Adequate Weight For Gestational Age Research Articles

Prediction of newborn assessment according to maternal nutritional status: a model based on decision trees.

Objective: To determine whether it is possible to predict the assessment of the newborn according to maternal nutritional status through a decision tree model. Methods: Cross-sectional analytical study. A total of 326 medical records of pregnant women from a Peruvian public hospital were reviewed, in 2021. The newborn was assessed using the APGAR score, gestational age at birth, birth weight, weight and height for gestational age. Maternal nutritional status included pregestational body mass index and gestational weight gain. The prediction was made using a supervised machine learning model called a “decision tree.” Results: The APGAR score at one minute and height for gestational age were not possible to predict by maternal nutritional status. The probability of having full-term gestational age at birth is 97.2% when gestational weight gain is > 5.4 kg (p = 0.007). The highest probabilities of adequate birth weight were with gestational weight gain between 4.5 kg (p < 0.001) and 17 kg (p < 0.001) and with pregestational body mass index ≤ 36.523 kg/m2 (p = 0.004). Finally, the highest probability of adequate weight for gestational age is when gestational weight gain is < 11.8 Kg (p < 0.001) and with a pregestational body mass index ≤ 36.523 Kg/m2 (p = 0.005). Conclusions: It is possible to predict the assessment of the newborn based on the mother’s nutritional status using machine learning

Effects of an Educational Intervention Program on Positional Cranial Deformity in Premature Infants.

Positional cranial deformities are associated with prematurity evolving during the first 2 years of life due to the malleable characteristics of the skull, the first year being the main/primary therapeutic window for intervention. The objectives were (a) to describe health characteristics, peri- and postnatal pathologies, and positional cranial deformities in infants enrolled in an early intervention program and (b) to analyze the effects of a parent education-based intervention program on positional cranial deformity in premature infants. A quantitative, analytical, longitudinal study was conducted. It included 103 premature infants enrolled in an early intervention program (EIP) during the year 2017, all under 4 months of corrected age, to whom a parent education-based intervention program was applied. Cranial circumference, cranial width, diagonals, and anteroposterior diameter were measured, and the cranial asymmetry index (CAI) and cephalic index (CI) were calculated at baseline and during two subsequent evaluations separated by a 3-month period. The main results showed that 75.7% of the infants belonged to a very premature gestational age category, and 57.3% had an adequate weight for gestational age. The most frequent pathologies were premature jaundice, premature anemia, and hyaline membrane disease. The most frequent positional cranial deformity was plagiocephaly. The parent education-based intervention program resulted in (1) a significant decrease in the CAI and a significant increase in the IC, (2) plagiocephalies: an increase in the mild category and a decrease in the moderate + severe categories, (3) brachycephalies: a decrease in the absence category and an increase in the moderate + severe category, and (4) dolichocephalies: an increase in the absence category and a decrease in the mild category. In conclusion, the recommended first line of intervention was not enough for this population, and future studies should support the development of national clinical guidelines, where education is complemented with other therapeutic measures.

Anthropometric Indicators and Dietary Intake in Toddlers Aged from 12 to 24 Months Who Attended Private Clinics in the Metropolitan Area of Guadalajara.

The objective was to evaluate the anthropometric indicators and dietary intake of toddlers attending private clinics in Guadalajara. In a cross-sectional study, 101 toddlers aged 12 to 24 months were included. They were born full term, had an adequate weight for gestational age, and attended private clinics in Guadalajara. Two 24 h dietary recalls were administered. Anthropometric measurements were taken, and anthropometric indices were estimated. Student's t test or the Mann-Whitney U test, chi-square test, and odds ratio were used for quantitative or qualitative variables. Males had lower Z scores for the weight/age index than females. During the week, energy intake was excessive in males [OR = 5.5 (95% CI 1.4, 20.8)], and cholesterol intake was insufficient in females [OR = 3.03 (95% CI 1.2, 7.1)]. On weekends, energy [OR = 2.5 (95% CI 1.1, 5.7)] and fiber intake [OR = 3.1 (95% CI 1.2, 7.8)] were insufficient in females. Most of the toddlers who attend the private clinics in the upper-middle socioeconomic stratum of the Guadalajara Metropolitan Area had excessive protein intake, excessive consumption of added sugars was frequent, and there was insufficient intake of vitamin D and calcium. Sex was shown to be a factor influencing nutrient intake in these toddlers aged 12-24 months. Males had a Z-score of weight/age lower than females, suggesting nutritional risk.

