Journal articles on the topic 'Gestational Age Infants'
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1
Owens, Rebecca. "Intraventricular Hemorrhage in the Premature Neonate." Neonatal Network 24, no. 3 (May 2005): 55–71. http://dx.doi.org/10.1891/0730-0832.24.3.55.
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THE MOST COMMON VARIETY of neonatal intracranial hemorrhage is an intraventricular hemorrhage (IVH).1 Although much research has been conducted concerning the etiology and prevention of IVH in the preterm infant, the problem continues to plague very low birth weight (VLBW) infants (<1,500 grams) in particular. The risk of IVH correlates inversely with gestational age. The incidence of hemorrhage in the infant <28 weeks gestation is three times that of infants 28–31 weeks gestational age. The incidence of severe hemorrhage in infants <28 weeks gestational age is twice that of infants 28–31 weeks gestational age.2
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Hodgman, Joan E., Paul Y. K. Wu, Nathaniel B. White, and Dolores A. Bryla. "Comparison of Phototherapy Results in Small-for-Gestational-Age and Appropriate-for-Gestational-Age Infants Weighing Less Than 2,000 Grams." Pediatrics 75, no. 2 (February 1, 1985): 413–41. http://dx.doi.org/10.1542/peds.75.2.413.
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The infant who is small for gestational age (SGA) is more mature at birth than similar weight infants who are appropriate for gestational age (AGA). Whether the SGA infant behaves as does the larger gestationally equivalent infant, or whether there are specific changes related to intrauterine growth retardation is a matter of some interest in the understanding of the special needs of these infants. The National Institute of Child Health and Human Development (NICHD) phototherapy study provided a large newborn population for whom birth weight, gestational age at birth, and, thereby, intrauterine growth were carefully assessed. Infants who weighed 2,000 g or more at birth were included in the study only when they became jaundiced, whereas infants who weighed less than 2,000 g at birth were routinely entered into the study. Consequently, this report will be limited to the lowbirth-weight population selected by birth weight. Too few SGA babies were present in the groups with greater birth weight to allow meaningful comparisons. PATIENT SELECTIQN All infants whose birth weight was less than 2,000 g were entered into the study at 24 ± 12 hours. Those excluded from the study were: (1) infants who died before 24 hours, (2) infants with serious congenital defects, and (3) infants whose mothers refused consent for study. The study population consisted of 922 infants surviving at 24 hours. Gestational age was calculated from the first day of the last menstrual period obtained from maternal history and also by the evaluation techniques of Dubowitz.25 Intrauterine growth was determined by plotting birth weight and gestational age on the Denver Intrauterine Growth Curves8; infants below the 10th percentile were considered SGA.
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Berk, Michael A., Francis Mimouni, Menachem Miodovnik, Vicki Hertzberg, and Jennifer Valuck. "Macrosomia in Infants of Insulin-Dependent Diabetic Mothers." Pediatrics 83, no. 6 (June 1, 1989): 1029–34. http://dx.doi.org/10.1542/peds.83.6.1029.
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The purpose of the present study was to evaluate factors affecting the rate of macrosomia and related complications in a population of infants of insulin-dependent diabetic mothers. The following factors were hypothesized to be predisposing to macrosomia: increased maternal weight gain during gestation, increased number of births until infant No. 3, white race, increased maternal age, poor glycemic control from the 20th week of gestation, and increased insulin dose. Advance White classification and increased duration of diabetes were predicted to be inversely related. In addition, macrosomia was hypothesized to predispose to selected adverse perinatal outcomes including premature labor, birth asphyxia, birth injury, hypoglycemia, polycythemia, and respiratory distress syndrome. From 1978 to 1986, 127 pregnancies were prospectively studied, 86 of the total number of women were entered prior to 10 weeks' gestation, and 41 were entered after 10 weeks' gestation. Patients monitored blood glucose at least twice daily with glycemic control achieved by "split-dosage" regimens of insulin. Glycohemoglobin was measured monthly. Pregnancy dating was based on the date of the last menstrual period and the Ballard score of the infant at birth. Macrosomia was defined as a birth weight greater than the 90th percentile of the intrauterine growth curves of Lubchenco. Of the babies born to mothers with insulin-dependent diabetes, 43% were large for gestational age and 57% were appropriate for gestational age. Maternal factors predisposing to an infant being large for gestational age included glycohemoglobin measurement at the time of delivery (large for gestational age = 8.4% ± 0.3%, appropriate for gestational age = 7.6% ± 0.2%, P < .05, normal = 5.5% to 8.5%), reflecting poorer glycemic control during the third trimester, weight gain in the third trimester, and advanced White classification by univariate analysis compared to mothers of babies with birth weights appropriate for gestational age. However, only glycohemoglobin at the time of delivery was significant when these variables were subjected to multiple logistical regression. Macrosomic infants had higher rates of both polycythemia (large for gestational age = 23.6%, appropriate for gestational age = 6.9%, P < .008) and hyperbilirubinemia (large for gestational age = 29.6%, appropriate for gestational age = 12.7%, P < .02) than nonmacrosomic infants but did not differ in other perinatal outcomes. The data suggest that, in spite of improvements in glycemic control in the recent past, macrosomia still exists at an increased rate in infants of diabetic mothers and is significantly related to poorer glycemic control in the third trimester. In addition, large for gestational age infants are at an increased risk for both polycythemia and hyperbilirubinemia.
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Fitzpatrick, Emer. "Small for Gestational Age Infants: Reading Their Future." Central European Journal of Paediatrics 16, no. 1 (March 1, 2020): 96–97. http://dx.doi.org/10.5457/p2005-114.263.
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Yudin, Mark H., Elizabeth V. Asztalos, Ann Jefferies, and Jon F. R. Barrett. "The Management and Outcome of Higher Order Multifetal Pregnancies: Obstetric, Neonatal and Follow-up Data." Twin Research 4, no. 1 (February 1, 2001): 4–11. http://dx.doi.org/10.1375/twin.4.1.4.
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AbstractThe objective of this study was to describe current obstetric, neonatal, and long-term neurodevelopmental outcomes of higher order multifetal gestations (≥ 3 fetuses) in the 1990s. We also intended to identify a target gestational age at which neonatal and neurodevelopmental morbidities are low. Records from all multifetal pregnancies (≥ 3 viable fetuses ≥ 20 weeks gestation) delivered at the two perinatal centers in Toronto, Ontario, Canada during the study period (January 1, 1990–December 31, 1996) were reviewed. Data were collected on obstetric, neonatal, and long-term neurodevelopmental outcomes. Follow up data were gathered regarding the presence of a severe deficit in four categories (vision, hearing, cognition, and motor skills). Statistical analysis was performed to determine a gestational age at which a significant decrease in deficit occurred. During the study period 165 multifetal pregnancies were delivered. This resulted in 511 fetuses, of which 496 were live births. Of these 496 infants, 453 survived to discharge. Follow up data were obtained on 332 (73.3 per cent) infants. Infant survival increased with gestational age, and was approximately 90 per cent or greater at 26 weeks or more. Of all infants followed, the proportion of those without deficit increased with increasing gestational age, such that the per cent without deficit was 96.9 at 31 weeks or greater. Of all infants followed, 301 (90.7 per cent) had no deficit. Statistical analysis revealed a significant difference in long-term neurodevelopmental outcome between infants born before and after 28 weeks gestation. The incidence of a major deficit was 44.1 per cent for those born earlier than and 5.4 per cent for those born later than this gestational age (p = 0.001). In our cohort, survival figures were high. Even in lower gestational groupings, survival was high, but not without serious concerns about severe morbidity. This information is useful when counseling parents of higher order multifetal pregnancies.
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Aris, Izzuddin M., Mihir Gandhi, Yin Bun Cheung, Shu E. Soh, Mya Thway Tint, Peter D. Gluckman, Yung Seng Lee, Fabian KP Yap, and Yap Seng Chong. "A New Population-based Reference for Gestational Age-specific Size-at-birth of Singapore Infants." Annals of the Academy of Medicine, Singapore 43, no. 9 (September 15, 2014): 439–47. http://dx.doi.org/10.47102/annals-acadmedsg.v43n9p439.
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Introduction: There is currently a lack of representative data for local gestational age-specific size-at-birth percentile charts. Existing charts also suffer from limitations relating to the measurement of gestational age (GA) and an outdated population. We aim to construct reference values and charts for size-at-birth from 35 to 41 weeks, based on the healthy local population. Materials and Methods: Prospective observational birth cohort study which recruited pregnant mothers from the 2 major public hospitals with obstetric service in Singapore, at <14 weeks gestation and data was collected for birth weight, length and head circumference of infants born from November 2009 to May 2011. Percentile curves were created separately for male and female infants using the lambda-mu-sigma (LMS) method. The new percentile curves were then compared with other internationally published growth charts. Results: Smoothened curves for birth weight, length and head circumference centiles were created from 863 infants (460 males, 403 females). Male infants consistently exceeded female infants in all 3 variables at each GA. For a male and female Singapore infant at 38 weeks gestation, the 10-50-90th centile values for weight would be 2663-3096-3597 vs. 2571-2966-3417 grams, for length 46.4-48.6-51.1 vs. 45.6-48.0-50.4 cm, and for head circumference 32.0-33.5-35.2 vs. 31.4-32.9-34.6 cm. There was no statistically significant difference between ethnic groups. On comparing our birth weight curves with data from Finland across all gestations, birth weights in our term infants (GA ≥37 weeks) were found to be lower across the 10-50-90th percentiles. Conclusion: The new centile charts in this study may be used as reference charts for size-at-birth for a subgroup of near-term and term infants. The use of foreign charts may lead to misclassification of small for gestational age (SGA) or large for gestational age (LGA) infants. Key words: Birth head circumference, Birth length, Birth weight
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Quinn, Mary K., Emily R. Smith, Paige L. Williams, Willy Urassa, Joy Shi, Gernard Msamanga, Wafaie W. Fawzi, and Christopher R. Sudfeld. "The Effect of Maternal Multiple Micronutrient Supplementation on Female Early Infant Mortality Is Fully Mediated by Increased Gestation Duration and Intrauterine Growth." Journal of Nutrition 150, no. 2 (October 12, 2019): 356–63. http://dx.doi.org/10.1093/jn/nxz246.
