Perinatal Adverse Effects in Newborns with Estimated Loss of Weight Percentile between the Third Trimester Ultrasound and Delivery. The GROWIN Study

Fetal growth restriction has been associated with an increased risk of adverse perinatal outcomes (APOs). We determined the importance of fetal growth detention (FGD) in late gestation for the occurrence of APOs in small-for-gestational-age (SGA) and appropriate-for-gestational-age (AGA) newborns. For this purpose, we analyzed a retrospective cohort study of 1067 singleton pregnancies. The newborns with higher APOs were SGA non-FGD and SGA FGD in 40.9% and 31.5% of cases, respectively, and we found an association between SGA non-FGD and any APO (OR 2.61; 95% CI: 1.35–4.99; p = 0.004). We did not find an increased APO risk in AGA FGD newborns (OR: 1.13, 95% CI: 0.80, 1.59; p = 0.483), except for cesarean delivery for non-reassuring fetal status (NRFS) with a decrease in percentile cutoff greater than 40 (RR: 2.41, 95% CI: 1.11–5.21) and 50 (RR: 2.93, 95% CI: 1.14–7.54). Conclusions: Newborns with the highest probability of APOs are SGA non-FGDs. AGA FGD newborns do not have a higher incidence of APOs than AGA non-FGDs, although with falls in percentile cutoff over 40, they have an increased risk of cesarean section due to NRFS. Further studies are warranted to detect these newborns who would benefit from close surveillance in late gestation and at delivery.

Clinical Implications of Second and Third Trimester Surveillance Ultrasounds of Growth-Restricted Fetuses

Objective We sought to investigate the positive predictive value of ultrasound-diagnosed fetal growth restriction (FGR) for estimating small for gestational age (SGA) at birth. Secondary objectives were to describe clinical interventions performed as a result of FGR diagnosis. Study Design This was a retrospective cohort of pregnancies diagnosed with FGR over 3 years at a single institution. Maternal demographics, antenatal and delivery data, and neonatal data were collected. Descriptive statistics and linear regression were conducted. Results We included 406 pregnancies with diagnosis of FGR in second or third trimester. Median birth weight percentile was 17 (interquartile range: 5–50) and only 35.0% of these fetuses were SGA at birth. The positive predictive value of a final growth ultrasound below the 10th percentile for SGA at birth was 56.9%. Patients averaged eight additional growth ultrasounds following FGR diagnosis. One hundred and fourteen (28.1%) received antenatal steroids prior to delivery, and 100% of those delivered after more than 7 days following administration. There were 6 fetal deaths and 14 neonatal deaths. Conclusion In the majority of cases, pregnancies diagnosed with FGR during screening ultrasounds resulted in normally grown neonates and term deliveries. These patients may be receiving unnecessary ultrasounds and premature courses of corticosteroids.

Assessment of pregnancy dietary intake and association with maternal and neonatal outcomes

Background Maternal dietary habits are contributors of maternal and fetal health; however, available data are heterogeneous and not conclusive. Methods Nutrient intake during pregnancy was assessed in 503 women with uncomplicated pregnancies, using the validated Food Frequency Questionnaire developed by the European Prospective Investigation into Cancer and Nutrition (EPIC-FFQ). Results In all, 68% of women had a normal body mass index at the beginning of pregnancy, and 83% of newborns had an appropriate weight for gestational age. Maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and placental weight were independently correlated with birth weight. GWG was not related to the pre-pregnancy BMI. EPIC-FFQ evaluation showed that 30% of women adhered to the European Food Safety Authority (EFSA) ranges for macronutrient intake. In most pregnant women (98.1%), consumption of water was below recommendations. Comparing women with intakes within EFSA ranges for macronutrients with those who did not, no differences were found in BMI, GWG, and neonatal or placental weight. Neither maternal nor neonatal parameters were associated with the maternal dietary profiles. Conclusions In our population, maternal pre-pregnancy BMI, GWG, and placental weight are determinants of birth weight percentile, while no association was found with maternal nutrition. Future studies should explore associations through all infancy. Impact Maternal anthropometrics and nutrition status may affect offspring birth weight. In 503 healthy women, maternal pre-pregnancy body mass index (BMI), gestational weight gain (GWG), and placental weight were independently correlated to neonatal birth weight. GWG was not related to the pre-pregnancy BMI. In all, 30% of women respected the EFSA ranges for macronutrients. Neither maternal nor neonatal parameters were associated with maternal dietary profiles considered in this study. Maternal pre-pregnancy BMI, GWG, and placental weight are determinants of neonatal birth weight percentile, while a connection with maternal nutrition profiles was not found.

