Appropriate For Gestational Age Research Articles

Is there an association between isolated sonographic abdominal circumference below the 10th percentile and placental vascular lesions?

To study the association between prenatal diagnosis of isolated abdominal circumference (AC) below the 10th percentile (AC <10th) in appropriate for gestational age (AGA) neonates and placental vascular lesions. A prospective study was conducted of healthy women who underwent sonographic fetal biometric measurements, up to 7days before delivery, and delivered AGA neonates. The study cohort was divided into those with and without prenatal isolated AC <10th. Placental histopathology lesions were classified into maternal and fetal vascular malperfusion (MVM, FVM) lesions. Compared to the AC over 10th percentile group (n=85), the AC <10th group (n=85) was characterized by lower maternal body mass index, higher rate of smokers, and increased rate of induced labor (P=0.029, P=0.029, P=0.001, respectively). There were no between-group differences regarding maternal age, gestational age, and neonatal outcome. Mean placental weight was lower in the isolated AC <10th (P<0.001). The rate of MVM or FVM lesions did not differ between the groups. By multivariate logistic regression analysis, isolated AC <10th was not found to be associated with increased risk for placental vascular lesions. Isolated AC <10th is associated with increased rate of induction of labor; however, it is not associated with increased placental vascular lesions.

First-Trimester Screening for Fetal Growth Restriction and Small-for-Gestational-Age Pregnancies without Preeclampsia Using Cardiovascular Disease-Associated MicroRNA Biomarkers.

The goal of the study was to determine the early diagnostical potential of cardiovascular disease-associated microRNAs for prediction of small-for-gestational-age (SGA) and fetal growth restriction (FGR) without preeclampsia (PE). The whole peripheral venous blood samples were collected within 10 to 13 weeks of gestation from singleton Caucasian pregnancies within the period November 2012 to March 2020. The case-control retrospective study, nested in a cohort, involved all pregnancies diagnosed with SGA (n = 37) or FGR (n = 82) without PE and 80 appropriate-for-gestational age (AGA) pregnancies selected with regard to equality of sample storage time. Gene expression of 29 cardiovascular disease-associated microRNAs was assessed using real-time RT-PCR. Upregulation of miR-16-5p, miR-20a-5p, miR-146a-5p, miR-155-5p, miR-181a-5p, and miR-195-5p was observed in SGA or FGR pregnancies at 10.0% false positive rate (FPR). Upregulation of miR-1-3p, miR-20b-5p, miR-126-3p, miR-130b-3p, and miR-499a-5p was observed in SGA pregnancies only at 10.0% FPR. Upregulation of miR-145-5p, miR-342-3p, and miR-574-3p was detected in FGR pregnancies at 10.0% FPR. The combination of four microRNA biomarkers (miR-1-3p, miR-20a-5p, miR-146a-5p, and miR-181a-5p) was able to identify 75.68% SGA pregnancies at 10.0% FPR in early stages of gestation. The detection rate of SGA pregnancies without PE increased 4.67-fold (75.68% vs. 16.22%) when compared with the routine first-trimester screening for PE and/or FGR based on the criteria of the Fetal Medicine Foundation. The combination of seven microRNA biomarkers (miR-16-5p, miR-20a-5p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-342-3p, and miR-574-3p) was able to identify 42.68% FGR pregnancies at 10.0% FPR in early stages of gestation. The detection rate of FGR pregnancies without PE increased 1.52-fold (42.68% vs. 28.05%) when compared with the routine first-trimester screening for PE and/or FGR based on the criteria of the Fetal Medicine Foundation. Cardiovascular disease-associated microRNAs represent promising early biomarkers with very suitable predictive potential for SGA or FGR without PE to be implemented into the routine screening programs.

Analysis of Gene Expression Profiles in the Liver of Rats With Intrauterine Growth Retardation.