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ABSTRACT Background Maternal micronutrient supplementation in pregnancy (MMS) has been shown to improve birth weight among infants in low- and middle-income countries. Recent evidence suggests that the survival benefits of MMS are greater for female infants compared to male infants, but the mechanisms leading to differential effects remain unclear. Objective The objective of this study was to examine the potential mechanisms through which MMS acts on infant mortality among Tanzanian infants. Methods We used data collected from pregnant women and newborns in a randomized, double-blind, placebo-controlled trial of MMS conducted in Tanzania to examine mediators of the effect of MMS on 6-wk infant mortality (NCT00197548). Causal mediation analyses with the counterfactual approach were conducted to assess the contributions of MMS on survival via their effects on birth weight, gestational age, weight-for-gestational age, and the joint effect of gestational age and weight-for-gestational age. The weighting method allowed for interaction between gestational age and weight-for-gestational age. Results Among 7486 newborns, the effect of MMS on 6-wk survival was fully mediated (100%) through the joint effect of gestational age and weight-for-gestational age. MMS was also found to have a significant natural indirect effect through increased birth weight (P-value < 0.001) that explained 75% of the total effect on 6-wk mortality. When analyses were stratified by sex, changes in gestational age and weight-for-gestational age fully mediated the mortality effect among female infants (n = 3570), but these mediators only explained 34% of the effect among males (n = 3833). Conclusions The potential sex-specific effects of MMS on mortality may be a result of differences in mechanisms related to birth outcomes. In the context of the Tanzanian trial, the observed effect of MMS on 6-wk mortality for female infants was entirely mediated by increased gestation duration and improved intrauterine growth, while these mechanisms did not appear to be major contributors among male infants.
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Wilson Jones, Martha, Elaine Morgan, and Jean Shelton. "Dysphagia and Oral Feeding Problems in the Premature Infant." Neonatal Network 21, no. 2 (March 2002): 51–57. http://dx.doi.org/10.1891/0730-0832.21.2.51.
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FEEDING DISORDERS AND dysphagia are common problems seen in premature infants following their discharge from the NICU. A major factor in the growing incidence of these problems is the number of infants born and surviving between 23 and 25 weeks gestational age, which has increased dramatically over the past decade. These infants experience both a lengthier exposure to noxious oral stimuli and a longer time until they develop the suck/swallow coordination that makes oral feeding safe.1 Oral feeding is generally not offered before 32–34 weeks gestational age, when the preterm infant’s sucking pattern begins to resemble that of a term infant.2,3 Therefore, there may be an 8- to 9-week lag between birth and oral feedings in a 23- or 24-week gestational age infant.
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Thuot, Meggie, Marc-André Coursol, Sonia Nguyen, Vanessa Lacasse-Guay, Marie-France Beauchesne, Anne Fillion, Amélie Forget, Fatima-Zohra Kettani, and Lucie Blais. "Impact of Obesity on Perinatal Outcomes among Asthmatic Women." Canadian Respiratory Journal 20, no. 5 (2013): 345–50. http://dx.doi.org/10.1155/2013/815143.
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BACKGROUND: Only one study has investigated the combined effect of maternal asthma and obesity on perinatal outcomes; however, it did not consider small-for-gestational age and large-for-gestational age infants.OBJECTIVES: To examine the impact of obesity on perinatal outcomes among asthmatic women.METHODS: A cohort of 1386 pregnancies from asthmatic women was reconstructed using three of Quebec’s administrative databases and a questionnaire. Women were categorized using their prepregnancy body mass index. Underweight, overweight and obese women were compared with normal weight women. The primary outcome was the birth of a small-for-gestational-age infant, defined as a birth weight below the 10th percentile for gestational age and sex. Secondary outcomes were large-for-gestational-age infants (birth weight >90th percentile for gestational age) and preterm birth (<37 weeks’ gestation). Logistic regression models were used to obtain the ORs of having small-for-gestational-age infants, large-for-gestational-age infants and preterm birth as a function of body mass index.RESULTS: The proportions of underweight, normal weight, overweight and obese women were 10.8%, 53.3%, 19.7% and 16.2%, respectively. Obese asthmatic women were not found to be significantly more at risk for giving birth to small-for-gestational-age infants (OR 0.6 [95% CI 0.4 to 1.1]), large-for-gestational-age infants (OR 1.2 [95% CI 0.7 to 2.2]) or having a preterm delivery (OR 0.7 [95% CI 0.4 to 1.3]) than normal-weight asthmatic women.CONCLUSIONS: No significant negative interaction between maternal asthma and obesity on adverse perinatal outcomes was observed.
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Keller, J. D., G. O. Utter, S. L. Dooley, J. P. Minogue, and L. G. Keith. "Northwestern University Twin Study X: Outcome of Twin Gestations Complicated by Gestational Diabetes Mellitus." Acta geneticae medicae et gemellologiae: twin research 40, no. 2 (April 1991): 153–57. http://dx.doi.org/10.1017/s0001566000002580.
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AbstractExisting data concerning the effect of gestational diabetes on perinatal outcome in twin pregnancies is scant. We hypothesized that altered carbohydrate metabolism would worsen perinatal outcome in twin gestation in a manner similar to singleton gestation. Thirteen twin pregnancies complicated by gestational diabetes mellitus were matched by gestational age at delivery to 13 twin pregnancies unaffected by gestational diabetes. Comparing infants of diabetic mothers to infants of control mothers, there was a trend of greater likelihood of respiratory distress syndrome, hyperbilirubinemia, and prolonged neonatal intensive care nursery admissions. Our experience suggests that altered carbohydrate metabolism in multiple gestations increases the potential for neonatal morbidity.
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Macdonald, Erin M., John J. Koval, Renato Natale, Timothy Regnault, and M. Karen Campbell. "Population-Based Placental Weight Ratio Distributions." International Journal of Pediatrics 2014 (2014): 1–7. http://dx.doi.org/10.1155/2014/291846.
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The placental weight ratio (PWR) is a health indicator that reflects the balance between fetal and placental growth. The PWR is defined as the placental weight divided by the birth weight, and it changes across gestation. Its ranges are not well established. We aimed to establish PWR distributions by gestational age and to investigate whether the PWR distributions vary by fetal growth adequacy, small, average, and large for gestational age (SGA, AGA, and LGA). The data came from a hospital based retrospective cohort, using all births at two London, Ontario hospitals in the past 10 years. All women who delivered a live singleton infant between 22 and 42 weeks of gestation were included(n=41441). Nonparametric quantile regression was used to fit the curves. The results demonstrate decreasing PWR and dispersion, with increasing gestational age. A higher proportion of SGA infants have extreme PWRs than AGA and LGA, especially at lower gestational ages. On average, SGA infants had higher PWRs than AGA and LGA infants. The overall curves offer population standards for use in research studies. The curves stratified by fetal growth adequacy are the first of their kind, and they demonstrate that PWR differs for SGA and LGA infants.Corrigendum to “Population-Based Placental Weight Ratio Distributions”
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Peterson, Jennifer, Mia Kahvo, Ramiyya Tharumakunarajah, Nabiah Malik, and Ranganath Ranganna. "Resuscitation Decisions for Extremely Premature Infants: A UK NICU Experience." Journal of Neonatology 35, no. 4 (December 2021): 176–82. http://dx.doi.org/10.1177/09732179211059725.
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Background: Improvements in extreme preterm infant outcomes have led to an increasing recognition of the importance of antenatal optimization and delivery room (DR) management strategies for these infants. Methods: Retrospective cohort evaluation of every infant born at 22+0 to 25+6 weeks gestation in St Mary’s tertiary NICU between 2008 and 2018. Aiming to evaluate utilization of chest compressions and resuscitation medications during DR-resuscitation of extremely premature infants. Results: This study found that 90% of infants 22+0 to 22+6 weeks did not receive antenatal steroids. Whereas, for infants born between 23+0 and 23+6 weeks gestation, 75% did receive antenatal steroids. This difference is significant ( P value = .00006). This study shows there is a predisposition to not provide DR-chest compressions (DR-CC) and/or adrenaline (DR-CC+/−A) to extremely preterm For infants that received DR-CC, there was no statistically significant increase in death and no clear association with poorer long-term outcomes in survivors. Conclusions: Marked differences in provision of perinatal care were found dependent on gestational age. If infants are inadequately prepared for delivery and resuscitative measures are not fully utilized, it cannot be clear whether subsequently increased rates of death in the lower gestational age groups are solely due to gestational age or are influenced by the lack of preparative management.
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McCarton, Cecelia M., Ina F. Wallace, Michael Divon, and Herbert G. Vaughan. "Cognitive and Neurologic Development of the Premature, Small for Gestational Age Infant Through Age 6: Comparison by Birth Weight and Gestational Age." Pediatrics 98, no. 6 (December 1, 1996): 1167–78. http://dx.doi.org/10.1542/peds.98.6.1167.
