scholarly journals Factors affecting the growth of infants diagnosed with cystic fibrosis by newborn screening

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
K. D. Patterson ◽  
T. Kyriacou ◽  
M. Desai ◽  
W. D. Carroll ◽  
F. J. Gilchrist
Keyword(s):  
Cystic Fibrosis ◽  
Birth Weight ◽  
Newborn Screening ◽  
Clinic Visit ◽  
Healthy Population ◽  
Z Score ◽  
Poor Growth ◽  
Increased Risk ◽  
Significant Difference ◽  
Future Growth

Abstract Background Newborn screening (NBS) for cystic fibrosis (CF) improves nutritional outcomes. Despite early dietetic intervention some children fail to grow optimally. We report growth from birth to 2 years in a cohort of children diagnosed with CF by NBS and identify the variables that influence future growth. Methods One hundred forty-four children were diagnosed with CF by the West Midlands Regional NBS laboratory between November 2007 and October 2014. All anthropometric measurements and microbiology results from the first 2 years were collated as was demographic and CF screening data. Classification modelling was used to identify the key variables in determining future growth. Results Complete data were available on 129 children. 113 (88%) were pancreatic insufficient (PI) and 16 (12%) pancreatic sufficient (PS). Mean birth weight (z score) was 3.17 kg (− 0.32). There was no significant difference in birth weight (z score) between PI and PS babies: 3.15 kg (− 0.36) vs 3.28 kg (− 0.05); p = 0.33. By the first clinic visit the difference was significant: 3.42 kg (− 1.39) vs 4.60 kg (− 0.48); p < 0.0001. Weight and height remained lower in PI infants in the first year of life. In the first 2 years of life, 18 (14%) infants failed to regain their birth weight z score. The median time to achieve a weight z score of − 2, − 1 and 0 was 18, 33 and 65 weeks respectively. The median times to reach the same z scores for height were 30, 51 and 90 weeks. Birth weight z score, change in weight z score from birth to first clinic, faecal elastase, isolation of Pseudomonas aeruginosa, isolation of Staphylococcus aureus and sweat chloride were the variables identified by the classification models to predict weight and height in the first and second year of life. Conclusions Babies with CF have a lower birth weight than the healthy population. For those diagnosed with CF by NBS, the weight difference between PI and PS babies was not significantly different at birth but became so by the first clinic visit. The presence of certain factors, most already identifiable at the first clinic visit can be used to identify infant at increased risk of poor growth.

scholarly journals Growth and Neurodevelopmental Outcome in Preterm LBW Infants with Sepsis in India: A Prospective Cohort

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sunil J. Pawar ◽  
Tejopratap Oleti ◽  
Siluvery Bharathi ◽  
Shyamsunder Tipparaju ◽  
Ershad Mustafa
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Neonatal Sepsis ◽  
Prospective Cohort ◽  
Neurodevelopmental Outcome ◽  
Low Birth Weight Infants ◽  
Neurodevelopmental Outcomes ◽  
Poor Growth ◽  
Increased Risk ◽  
Significant Difference

Objective. Neonatal sepsis is associated with abnormal neurodevelopmental outcomes but not with poor growth at 9 to 15 months of corrected age in LBW infants. Design, Setting, and Participants. This is a prospective cohort study involving 128 eligible preterm low-birth-weight (LBW) infants admitted during the period of 2013-2014 to the Durgabai Deshmukh Hospital and Research Center. All patients were followed up in the outpatient Department of Pediatrics. They were divided into the sepsis and nonsepsis group. Results. A total of 94 infants were evaluated (40 in sepsis and 54 in nonsepsis group). At the age of 9–15 months, low-birth-weight infants with neonatal sepsis had an increased risk of neurodevelopmental disorders (67.5 versus 20.3%; RR: 3.31 (1.87–5.85)). There is no statistically significant difference in the growth outcomes. Conclusion. Neonatal infections are associated with the abnormal neurodevelopmental outcomes in LBW infants but there was no significant difference at growth outcome at 9 to 15 months of corrected age between both groups.