Analysis of the Characteristics of Environmental Impacts According to the Cut-Off Criteria Applicable to the Streamlined Life Cycle Assessment (S-LCA) of Apartment Buildings in South Korea

This study analyzed the characteristics of the environmental impacts of apartment buildings, a typical housing type in South Korea, as part of a research project supporting the streamlined life cycle assessment (S-LCA) of buildings within the G-SEED (Green Standard for Energy and Environmental Design) framework. Three recently built apartment building complexes were chosen as study objects for the quantitative evaluation of the buildings in terms of their embodied environmental impacts (global warming potential, acidification potential, eutrophication potential, ozone layer depletion potential, photochemical oxidant creation potential, and abiotic depletion potential), using the LCA approach. Additionally, we analyzed the emission trends according to the cut-off criteria of the six environmental impact categories by performing an S-LCA with cut-off criteria 90–99% of the cumulative weight percentile. Consequently, we were able to present the cut-off criterion best suited for S-LCA and analyze the effect of the cut-off criteria on the environmental impact analysis results. A comprehensive environmental impact analysis of the characteristics of the six environmental impact categories revealed that the error rate was below 5% when the cut-off criterion of 97.5% of the cumulative weight percentile was applied, thus verifying its validity as the optimal cut-off criterion for S-LCA.

Factors Associated with Failure of Pneumatic Reduction in Children with Ileocolic Intussusception

Intussusception is one of the most common causes of intestinal obstruction in children. Pneumatic reduction is the treatment of choice and has a high success rate. The most common cause of pneumatic reduction failure is the presence of a pathological leading point. We aimed to identify other factors that can lead to pneumatic reduction failure in children with ileocolic intussusception. This was a retrospective study conducted in two centers. Data were collected from January 2013 to December 2014. A total of 156 patients were diagnosed with intussusception and underwent pneumatic reduction, with the exception of one patient with peritonitis. We included patients with ileocolic-type intussusception without apparent pathological leading points. Logistic regression analysis of clinical parameters was performed to identify factors associated with pneumatic reduction failure. Of 156 patients diagnosed with intussusception in both hospitals, 145 were enrolled in the study. The overall efficacy of pneumatic reduction was 85.7%, and surgical reduction was performed in 21 patients. Univariate analysis showed that a high segmented neutrophil count, low hemoglobin level, high body temperature, and higher weight percentile were associated with pneumatic reduction failure. Multivariate analysis showed that a high segmented neutrophil count, low hemoglobin level, and higher weight percentile were significantly associated with pneumatic reduction failure. Pneumatic reduction is safe and effective as a first-line treatment for pediatric intussusception. However, a high segmented neutrophil count, low hemoglobin level, and higher weight percentile are associated with the failure of this treatment.

Behcet Uz Cocuk Hast Derg. 2021; 11(2): 174-180 | DOI: 10.5222/buchd.2021.60320 Does Prophylaxis Against Respiratory Syncytial Virus Infection Affect the Weight Percentiles of Infants with Hemodynamically Significant Congenital Heart Disease?