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Objective. To compare the neurologic and cognitive outcomes of 129 premature small for gestational age (SGA) infants with 300 premature appropriate for gestational age (AGA) infants through 6 years of age. Design. Infants born at ≤37 weeks gestational age and ≤2500 g with birth weight 2 standard deviations or more below the mean birth weight for gestational age were categorized as SGA. Cognitive and neurologic outcomes of SGA and AGA prematures at 1, 2, 3, and 5 and/or 6 years of age were compared when the infants were stratified by gestational age in 2-week intervals or by birth weight in 500-g intervals. The association between SGA/AGA and neurologic status on cognitive outcomes at each age was also examined. Results. SGA infants had significantly poorer cognitive scores at each age when compared with AGA infants of similar gestational ages. Normal neurologic status was more likely at all assessments for the AGA than for SGA infants of comparable gestational age. There were no differences between SGA and AGA children in cognitive or neurologic outcomes at any age when grouped by birth weight. Cognitive impairment was closely associated with neurologic abnormality in both SGA and AGA groups. There was, nevertheless, a significant effect of SGA on cognitive outcome independent of neurologic status at all ages except 3 years. Conclusions. Irrespective of degree of prematurity, SGA infants are at greater risk for neurodevelopmental impairment than are equally premature AGA infants. The cognitive impairment can be largely, but not entirely, attributed to a higher incidence of neurologic abnormalities in the SGA infants at each gestational age.
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van BEEK, Y., J. B. Hoeksma, and B. Hopkins. "The Development of Communication in Preterm Infant-Mother Dyads." Behaviour 129, no. 1-2 (1994): 35–61. http://dx.doi.org/10.1163/156853994x00343.
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AbstractThe present study examines the effects of gestational age and birthweight status on the development of infant and maternal behaviour as well as the (mutual) predictability between partners during face-to-face interaction at 6, 12 and 18 weeks of corrected age. Subjects are healthy fullterm infants (N = 6) and three groups of healthy preterm infants: small-for-gestational age (N = 6), and appropriate for gestational age, the latter being born after a pregnancy duration of less than 32 weeks (N = 6) or between 32 and 34 weeks (N = 6). Using dyadic sequential analyses, based on log-linear modelling and information statistics, for each individual infant-mother pair at each age, the effect of both partners on the behaviour of the other was quantified, while accounting for autocorrelational effects. In the majority of cases the interactions could be labelled as showing 'bidirectionality', particularly at 18 weeks. Mothers were more likely to be influenced by the previous behaviour of the infants than vice versa. No group differences were apparent in the way mothers were influenced by their infants. However, the small-for-gestational age preterm infants were less likely to be influenced by maternal behaviour, particularly at 6 and 12 weeks of age. A lower variability was the most common finding in infants who were not predictable from the previous behaviour of the mother. At 6 and 12 weeks they were less expressive and more often showed a monotonous behavioural pattern in which 'looking at mother's face without positive expressions' was shown during most of the interaction. As this lack of variability was more often found in SGA preterm infants, they were less predictable from their mother's behaviour than the fullterm and AGA preterm infants. These data suggest that having a low birthweight for gestational age may be a risk factor for a lack of 'bidirectionality' during early mother-infant interaction.
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Urquia, ML, TA Stukel, K. Fung, RH Glazier, and JG Ray. "Estimating gestational age at birth: a population-based derivation-validation study." Chronic Diseases and Injuries in Canada 31, no. 3 (June 2011): 103–8. http://dx.doi.org/10.24095/hpcdp.31.3.04.
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Introduction Information on newborn gestational age (GA) is essential in research on perinatal and infant health, but it is not always available from administrative databases. We developed and validated a GA prediction model for singleton births for use in epidemiological studies. Methods Derivation of estimated GA was calculated based on 130 328 newborn infants born in Ontario hospitals between 2007 and 2009, using linear regression analysis, with several infant and maternal characteristics as the predictor (independent) variables. The model was validated in a separate sample of 130 329 newborns. Results The discriminative ability of the linear model based on infant birth weight and sex was reasonably approximate for infants born before the 37th week of gestation (r2 = 0.67; 95% CI: 0.65–0.68), but not for term births (37–42 weeks; r2 = 0.12; 95% CI: 0.12–0.13). Adding other infant and maternal characteristics did not improve the model discrimination. Conclusion Newborn gestational age before 37 weeks can be reasonably approximated using locally available data on birth weight and sex.
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Valūnienė, Margarita, Rasa Verkauskienė, Margaret Boguszewski, Jovanna Dahlgren, Danutė Lašienė, Liudvikas Lašas, and Kerstin Wikland. "Leptin levels at birth and in early postnatal life in small- and appropriate-for-gestational-age infants." Medicina 43, no. 10 (October 9, 2007): 784. http://dx.doi.org/10.3390/medicina43100100.
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The aim of this study was to evaluate leptin concentration at birth and in early postnatal life in small- and appropriate-for-gestational-age infants and to assess its relationship with infants’ anthropometry at birth and some characteristics of maternal pregnancy. Materials and methods. A total of 367 infants born after 32–42 weeks of gestation were enrolled in the study. Umbilical cord blood samples were collected from 80 small- and 287 appropriate- for-gestational-age newborns. Altogether, 166 venous blood samples were taken from these neonates on days 2–6 of life. Results. Cord leptin levels were significantly lower in small- compared to appropriate-forgestational- age infants. We observed a positive correlation between cord leptin and birth weight, all neonatal anthropometric parameters, placental weight, and some maternal nutritional factors. In multivariate analysis, cord leptin concentration explained up to 15% of the variation in sum of newborn’s skinfold thickness but only 5% of the variation in birth weight. Postnatally, leptin concentration decreased markedly to the similar low levels in both infant groups and remained so during the first postnatal week. Conclusions. Significantly lower cord leptin concentration in small-for-gestational-age neonates reflects a lower fat mass content compared to appropriate-for-gestational-age infants. However, an abrupt decrease in leptin levels shortly after birth in both groups suggests that placenta could be an important source of leptin in fetal circulation. The impact of low leptin levels at birth in small-for-gestational-age infants on their postnatal appetite and weight gain remains to be elucidated in future studies.
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Jensen, Erik A., Elizabeth E. Foglia, Kevin C. Dysart, Rebecca A. Simmons, Zubair H. Aghai, Alison Cook, Jay S. Greenspan, and Sara B. DeMauro. "Adverse effects of small for gestational age differ by gestational week among very preterm infants." Archives of Disease in Childhood - Fetal and Neonatal Edition 104, no. 2 (May 5, 2018): F192—F198. http://dx.doi.org/10.1136/archdischild-2017-314171.
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ObjectiveTo characterise the excess risk for death, grade 3–4 intraventricular haemorrhage (IVH), bronchopulmonary dysplasia (BPD) and stage 3–5 retinopathy of prematurity independently associated with birth small for gestational age (SGA) among very preterm infants, stratified by completed weeks of gestation.MethodsRetrospective cohort study using the Optum Neonatal Database. Study infants were born <32 weeks gestation without severe congenital anomalies. SGA was defined as a birth weight <10th percentile. The excess outcome risk independently associated with SGA birth among SGA babies was assessed using adjusted risk differences (aRDs).ResultsOf 6708 infants sampled from 717 US hospitals, 743 (11.1%) were SGA. SGA compared with non-SGA infants experienced higher unadjusted rates of each study outcome except grade 3–4 IVH among survivors. The excess risk independently associated with SGA birth varied by outcome and gestational age. The highest aRD for death (0.27; 95% CI 0.13 to 0.40) occurred among infants born at 24 weeks gestation and declined as gestational age increased. In contrast, the peak aRDs for BPD among survivors (0.32; 95% CI 0.20 to 0.44) and the composites of death or BPD (0.35; 95% CI 0.24 to 0.46) and death or major morbidity (0.35; 95% CI 0.24 to 0.45) occurred at 27 weeks gestation. The risk-adjusted probability of dying or developing one or more of the evaluated morbidities among SGA infants was similar to that of non-SGA infants born approximately 2–3 weeks less mature.ConclusionThe excess risk for neonatal morbidity and mortality associated with being born SGA varies by adverse outcome and gestational age.
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Köstlin-Gille, Natascha, Lara-Antonia Flaig, Marco Ginzel, Jörg Arand, Christian F. Poets, and Christian Gille. "Granulocytic Myeloid-Derived Suppressor Cells in Breast Milk (BM-MDSC) Correlate with Gestational Age and Postnatal Age and Are Influenced by Infant’s Sex." Nutrients 12, no. 9 (August 25, 2020): 2571. http://dx.doi.org/10.3390/nu12092571.
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Background: Infections are the main cause of death in preterm infants. Causative agents often descend from the intestinal flora of the infected neonate, indicating insufficient protection by the mucosal barrier. Breast milk (BM) contains different subsets of immune cells. We recently showed that BM contains significant numbers of myeloid-derived suppressor cells (MDSC)—immune cells that actively suppress pro-inflammatory immune responses—and hypothesized that the transfer of BM-MDSC may modulate the mucosal immunity of the newborn. Methods: Percentages of MDSC in the BM from mothers of 86 preterm infants between 23 + 0 and 36 + 6 weeks of gestation during their first five postnatal weeks were analyzed by flow cytometry and correlated with maternal and infant characteristics. Results: Percentages of BM-MDSC positively correlated with gestational age and postnatal age. The expression of activation markers on BM-MDSC did not change with gestational age, but it decreased with postnatal age. Mothers who received antepartum tocolytics had lower percentages of BM-MDSC, and infant’s sex strongly influenced percentages of BM-MDSC. Conclusion: Our results point toward a role of BM-MDSC for immune regulation in the neonatal gut, making them a potential target of immune-based therapies shortly after birth.
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Gill, Jane V., and Elaine M. Boyle. "Outcomes of infants born near term." Archives of Disease in Childhood 102, no. 2 (August 19, 2016): 194–98. http://dx.doi.org/10.1136/archdischild-2015-309584.