scholarly journals Pulmonary function deficits in newborn screened infants with cystic fibrosis managed with standard UK care are mild and transient

2017 ◽  
Vol 50 (5) ◽  
pp. 1700326 ◽  
Author(s):  
Gwyneth Davies ◽  
Janet Stocks ◽  
Lena P. Thia ◽  
Ah-Fong Hoo ◽  
Andrew Bush ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Lung Function ◽  
Early Life ◽  
Treatment Protocol ◽  
Forced Expiratory Volume ◽  
Z Score ◽  
Average Group ◽  
Significant Difference ◽  
Residual Capacity ◽  
High Risk Infants

With the advent of novel designer molecules for cystic fibrosis (CF) treatment, there is huge need for early-life clinical trial outcomes, such as infant lung function (ILF). We investigated the degree and tracking of ILF abnormality during the first 2 years of life in CF newborn screened infants.Forced expiratory volume in 0.5 s (FEV0.5), lung clearance index (LCI) and plethysmographic functional residual capacity were measured at ∼3 months, 1 year and 2 years in 62 infants with CF and 34 controls.By 2 years there was no significant difference in FEV0.5 z-score between CF and controls, whereas mean LCI z-score was 0.81 (95% CI 0.45–1.17) higher in CF. However, there was no significant association between LCI z-score at 2 years with either 3-month or 1-year results. Despite minimal average group changes in any ILF outcome during the second year of life, marked within-subject changes occurred. No child had abnormal LCI or FEV0.5 on all test occasions, precluding the ability to identify “high-risk” infants in early life.In conclusion, changes in lung function are mild and transient during the first 2 years of life in newborn screened infants with CF when managed according to a standardised UK treatment protocol. Their potential role in tracking disease to later childhood will be ascertained by ongoing follow-up.

scholarly journals Perbedaan arus puncak ekspirasi antara anak asma dengan obesitas dan anak asma tanpa obesitas

2013 ◽  
Vol 10 (1) ◽  
pp. 19
Author(s):  
Nurul Hadi ◽  
Madarina Julia ◽  
Roni Naning
Keyword(s):  
Peak Flow ◽  
Pearson Correlation ◽  
Cross Sectional Study ◽  
Growth Chart ◽  
Z Score ◽  
Flow Meter ◽  
Cross Sectional ◽  
Asthmatic Children ◽  
Increased Risk ◽  
Significant Difference

Background: Obesity in children is associated with impairment of pulmonary function and increased risk of asthma. Obesity in asthmatic children may reduce lung function, that can be assessed by peak flow meter, a practical and an inexpensive tool.Objectives: To compare the peak expiratory flow (PEF) between obese and non-obese asthmatic children.Method: We conducted a cross sectional study in Yogyakarta during March 2010-September 2012. Fifty obese asthmatic patients and 50 non obese asthmatic control subjects participated in this study. Inclusion criteria were asthmatic patient, according to Pedoman Nasional Asma Anak (PNAA), and 6-18 years of age. Exclusion criteria were asthmatic attack, respiratory disease, heart disease and congenital chest malformation. Obesity is defined as body mass index (BMI) for age more than +3 SD WHO growth chart standards BMI for age 2007 z-score. Z-score is calculated with WHO AnthroPlus for Personal Computers. Data PEF is taken with electrical peak flow meter when the patient was not suffering from asthma attack. Normal PEF was defined as PEF ≥80% average (predicted) value for height.Results: The mean of age of asthmatic children in this study was 9.38 years and 9.50 years for non obese and obese respectively. The PFR was not different between obese asthmatic children and non obese asthmatic children (p=0,83). Pearson correlation of PFR and z-score BMI for age was positive weak correlation (r=0.12). There was significant difference of PFR between z-score BMI for age <3,20 and z-score BMI for age ≥3.20 (p=0.03). Significant difference of PFR also appears in duration of illness (p<0.001).Conclusion: There is no PFR difference between obese asthmatic children and non-obese asthmatic children. The difference of PFR emerges when statistic analysis performed using z-score BMI ≥3.20.

