Low length/weight growth trajectories of early-term infants during the first year: evidence from a longitudinal study in China

ObjectiveTo identify common length, weight and body mass index (BMI) growth trajectories of term infants during infancy, and to determine their association with early-term infants.DesignProspective longitudinal study.SettingWuhan, China.PatientsA total of 4308 term infants (born at 37–41 weeks of gestation) were included. All term infants were single live birth with no defects and birth weight ≥2500 g, and their mothers were permanent residents of Wuhan for more than 2 years. After excluding 887 infants, a total of 3421 term infants (1028 early-term infants born at 37–38 weeks of gestation and 2393 full-term infants born at 39–41 weeks of gestation) entered the statistical analysis stage.Main outcome measuresPatterns of length, weight and BMI growth trajectories by using group-based trajectory modelling.ResultsThree distinct physical growth trajectories were identified as follows: length: low stable (1056, 30.9%), moderate stable (1887, 55.2%) and high increasing (477, 13.9%); weight: low stable (1031, 30.1%), moderate stable (1884, 55.1%) and high increasing (505, 14.8%); BMI: low stable (689, 20.1%), moderate stable (2167, 63.4%) and high increasing (564, 16.5%). Compared with the full-term infants, early-term infants were more likely to remain at low-stable trajectory in length (OR: 1.40; 95% CI: 1.19 to 1.66) and weight (OR:1.29; 95% CI: 1.09 to 1.53). These associations were still statistically significant after adjusting potential confounders and were more evident among girls in the stratified analysis. There was no statistical association between BMI trajectory patterns and gestational age categories.ConclusionOur results suggested the heterogeneity of term infants existed in length, weight and BMI growth trajectories of early childhood. Compared with full-term birth, early-term birth was related to low length and weight trajectories rather than BMI trajectory. Further research is needed to evaluate the duration of these low trajectories and their possible long-term health effects.

Early-term birth and its association with universal two-child policy: a national cross-sectional study in China

ObjectiveTo describe the epidemiology of early-term birth (ETB) at the national level in China, and explore the association and mediating factors between ETB and policy between universal two-child policy and ETB, so as to explain the potential reason for such a relationship and provide evidence for future ETB interventions in the era of the new birth control policy.DesignCross-sectional study.ParticipantsThe cross-sectional study used data from China Labour and Delivery Survey between 2015 and 2016. A total of 75 132 survey data collected from 89 hospitals in 25 provinces were included in the analysis. We further explored the association between the universal two-child policy and ETB.ResultsThe weighted incidence of ETB was 30.1 per 100 all births (95% CI 30.06% to 30.14%) or 29.88 per 100 live births (95% CI 29.97% to 30.05%) between 2015 and 2016 in China. There was an association between the universal two-child policy and ETB (relative risk, RR 1.19, 95% CI 1.15 to 1.23), which was not mediated by maternal age (RR 1.17, 95% CI 1.13 to 1.22), previous uterine scars (RR 1.18, 95% CI 1.14 to 1.22), parity (RR 1.19, 95% CI 1.15 to 1.24) and other measured conditions (each p<0.05). Stratified analysis showed that the association between universal two-child policy and ETB were the strongest in multiparous young women or women without previous uterine scars (each p<0.05), and disappeared in all women of advanced maternal age (each p>0.05).ConclusionThe incidence of ETB was high in China when compared with most of reported countries, and there might be a link between two-child policy and ETB. Obstetric practice such as selective induced labour and caesarean section should be revised with ETB risks in mind, when ETB is more likely to happen under the universal two-child policy. Preventing ETB should not be neglected in multiparous young women or those without previous uterine scars under the new policy.

Flavivirus replication kinetics in early-term placental cell lines with different differentiation pathways

Background The uncontrollable spread of Zika virus (ZIKV) in the Americas during 2015–2017, and its causal link to microcephaly in newborns and Guillain-Barré syndrome in adults, led the World Health Organisation to declare it a global public health emergency. One of the most notable features of ZIKV pathogenesis was the ability of the virus to pass the placental barrier to infect the growing foetus. This pathogenic trait had not been observed previously for medically important flaviviruses, including dengue and yellow fever viruses. Methods In this study we evaluated the replication kinetics of ZIKV and the related encephalitic flavivirus West Nile strain Kunjin virus (WNVKUN) in early-term placental cell lines. Results We have observed that WNVKUN in fact replicates with a greater rate and to higher titres that ZIKV in these cell lines. Conclusions These results would indicate the potential for all flaviviruses to replicate in placental tissue but it is the ability to cross the placenta itself that is the restrictive factor in the clinical progression and presentation of congenital Zika syndrome.

Short Term Outcomes of Early Term Neonates in a Tertiary Care Centre: A Descriptive Study

Introduction: The number of babies delivered between 37 weeks to 38 weeks and 6 days has been on the rise with increase in lower segment caesarian section (LSCS). These early term neonates have increased risk of developing respiratory distress syndrome, neonatal hyperbilirubinemia, transient tachypnoea, prolonged hospital stays, hypothermia, and feeding difficulty, when compared to a term neonate. An audit of early term neonatal short-term outcomes was undertaken at our institute. Methodology: A retrospective descriptive cross- sectional study was carried out between July 2020 and December 2020 at a private medical college Neonatal Intensive Care Unit. Neonates with a gestation age of 37 weeks and 0 days to 38 weeks and 6 days born were included. Results: A total of 137 early term delivery data were obtained. Hypothyroidism (23%) and gestational diabetes (23%) were found to be the most common associated antenatal problems. The most common morbidity out of 137 early term neonates was neonatal jaundice 91(66.4%) followed by respiratory distress which affected 38 (28%) neonates. Conclusion: This study establishes the high incidence of neonatal jaundice and respiratory morbidities in early term neonates. Hence it is better to avoid elective LSCS before 39 weeks of gestation provided there are no medical indications for the same.