Gestational weight gain in triplet, trichorionic and triamniotic pregnancy: experience report with a case.

Introduction: inadequate weight gain during pregnancy is recognized as a risk factor for unfavorable maternal and perinatal outcomes, such as preeclampsia. Reports focusing on weight gain in triplet pregnancies are scarce in the literature.Aim: to achieve the evolution of gestational weight gain and the maternal and perinatal outcomes of a triple pregnancy case.Description of case: in the present experience report, the case of a triplet, trichorionic and triamniotic pregnancy was presented. The patient in the case, 36 years old, started prenatal care at 12 weeks of gestation and pre gestational nutritional diagnosis of grade I obesity. The total gestational weight gain was 21 kg, agreed according to the current recommendation. The case presented gestational diabetes mellitus and preeclampsia. However, surgical delivery took place at 32 weeks and 6 days and the newborns had adequate weight for gestational age, without serious clinical complications.Conclusions: the observed results reinforce the importance of nutritional monitoring and the need for more studies that address weight gain in triplet pregnancy.

Perfil epidemiológico em uma Unidade de Terapia Intensiva Neonatal na Região da Amazônia brasileira

AIM: To trace the epidemiological profile of newborns admitted to a Neonatal Intensive Care Unit in a region of the Brazilian Amazon. METHODS: Data were collected from 234 newborns admitted to the Neonatal Intensive Care Unit of the studied department between June 15, 2019 and June 15, 2020. RESULTS: The data pointed to a prevalence of males with adequate weight for gestational age, with main diagnosis on admission of respiratory tract comorbidity and prematurity. In 57.03% of the blood cultures there was no bacterial growth, and when there was growth, coagulase-negative Staphylococcus was present in 20.27%. The death rate calculated in the period was 19.74%. Regarding the maternal profile, 52.36% had six or more prenatal consultations, 73.39% had cesarean section and 32.76% had diabetes and/or hypertension. CONCLUSION: The profile found in this study corroborates the literature, demonstrating a high rate of death and cesarean delivery, with possibly preventable causes with better maternal-fetal care during prenatal care, as assessed in the neonatal near miss. More studies are necessary in relation to the epidemiological profile in Neonatal Intensive Care Units in the northern region because the scarcity and insufficiency of epidemiological data in this region make it difficult to develop public actions aimed at improving the quality of care in Neonatal Intensive Care Units.

Neonate Brain Abscess by Cronobacter spp: A Powdered Infant Formula's Opportunistic Pathogen

Abstract Cronobacter spp is an opportunistic pathogen that can cause severe neonatal infections, including septicemia, meningitis, and necrotizing enterocolitis. Over 90% of these infections outbreaks are associated with the increased consumption of powdered infant formula (PIF). We report the case of a male neonate born at term with adequate weight for gestational age, fed by breast milk and PIF. He was admitted to the ICU at 22 days old due to fever, irritability, impaired consciousness, and food intolerance. Investigation revealed an extensive abscess in the right frontoparietal region, that was surgically drained. The culture of the purulent material showed the growth of Cronobacter spp. Guided antibiotic was kept for 21 days. The patient presented a good clinical outcome, without neurological deficits. The microbiological powdered formula contamination by Enterobacter sakazakii (Cronobacter spp) can lead to a higher risk of severe infections in infants. Children may present sepsis, sensory alteration, and refractory seizures. An early brain image should be considered for symptomatic infants. The mortality rate ranges from 40 to 80%, and 74% of survivors have an adverse neurological outcome. From 1997–2013, there were reports of 6 outbreaks of E. sakazakii disease in Brazil. According to the World Health Organization (WHO), this disease is undernotified, and active foodborne surveillance systems are less than ideal. To better address this problem, in some countries, the notification is mandatory, and the adoption of stricter sanitary measures by regulatory agencies are proposed.

Long-term follow-up of congenital anomalies of the kidney and urinary tract diagnosed in utero: a longitudinal study.

