the AF size was not different between these2 groups of newborns (P =0 .28). Correlation test between GA andBW to HC size revealed a positive correlation (r=0.620, P<O.OO 1and r=0.801, P<O.OOl, respectively), but not to AF size (r=􀀿 0.06,p􀁀 0.279 and F- 0.049, P􀁀0.44, respectively).Concl usions We found that the HC size of pre terms wassignificantly lower than thefullterms, but no significant differences in AF size between the two groups. GA and BW were associatedwith HC size, but not associated to AF size. [paediatr lndones.2012;52:145-51].

scholarly journals Low Gestational Age Is the Strongest Predictor for Severe Retinopathy of Prematurity and Adverse Outcomes at Two-Year Follow-Up in a Low Incidence Setting

2017 ◽  
Vol 07 (01) ◽  
pp. e106-e109
Author(s):  
Stefano Nobile ◽  
Linda Bordignon ◽  
Anna Peretti ◽  
Virgilio Carnielli
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Gestational Age ◽  
Univariate Analysis ◽  
Adverse Outcomes ◽  
Neurological Development ◽  
Neurodevelopmental Outcomes ◽  
Surfactant Administration ◽  
Low Incidence ◽  
Type 1 Rop

AbstractWe aimed to determine the risk factors for type 1 ROP and outcomes at 2 years of corrected age among preterms born < 30 weeks of gestational age (GA) in a low-incidence setting. A cohort study with 447 infants was conducted. Those who underwent laser therapy for type 1 ROP were compared with controls by univariate and multivariate analysis. Neurological development was assessed by Bayley scales. Using univariate analysis, gestational age, sepsis, necrotizing enterocolitis, and insulin administration were found to be associated with type 1 ROP. Only GA remained significant with logistic regression. Infants with type 1 ROP had worse visual and neurodevelopmental outcomes at 2 years. Predictors of impaired neurodevelopment were type 1 ROP, surfactant administration, and bronchopulmonary dysplasia. Low GA was found to be a strong predictor of type 1 ROP, which was associated (along with surfactant administration and bronchopulmonary dysplasia) with worse neurological development.

scholarly journals SP3 Evaluating the impact of concentrated standardised parenteral nutrition on growth of preterm infants

2020 ◽  
Vol 105 (9) ◽  
pp. e2.1-e2
Author(s):  
Lucy Stachow ◽  
T’ng Chang Kwok ◽  
Ramune Snuggs ◽  
Rowan Toyer ◽  
Emmanuel Oyewole ◽  
...  
Keyword(s):  
Parenteral Nutrition ◽  
Preterm Infants ◽  
Gestational Age ◽  
Head Circumference ◽  
Growth Failure ◽  
Neonatal Unit ◽  
Extremely Low Birth Weight ◽  
Z Score ◽  
Early Nutrition ◽  
Growth Outcomes

Background and AimConcentrated standardised parenteral nutrition (CSPN) may reduce the delay in commencing parenteral nutrition (PN) in preterm infants compared with conventional individualised PN. Optimisation of early nutrition, with emphasis on earlier commencement of PN to include amino acids and addition of lipids within 24 hours of birth, ameliorates early postnatal growth failure.1 2 Cumulative nutritional deficit often seen in significantly preterm infants may lead to poor neurodevelopmental outcome.3 4 CSPN was introduced in our neonatal unit in December 2017 with the objective of improving early nutrition. The aim of this service evaluation was to assess the suitability of CSPN and its impact on the growth of preterm infants in our tertiary level neonatal unit.MethodsIn December 2017, the neonatal PN provided was switched from individualised PN to CSPN based on a modified ‘SCAMP’ regimen. Retrospective and prospective growth parameter data was collected for infants receiving PN within 24 hours of birth born between September to November 2017 (individualised PN arm) and from September to November 2018 (CSPN arm). Infants were excluded if they died or transferred out of the local neonatal service before day 28 of life, or died before transitioning from PN to full enteral feeds. Weight and head circumference at birth, 28 days old and 36 weeks corrected gestation/discharge were converted to z scores using the LMS method. The Mann-Whitney test was used to compare continuous data. Annual PN expenditure, and wastage of ordered PN, before and after the switch to CSPN, was calculated using the pharmacy stock management system, pharmacist and finance records.Results20 infants (mean gestational age 28 weeks) and 21 infants (mean gestational age 29.6 weeks) were included in the CSPN and individualised PN groups respectively. There were no differences in demographic data of each group. CSPN was commenced earlier (median 8 hours old (n=20)) than individualised PN (median 25 hours old (n=19)), (U=42, p<0.0001). There was no statistical difference in the change in weight z score from birth at 28 days old (median -0.47 (n=20) CSPN vs -0.66 (n=19) individualised PN, U=178.5, p=0.75) and at 36 weeks corrected gestation/discharge (median -0.72 (n=20) CSPN vs -0.86 (n=21) individualised PN, U=106, p=0.7). There was insufficient data collected to analyse effect on head circumference. Replacing individualised PN with CSPN resulted in a 37% reduction in procurement costs, despite an increase in the wastage of ordered PN from 7.2% to 8.5%.ConclusionA PN strategy using concentrated standardised PN can be implemented successfully in a tertiary neonatal unit setting in the United Kingdom and allows earlier commencement of PN. Use of CSPN appeared to have no adverse effect on weight gain, although small sample size may account for the lack of statistical significance in improvement of weight z score seen. Improved rates of head circumference documentation for our patients are required. Introducing CSPN resulted in a considerable reduction in procurement costs, and identifying strategies to minimise wastage of CSPN bags would further improve cost-effectiveness.ReferencesMorgan C, McGowan P, Herwitker S, et al. Postnatal head growth in preterm infants: a randomised controlled parenteral nutrition study. Pediatrics 2014;133:e120–8.Moyses HE, Johnson MJ, Leaf AA, et al. Early parenteral nutrition and growth outcomes in preterm infants: a systematic review and meta-analysis. Am J Clin Nutr 2013;97:816–26.Ehrenkranz RA, Dusick AM, Vohr BR, et al. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics 2006;117:1253–61.Dusick AM, Poindexter BB, Ehrenkranz RA, et al. Growth failure in the preterm infant: can we catch up?Semin Perinatol 2003;27:302–10.