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Most research on outcomes of preterm birth has centred on babies born at <32 weeks gestation and at highest risk of mortality and serious morbidity. Recent years have seen a dramatic increase in studies focusing on late preterm infants (34–36 weeks gestation). Early epidemiological studies demonstrated increased risks of mortality and adverse neonatal outcomes in this group, prompting further investigations. These increased risks have been confirmed and more recent studies have also included babies born at 37–38 weeks, now defined as ‘early-term’ births. It now seems that it is inappropriate to consider term and preterm as a dichotomy; gestational age rather represents a continuum in which risk and severity of adverse outcomes increase with decreasing gestational age, but where measurable effects can be detected even very close to full term. In this review, we summarise current evidence for the outcomes of infants born at late preterm and early-term gestations.
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Fuertes, Marina, Marjorie Beeghly, Pedro Lopes dos Santos, and Edward Tronick. "Predictors of infant positive, negative and self-direct coping during face to face still-face in a Portuguese preterm sample." Análise Psicológica 29, no. 4 (November 25, 2012): 553–65. http://dx.doi.org/10.14417/ap.103.
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Past studies found three types of infant coping behaviour during Face-to-Face Still-Face paradigm (FFSF): a Positive Other-Directed Coping; a Negative Other-Directed Coping and a Self-Directed Coping. In the present study, we investigated whether those types of coping styles are predicted by: infants’ physiological responses; maternal representations of their infant’s temperament; maternal interactive behaviour in free play; and infant birth and medical status. The sample consisted of 46, healthy, prematurely born infants and their mothers. At one month, infant heart rate was collected in basal. At three months old (corrected age), infant heart-rate was registered during FFSF episodes. Mothers described their infants’ temperament using a validated Portuguese temperament scale, at infants three months of corrected age. As well, maternal interactive behaviour was evaluated during free play situation using CARE-Index. Our findings indicate that positive coping behaviours were correlated with gestational birth weight, heart rate (HR), gestational age, and maternal sensitivity in free play. Gestational age and maternal sensitivity predicted Positive Other-Direct Coping behaviours. Moreover, Positive Other-Direct coping was negatively correlated with HR during Still-Face Episode. Self-directed behaviours were correlated with HR during Still-Face Episode and Recover Episode and with maternal controlling/intrusive behaviour. However, only maternal behaviour predicted Self-direct coping. Early social responses seem to be affected by infants’ birth status and by maternal interactive behaviour. Therefore, internal and external factors together contribute to infant ability to cope and tore-engage after stressful social events.
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Gidi, Netsanet Workneh, Robert L. Goldenberg, Assaye K. Nigussie, Elizabeth McClure, Amha Mekasha, Bogale Worku, Matthias Siebeck, Orsolya Genzel-Boroviczeny, and Lulu M. Muhe. "Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia." BMJ Paediatrics Open 4, no. 1 (September 2020): e000740. http://dx.doi.org/10.1136/bmjpo-2020-000740.
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PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.
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Hua, Jing, Jie Sun, Zhijuan Cao, Xiaotian Dai, Senran Lin, Jialin Guo, Guixiong Gu, and Wenchong Du. "Differentiating the cognitive development of early-term births in infants and toddlers: a cross-sectional study in China." BMJ Open 9, no. 4 (April 2019): e025275. http://dx.doi.org/10.1136/bmjopen-2018-025275.
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ObjectivesThis study aimed to explore the cognitive development of low-risk children during early childhood for early-term births at 37 and 38 weeks of gestation compared with full term births at 39–41 weeks of gestation.Setting and participantsWe conducted a cross-sectional study in Shanghai, one of the largest cities in China. A total of 1444 children from singleton pregnancies born at term gestation were included in the study.MeasuresThe cognitive outcomes of the subjects were measured using the cognitive subtest of Bayley Scales of Infant and Toddler Development, Third Edition (BSID-III) across three cities in China. We analysed the association between gestational age and cognitive development during infancy and toddler stages using multivariate linear modelling.ResultsThe cognitive development scores for infants born at 37 gestational weeks were significantly lower than those born at 39–41 gestational weeks (β=−2.257, 95% CI −4.280 to −0.235; p<0.05) after adjusting for children’s and maternal characteristics, as well as socio-economic factors. However, there were no significant differences in cognitive ability between infants born at 38 gestational weeks compared with their full-term counterparts (p>0.05). Moreover, these effects were not found in toddlers (between 17 and 48 months of age) after adjusting for the possible confounders (p>0.05).ConclusionsInfants born at 37 weeks of gestation exhibited weaker cognitive ability compared with those born at 39–41 weeks of gestation. Our findings provide evidences for the close monitoring of potential developmental problems in early-term children, especially those born at 37 gestational weeks.
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Verkauskiene, R., J. Beltrand, O. Claris, D. Chevenne, S. Deghmoun, S. Dorgeret, M. Alison, P. Gaucherand, O. Sibony, and C. Lévy-Marchal. "Impact of fetal growth restriction on body composition and hormonal status at birth in infants of small and appropriate weight for gestational age." European Journal of Endocrinology 157, no. 5 (November 2007): 605–12. http://dx.doi.org/10.1530/eje-07-0286.
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AbstractBackgroundFetal growth restriction (FGR) has been related to several health risks, which have been generally identified in small-for-gestational age (SGA) individuals.ObjectiveTo evaluate the impact of FGR on body composition and hormonal status in infants born either small- or appropriate-for-gestational age (AGA).MethodsFetal growth was assessed by ultrasound every 4 weeks from mid-gestation to birth in 248 high-risk pregnancies for SGA. Fetal growth velocity was calculated as change in the estimated fetal weight percentiles and FGR defined as its reduction by more than 20 percentiles from 22 gestational weeks to birth. Impact of FGR on body composition, cord insulin, IGF-I, IGF binding protein-3 (IGFBP-3), and cortisol concentrations was assessed in SGA and AGA newborns.ResultsGrowth-retarded AGA infants showed significantly reduced birth weight, ponderal index, percentage of fat mass, and bone mineral density when compared with AGA newborns with stable intrauterine growth. Cord IGF-I and IGFBP-3 concentrations were significantly decreased in growth-retarded infants in both SGA and AGA groups. Cord insulin concentration was significantly lower and cord cortisol significantly higher in AGA infants with FGR versus AGA newborns with stable intrauterine growth.After adjustment for gestational age and gender, birth weight was directly related to fetal growth velocity and cord IGF-I concentration. The variation in infant's adiposity was best explained by fetal growth velocity and cord insulin concentration.ConclusionsFGR affects body composition and hormonal parameters in newborns with birth weight within the normal range, suggesting these individuals could be at similar metabolic risks as SGA.
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Chahin, Nayef, Miheret S. Yitayew, Alicia Richards, Brielle Forsthoffer, Jie Xu, and Karen D. Hendricks-Muñoz. "Ascorbic Acid and the Premature Infant." Nutrients 14, no. 11 (May 24, 2022): 2189. http://dx.doi.org/10.3390/nu14112189.
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Little information exists about the plasma target nutritional needs of the >15 million premature infants <37 weeks gestation. Investigating ascorbic acid’s (AscA) role in infant health, our study details the relationship of infant characteristics and maternal health on infant plasma AscA level (pAscA) during postnatal development. Furthermore, we determined pAscA influence during the first week of life (EpAscA) with later infant morbidities. We hypothesize that pAscA is influenced by gestational organ immaturity, as well as maternal factors, with EpAscA associated with greater morbidity risk. We conducted a prospective longitudinal observational study of pAscA, demographics and hospital course detailed in infants ≤34 weeks. Sixty-three subjects were included, with >200 urine and plasma data points analyzed. Maternal smoking, exposure to magnesium sulfate (MgSO4) and advancing gestational and postnatal age were associated with lower pAscA. Non-white infants and those ≤30 weeks that developed bronchopulmonary dysplasia or retinopathy of prematurity had lower pAscA. Prenatal smoking, MgSO4, birth gestational age and race negatively influence pAscA. These results show prenatal and postnatal developmental factors influencing initial pAscA and metabolism, potentially setting the stage for organ health and risk for disease. Assessment of dietary targets may need adjustment in this population.
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MD, Jogender Kumar. "A Brief Review of Hyperinsulinism in Small for Gestational Age Infants." Journal of Medical Science And clinical Research 05, no. 01 (January 5, 2017): 15379–83. http://dx.doi.org/10.18535/jmscr/v5i1.29.
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Watanabe, Yuki, Kayo Osawa, Itsuko Sato, Sota Iwatani, Ruri Kono, Ikuyo Hayakawa, Nobuhide Hayashi, Kazumoto Iijima, Jun Saegusa, and Ichiro Morioka. "Foetal haemoglobin concentration at postmenstrual age is unaffected by gestational age at birth." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 55, no. 3 (July 20, 2017): 400–403. http://dx.doi.org/10.1177/0004563217721253.
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Background Our aim was to determine whether the postnatal age or postmenstrual age is a more appropriate criterion for evaluating foetal haemoglobin concentrations. Methods Blood samples ( n = 1095) were obtained from 394 infants and were divided into two groups based on gestational age at birth: <37 weeks ( n = 491) and ≥37 weeks ( n = 604). (1) Foetal haemoglobin concentrations divided by one month at age after birth were compared between the groups. (2) Foetal haemoglobin concentrations divided into ≤9 months from last menstruation and one month thereafter were compared between the groups. Results In samples from infants ≥37 weeks’ gestational age at birth, the median foetal haemoglobin concentrations were 69.5%, 21.4% and 3.6% at 0–1 month, 2–3 months and ≥5 months after birth, respectively. The median foetal haemoglobin concentrations in infants <37 weeks’ gestational age at birth were 75.5%, 62.7% and 5.1% at 0–1 month, 2–3 months and ≥5 months after birth, respectively. The median foetal haemoglobin concentrations in infants <37 weeks’ gestational age at birth were significantly higher than that in infants ≥37 weeks’ gestational age at birth at all postnatal age points. (2) There was no significant difference between the groups at all age points after nine months of postmenstrual age: 72.5 and 75.3% at 9–10 months, 25.1 and 26.6% at 11–12 months and 5.5 and 4.6% at >13 months after last menstruation in infants ≥37 and <37 weeks’ gestational age at birth, respectively. Conclusions Evaluation of foetal haemoglobin concentrations at postmenstrual age is unaffected by gestational age at birth.