Congenital-anomalies of the kidney-and-urinary-tract (CAKUT) are diagnosed in 3-6 per 1000 live-births. The objective of the current study was to examine the short and long-term outcomes of children diagnosed prenatally with CAKUT. A retrospective study was performed in 2018 on all pregnancies diagnosed with CAKUT between 2004 and 2008 at our hospital. Pregnancy outcomes and long-term morbidity were evaluated. Comparison was made between mildand severe forms of CAKUT and between unilateral and bilateral anomalies. Ninety-eight children were included in the study. Most of them were born with anadequateweight for gestational-age, and wereborn at term by vaginal-deliveries. Children with major renal anomalies suffered significantly more frequentlyfrom recurrent UTIs (33.3% vs. 8.4%), needed more preventive antibiotics (50% vs. 20.5%), and had more renal surgeries (75% vs. 28%) than those with milder forms ofCAKUT. Significantly more children with polycystic/multicystic kidney disease had recurrent UTIs (50% compared to 25% of the children with renal agenesis, and 5.6% of the children with hydronephrosis/hydroureter). There were no significant differences in the need for neurodevelopmental follow-up between the different groups of severity. Unilateral CAKUT patientsrequired longer periods of nephrologist follow-up and repeated sonographic exams compared to bilateral CAKUTpatients. Children with bilateral CAKUT more often neededspecial educational support thanpeers with unilateraldisease (29.4% vs. 11.1%, P = 0.03). Pregnancies whose children are diagnosed withCAKUTin utero usuallydeliver at term, with adequate-weight for gestational-age. The most common long-term comorbidities in children were recurrent UTIs and the use of preventive antibioticswasoften needed. Expecting couples can be reassured of a generally good outcome oftheir children, at leastduring the first decade of life.

Meconium microbiome and its relation to neonatal growth and head circumference catch-up in preterm infants.

The purpose was identify an association between meconium microbiome, extra-uterine growth restriction, and head circumference catch-up. Materials and methods: Prospective study with preterm infants born <33 weeks gestational age (GA), admitted at Neonatal Unit and attending the Follow-Up Preterm Program of a tertiary hospital. Excluded out born infants; presence of congenital malformations or genetic syndromes; congenital infections; HIV-positive mothers; and newborns whose parents or legal guardians did not authorize participation. Approved by the institution's ethics committee. Conducted 16S rRNA sequencing using PGM Ion Torrent meconium samples for microbiota analysis. Results: Included 63 newborns, GA 30±2.3 weeks, mean weight 1375.80±462.6 grams, 68.3% adequate weight for GA at birth. Polynucleobacter (p = 0.0163), Gp1 (p = 0.018), and Prevotella (p = 0.038) appeared in greater abundance in meconium of preterm infants with adequate birth weight for GA. Thirty (47.6%) children reached head circumference catch-up before 6 months CA and 33 (52.4%) after 6 months CA. Salmonella (p<0.001), Flavobacterium (p = 0.026), and Burkholderia (p = 0.026) were found to be more abundant in meconium in the group of newborns who achieved catch-up prior to 6th month CA. Conclusion: Meconium microbiome abundance was related to adequacy of weight for GA. Meconium microbiome differs between children who achieve head circumference catch-up by the 6th month of corrected age or after this period.

Awareness towards an increasing concern during pregnancy: maternal and perinatal outcomes of women with cancer

Increased incidence of cancer in women of childbearing age and improvements on treatment for preserving fertility have led to higher frequency of pregnancy during or after cancer treatment. This study aimed to describe maternal and perinatal outcomes associated with cancer and pregnancy and, as a secondary analysis, to compare outcomes of women with active disease and with remission before pregnancy. We performed a retrospective study of women followed up at a referral center owing to a history of cancer or cancer diagnosed during pregnancy. Data on sociodemographic information, obstetrical history, types of neoplasia, treatments offered, antenatal follow-up, and maternal and perinatal outcomes were retrieved from medical chart review. A descriptive analysis was performed and a comparison among women with active and nonactive disease was performed using Student t-test and chi-square test. A total of 66 women were included in a 5-year period. The most frequent types of cancer were breast (33%), hematologic (21%), brain (11%), cervical (9%), and ovarian (5%) cancers. There were 39 participants (59%) who had active disease and 26 who received oncological treatment during pregnancy, and 23 (34.8%) had a vaginal delivery. There were 4 women who needed intensive care unit admission postpartum. A total of 18 (29.5%) deliveries were at term, most newborns (59%) with adequate weight for gestational age and only 1 had Apgar score lower than 7 in the fifth minute of life. There was 1 stillbirth. The active invasive cancer during pregnancy group showed a higher rate of preterm birth and lower birthweight with significant statistical difference (P=.03 and P<.01, respectively). Breast cancer was the most frequent type of cancer in our cohort. Most deliveries were preterm, with adequate birthweight. Women with active cancer are more likely to have a preterm childbirth and newborns with lower birthweight.