scholarly journals Protein Enrichment of Donor Breast Milk and Impact on Growth in Very Low Birth Weight Infants

Nutrients ◽  
2021 ◽  
Vol 13 (8) ◽  
pp. 2869
Author(s):  
Ting Ting Fu ◽  
Heather C. Kaplan ◽  
Trayce Fields ◽  
Alonzo T. Folger ◽  
Katelyn Gordon ◽  
...  
Keyword(s):  
Birth Weight ◽  
Breast Milk ◽  
Low Birth Weight ◽  
Very Low Birth Weight ◽  
Average Weight ◽  
Protein Enrichment ◽  
Z Score ◽  
Low Birth Weight Infants ◽  
Poor Growth ◽  
Vlbw Infants

Protein content is often inadequate in donor breast milk (DBM), resulting in poor growth. The use of protein-enriched target-pooled DBM (DBM+) has not been examined. We compared three cohorts of very low birth weight (VLBW) infants, born ≤ 1500 g: DBM cohort receiving > 1-week target-pooled DBM (20 kcal/oz), MBM cohort receiving ≤ 1-week DBM, and DBM+ cohort receiving > 1-week DBM+. Infants followed a standardized feeding regimen with additional fortification per clinical discretion. Growth velocities and z-scores were calculated for the first 4 weeks (n = 69 for DBM, 71 for MBM, 70 for DBM+) and at 36 weeks post-menstrual age (n = 58, 64, 59, respectively). In total, 60.8% MBM infants received fortification >24 kcal/oz in the first 30 days vs. 78.3% DBM and 77.1% DBM+. Adjusting for SGA, length velocity was greater with DBM+ than DBM in week 1. Average weight velocity and z-score change were improved with MBM compared to DBM and DBM+, but length z-score decreased similarly across all groups. Incidences of NEC and feeding intolerance were unchanged between eras. Thus, baseline protein enrichment appears safe in stable VLBW infants. Weight gain is greatest with MBM. Linear growth comparable to MBM is achievable with DBM+, though the overall length trajectory remains suboptimal.

scholarly journals Identifying Faltering of Growth Velocity and Associated Risk Factors Among Preschool Aged Children in Nepal

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 864-864
Author(s):  
Swetha Manohar ◽  
Andrew Thorne-Lyman ◽  
Elizabeth Colantuoni ◽  
K C Angela ◽  
Binod Shrestha ◽  
...  
Keyword(s):  
Risk Factors ◽  
Growth Velocity ◽  
Regression Models ◽  
Linear Growth ◽  
Height Velocity ◽  
Individual Risk ◽  
Z Score ◽  
Poor Growth ◽  
Growth Faltering ◽  
Increased Risk

