scholarly journals The Impact of Neonatal Morbidities on Child Growth and Developmental Outcome in Very Low Birth Weight Infants: Nationwide Cohort Study

2021 ◽  
Author(s):  
Jung Ho Han ◽  
So Jin Yoon ◽  
Joo Hee Lim ◽  
Jeong Eun Shin ◽  
Ho Seon Eun ◽  
...  
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Head Circumference ◽  
Growth Parameters ◽  
Periventricular Leukomalacia ◽  
Normal Growth ◽  
Child Growth ◽  
Growth Restriction ◽  
Neurodevelopmental Outcomes ◽  
The Impact

Abstract IntroductionGrowth in preterm infants has long-term implications for neurodevelopmental outcomes. We aimed to estimate the nationwide growth outcomes from birth to 5 years in infants born under 1,500 g and to analyze the effects of major morbidities of preterm infants on growth.MethodsTotal 2,961 children with birth weight under 1,500 g who were born in 2013 and examined the Infant Health Check-up between 2013 and 2018 from the National Health Insurance Service database were included. Check-ups were at 4-6, 9-12, 18-24, 30-36, 42-48, and 54-60 months of age. Information was obtained by the International Classification of Diseases-10 codes or by the questionnaire in the check-up program.ResultsAt 60 months of age, mean percentiles of weight, height, and head circumference showed only 30 – 40th percentile of normal growth for their ages. About 30% had growth parameters below the 10th percentile and showed worse neurodevelopmental outcomes. Using multiple logistic regression, infants with bronchopulmonary dysplasia showed significantly higher incidence of growth restriction in all three categories, weight (odds ratio [OR] 1.50), height (OR 1.33), and head circumference (OR 1.36) at 60 months. Sepsis was associated with growth restriction in weight (OR 1.43) and head circumference (OR 1.33). Periventricular leukomalacia infants had relatively small head circumferences (OR 1.91) and poor developmental screening results (OR 2.89).ConclusionCatch-up growth remains a major issue in infants born under 1,500 g, especially those with some morbidities of preterm birth. Regular check-ups to monitor and early intervention for their normal growth is essential.

scholarly journals Lithium exposure during pregnancy increases fetal growth

2020 ◽  
pp. 026988112094091
Author(s):  
Eline MP Poels ◽  
Karin Sterrenburg ◽  
André I Wierdsma ◽  
Richard Wesseloo ◽  
Annemerle Beerthuizen ◽  
...  
Keyword(s):  
Birth Weight ◽  
Confidence Interval ◽  
Fetal Growth ◽  
Head Circumference ◽  
Growth Parameters ◽  
Abdominal Circumference ◽  
Average Increase ◽  
Femur Length ◽  
Pregnancy And Postpartum ◽  
The Impact

Background: Lithium is an effective treatment in pregnancy and postpartum for the prevention of relapse in bipolar disorder, but there is a lack of knowledge about the potential adverse impact on fetal development. Aims: To investigate the impact of lithium exposure on early fetal growth. Methods: In this retrospective observational cohort study, we included all singleton pregnancies of women using lithium and referred for advanced fetal ultrasound scanning between 1994 and 2018 to the University Medical Centers in Leiden and Rotterdam, the Netherlands ( n=119). The Generation R study, a population-based cohort, served as a non-exposed control population from the same geographic region ( n=8184). Fetal head circumference, abdominal circumference, femur length, and transcerebellar diameter were measured by ultrasound at 18–22 weeks of gestation. Results: Lithium use during pregnancy was associated with an average increase in head circumference of 1.77 mm (95% confidence interval: 0.53, 3.01), in abdominal circumference of 5.54 mm (95% confidence interval: 3.95, 7.12) and in femur length of 0.59 mm (95% confidence interval: 0.22, 0.96) at 18–22 weeks gestation. Furthermore, lithium use during pregnancy was associated with an average increase in birth weight of 142.43 grams (95% confidence interval: 58.01, 226.89), whereas it was associated with an average decrease of 1.41 weeks in gestational duration (95% confidence interval: −1.78, −1.05). Conclusions: Lithium use during pregnancy was associated with increased fetal growth parameters at 18–22 weeks gestational age and increased birth weight. Further research is needed to evaluate both short- and long-term implications, as well as the mechanisms driving this difference in growth.