scholarly journals Prolonged ventilation and postnatal growth of preterm infants

2019 ◽  
Vol 48 (1) ◽  
pp. 82-86 ◽  
Author(s):  
Emma Williams ◽  
Theodore Dassios ◽  
Kate Arnold ◽  
Ann Hickey ◽  
Anne Greenough
Keyword(s):  
Mechanical Ventilation ◽  
Gestational Age ◽  
Head Circumference ◽  
Invasive Mechanical Ventilation ◽  
Postnatal Growth ◽  
Z Score ◽  
Prolonged Ventilation ◽  
Gestational Age At Birth ◽  
Age At Birth ◽  
Prematurely Born Infants

AbstractBackgroundExtremely premature infants often need invasive respiratory support from birth, but have low nutritional reserves and high metabolic demands. Our aim was to determine if there was a relationship between prolonged ventilation and reduced postnatal growth in such infants.MethodsA retrospective, observational study was undertaken. Data from infants born at less than 28 weeks of gestational age and ventilated for 7 days or more were collected and analysed including gestational age, gender, birth and discharge weight, birth and discharge head circumference, days of invasive mechanical ventilation and use of postnatal corticosteroids. The duration of invasive mechanical ventilation and the differences in weight (ΔWz) and head circumference (ΔHz) z-score from birth to discharge were calculated.ResultsFifty-five infants were studied with a median [interquartile range (IQR)] gestational age at birth of 25.3 (24.3–26.7) weeks and birth weight of 0.73 (0.65–0.87) kg. The median duration of mechanical ventilation was 45 (33–68) days. Both ΔWz and ΔHz were significantly negatively correlated to the number of invasive mechanical ventilation days (P = 0.01 and P = 0.03, respectively), but not to the use of postnatal corticosteroids.ConclusionPoor postnatal growth is significantly negatively associated with a longer duration of mechanical ventilation in extremely prematurely born infants.

scholarly journals Differential Effect of Growth on Development between AGA and SGA Preterm Infants

2020 ◽  
Vol 17 (9) ◽  
pp. 3022
Author(s):  
In Gyu Song ◽  
Ee-Kyung Kim ◽  
Hannah Cho ◽  
Seung Han Shin ◽  
Jin A. Sohn ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Gestational Age ◽  
Physical Growth ◽  
Growth Spurt ◽  
Z Score ◽  
Neurodevelopmental Outcomes ◽  
Important Indicator ◽  
Very Preterm Infants ◽  
Growth Measurement ◽  
Appropriate For Gestational Age

Predicting developmental outcomes with growth measurement would be beneficial for primary healthcare or in developing countries with low medical resources. This study aimed to identify physical growth measures that indicate neurodevelopment in very preterm infants. Preterm infants, born at <32 weeks’ gestation or weighing <1500 g, were included. We calculated the changes in z-score of weight, length, and head circumference (HC) at different time points: birth, postmenstrual age (PMA) 35 weeks, and 4 and 18 months corrected age (CA). We examined the relationship between growth and Bayley-III scores using linear regression. Among 122 infants, HC at 4 months CA and HC growth between PMA 35 weeks and 4 months CA showed a positive correlation with Bayley-III scores in appropriate-for-gestational-age infants (AGAs). Weight and length increases between birth and 18 months CA were also associated with AGAs’ development. In small-for-gestational-age infants (SGAs), only birthweight’s z-score was associated with improved neurodevelopmental outcomes. HC at 4 months CA was an important indicator of favorable neurodevelopmental outcomes, and head growth spurt between PMA 35 weeks and 4 months CA contributed to this benefit in preterm AGAs. The period and indices should be monitored differently for SGAs and AGAs.

Sign in / Sign up

Export Citation Format

Share Document