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Berg, Jennifer, Martin Keszler, Kabir Abubakar, and Melissa Scala. "Premature Infants Conceived with Assisted Reproductive Technology: An Analysis of Infant Morbidity, Compared with Infants Conceived Naturally." American Journal of Perinatology 36, no. 03 (July 31, 2018): 258–61. http://dx.doi.org/10.1055/s-0038-1667288.
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Objective This article evaluates the morbidity of infants born via assisted reproductive technology (ART) compared with matched naturally conceived infants. Study Design This is a retrospective review of maternal and infant data among inborn infants conceived via ART and matched control infants born at 30 to 34 weeks' gestational age (GA) between 2006 and 2012. Data were analyzed using paired t-test or Wilcoxo–Mann–Whitney test for continuous and Fisher's exact test for categorical variables. p-Value of < 0.05 was considered significant. Result Of 120 study infants, 60 were conceived via ART and 60 naturally. Control infants were matched for GA, gender, race, and multiple gestations. ART infants required more respiratory support and took longer to reach full feeds compared with control infants. Conclusion Infants born via ART are physiologically more immature with more intensive care needs than naturally conceived infants of similar gestation, potentially increasing health care costs. This immaturity should be considered when planning early delivery in these pregnancies.
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Purwandari, Haryatiningsih, and Wastu Adi Mulyono. "Correlation Preterm Infants Gestational Age and Birth Weight at one Medical Center at Banyumas Regency Indonesia." Journal of Bionursing 4, no. 1 (February 17, 2022): 19–23. http://dx.doi.org/10.20884/1.bion.2022.4.1.124.
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Introduction: Preterm infants commonly experience with low birth weight. Identifying preterm infants’ gestational age and birth weight is pivotal to prevent intra uterine growth retardation and prevent case of LBW infants. Aims: To clarify the correlation between preterm infants’ gestational age and birth weight. Methods: An observational study involving a convenience samples of 46 preterm infants who were born less than 37 weeks gestation were taken from level 1, 2, and 3 neonatal care at one medical center at Banyumas Regency, Indonesia. Data were retrieved from infants’ medical record using a self-designed collection data sheet. Data were analyzed using univariate, Shapiro Wilk, and Spearman Rank test. Result: The preterm infants gestation age had moderate positive correlation with birthweight (r=.490, p= 0.01, n=46). Conclusion: Increasing the maturity of preterm infants’ gestation will effect on the increased of birth weight. It means that health care professional should give health education to mothers to reduce the high risk for preterm infants’ delivery and reduce the risk of LBW infants
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Morriss, Frank H., Marylynn Moore, Norman W. Weisbrodt, and M. Stewart West. "Ontogenic Development of Gastrointestinal Motility: IV. Duodenal Contractions in Preterm Infants." Pediatrics 78, no. 6 (December 1, 1986): 1106–13. http://dx.doi.org/10.1542/peds.78.6.1106.
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Duodenal motility was studied by intraluminal manometry in 27 healthy infants of 26 to 42 weeks, gestational age. The frequency of contractions, the number of contractions per burst, and the intraluminal peak pressure during contractions all increased during a narrow postconceptual period, 29 to 32 weeks, regardless of length of gestation before birth. Antenatal β-methasone administration to the mothers of 11 additional infants of 26 to 32 weeks gestational age was associated with creased duodenal contraction rate, number of contracintions per burst, and intraluminal peak pressure compared with infants of similar gestational age whose mothers did not receive β-methasone. The maturational effect of β-methasone on duodenal motility was most pronounced in infants whose gestational age at birth was 26 to 29 weeks. Seven infants of 31 weeks' or longer gestational duration who had a CNS abnormality or insult had fasting duodenal contraction rates that were less than one half of the rate for normal infants of similar gestational age. These observations suggest that neonatal duodenal motility undergoes marked maturational changes between 29 and 32 weeks after conception and that these changes may be inducible before 29 weeks by corticosteroid administration. An intact CNS appears to be required for full expression of the maturational changes.
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Himes, Katherine, and Adriane Haragan. "Accuracy of Ultrasound Estimated Fetal Weight in Small for Gestational Age and Appropriate for Gestational Age Grown Periviable Neonates." American Journal of Perinatology 35, no. 08 (December 29, 2017): 703–6. http://dx.doi.org/10.1055/s-0037-1617433.
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Objective Clinicians use estimated fetal weight (EFW) as a proxy for birth weight (BW) in the antenatal period. Our objective was to compare the accuracy of EFW obtained by ultrasound to BW among infants born during the periviable period and determine if accuracy of EFW varied among small for gestational age (SGA) versus appropriate for gestational age (AGA) grown neonates. Study Design We included women who delivered between 230/7 and 256/7 weeks' gestation and had an EFW within 7 days of delivery. Mean percentage difference and median absolute percentage difference between EFW and BW were calculated. Results Our cohort included 226 neonates with a mean gestational age of 241/7 ± 0.8 weeks and median BW of 653 g (interquartile range [IQR]: 580–750 g). The median absolute percentage difference between EFW and BW of fetal weight estimates was 9.2% (IQR: 3.6–17.2). EFW overestimated BW for 75% (n = 171) of the cohort. Among SGA infants, the mean percentage difference in EFW and BW was 16.2 ± 19.4% versus 6.9% ± 13.1% in AGA infants (p = 0.019). Conclusion EFW overestimated BW in this cohort. In addition, ultrasound was less accurate among infants born SGA. These data are important to consider when counseling families facing periviable delivery.
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Walsh, Eileen, Sherian Li, Libby Black, and Michael Kuzniewicz. "Incremental Cost of Prematurity by Week of Gestational Age." American Journal of Perinatology Reports 09, no. 01 (January 2019): e76-e83. http://dx.doi.org/10.1055/s-0039-1683934.
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Objective This study was aimed to compare health care costs and utilization at birth through 1 year, between preterm and term infants, by week of gestation. Methods A cross-sectional study of infants born at ≥ 23 weeks of gestational age (GA) at Kaiser Permanente Northern California facilities between 2000 and 2011, using outcomes data from an internal neonatal registry and cost estimates from an internal cost management database. Adjusted models yielded estimates for cost differences for each GA group. Results Infants born at 25 to 37 weeks incur significantly higher birth hospitalization costs and experience significantly more health care utilization during the initial year of life, increasing progressively for each decreasing week of gestation, when compared with term infants. Among all very preterm infants (≤ 32 weeks), each 1-week decrease in GA is associated with incrementally higher rates of mortality and major morbidities. Conclusion We provide estimates of potential cost savings that could be attributable to interventions that delay or prevent preterm delivery. Cost differences were most extreme at the lower range of gestation (≤ 30 weeks); however, infants born moderately preterm (31–36 weeks) also contribute substantially to the burden, as they represent a higher proportion of total births.
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Zhang, Min, Yan-Chen Wang, Jin-Xing Feng, Ai-Zhen Yu, Jing-Wei Huang, Si-Yuan Jiang, Xin-Yue Gu, et al. "Variations in length of stay among survived very preterm infants admitted to Chinese neonatal intensive care units." World Journal of Pediatrics 18, no. 2 (January 5, 2022): 126–34. http://dx.doi.org/10.1007/s12519-021-00494-1.
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Abstract Background This study aimed to describe length of stay (LOS) to discharge and site variations among very preterm infants (VPIs) admitted to 57 Chinese neonatal intensive care units (NICUs) and to investigate factors associated with LOS for VPIs. Methods This retrospective multicenter cohort study enrolled all infants < 32 weeks’ gestation and admitted to 57 NICUs which had participated in the Chinese Neonatal Network, within 7 days after birth in 2019. Exclusion criteria included major congenital anomalies, NICU deaths, discharge against medical advice, transfer to non-participating hospitals, and missing discharge date. Two multivariable linear models were used to estimate the association of infant characteristics and LOS. Results A total of 6580 infants were included in our study. The overall median LOS was 46 days [interquartile range (IQR): 35–60], and the median corrected gestational age at discharge was 36 weeks (IQR: 35–38). LOS and corrected gestational age at discharge increased with decreasing gestational age. The median corrected gestational age at discharge for infants at 24 weeks, 25 weeks, 26 weeks, 27–28 weeks, and 29–31 weeks were 41 weeks, 39 weeks, 38 weeks, 37 weeks and 36 weeks, respectively. Significant site variation of LOS was identified with observed median LOS from 33 to 71 days in different hospitals. Conclusions The study provided concurrent estimates of LOS for VPIs which survived in Chinese NICUs that could be used as references for medical staff and parents. Large variation of LOS independent of infant characteristics existed, indicating variation of care practices requiring further investigation and quality improvement.
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Hawken, Steven, Robin Ducharme, Malia S. Q. Murphy, Katherine M. Atkinson, Beth K. Potter, Pranesh Chakraborty, and Kumanan Wilson. "Performance of a postnatal metabolic gestational age algorithm: a retrospective validation study among ethnic subgroups in Canada." BMJ Open 7, no. 9 (September 2017): e015615. http://dx.doi.org/10.1136/bmjopen-2016-015615.
