Fetal Size Classified Using Gestational Days rather than Gestational Weeks Improves Correlation with Stillbirth Risk: A Statewide Population Study.

Objective: Many growth charts provide single centile cutoffs for each week of gestation, yet fetuses gain weight throughout the week. We aimed to assess whether using a single centile per week distorts the proportion of infants classified as small and their risk of stillbirth across the week. Design: Retrospective cohort study. Setting: Victoria, Australia. Population: Singleton, non-anomalous infants born from 2005-2015 (529,261). Methods: We applied growth charts to identify small-for-gestational-age (SGA) fetuses on week-based charts (single centile per gestational week) and day-based charts (centile per gestational day). Main outcome measures: Proportions <10th centile by each chart, and stillbirth risk amongst SGA infants. Results: Using week-based charts, 12.1% of infants born on the first day of a gestational week were SGA, but only 7.8% on the final day; ie. an infant born at the end of the week was 44% less likely to be classed as SGA (p<0.0001). The relative risk of stillbirth amongst SGA infants born on the final day of the week compared with the first was 1.47 (95%CI 1.09-2.00, p=0.01). Using day charts, SGA proportions were similar and stillbirth risk equal between the beginning and end of the week (9.5% vs 9.9%). Conclusions: Growth standards using a single cutoff for a gestational week overestimate the proportion of infants that are small at the beginning of the week and underestimate the proportion at the end. This distorts the risk of stillbirth amongst SGA infants based on when in the week an infant is born. Day-based charts should be used

Smoking influence on early and late fetal growth

Objectives Smoking during pregnancy is a leading and modifiable risk factor for fetal growth restriction (FGR) and low birthweight (<10th centile). We studied the effects of smoking in the development of early and late FGR or low birthweight, as well as in uteroplacental and fetoplacental hemodynamics of growth-restricted fetuses. Methods Retrospective cohort study of 5,537 consecutive singleton pregnancies delivered at ≤34 + 0 (“early delivery” group, n=95) and >34 + 0 (“late delivery” group, n=5,442) weeks of gestation. Each group was divided into smokers and non-smokers. Prenatal diagnosis of FGR was based on customized fetal growth standards and fetal Doppler, and postnatal birthweight was assessed using the Olsen newborn chart. Results There were 15/95 (15.8%) and 602/5,442 (11.1%) smokers in the early and late delivery groups, respectively. In early deliveries, FGR was diagnosed in 3/15 (20%) of smokers and in 20/80 (25%) of non-smokers (p=0.68). We also found no differences in birthweights and hemodynamics. In late deliveres, FGR was detected in 30/602 (5%) smokers and 64/4,840 (1.3%) non-smokers (p<0.001). Birthweights <3rd centile and <10th centile were more common in smokers vs. non-smokers: 38/602 (6.3%) vs. 87/4,840 (1.8%) and 89/602 (14.8%) vs. 288/4,840 (6%), respectively (all p<0.01). Fetal Doppler of late FGR showed slightly higher umbilical artery resistances in smokers. Conclusions Smoking in pregnancy is associated with FGR, low birthweight and higher umbilical artery Doppler resistances after 34 weeks of gestation, but we could not confirm this association in earlier deliveries.

Penyuluhan Kesehatan Cegah Stunting dengan Perbaikan Pola Makan, Pola Asuh Dan Sanitasi pada Ibu Hamil di UPT Puskesmas Antang

: Stunting is a chronic malnutrition problem caused by lack of nutritional intake for a long time, resulting in growth disorders in children, namely the child's height is lower or shorter (short) than the standard age. The condition of a child's short body is often said to be a hereditary factor (genetic) from both parents, so that many people just accept it without doing anything to prevent it. In fact, as we all know, genetics is a determinant of health that has the least effect when compared to behavioral, environmental (social, economic, cultural, political) factors and health services. In other words, stunting is a preventable problem. Stunting is a growth failure problem experienced by infants under 5 years of age who are malnourished since in the womb until the baby is born. Assessment of stunting nutritional status can be done through anthropometric measurements of TB/U classified through nutritional classification status. Stunting is a condition where the child's height is shorter than the height of children his age. According to UNICEF, stunting occurs in children aged 0 to 59 months with a height below minus (moderate and severe stunting) and minus three (chronic stunting) measured from the WHO child growth standards. In Indonesia, stunting is still a health problem in quite a large number. Based on the 2013 Basic Health Research, around 37.2 percent of Indonesian children under the age of 5 are stunted.

Adjusting growth standards for fetal sex improves correlation of small babies with stillbirth and adverse perinatal outcomes: A state-wide population study

Objective: Identify the proportion of infants reclassified if sex-specific birthweight charts were used, and if this reclassification has an impact on the correlation between birthweight centile and adverse perinatal outcome. Design: Retrospective cohort study Setting: Victoria, Australia. Population: All infants born from 2005-2015 (529,261) Methods: We applied GROW centiles, either adjusted or unadjusted for fetal sex. We compared proportions of small for gestational age (SGA, <10th centile) infants, then the populations of males considered small only by sex-specific charts and females considered small only by unadjusted charts. Main Outcome Measures: Stillbirth, combined perinatal mortality, NICU admissions, Apgars <7 at 5 minutes, emergency caesarean sections. Results: Of those <10th centile by unadjusted charts, 39.6% were male, and 60.5% female. Using sex-specific charts, 50.3% <10th centile were male and 49.7% female. 9,449 (19.2%) females that were SGA according to unadjusted charts were appropriate for gestational age (AGA,>10th-<90th centile) using sex-specific charts. These reclassified newborn females were not at increased risk of adverse outcomes compared with an AGA infant, but were at increased risk of being iatrogenically delivered for suspected growth restriction (RR 4.90, 95%CI 4.39–5.48). 8,048 male infants were reclassified as SGA by sex-specific charts (25% SGA increase). Compared with AGA infants, these reclassified male newborns were at greater risk of stillbirth (RR 1.94, 95%CI 1.30-2.90) and all other adverse perinatal outcomes. Conclusions: Sex-specific growth standards classify a new high-risk cohort of male infants as SGA, and exclude a cohort of females, whose risk is no greater than appropriately grown infants.

Marasmus and stunting in 2-month-old boy with pneumatocele

BackgroundNutrition is essential for humans and if inadequate may lead to undernutrition. Undernourished children are very susceptible to infections, such as pneumonia, one of its complications being pneumatocele, which is a more severe condition. Pulmonary pneumatoceles are thin-walled, air-filled cysts that develop within the lung parenchyma and have been found in 2.4 percent of 493 infants and children with pneumonia. However, in staphylococcal pneumonias, the frequency of pneumatocele can reach as high as 85 percent. Infants and young children are more likely to have pneumatoceles. It is critical to distinguish marasmus with pneumatocele from many other similar diagnoses. Failure to recognize can lead to incorrect diagnosis and treatment, causing more harm than good to patient care. This case highlights the importance of maintaining a high suspicion of pneumonia in neonates even with normal radiological findings and of searching for pneumatoceles. Case DescriptionWe report a case of marasmus and stunting accompanied by pneumatocele in a 2-month-old boy. The diagnosis was made based on history, physical examination, anthropometric examination using the WHO child growth standards, laboratory tests, and radiological imaging. Management of the patient was according to a multidisciplinary system including antibiotics administration and wasting management. ConclusionPneumatoceles are serious complications after pneumonia. Pneumonia is common in children with marasmus. Children with marasmus are caused by various underlying factors. The progression begins in the womb and continues through the first 1000 days of life.