scholarly journals Growth, Feeding Tolerance and Metabolism in Extreme Preterm Infants under an Exclusive Human Milk Diet

Nutrients ◽  
2019 ◽  
Vol 11 (7) ◽  
pp. 1443 ◽  
Author(s):  
Eibensteiner ◽  
Auer-Hackenberg ◽  
Jilma ◽  
Thanhaeuser ◽  
Wald ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Growth Parameters ◽  
Extremely Low Birth Weight ◽  
Multicenter Cohort Study ◽  
Protein Sources ◽  
The Impact ◽  
Feeding Tolerance

Background: For preterm infants, human milk (HM) has to be fortified to cover their enhanced nutritional requirements and establish adequate growth. Most HM fortifiers are based on bovine protein sources (BMF). An HM fortifier based on human protein sources (HMF) has become available in the last few years. The aim of this study is to investigate the impact of an HMF versus BMF on growth in extremely low birth weight (ELBW, <1000 g) infants. Methods: This was a retrospective, controlled, multicenter cohort study in infants with a birthweight below 1000 g. The HMF group received an exclusive HM diet up to 32+0 weeks of gestation and was changed to BMF afterwards. The BMF group received HM+BMF from fortifier introduction up to 37+0 weeks. Results: 192 extremely low birth weight (ELBW)-infants were included (HMF n = 96, BMF n = 96) in the study. After the introduction of fortification, growth velocity up to 32+0 weeks was significantly lower in the HMF group (16.5 g/kg/day) in comparison to the BMF group (18.9 g/kg/day, p = 0.009) whereas all other growth parameters did not differ from birth up to 37+0 weeks. Necrotizing enterocolitis (NEC) incidence was 10% in the HMF and 8% in the BMF group. Conclusion: Results from this study do not support the superiority of HFM over BMF in ELBW infants.

Postnatal Growth Restriction in Preterm Infants: A Major Impact of Nutritional Practices and Methods of Assessment

2021 ◽  
Vol 03 ◽  
Author(s):  
Atef Alshafei ◽  
Mahmoud Galal ◽  
Anwar Khan ◽  
Yaser Saba ◽  
Moustafa Hassan
Keyword(s):  
Birth Weight ◽  
Preterm Infants ◽  
Growth Parameters ◽  
Caloric Intake ◽  
Growth Failure ◽  
Postnatal Growth ◽  
Protein Supplementation ◽  
Growth Restriction ◽  
Growth Trajectories ◽  
Z Score

Background: Nutritional management of preterm infants represents a significant challenge for most practitioners caring for sick and/or premature babies. Despite aggressive parenteral and enteral alimentation, a considerable number of preterm infants continue to fall far short of expected growth trajectories that match infants of similar gestation in-utero. Postnatal growth failure may be associated with future neurodevelopmental and cognitive impairments. Objective: The aim of the research is to investigate the incidence of postnatal growth restriction (PNGR) and characteristics of nutritional practices and growth parameters in a cohort of preterm infants born <32 weeks’ gestational age (GA) in a single neonatal intensive care unit (NICU). Methodology: This prospective study included 130 preterm infants born <32 weeks’ GA and admitted to the NICU between February 2018 and January 2020. The infants were divided into two groups: A (GA 23–26+6 weeks [n=50]) and B (27–31+6 weeks [n=80]). The association between PNGR and predicting risk factors was evaluated using logistic regression models. Results: PNGR was found in 62 (47%) infants at 28 days of life and increased to 73% of infants at 36 weeks’ postmenstrual age. Low birth weight and GA were independent factors predicting growth failure. PNGR was significantly correlated with birth weight (p < 0.01), length (p < 0.002), and GA (p < 0.03) at birth; however, HC was not a predictor of PNGR at 28 days. At 36 weeks’ PMA or discharge, PNGR was more pronounced in length, with a mean Z-score of -3.0, followed by weight, with a mean Z-score of -2.1, and an HC Z-score of -1.4. Conclusion : PNGR was significantly high in preterm infants <32 weeks’ gestation. A significant nutritional gap still exists between the recommended and actual caloric and protein supplementation, especially in the first few days after birth. Delayed optimization of caloric intake may be insufficient to promote growth trajectories, especially in preterm infants with significant morbidities.

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.