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ObjectivesBiological modelling of routinely collected newborn screening data has emerged as a novel method for deriving postnatal gestational age estimates. Validation of published models has previously been limited to cohorts largely consisting of infants of white Caucasian ethnicity. In this study, we sought to determine the validity of a published gestational age estimation algorithm among recent immigrants to Canada, where maternal landed immigrant status was used as a surrogate measure of infant ethnicity.DesignWe conducted a retrospective validation study in infants born in Ontario between April 2009 and September 2011.SettingProvincial data from Ontario, Canada were obtained from the Institute for Clinical Evaluative Sciences.ParticipantsThe dataset included 230 034 infants born to non-landed immigrants and 70 098 infants born to immigrant mothers. The five most common countries of maternal origin were India (n=10 038), China (n=7468), Pakistan (n=5824), The Philippines (n=5441) and Vietnam (n=1408). Maternal country of origin was obtained from Citizenship and Immigration Canada’s Landed Immigrant Database.Primary and secondary outcome measuresPerformance of a postnatal gestational age algorithm was evaluated across non-immigrant and immigrant populations.ResultsRoot mean squared error (RMSE) of 1.05 weeks was observed for infants born to non-immigrant mothers, whereas RMSE ranged from 0.98 to 1.15 weeks among infants born to immigrant mothers. Area under the receiver operating characteristic curve for distinguishing term versus preterm infants (≥37 vs <37 weeks gestational age or >34 vs ≤34 weeks gestational age) was 0.958 and 0.986, respectively, in the non-immigrant subgroup and ranged from 0.927 to 0.964 and 0.966 to 0.99 in the immigrant subgroups.ConclusionsAlgorithms for postnatal determination of gestational age may be further refined by development and validation of region or ethnicity-specific models. However, our results provide reassurance that an algorithm developed from Ontario-born infant cohorts performs well across a range of ethnicities and maternal countries of origin without modification.
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Kemfang Ngowa, Jean Dupont, Irénée Domkam, Anny Ngassam, Georges Nguefack-Tsague, Walter Dobgima Pisoh, Cyrille Noa, and Jean Marie Kasia. "References of Birth Weights for Gestational Age and Sex from a Large Cohort of Singleton Births in Cameroon." Obstetrics and Gynecology International 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/361451.
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Objective.To establish the percentile charts of birth weights for gestational age and sex within the Cameroonian population.Methods.A review of medical records of infants born between January 2007 and December 2011 at the maternities of two hospitals in Cameroon, Central Africa. Multiple pregnancies, births of HIV infected women, stillbirths, and births with major fetal malformations were excluded. The smooth curves of birth weight for gestational age and sex were created using the Gamlss package under R.3.0.1 software.Results.The birth weights of 12837 live birth singleton infants born to HIV negative women between 28 and 42 weeks of gestation were analyzed to construct the birth weight curves for gestational age and sex. The smoothed percentile curves of birth weights for gestational age and sex of Cameroonian infants have demonstrated an increasing slope until 40 weeks and then a plateau. There was a varied difference of distribution in birth weights for gestational age between Cameroonian, Botswanan, American, and French infants.Conclusion.We established the reference curves of birth weights for gestational age and sex for Cameroonians. The difference in birth weight curves noted between Cameroonian, Botswanan, American, and French infants suggests the importance of establishing the regional birth weight norms.
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Syrengelas, Dimitris, Eirini Nikaina, Paraskevi Kleisiouni, and Tania Siahanidou. "Alberta Infant Motor Scale (AIMS) Performance of Early-Term Greek Infants: The Impact of Shorter Gestation on Gross Motor Development among “Term-Born” Infants." Children 9, no. 2 (February 16, 2022): 270. http://dx.doi.org/10.3390/children9020270.
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Early-term birth (37+0 to 38+6 gestational weeks) may have a negative impact on infants’ neurodevelopment compared to delivery at 39 weeks or beyond. The purpose of this study was to evaluate the gross motor development of early-term infants using the Alberta Infant Motor Scale (AIMS). A total of 1087 healthy infants (559 early-term and 528 full-term infants born at 39+0 to 41+6 weeks of gestation) were studied. Mean AIMS scores were compared between the two groups at monthly intervals. The impact of gestational age on total AIMS scores was assessed by linear regression, after adjustment for chronological age, sex and SGA. Mean total AIMS scores, albeit within normal range, were significantly lower in early-term than full-term infants at the 2nd, 6th, 7th, 8th and 12th month of age; differences between groups were within three points. In multivariate regression analysis, a longer gestation by one week had a positive impact on total AIMS score during the first year of life (β = 0.90; 95% CI 0.45, 1.35). In conclusion, early-term infants exhibit worse gross motor performance during the first year of life in comparison with their full-term peers; however, the differences between the two groups are small.
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PETERSEN, STEN, ANDERS GOTFREDSEN, and FINN URSIN KNUDSEN. "Total Body Bone Mineral in Light-for-Gestational-Age Infants and Appropriate-for-Gestational-Age Infants." Acta Paediatrica 78, no. 3 (May 1989): 347–50. http://dx.doi.org/10.1111/j.1651-2227.1989.tb11090.x.
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Kraft, Karianne E., Artur C. Jaschke, Anne-Greet Ravensbergen, Annet Feenstra-Weelink, Maud E. L. van Goor, Marlou L. A. de Kroon, Sijmen A. Reijneveld, Arend F. Bos, and Nienke H. van Dokkum. "Maternal Anxiety, Infant Stress, and the Role of Live-Performed Music Therapy during NICU Stay in The Netherlands." International Journal of Environmental Research and Public Health 18, no. 13 (July 2, 2021): 7077. http://dx.doi.org/10.3390/ijerph18137077.
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Having an infant in the neonatal intensive care unit (NICU) elicits maternal anxiety, which may hamper parent−child bonding. We performed a prospective cohort study to describe anxiety in mothers of infants born before 30 weeks of gestation during NICU stay in The Netherlands, and investigated the influence of infant stress and gestational age. Second, we performed a randomized-controlled live-performed music therapy trial (LPMT trial) to investigate whether music therapy applied to the infant alleviated maternal anxiety. The relation between infant stress, gestational age, and maternal anxiety was measured in 45 mother−infant dyads, using the Neonatal Infant Stressor Scale and the State-Trait Anxiety Inventory (STAI). The effect of LPMT on anxiety was assessed in 21 mothers whose infants were assigned to either LPMT (n = 12) or waitlist (n = 9). Mothers completed the STAI before and after this period. Maternal anxiety decreased over time in all mothers, and was strongly related with infant stress (r = 0.706, p < 0.001), but not with gestational age. Anxiety scores decreased by 12% after LMPT, and increased by 1% after a waitlist period (p = 0.30). Our results indicate that LPMT in the weeks after birth may accelerate the reduction of maternal anxiety. Further research should focus on the effects on mother−child bonding.
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Jegathesan, Thivia, Michael Sgro, Vibhuti Shah, Aidan Campbell, and Douglas Campbell. "INVESTIGATING THE PHOTOTHERAPY THRESHOLDS IN PRETERM INFANTS." Paediatrics & Child Health 23, suppl_1 (May 18, 2018): e28-e28. http://dx.doi.org/10.1093/pch/pxy054.073.
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Abstract BACKGROUND Currently there are limited guidelines for the management of hyperbilirubinemia in preterm infants. Current guidelines are limited to individual sites and are consensus-based opinions. The current decrease in chronic bilirubin encephalopathy in preterm infants is a result of liberal use of phototherapy that are not based on evidence from a large dataset of preterm infants. The pattern of bilirubin levels in preterm is unclear and currently based on clinical judgement. Nomograms in term infants has been proven to be beneficial and effective in reducing unnecessary treatment of hyperbilirubinemia. A nomogram designed for preterm infants would allow health professionals to quantify risk based on evidence based methods and reduce the number of test done on preterm infants. OBJECTIVES The objectives of this study are 1) To determine photherapy thresholds in preterm infants and 2) To determine the normative pattern of bilirubin values in preterm infants. DESIGN/METHODS A multi-site retrospective chart review of preterm infants ≤ 35 weeks gestation born between January 2012- November 2017 was conducted. The following data was collected; all TSB, postnatal hours of age, duration of phototherapy, infant characteristics (gestational age, birth weight, outcomes) and maternal history (inter and anter partum medication). TSB samples prior to the initiation of phototherapy were analyzed per hour and stratified by gestational age groups. RESULTS A total of 330 preterm infants were included in the retrospective review (50 24-28 weeks gestation, 100 29-32 weeks gestation, and 180 33–35 weeks gestation). The mean peak bilirubin in infants 33-35 week gestation was 198 umol/L at 4 days. These infants were started on phototherapy at a mean age of 89 hours. At 24 hours of age these infants’ bilirubin was 104 umol/L (72-189umol/L). The mean peak bilirubin in infants 29–32 weeks gestation was 181umol/L at 5 days. At 24 hours of age the mean bilirubin was 109 umol/L. Finally in infants 24–28 weeks gestation the mean peak bilirubin was 127 umol/L at 4 days. These infants were started on phototherapy at 44 hours of age. CONCLUSION Bilirubin values in preterm infants is hetergenous across gestional ages. Phototherapy treatment thresholds are lower in preterm infants between 24–28 weeks gestation. A nomogram for preterm infants maybe possible in infants between 29–35 weeks. Further research is required to determine hour specific bilirubin levels in preterm infants.
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Rachma Erawati, Dini, and Yuyun Yueniwati. "CRANIAL ULTRASOUND: EFFICIENT SCREENING TOOL FOR EARLY DETECTION OF BRAIN INJURY IN PRETERM INFANTS." MNJ (Malang Neurology Journal) 7, no. 1 (January 1, 2021): 7–11. http://dx.doi.org/10.21776/ub.mnj.2021.007.01.2.