BackgroundIntrauterine growth restriction (IUGR) is highly associated with fetal as well as neonatal morbidity, mortality, and an increased risk metabolic disease development later in life. The mechanism involved in the increased risk has not been established. We compared differentially expressed genes between the liver of appropriate for gestational age (AGA) and IUGR rat models and identified their effects on molecular pathways involved in the metabolic syndrome.MethodsWe extracted RNA from the liver of IUGR and AGA rats and profiled gene expression by microarray analysis. GO function and KEGG pathway enrichment analyses were conducted using the Search Tool for the Retrieval of Interacting Genes database. Then, the Cytoscape software was used to visualize regulatory interaction networks of IUGR-related genes. The results were further verified via quantitative reverse transcriptase PCR analysis.ResultsIn this study, 815 genes were found to be markedly differentially expressed (fold-change >1.5, p < 0.05) between IUGR and AGA, with 347 genes elevated and 468 suppressed in IUGR, relative to AGA. Enrichment and protein–protein interaction network analyses of target genes revealed that core genes including Ppargc1a, Prkaa2, Slc2a1, Rxrg, and Gcgr, and pathways, including the PPAR signaling pathway and FoxO signaling pathway, had a potential association with metabolic syndrome development in IUGR. We also confirmed that at the mRNA level, five genes involved in glycometabolism were differentially expressed between IUGR and AGA.ConclusionOur findings elucidate on differential gene expression profiles in IUGR and AGA. Moreover, they elucidate on the pathogenesis of IUGR-associated metabolic syndromes. The suggested candidates are potential biomarkers and eventually intended to treat them appropriately.

417 IS ACCELERATED GROWTH VELOCITY A RISK FACTOR OF ADVERSE PERINATAL OUTCOME

Introduction: Large for gestational age and macrosomia are known risk factors of adverse perinatal outcome. Less is known on the association between accelerated growth velocity and placental insufficiency which results in such adverse outcomes as intrauterine death, reduced Apgar scores and cesarean section for fetal distress. Aim of the study: The aim of this study was to assess the incidence of accelerated growth velocity (AGV) and its relationship with adverse perinatal outcome. Methods: This is a retrospective cohort study. The study included singleton deliveries that had an ultrasound performed between 28-32 weeks of gestation and subsequently delivered at our maternity unit. We defined appropriate-for-gestational-age (AGA) as between the 10-90th centile, large-for-gestational-age (LGA) as above the 90th centile, by the Intergrowth chart. Accelerated growth velocity was defined as increase by at least 50 centiles between birthweight and estimated fetal weight on ultrasound at 28-32 weeks of gestation. Composite neonatal outcome, intrauterine fetal death and neonatal death were assessed in the following groups: LGA, LGA+AGV, AGA+AGV, AGA. Results: The final database of combined ultrasound and delivery records comprised of 2209 records (AGA n=1688, AGA+AGV n=86, LGA n=391, LGA+AGV n=44; 88.56%, 4.51%, 20.51%, 2.31% respectively). The highest risk of APO was in AGA neonates with AGV 26.74%, followed by LGA with AGV 18,18%. The lowest risk of APO was among LGA neonates 16.37%. Conclusions: The role of accelerated growth velocity needs further assessment. The highest risk of APO is among AGA neonates with AGV. This could be explained by the disproportion between fetal and placental size resulting in placental insufficiency.

Adverse neonatal outcome in twin pregnancy complicated by small-for-gestational age: twin vs singleton reference charts.

The use of twin-specific vs singleton growth charts in the assessment of twin pregnancy has been controversial. The aim of this study was to assess whether a diagnosis of small-for-gestational age (SGA) made using twin-specific estimated-fetal-weight (EFW) and birth-weight (BW) charts is associated more strongly with adverse neonatal outcomes in twin pregnancies, compared with when the diagnosis is made using singleton charts. This was a cohort study of twin pregnancies delivered at St George's Hospital, London, between January 2007 and May 2020. Twin pregnancies complicated by intrauterine death of one or both twins, fetal aneuploidy or major abnormality, twin-twin transfusion syndrome or twin anemia-polycythemia sequence and those delivered before 32 weeks' gestation, were excluded. SGA was defined as EFW or BW below the 10th centile, and was assessed using both twin-specific and singleton EFW and BW charts. The main study outcome was composite adverse neonatal outcome. Mixed-effects logistic regression analysis with random pregnancy-level intercepts was used to test the association between SGA classified using the different charts and adverse neonatal outcome. A total of 1329 twin pregnancies were identified, of which 913 (1826 infants) were included in the analysis. Of these pregnancies, 723 (79.2%) were dichorionic and 190 (20.8%) were monochorionic. Using the singleton charts, 33.3% and 35.7% of pregnancies were classified as SGA based on EFW and BW, respectively. The corresponding values were 5.9% and 5.6% when using the twin-specific charts. Classification as SGA based on EFW using the twin charts was associated significantly with composite adverse neonatal outcome (odds ratio (OR), 4.78 (95% CI, 1.47-14.7); P = 0.007), as compared with classification as appropriate-for-gestational age (AGA). However, classification as SGA based on EFW using the singleton standard was not associated significantly with composite adverse neonatal outcome (OR, 1.36 (95% CI, 0.63-2.88); P = 0.424). Classification as SGA based on EFW using twin-specific standards provided a significantly better model fit than did using the singleton standard (likelihood ratio test, P < 0.001). When twin-specific charts were used, classification as SGA based on BW was associated significantly with a 9.3 times increased odds of composite adverse neonatal outcome (OR, 9.27 (95% CI, 2.86-30.0); P < 0.001). Neonates classified as SGA according to the singleton BW standard but not according to the twin-specific BW standards had a significantly lower rate of composite adverse neonatal outcome than did AGA twins (OR, 0.24 (95% CI, 0.07-0.66); P = 0.009). The singleton charts classified one-third of twins as SGA, both prenatally and postnatally. Infants classified as SGA according to the twin-specific charts, but not those classified as SGA according to the singleton charts, had a significantly increased risk of adverse neonatal outcome compared with infants classified as AGA. This study provides further evidence that twin-specific charts perform better than do singleton charts in the prediction of adverse neonatal outcome in twin pregnancies. The use of these charts may reduce misclassification of twins as SGA and improve identification of those that are truly growth restricted. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.