Persistent pulmonary hypertension of the newborn in extremely preterm infants: a Japanese cohort study

2018 ◽  
Vol 103 (6) ◽  
pp. F554-F561 ◽  
Author(s):  
Hidehiko Nakanishi ◽  
Hideyo Suenaga ◽  
Atsushi Uchiyama ◽  
Satoshi Kusuda
Keyword(s):  
Pulmonary Hypertension ◽  
Cohort Study ◽  
Preterm Infants ◽  
Research Network ◽  
Persistent Pulmonary Hypertension ◽  
Neurodevelopmental Outcomes ◽  
Significant Independent Risk Factor ◽  
Extremely Preterm ◽  
Extremely Preterm Infants ◽  
The Impact

ObjectiveTo investigate the characteristics of persistent pulmonary hypertension of the newborn (PPHN) in extremely preterm infants and its impact on neurodevelopmental outcomes at 3 years of age.DesignA retrospective multicentre cohort study.Settings202 tertiary perinatal centres registered in the Neonatal Research Network of Japan (NRNJ).PatientsInfants born at <28 weeks of gestational age (GA), between 2003 and 2012, were extracted from tertiary perinatal centres participating in NRNJ.Main outcome measuresDemographic characteristics, morbidity, interventions and mortality were compared for infants with and without PPHN. Multivariable logistic analysis was performed to evaluate the impact of PPHN on long-term neurodevelopmental outcomes (the prevalence rate of cerebral palsy, need for home oxygen therapy, and visual, hearing and cognitive impairment) at 3 years of age.ResultsThe prevalence of PPHN among the 12 954 extremely preterm infants enrolled was 8.1% (95% CI 7.7% to 8.6%), with the trend increasing annually, and a higher proportion as GA decreased: 18.5% (range, 15.2% to 22.4%) for infants born at 22 weeks compared with 4.4% (range, 3.8% to 5.2%) for those born at 27 weeks. Clinical chorioamnionitis and premature rupture of membranes were associated with PPHN. On multivariate analysis of the data from 5923 infants followed up for 3 years, PPHN was a significant independent risk factor for visual impairment (adjusted OR, 1.42, 95% CI 1.03 to 1.97).ConclusionsThe prevalence of PPHN in extremely preterm infants has been increasing over the past decade in Japan. Clinicians should be aware of visual impairments as a neurodevelopmental abnormality among infants with PPHN.

scholarly journals Growth and nutrient intake among very-low-birth-weight infants fed fortified human milk during hospitalisation

2009 ◽  
Vol 102 (8) ◽  
pp. 1179-1186 ◽  
Author(s):  
Christine Henriksen ◽  
Ane C. Westerberg ◽  
Arild Rønnestad ◽  
Britt Nakstad ◽  
Marit B. Veierød ◽  
...  
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Human Milk ◽  
Preterm Infants ◽  
Nutrient Intake ◽  
Very Low Birth Weight ◽  
Growth Restriction ◽  
Vlbw Infants ◽  
Uterine Growth ◽  
Discharge From Hospital

Postnatal growth failure in preterm infants is due to interactions between genetic and environmental factors, which are not fully understood. We assessed dietary supply of nutrients in very-low-birth-weight (VLBW, < 1500 g) infants fed fortified human milk, and examined the association between nutrient intake, medical factors and growth during hospitalisation lasting on average 70 d. We studied 127 VLBW infants during the early neonatal period. Data were obtained from medical records on nutrient intake, growth and growth-related factors. Extra-uterine growth restriction was defined as body weight < 10th percentile of the predicted value at discharge. Using logistic regression, we evaluated nutrient intake and other relevant factors associated with extra-uterine growth restriction in the subgroup of VLBW infants with adequate weight for gestational age at birth. The proportion of growth restriction was 33 % at birth and increased to 58 % at discharge from hospital. Recommended values for energy intake (>500 kJ/kg per d) and intra-uterine growth rate (15 g/kg per d) were not met, neither in the period from birth to 28 weeks post-conceptional age (PCA), nor from 37 weeks PCA to discharge. Factors negatively associated with growth restriction were energy intake (Ptrend = 0·002), non-Caucasian ethnicity (P = 0·04) and weight/predicted birth weight at birth (Ptrend = 0·004). Extra-uterine growth restriction is common in VLBW infants fed primarily fortified human milk. Currently recommended energy and nutrient intake for growing preterm infants was not achieved. Reduced energy supply and non-Caucasian ethnicity were risk factors for growth restriction at discharge from hospital.

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