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Background: Cranial ultrasound becomes an important diagnostic tool to evaluate brain injury in infants. Brain injury is a major complication for preterm birth. The brain injury of preterm infants differs from that of a term infant. Brain injury has correlation with gestational age and mode of delivery. Objective: To analyze the correlation between cranial ultrasound findings with gestational age and mode of delivery and to reveal if cranial ultrasound can be used to detect brain injury in premature infants. Methods: An observational analytic study using cross-sectional design took place in Saiful Anwar Hospital Malang, Indonesia. 38 healthy preterm infants underwent cranial ultrasound examination within the first four day of life. Fisher Exact test was used to analyze the correlation between cranial ultrasound findings with gestational age and mode of delivery. Results: Most of the healthy preterm infants (89.5%) were ≥ 32 weeks gestational age, and 52.6% of samples had caesarean section as their mode of delivery. There were three abnormal findings in cranial ultrasound; increased periventricular echogenic (5.3%), increased parenchym echogenic (5.3%), and indistinguishable of gray-white matter differentiation (5.3%). There was no significant correlation between abnormal cranial ultrasound findings with gestational age and mode of delivery (p= 0.202; p= 0.218). Conclusion: There were abnormal cranial ultrasound findings in some healthy preterm infants despite no significant correlation between ultrasound findings with gestational age and mode of delivery. Cranial ultrasound in preterm infants could become a screening tool for early detection of brain injury.
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Khasanova, S. S., A. T. Kamilova, and D. I. Akhmedova. "Fecal elastase activity in premature children." Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) 64, no. 5 (November 16, 2019): 44–48. http://dx.doi.org/10.21508/1027-4065-2019-64-5-44-48.
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We studied the activity of fecal elastase in 54 premature newborns of a gestation period of 22–32 weeks. The samples of feces were collected at the age of 13–14 days. Premature children born at gestational age of 22–28 weeks had pancreatic insufficiency of light degree by 2 weeks of age, preterm infants with a gestational age of 28–32 weeks by 2 weeks of age had the values of pancreatic elastase equal to that of full-term children. The authors have established the relationship between the degree of pancreatic insufficiency and the gestational age of newborns. Fecal elastase activity was significantly lower in premature infants who received milk mixtures as compared to breast-fed infants or infants with mixed feeding. The study substantiated the necessity of early replacement therapy in such newborns to prevent exocrine pancreatic insufficiency.
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Putra, Putu Junara. "Characteristics and outcomes of low birth weight infants in Bali." Paediatrica Indonesiana 52, no. 5 (October 31, 2012): 300. http://dx.doi.org/10.14238/pi52.5.2012.300-3.
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Background The prevalence and the mortality of low birthweight infants are still high. Low birth weight (LBW) births areresponsible for newborn death. LBW infants are easier to sufferserious health problems and death. Lower infant body weightand younger gestational age are determinants of greater risk ofmortality.Objective To determine the characteristics of LBW infants andtheir outcomes in Sanglah Hospital, Denpasar.Methods This prospective study was conducted on all LBWinfants in the nursery from their time of admission until dischargefor the year of 20 11..Results There were 120 LBW infants admitted to SanglahHospital fromJanuary 2011 to December 2011. The prevalenceofLBW was 8.9%. The birth weight group of 15002499 gramshad the highest number of infants (79.2%). The gestational agegroup of 3336 weeks had 53.3% of the infants, while 68.3% ofthe LBW infants were of the appropriate gestational age. Themost common method of delivery was normal spontaneousdelivery (70%). Moderate asphyxia was observed in 25% of thesubjects, while severe asphyxia was observed in 22.5% of subjects.The mortality rate was 24.2%.Conclusions The prevalence of LBW of all newborns in ourhospital was 8.9%. Severe asphyxia was observed in 22.5% ofsubjects. The mortality rate of the LBW infants was 24.2%. OurLBW infants were most cormnonly in the categories of birth weightof 15002499 grams, gestational age was between 3336 weeks,appropriate for gestational age, as well as delivered spontaneously.[Paediatr lndanes. 2012,52:30003].
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Setu, Mumtahina, Md Abid Hossain Mollah, Syed Khairul Amin, S. M. Nahid Morshed, Mehdi Pervez, and Afroza Akhter. "Duration of Meconium Passage in Term and Preterm Infants." Anwer Khan Modern Medical College Journal 4, no. 1 (February 6, 2013): 6–9. http://dx.doi.org/10.3329/akmmcj.v4i1.13677.
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Delayed first passage of meconium and also prolongation of meconium passage creates great anxiety among parents. Some study showed that that first passage of meconium is delayed in preterm infants compared to term infants. The difference in duration of meconium passage in term and preterm infant has however never been assessed before. This cross sectional study was carried between July 2010 to December 2010 among 100 Newborn babies ranging from 28 to 42 weeks of gestation who were delivered in the Department of Obstetrics and Gynaecology or admitted in the Department of Neonatology of Dhaka Medical college Hospital were included in the study. Gestational age was determined from first day of last menstruation (when available) and also by using Expanded Ballard Scoring System. In case of any discrepancy of more than 2 weeks, the later was accepted. This study was carrying out to determine the time of first passage of meconium and duration of passage of meconium in term and preterm infants. Out of total 100 infants, 58 were male and 42 were female. The numbers of babies were 21, 28, 25 and 26 in group I, II, III and IV respectively. The mean age at which the babies passed first meconium were 23.5±3.5, 33.0±3.8, 25.7±4.2 and 17.3±4.6 hours in group I, II, III and IV respectively, which was<48 hours irrespective of gestational age. The mean gestational age of the babies who passed meconium for <4 days was 37.1±2.2 weeks. On the contrary, mean gestational age of the babies who passed meconium for>4 days was 32.6±4.3 weeks and this observation was statistically significant (p<0.001). First passage of meconium in all newborn was within 48 hours irrespective of gestational age. Duration of passage of meconium was significantly prolonged among babies with lower gestational age. DOI: http://dx.doi.org/10.3329/akmmcj.v4i1.13677 AKMMC J 2013; 4(1): 6-9
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Petousis-Harris, Helen, Yannan Jiang, Lennex Yu, Donna Watson, Tony Walls, Nikki Turner, Anna S. Howe, and Jennifer B. Griffin. "A Retrospective Cohort Study of Safety Outcomes in New Zealand Infants Exposed to Tdap Vaccine in Utero." Vaccines 7, no. 4 (October 11, 2019): 147. http://dx.doi.org/10.3390/vaccines7040147.
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We aimed to evaluate the safety of maternal Tdap; thus, we assessed health events by examining the difference in birth and hospital-related outcomes of infants with and without fetal exposure to Tdap. This was a retrospective cohort study using linked administrative datasets. The study population were all live-born infants in New Zealand (NZ) weighing at least 400 g at delivery and born to women who were eligible for the government funded, national-level vaccination program in 2013. Infants were followed from birth up to one year of age. There were a total of 69,389 eligible infants in the cohort. Of these, 8299 infants were born to 8178 mothers exposed to Tdap (12%), primarily between 28 and 38 weeks gestation as per the national schedule. Among the outcomes, we found a reduced risk for moderate to late preterm birth, low birth weight, small for gestational age, large for gestational age, respiratory distress syndrome, transient tachypnea of newborn, tachycardia or bradycardia, haemolytic diseases, other neonatal jaundice, anaemia, syndrome of infant of mother with gestational diabetes, and hypoglycemia in infants born to vaccinated mothers. There was no association between maternal Tdap, infant Apgar score at 5 min after birth, asphyxia, sepsis or infection, or hypoxic ischemic encephalopathy. Infant exposure to Tdap during pregnancy was associated with a higher mean birthweight (not clinically significant) and higher odds for ankyloglossia and neonatal erythema toxicum diagnoses. There were insufficient observations to allow examination of the effect of Tdap on extreme preterm and very preterm birth, and stillbirth, infant death, or microcephaly. Overall, we found no outcomes of concern associated with the administration of Tdap during pregnancy. NZ Health and Disability Ethics Committee Approval #14/N.T.A/169/AM05.
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Greenberg, David N., Bradley A. Yoder, Reese H. Clark, Clifford A. Butzin, and Donald M. Null. "Effect of Maternal Race on Outcome of Preterm Infants in the Military." Pediatrics 91, no. 3 (March 1, 1993): 572–77. http://dx.doi.org/10.1542/peds.91.3.572.
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Previous studies suggest that low birth weight black infants have less morbidity and birth-weight-specific mortality during the perinatal period than low birth weight white infants. We studied the effect of maternal race on outcome in preterm infants born at a military hospital that offers free access to obstetric and neonatal care. Between January 1, 1986, and December 31, 1991, data were prospectively collected on all 667 infants delivered at Wilford Hall USAF Medical Center with an estimated gestational age of less than 35 weeks. Three hundred ninety-two white infants and 165 black infants were included in the data analysis. The mean (±SD) birth weight was 1701 ± 65 g for white infants and 1462 ± 66 g for black infants. The mean estimated gestational age was 31.0 ± 3.2 weeks for white infants and 29.9 ± 3.8 weeks for black infants. Preeclampsia was more frequent in black mothers than in white mothers for the entire study population (21% vs 14%), but the birth weight differential between races remained after correction for preeclampsia. There were no significant differences between races in stillbirths, gender, maternal age, maternal transfer status, number of prenatal visits, or percentages of mothers with small-for-gestational-age infants, multiple-gestation infants, prolonged rupture of membranes, or initial prenatal visit during the first trimester. Intraventricular hemorrhage was more frequent in white infants at 27 through 29 weeks estimated gestational age (50% vs 13%). There were no significant differences between the two groups in survival or in the occurrence of severe infraventricular hemorrhage or bronchopulmonary dysplasia. It is concluded that preterm black infants are smaller than preterm white infants when matched for gestational age despite essentially equal utilization of prenatal care. However, maternal race has little direct effect on the survival of liveborn preterm infants in this population.