Abstract Objectives Linear growth failure is often assessed as a height-for-age z-score (HAZ) &lt; −2, which defines stunting. Faltering growth velocity on the other hand reveals a dynamic process, for which improving risk factors could help prevent poor growth, regardless of HAZ. Our aim was to reveal rates and risk factors of growth faltering in Nepali preschool children using a novel linear growth velocity (LGV) reference. Methods We assessed length/height in children under-five from 2013–16 during the same season in 21 wards across the plains (Tarai) of Nepal (n = 4439). Annualized LGVs were calculated from paired measures and stratified into interval-initiating ages of &lt;6, 6–11, 12–23, 24–35, 36–47, 48–59 mo. An annualized, age-sex-specific LGV reference was derived by combining the WHO Growth Standards (for intervals starting &lt;12 mo) and the Tanner Height Velocity Reference (for intervals starting later) using linear restricted cubic spline regression models, from which LGV z-scores (LGVZ) were derived and used to evaluate Nepali child growth. Community, household and individual risk factors were assessed during interval-initiating visits and subjected to multivariable logistic regression models to examine associations with LGVZ &lt; −2 (growth faltering) vs &gt; 2. Results LGV faltering affected 29.8% and 34.8% of boys and girls &lt;24 months, and 6.8% and 7.1% 24–60 months, respectively. Girls were at higher odds of faltering, although 95% CI excluded 1 only for the interval starting at 12–23 mo (OR: 1.77; 95% CI: 1.26, 2.50). Children &lt;24 mo whose weight-for-height z- score was &gt; the WHO median had lower odds of faltering than thinner children (OR: 0.25 - 0.40, all upper 95% CLs &lt; 1). Children of short (&lt;150 cm) mothers had higher odds of faltering, with 95% CIs excluding 1 for interval-initiating ages &lt; 6, 12–23 and 24–35 mo. Above 36 mo, community characteristics such as proximity to market, and access to roads and schools were stronger in their protective growth association than individual or household factors. Conclusions Growth faltering can be assessed across all preschool years by this WHO-Tanner linear growth velocity reference. Nepali children exhibited substantial growth faltering &lt;24 months. Females, children who were thin, and born to short mothers were at an increased risk of growth faltering. Funding Sources USAID, Sight and Life, and Procter & Gamble.

Abstract 14185: Targeting Lower Oxygen Saturation Parameters in Premature Infants Does Not Increase Incidence of Pulmonary Hypertension in the Neonatal Intensive Care Unit

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Maria Niccum ◽  
Fotios Spyropoulos ◽  
Jonathan Levin ◽  
Carter Petty ◽  
Mary P Mullen ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Logistic Regression ◽  
Birth Weight ◽  
Oxygen Saturation ◽  
Preterm Infants ◽  
Ductus Arteriosus ◽  
Positive Association ◽  
Increased Risk ◽  
Significant Difference ◽  
Lower Oxygen

Introduction: Lower oxygen saturation targets in preterm infants have been associated with decreased incidence of bronchopulmonary dysplasia (BPD) but increased risk of pulmonary hypertension (PH). Studies have shown that targets of <90% are associated with higher incidence of PH, however data on the optimal saturation target >90% are lacking. In this study, we compared the rate of BPD and PH in two cohorts with saturation targets of 94-98% and 92-97%. We hypothesized that BPD rate would be lower and PH rate would be unchanged at the lower saturation target. Methods: We performed a retrospective cohort study comparing PH and BPD rates among two cohorts of infants born at ≤32 weeks gestation at Brigham and Women’s Hospital: cohort 1 with saturation target of 94-98% (n = 129, July 2017-July 2018), cohort 2 with saturation target of 92-97% (n = 124, July 2018-July 2019). PH was defined by echocardiographic evidence of systolic septal flattening or right ventricular pressure ≥35 mmHg (estimated by tricuspid regurgitant jet velocity or shunt velocity) at gestational age (GA) ≥36 weeks. Comparisons between groups were carried out by Chi-square test, t-test, and multivariable logistic regression. Results: Subjects had a GA of 23-32 weeks; 46% were female. Groups did not differ with respect to GA, sex, or birth weight. There was no difference in rate of PH (2.4% vs. 4.2%, p = 0.12) or BPD (25% vs. 20%, p = 0.31) between cohort 1 and cohort 2. Other clinical parameters were not different between groups, including presence of patent ductus arteriosus, presence of atrial septal defect, use of diuretics, or use of steroids. After controlling for GA, birth weight, sex, and diagnosis of BPD using logistic regression, there was no difference in rate of PH between groups (p = 0.47), but there was a positive association of BPD with PH (OR 3.45; 95% CI, 1.18-10.09; p = 0.02). Conclusions: A lower oxygen saturation target was not associated with a higher rate of PH or lower rate of BPD in preterm infants. The overall rate of PH was much lower than rates previously reported at saturation targets <90%. Given our low incidence of PH, and the lack of a significant difference in rate of PH between groups, a saturation target of 92-97% may be safe while also minimizing need for supplemental oxygen in this population.