Perfil epidemiológico das cardiopatias congênitas em uma maternidade na serra Catarinense em 2016

Objetivos: Identificar os tipos das cardiopatias congênitas entre os recém nascidos no ano de 2016. Métodos: Foi realizado um estudo, retrospectivo, quantitativo e descritivo a partir da avaliação dos prontuários. Foram analisados os prontuários dos pacientes que realizaram ecocardiograma transtorácico realizado no ano de 2016, sobre: tipo de cardiopatia, peso ao nascimento, idade gestacional, sexo e desfecho clínico de recém nascidos na maternidade na serra catarinense com idade de 0 a 28 dias de vida. Resultados: Os ecocardiogramas transtorácico realizados apontaram comunicação interatrial, persistência do canal arterial, comunicação interventricular, transposição de grandes vasos da base, defeito septal atrioventricular, insuficiência tricúspide e coarctação da aorta em ordem decrescente. A incidência de cardiopatia congênita na amostra coletada foi 14:1000. A idade gestacional prevalente foram os pré termos, a maioria com peso adequado para a idade gestacional com baixo peso. O desfecho clínico foi alta hospitalar na maioria dos casos. Conclusões: O perfil das cardiopatias, o predomínio de baixo peso e a idade gestacional precoce apontam para a necessidade de diagnóstico precoce visando evitar repercussões tardias que poderiam ser evitadas através de acompanhamento clínico e de intervenções cirúrgicas quando necessário. A pesquisa aponta a importância da busca ativa por cardiopatias congênitas no período neonatal, sugerindo-se a utilização do ecocardiograma fetal como exame integrante no pré-natal preconizado pelo Sistema Único de Saúde, a partir das 30 semanas de gestação.

Plasma Metabolome Alterations Associated with Extrauterine Growth Restriction.

Very preterm infants (VPI, born at or before 32 weeks of gestation) are at risk of adverse health outcomes, from which they might be partially protected with appropriate postnatal nutrition and growth. Metabolic processes or biochemical markers associated to extrauterine growth restriction (EUGR) have not been identified. We applied untargeted metabolomics to plasma samples of VPI with adequate weight for gestational age at birth and with different growth trajectories (29 well-grown, 22 EUGR) at the time of hospital discharge. A multivariate analysis showed significantly higher levels of amino-acids in well-grown patients. Other metabolites were also identified as statistically significant in the comparison between groups. Relevant differences (with corrections for multiple comparison) were found in levels of glycerophospholipids, sphingolipids and other lipids. Levels of many of the biochemical species decreased progressively as the level of growth restriction increased in severity. In conclusion, an untargeted metabolomic approach uncovered previously unknown differences in the levels of a range of plasma metabolites between well grown and EUGR infants at the time of discharge. Our findings open speculation about pathways involved in growth failure in preterm infants and the long-term relevance of this metabolic differences, as well as helping in the definition of potential biomarkers.

The entropy of RR intervals is associated to gestational age in full-term newborns with adequate weight for gestational age