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Thompson, Clare M., Sandro S. Buccimazza, Joanne Webster, Atties F. Malan, and Christopher D. Molteno. "Infants of Less Than 1250 Grams Birth Weight at Groote Schuur Hospital: Outcome at 1 and 2 Years of Age." Pediatrics 91, no. 5 (May 1, 1993): 961–68. http://dx.doi.org/10.1542/peds.91.5.961.
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A prospective 2-year follow-up study of infants with birth weights of less than 1250 g was undertaken at Groote Schuur Hospital Neonatal Intensive Care Unit. For a 12-month period beginning July 1988, all live infants born at Groote Schuur Hospital or referred to the Neonatal Intensive Care Unit were included in the study cohort. The aim of the study was to document the morbidity, mortality, and neurodevelopmental outcome of these infants to 2 years of age. Of 235 liveborn infants, 143 (61%) survived to discharge. One hundred twenty-six infants were born weighing less than 1000 g; 42% survived to discharge. One hundred nine infants weighed 1000 g or more at birth, and 83% survived to discharge. Better survival was documented for infants whose mothers attended antenatal care, who weighed more than 900 g, and who were of greater than 30 weeks' gestation. Eleven infants died in the first 6 months after discharge. One hundred six infants (83% of survivors) underwent Griffiths developmental testing and clinical assessment at 1 year of age. Ninety-six (91%) of these survivors were seen and tested at 2 years of age. Of the 106 infants assessed at 1 year of age, 6 infants had cerebral palsy, 6 were globally developmentally delayed without signs of cerebral palsy, and 1 infant showed significant motor delay with a normal developmental quotient. At 2 years of age 1 additional infant had cerebral palsy and 9 more infants are likely to be mentally retarded. At 2 years of age the major handicap rate was, therefore, 22% . Sixty-nine percent of surviving infants, and all but 1 of the infants with cerebral palsy, were underweight for gestational age at birth. There was a tendency for these underweight-for-gestational-age infants to score less well at 2 years of age. Infants who received ventilation and infants with a birth weight of less than 1000 g were not found to score less well than other infants in the cohort.
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Song, Young Hwa, Jin A. Lee, Byung Min Choi, and Jae Woo Lim. "Risk factors and prognosis in very low birth weight infants treated for hypotension during the first postnatal week from the Korean Neonatal Network." PLOS ONE 16, no. 10 (October 14, 2021): e0258328. http://dx.doi.org/10.1371/journal.pone.0258328.
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Hypotension in the early stages of life appears in 20% of very low birth weight (VLBW) infants. The gestational age and birth weight are the risk factors highly related to the postnatal hypotension. Other risk factors slightly differ between different studies. So, we evaluated the risk factors and prognosis that are associated with infants treated with hypotension in the early stages of life, after excluding the influences of gestational age and small for gestational age (SGA). VLBW infants registered in the Korean Neonatal Network between 2013 and 2015 treated for hypotension within a week after their birth were selected as study subjects. The rest were used as a control group. Risk factors and the prevalence of severe complications, including mortality, were investigated and compared after matching for gestational age and SGA. The treatment rate for hypotension within the first postnatal week was inversely related to decreasing gestational ages and birth weights. In particular, 63.4% of preterm infants born at ≤ 24 weeks’ gestation and 66.9% of those with a birth weight < 500 g were treated for hypotension within a week of birth. Regression analysis after matching showed that 1-minute Apgar score, neonatal cardiac massage or epinephrine administration, symptomatic patent ductus arteriosus, early onset sepsis, and chorioamnionitis were significantly associated with hypotension. In the hypotension group, mortality, grade 3 or higher intraventricular hemorrhage, periventricular leukomalacia, and moderate to severe bronchopulmonary dysplasia rates were significantly higher after the matching for gestational age and SGA. Hypotension during the first postnatal week is very closely related to the prematurity and the condition of the infant shortly after birth. Regular prenatal care including careful monitoring and appropriate neonatal resuscitation are very crucial to decrease the risk of hypotension in the early stages of life.
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Pritchard, Natasha L., Stephen Tong, Susan P. Walker, and Anthea C. Lindquist. "Fetal size classified using gestational days rather than gestational weeks improves correlation with stillbirth risk: A statewide population study." PLOS ONE 17, no. 8 (August 10, 2022): e0271538. http://dx.doi.org/10.1371/journal.pone.0271538.
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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.
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Curzi-Dascalova, Lilia, Patricio Peirano, and Emilia Christova. "Respiratory Characteristics During Sleep in Healthy Small-for-Gestational Age Newborns." Pediatrics 97, no. 4 (April 1, 1996): 554–59. http://dx.doi.org/10.1542/peds.97.4.554.
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Objective. Small-for-gestational age (SGA) infants born with intrauterine growth retardation (IUGR) differ from appropriate-for-gestational age (AGA) infants by: a) alterations in a number of neurologic and neurophysiologic characteristics; b) modified heart rate variability during the neonatal period; and c) increased morbidity rates during the first months of life. However, there are no data on the impact of IUGR on respiratory function control at birth. Methods. We studied 57 newborns who were 35 to 36, 37 to 38, and 39 to 41 weeks' conceptional age (CA): 31 were AGA and 26 were SGA. All were clinically and neurologically normal at birth and none exhibited abnormal events during the first year of life. Polygraphic recordings were performed between two meals during the normal postnatal stay in the maternity ward. Results. During both active sleep (AS) and quiet sleep (QS), SGA infants in all CA groups had significently higher values for the incidence of 2 to 4.9 seconds and 5 to 9.9 seconds central respiratory pauses (RP), the apnea index (AI) [AI = % of nonbreathing time], and the time spent with periodic breathing (PB), as compared with AGA infants Respiratory frequency was usually similar in SGA and AGA infants. In addition, the trend of age-related respiratory modifications was disturbed in SGA infants, as compared with AGA infants: at 39 to 41 weeks CA, SGA infants had no significant decreases in RP, AI, or PB, and no increase in respiratory frequency. However, between-state differences were similar in both groups. In all AGA and SGA infant groups respiratory frequency seemed to be an individual characteristic: infants who breathed faster during AS breathed faster during QS, and vice-versa. Conclusion. Our data demonstrate significant modifications in the establishment of respiratory rhythm control in SGA infants, whereas the patterns of state-related and subject-dependent breathing characteristics were similar in SGA and AGA infants. We speculate that the dysregulation of respiratory function control maturation observed in healthy SGA infants may be related to subtle brainstem modifications attributable to the decreased blood supply and chronic hypoxia associated with IUGR.
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Nusinovici, Simon, Bertrand Olliac, Cyril Flamant, Jean-Baptiste Müller, Marion Olivier, Valérie Rouger, Géraldine Gascoin, et al. "Impact of preterm birth on parental separation: a French population-based longitudinal study." BMJ Open 7, no. 11 (November 2017): e017845. http://dx.doi.org/10.1136/bmjopen-2017-017845.
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ObjectiveThe objective of this study was to investigate both the effects of low gestational age and infant’s neurodevelopmental outcome at 2 years of age on the risk of parental separation within 7 years of giving birth.DesignProspective.Setting24 maternity clinics in the Pays-de-la-Loire region.ParticipantsThis study included 5732 infants delivered at <35 weeks of gestation born between 2005 and 2013 who were enrolled in the population-based Loire Infant Follow-up Team cohort and who had a neurodevelopmental evaluation at 2 years. This neurodevelopmental evaluation was based on a physical examination, a psychomotor evaluation and a parent-completed questionnaire.Outcome measureRisk of parental separation (parents living together or parents living separately).ResultsTen percent (572/5732) of the parents reported having undergone separation during the follow-up period. A mediation analysis showed that low gestational age had no direct effect on the risk of parental separation. Moreover, a non-optimal neurodevelopment at 2 years was associated with an increased risk of parental separation corresponding to a HR=1.49(1.23 to 1.80). Finally, the increased risk of parental separation was aggravated by low socioeconomic conditions.ConclusionsThe effect of low gestational age on the risk of parental separation was mediated by the infant’s neurodevelopment.
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Ibáñez, Lourdes, Carme Valls, Maria Cols, Angela Ferrer, Maria Victoria Marcos, and Francis de Zegher. "Hypersecretion of FSH in Infant Boys and Girls Born Small for Gestational Age." Journal of Clinical Endocrinology & Metabolism 87, no. 5 (May 1, 2002): 1986–88. http://dx.doi.org/10.1210/jcem.87.5.8459.
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Prenatal growth restraint, as reflected in a low birthweight for gestational age, is a risk factor for postpubertal FSH hypersecretion and for reduced gonadal size. The ontogeny of the low-birthweight effect on the FSH-inhibin B feedback loop is unknown. Infancy is an episode of choice to study the possibility of an early low-birthweight effect on the FSH-inhibin B loop because this phase is characterized by high activity within the gonadal axis. We assessed serum concentrations of FSH and inhibin B in 46 infants [26 girls and 20 boys; mean age, 4 months; range, 3–6 months; 17 appropriate for gestational age (AGA), 29 small for gestational age (SGA); mean birthweight, 3.2 kg for AGA vs. 2.3 kg for SGA], together with circulating levels of LH, E2, and free androgen index. In SGA girls and boys, serum FSH levels were 2- and 4-fold higher (P < 0.001), respectively, than in AGA controls of the same gender (7.3 ± 0.9 vs. 3.8 ± 0.4 IU/ml and 2.9 ± 0.5 vs. 0.7 ± 0.2 IU/ml). Serum LH, inhibin B, and free androgen index/E2 concentrations were similar in AGA and SGA infants. In conclusion, prenatal growth restraint was found to be followed by elevated serum FSH concentrations in infant girls and boys. SGA infants seem to need an augmented FSH drive to fulfill inhibin B requirements on the afferent side of the feedback loop. The late-endocrine correlates of early growth restraint are herewith extended to include the main axis of reproduction in both genders. It remains to be studied whether FSH hypersecretion in infancy is a marker of subsequent subfertility.