Objective: The risk of severe respiratory syncytial virus (RSV) infection with significant morbidity and mortality is greatest in patients with hemodynamically significant congenital heart disease (hs-CHD). The humanized monoclonal antibody, palivizumab, was used as prophylaxis for RSV infection in children <24 months of age suffering from hs-CHD. We performed this study to evaluate the effects of RSV prophylaxis with palivizumab on the weight percentiles of infants with hs-CHD. Methods: During the RSV seasons between 2013 and 2017, children <24 months of age with hs-CHD who received ≥3 doses of palivizumab prophylaxis were included in this study. All patients were evaluated according to their weight percentiles examined at birth, at the first, and the last dose of palivizumab prophylaxis. The third percentile was accepted as the cut-off value of the lower weight percentile, and values below the 25th percentile were accepted as poorly controlled hs-CHD. Results: Sixty-one infants aged between 10 days and 15 months were included in the study. The infants received the first dose of palivizumab at the age of 5 months, and all infants received 4.56±0.78 injections on an average. The number of patients weighing lower than the 25th percentile at the first, and the last dose of palivizumab were 36 (59 %) and 29 (47.5 %), respectively. A statistically significant difference was found between weight percentiles of infants at the first and the last dose of palivizumab (p<0.05). Discussion and conclusion: RSV prophylaxis with palivizumab affects weight percentiles positively, and it may help to reduce the hospitalization rate due to RSV infections in infants with hs-CHD.

Association between Age, Weight, and Dose and Clinical Response to Probiotics in Children with Acute Gastroenteritis

ABSTRACT Background Gastroenteritis is a common and impactful disease in childhood. Probiotics are often used to treat acute gastroenteritis (AGE); however, in a large multicenter randomized controlled trial (RCT) in 971 children, Lactobacillus rhamnosus GG (LGG) was no better than placebo in improving patient outcomes. Objectives We sought to determine whether the effect of LGG is associated with age, weight z score and weight percentile adjusted for age and sex, or dose per kilogram administered. Methods This was a preplanned secondary analysis of a multicenter double-blind RCT of LGG 1 × 1010 CFU twice daily for 5 d or placebo in children 3–48 mo of age with AGE. Our primary outcome was moderate to severe gastroenteritis. Secondary outcomes included diarrhea and vomiting frequency and duration, chronic diarrhea, and side effects. We used multivariable linear and nonlinear models testing for interaction effects to assess outcomes by age, weight z score and weight percentile adjusted for age and sex, and dose per kilogram of LGG received. Results A total of 813 children (84%) were included in the analysis; 413 received placebo and 400 LGG. Baseline characteristics were similar between treatment groups. There were no differential interaction effects across ranges of age (P-interaction = 0.32), adjusted weight z score (P-interaction = 0.43), adjusted weight percentile (P-interaction = 0.45), or dose per kilogram of LGG received (P-interaction = 0.28) for the primary outcome. Whereas we found a statistical association favoring placebo at the extremes of adjusted weight z scores for the number of vomiting episodes (P-interaction = 0.02) and vomiting duration (P-interaction = 0.0475), there were no statistically significant differences in other secondary outcome measures (all P-interactions &gt; 0.05). Conclusions LGG does not improve outcomes in children with AGE regardless of the age, adjusted weight z score, and adjusted weight percentile of participants, or the probiotic dose per kilogram received. These results further strengthen the conclusions of low risk of bias clinical trials which demonstrate that LGG provides no clinical benefit in children with AGE. This trial was registered at clinicaltrials.gov as NCT01773967.

Biological Maturity Status, Anthropometric Percentiles, and Core Flexion to Extension Strength Ratio as Possible Traumatic and Overuse Injury Risk Factors in Youth Alpine Ski Racers: A Four-Year Prospective Study

The aim of the present study was to investigate prospectively the role of biological maturity status, anthropometric percentiles, and core flexion to extension strength ratios in the context of traumatic and overuse injury risk identification in youth ski racing. In this study, 72 elite youth ski racers (45 males, 27 females) were prospectively observed from the age of 10 to 14 years. Anthropometric parameters, biological maturity status, and core flexion to extension strength ratios were assessed twice per year. Type and severity of traumatic and overuse injuries were prospectively recorded during the 4 years. Generalized estimating equations were used to model the binary outcome (0: no injury; 1: ≥1 injury). Factors tested on association with injury risk were sex, relative age quarter, age, maturity group, puberty status, core flexion to extension strength ratio, height percentile group, and weight percentile group. In total, 104 traumatic injuries and 39 overuse injuries were recorded. Age (odds ratio (OR) = 3.36) and weight percentile group (OR = 0.38) were significant risk factors for traumatic injuries (tendency: pubertal status). No significant risk factor for overuse injuries was identified (tendency: maturity group, puberty status, height percentile group). Future studies should focus on identifying risk factors for overuse injuries; growth rates might be of importance.