Introduction The variability of successive RR intervals has been pointed out as an indicator of systemic homeostasis. The entropy of successive RR intervals is associated with a greater adaptive capacity, which is essential after childbirth, characterized by a change from an intrauterine environment that constantly adapts to the fetal demands, to an extrauterine environment that requires constant biological adaptations by the neonate. Objectives To analyze the association between gestational age (GA) and the entropy of RR intervals in term infants with adequate birth weight in the first hours of extrauterine life. Methods In a cross-sectional study design maternal, labor and neonatal characteristics were collected from the obstetric records. Successive RR intervals were recorded from neonates up to 72 hours (i.e. 3 days) of birth. Subjects Fifty term infants, healthy and with adequate birth weight. Outcome measures: the variability of RR intervals was analyzed obtaining the entropy of 1000 successive RR intervals. Pearson’s correlation was used to evaluate the association between GA and the entropy of successive RR intervals, while linear regression was used to obtain the coefficient of determination (r 2) as well as a prediction model. The adequacy of the prediction model was evaluated using the Komolgorov-Smirnov test to evaluate the residuals distribution. Results There was a positive and significant association between the studied variables (r = 0.437; p = .002). The coefficient of determination allowed us to infer that approximately 19.3% of the RR interval entropy from the studied sample can be explained by the GA (r 2 = 0.193; p = .002). The analysis of the residuals distribution confirmed that the regression model obtained here was adequate. Conclusion Our results indicate that, even within a normal range of GA (≥37 a < 42 weeks) and birth weight, a longer intrauterine life allows a greater entropy of successive RR intervals, indicating a greater maturation of biological systems and adaptive capacity.

Myeloperoxidase as cardiovascular risk marker in pre-pubertal preterm children?

Background and aimsTo evaluate the biomarkers related to cardiovascular risk in pre-pubertal preterm children with a birth weight of less than 1,500 g and relate them to current nutritional status, insulin resistance, and inflammation. Methods & resultsThis is a cross-sectional, controlled study with pre-pubertal preterm children aged 5–9 years with a birth weight of less than 1500 g (Preterm group, n = 44) compared to full term children of adequate weight for gestational age (Control group, n = 30). Clinical evaluation: anthropometry and pubertal staging. Laboratory tests: total cholesterol and fractions, triglycerides, paraoxonase 1, apolipoproteins A-I and B, myeloperoxidase (MPO), high sensitivity C-reactive protein (hs-CRP), glycemia and insulin (to calculate HOMA-IR). In the preterm group, 19 (43.2%) were male, with mean birth weight and gestational age of 1157 ± 242 g and 30.0 ± 2.3 weeks, respectively. The preterm group showed lower concentrations of HDL-c (60.1 ± 10.1 vs. 69.0 ± 10.0 mg/dL; p < 0.001); higher concentrations of hs-CRP [0.55 mg/dL (0.30; 39.4) vs. 0.30 mg/dL (0.30; 10.80); p = 0.043], of MPO [21.1 ng/mL (5.7; 120.0) vs. 8.1 ng/mL (2.6; 29.6); p < 0.001] and of MPO/HDL-c ratio [0.39 (0.09; 2.07) ng/mg vs. 0.11 (0.05; 0.58)]. The MPO/HDL-c ratio was the variable that showed the best discriminatory power between the groups (AUC = 0.878; 95% CI; 0.795–0.961). MPO concentrations in the preterm group were correlated with those of hs-CRP (r = 0.390; p = 0.009), insulin (r = 0.448; p = 0.002) and HOMA-IR (r = 0.462; p = 0.002). ConclusionPrepubertal preterm children show high MPO concentrations and MPO/HDL-c ratio that are associated with inflammation and oxidative stress, which, in turn, may be associated with atherosclerosis.

Evaluation of pain in children of 2, 4 and 6 months after the application of non-pharmacological analgesia methods during vaccination

IntroductionYoung children perceive pain as much, or even more than adults, and the pain may have short- and long-term consequences. The literature describes the use of non-pharmacological interventions to alleviate pain during vaccination. The aim of this study was to assess 3 such interventions for analgesia during vaccination: non-nutritive sucking (NNS), breastfeeding (BF), and administration of a 50% dextrose solution (D50W). Materials and methodsA prospective, non-randomised cohort study was carried out on infants aged 2, 4 and 6 months that received 1, 2, or 3 vaccines, respectively, according to the routine immunisation schedule. There were 3 treatments: NNS, BF, and 2mL of D50W combined with NNS. Pain was assessed using the LLANTO scale, and the duration of crying. ResultsThe study included 387 infants. The mean scores in the LLANTO scale at ages 2 and 6 months were significantly lower in breastfed infants compared to infants managed with NNS (P=.025 and P<.001, respectively), or infants given D50W (P=.025 and P=.001), and the difference was not statistically significant at age 4 months (P=.21 and P=.27). There were no significant differences between infants managed with NNS and D50W at 2, 4, and 6 months (P=.66, P=.93 and P=.45, respectively). The duration of crying was significantly lower at age 6 months in breastfeed infants compared to infants managed with NNS or D50W (P=.013 and P=.017). No breastfed child (n=129) experienced side effects. ConclusionsIn infants born to term with adequate weight for gestational age, breastfeeding reduces pain on the administration of 1 or 2 vaccines. When 3 vaccines are given, the reduction is minimal. Administration of D50W does not have any additional analgesic effect in infants compared to being held by a parent combined with NNS during vaccination. BF during vaccination is not associated with any side effects.