scholarly journals Impact of cystic fibrosis on birthweight: a population based study of children in Denmark and Wales

Thorax ◽  
2018 ◽  
Vol 74 (5) ◽  
pp. 447-454 ◽  
Author(s):  
Daniela K Schlüter ◽  
Rowena Griffiths ◽  
Abdulfatah Adam ◽  
Ashley Akbari ◽  
Martin L Heaven ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Socioeconomic Background ◽  
Hospital Inpatient ◽  
Poor Growth ◽  
Intrauterine Growth ◽  
Causal Mediation ◽  
The Impact

BackgroundPoor growth during infancy and childhood is a characteristic feature of cystic fibrosis (CF). However, the impact of CF on intrauterine growth is unclear. We studied the effect of CF on birth weight in Denmark and Wales, and assessed whether any associations are due to differences in gestational age at birth.MethodsWe conducted national registry linkage studies in two countries, using data for 2.2 million singletons born in Denmark (between 1980 and 2010) and Wales (between 1998 and 2015). We used hospital inpatient and outpatient data to identify 852 children with CF. Using causal mediation methods, we estimated the direct and indirect (via gestational age) effect of CF on birth weight after adjustment for sex, parity and socioeconomic background. We tested the robustness of our results by adjusting for additional factors such as maternal smoking during pregnancy in subpopulations where these data were available.ResultsBabies with CF were more likely to be born preterm and with low birth weight than babies with no CF (12.7% vs 5% and 9.4% vs 5.8% preterm; 11.9% vs 4.2% and 11% vs 5.4% low birth weight in Denmark and Wales, respectively). Using causal mediation methods, the total effect of CF on birth weight was estimated to be −178.8 g (95% CI −225.43 to −134.47 g) in the Danish population and −210.08 g (95% CI −281.97 to −141.5 g) in the Welsh population. About 40% of this effect of CF on birth weight was mediated through gestational age.ConclusionsCF significantly impacts on intrauterine growth and leads to lower birth weight in babies with CF, which is only partially explained by shorter gestation.

scholarly journals Perinatal Factors Associated with Infant Maltreatment

2008 ◽  
Vol 1 ◽  
pp. CMPed.S980 ◽  
Author(s):  
Takeo Fujiwara ◽  
Makiko Okuyama ◽  
Haley Tsui ◽  
Karestan C. Koenen
Keyword(s):  
At Risk ◽  
Chronic Disease ◽  
Birth Weight ◽  
Low Birth Weight ◽  
Gestational Age ◽  
Small For Gestational Age ◽  
Odds Ratio ◽  
Adjusted Odds Ratio ◽  
Z Score ◽  
Increased Risk

Background The association between birth outcomes and child maltreatment remains controversial. The purpose of this study is to test whether infants without congenital or chronic disease who are low birth weight (LBW), preterm, or small for gestational age (SGA) are at an increased risk of being maltreated. Methods A hospital-based case-control study of infants without congenital or chronic diseases who visited the National Center for Child Health and Development, Tokyo, between April 1, 2002 and March 31, 2005 was conducted. Cases (N = 35) and controls (N = 29) were compared on mean birth weight, gestational age, and z-score of birth weight. Results SGA was significantly associated with infant maltreatment after adjusting for other risk factors (adjusted odds ratio: 4.45, 95% CI: 1.29–15.3). LBW and preterm births were not associated with infant maltreatment. Conclusion Infants born as SGA are 4.5 times more at risk of maltreatment, even if they do not have a congenital or chronic disease. This may be because SGA infants tend to have poorer neurological development which leads them to be hard-to-soothe and places them at risk for maltreatment. Abbreviations SCAN, Suspected Child Abuse and Neglect; LBW, low birth weight; ZBW, z-score of birth weight adjusted for gestational age, sex, and parity; SGA, small for gestational age; SD, standard deviation; OR, odds ratio; aOR, adjusted odds ratio; CI, confidence interval; IPV, intimate partner violence.

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