EMBARAZO POST TRANSPLANTE RENAL

Se estudió a 8 mujeres transplantadas renales, que cursaron 10 gestaciones. Todos los injertos provenían de personas vivas y el 75% eran de familiares. La edad de las gestantes fluctuó entre 17 y 33 años. El intervalo entre el injerto y la gestación fue de 4 meses a 5 años, en 3 casos menor a un año. La inmunosupresión durante el embarazo se realizó con prednisona (0.15 a 0.20 mglKgldía) y Azothioprina (1.5 a 2.0 mgldía). La complicación materna más frecuente fué la hipertensión inducida por el embarazo (7 casos), incluyendo un caso de eclampsia. Fue alta la incidencia de infección del tracto urinario (3 casos), y la hidronefrosis, factores negativos en el futuro del injerto. Se detectó disminución de la función renal en 2 casos y rechazo agudo reversible en 1 caso. El parto fue por cesárea en siete casos, cifra que la consideramos alta y que puede disminuir en el futuro. Se sugiere el parto instrumentado para acortar el expulsivo. En cuatro casos se realizó salpinguectomía bilateral a solicitud de la pareja. Cuatro de los recién nacidos son prematuros. Con la excepción de un bebe a término, todos tuvieron peso adecuado para la edad gestacional. Hubo hipoxia moderada en 3 casos, alteraciones metabólicas en 2 diarrea aguda en otros dos casos. No se detectó malformaciones congénitas.

Low birthweight and postnatal weight in full-term infants under six months old, Rio de Janeiro, RJ, Brazil.

This study investigated the association between low birthweight and postnatal weight in full-term infants, taking social, economic, maternal and babies characteristics into account. A cross-sectional study was conducted with infants under six months old at 27 primary healthcare units in the Rio de Janeiro municipality, Brazil, in 2007. Only singleton full-term babies were included. The association between full-term low birthweight and postnatal weight was tested using the multiple regression model adjusted for the gender and age of the baby, as well as potential confounding factors. A total of 875 babies were evaluated, of whom 4.5% were small for gestational age. Small-for-gestational-age babies weighted, on average, 977.4 grams less than those born with adequate weight for gestational age, after adjustment by gender and age, as well as marital status and parity. Girls were 426.74 grams lighter than boys; children from mothers with live-in partners were 146.2 grams heavier than those of single mothers, and the babies of primiparae weighed 204.67 grams less than the children of multiparae. Low birthweight is an unfavorable factor for postnatal weight of full-term infants. These children, particularly daughters of primipara single mothers, must be followed more frequently in relation to their postnatal growth.

Cortical Thumb Sign

A 7-month-old male infant was brought to our attention because of feeding difficulties. In the past 2 months, he had also become more irritable, requiring that he was always held and displaying reduced smiling and interaction with parents. He was born at term via an uncomplicated vaginal delivery, with an adequate weight for gestational age. He had been breastfed for 5 months and had previously shown a normal attainment of developmental milestones. Physical examination revealed axial hypotonia with reduced postural control, spasticity of limbs, and rare spontaneous movements.

Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study

BackgroundRates of preterm birth are increasing worldwide and this increase is mostly due to infants born between 34 and 36 weeks of gestational age, the so-called "late preterm" births. The aim of this study was to assess the effect of late preterm birth over growth outcomes, assessed when children were 12 and 24 months old.MethodsIn 2004, all births taking place in Pelotas (Southern Brazil) were recruited for a cohort study. Late preterm (34/0-36/6 weeks of gestational age) and term children (37/0-42/6 weeks) were compared in terms of weight-for-age, length-for-age and weight-for-length z-scores. Weight-for-age, length-for-age and weight-for-length z-scores below -2 were considered, respectively, underweight, stunting and wasting. Singleton newborns with adequate weight for gestational age at birth, successfully followed-up either at 12 or 24 months of age were analyzed and adjusted odds ratios with 95% confidence intervals calculated through logistic regression.Results3285 births were included, 371 of whom were late preterm births (11.3%). At 12 months, prevalence of underweight, stunting and wasting were, respectively, 3.4, 8.7 and 1.1% among late preterm children, against 1.0, 3.4 and 0.3% among term children. At 24 months, correspondent values were 3.0, 7.2 and 0.8% against 0.8, 2.9 and 0.4%. Comparing with the term children, adjusted odds of being underweighted among late preterm children was 2.57 times higher (1.27; 5.23) at 12 months and 3.36 times higher (1.56; 7.23) at 24; of being stunted, 2.35 (1.49; 3.70) and 2.30 (1.40; 3.77); and of being wasted, 3.98 (1.07; 14.85) and 1.87 (0.50; 7.01). Weight gain from birth to 12 and 24 months was similar in late preterm and term children, whereas length gain was higher in the former group in both periods.ConclusionLate preterm children grow faster than children born at term, but they are at increased risk of underweight and stunting in the first two years of life. Failure to thrive in the first two years may put them at increased risk of future occurrences of serious morbidity in late childhood and of chronic disease development in adult life.

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

Postnatal growth failure in preterm infants is due to interactions between genetic and environmental factors, which are not fully understood. We assessed dietary supply of nutrients in very-low-birth-weight (VLBW, < 1500 g) infants fed fortified human milk, and examined the association between nutrient intake, medical factors and growth during hospitalisation lasting on average 70 d. We studied 127 VLBW infants during the early neonatal period. Data were obtained from medical records on nutrient intake, growth and growth-related factors. Extra-uterine growth restriction was defined as body weight < 10th percentile of the predicted value at discharge. Using logistic regression, we evaluated nutrient intake and other relevant factors associated with extra-uterine growth restriction in the subgroup of VLBW infants with adequate weight for gestational age at birth. The proportion of growth restriction was 33 % at birth and increased to 58 % at discharge from hospital. Recommended values for energy intake (>500 kJ/kg per d) and intra-uterine growth rate (15 g/kg per d) were not met, neither in the period from birth to 28 weeks post-conceptional age (PCA), nor from 37 weeks PCA to discharge. Factors negatively associated with growth restriction were energy intake (Ptrend = 0.002), non-Caucasian ethnicity (P = 0.04) and weight/predicted birth weight at birth (Ptrend = 0.004). Extra-uterine growth restriction is common in VLBW infants fed primarily fortified human milk. Currently recommended energy and nutrient intake for growing preterm infants was not achieved. Reduced energy supply and non-Caucasian ethnicity were risk factors for growth restriction at discharge from hospital.

Water aerobics II: maternal body composition and perinatal outcomes after a program for low risk pregnant women

BackgroundTo evaluate the effectiveness and safety of water aerobics during pregnancy.MethodsA randomized controlled trial carried out in 71 low-risk sedentary pregnant women, randomly allocated to water aerobics or no physical exercise. Maternal body composition and perinatal outcomes were evaluated. For statistical analysis Chi-square, Fisher's or Student's t-tests were applied. Risk ratios and their 95% CI were estimated for main outcomes. Body composition was evaluated across time using MANOVA or Friedman multiple analysis.ResultsThere were no significant differences between the groups regarding maternal weight gain, BMI or percentage of body fat during pregnancy. Incidence of preterm births (RR = 0.84; 95%CI:0.28–2.53), vaginal births (RR = 1.24; 95%CI:0.73–2.09), low birthweight (RR = 1.30; 95%CI:0.61–2.79) and adequate weight for gestational age (RR = 1.50; 95%CI:0.65–3.48) were also not significantly different between groups. There were no significant differences in systolic and diastolic blood pressure and heart rate between before and immediately after the water aerobics session.ConclusionWater aerobics for sedentary pregnant women proved to be safe and was not associated with any alteration in maternal body composition, type of delivery, preterm birth rate, neonatal well-being or weight.