Serum S100B Protein Concentrations in SGA/FGR newborns.

Fetal growth restriction is associated with chronic fetal hypoxia, poor perinatal outcome and increased perinatal mortality. There are no reliable methods to detect cell damage in the central nervous system (CNS) in these patients. The findings of increased an acidic calcium-binding protein (S100B) concentration in biological fluids of infants after brain injury have supported the use of S100B as a biochemical marker of CNS damage. The purpose of the study was to assess blood S100B concentrations in small for gestational age (SGA) and appropriate for gestational age (AGA) newborns and to evaluate the usefulness of S100B for early detection of hypoxia. The investigation was carried out between November 2011 and April 2014. Serum S100B protein level was assessed in cord blood collected from newborns after birth. Medical records of mothers of neonates studied were reviewed for pregnancy induced hypertension (PIH), preeclampsia, maternal smoking during pregnancy and abnormalities in umbilical artery (UA) Doppler ultrasound examination. The study was carried out in 88 SGA neonates and 80 AGA neonates. The median value of S100B protein concentration in the SGA study group was significantly higher than in AGA controls (p < 0.001). Cord blood serum S100B concentration in SGA neonates with prenatal normal UA Doppler ultrasound findings (n = 32) did not differ from that SGA neonates with abnormal prenatal UA Doppler findings (n = 25) (p = 0.74), but was significantly higher than in AGA newborns (p < 0.001). Elevated S100B protein levels in cord blood collected from SGA newborns may be helpful in detecting infants at higher risk of postnatal neurologic disturbances at an early stage.

Blood Acylated Ghrelin Concentrations in Healthy Term Newborns: A Prospective Cohort Study

Objective The effect of ghrelin, a growth hormone (GH) secretagogue on growth of neonates, has been studied in the past, but not fully clarified. We aimed to investigate the relationship between ghrelin and growth parameters at birth and at the age of three months in healthy term infants. Methodology. This was a prospective observational study carried out in a tertiary care hospital. Eighty-four infants born at gestational ages between 37 and 42 weeks and classified as term small for gestational age (SGA) and appropriate for gestational age (AGA) were included in the study. Estimation of acylated ghrelin (AG) concentrations was done in the cord blood at birth and in venous blood at the age of 3 months in all the infants. The correlation between AG concentrations and growth parameters at birth and at 3 months was studied. Results AG concentrations were significantly higher in SGA (236.16 ± 152.4 pg/ml) than AGA neonates (59.45 ± 20.95 pg/ml) at birth. Concentrations were observed to be negatively correlated with birth weight (r = −0.34, p value 0.03), birth length, and head circumference (r = −0.509 and -0.376, respectively) in SGA neonates. However, at 3 months, AG concentrations did not correlate with changes in anthropometric parameters in both the groups. Conclusion Cord acylated ghrelin concentrations are higher in SGA neonates, and the concentrations are inversely proportional to the birth weight. Hence, its role as a surrogate marker for intrauterine nutrition can be suggested. However, its concentrations do not correlate with anthropometric parameters in early postnatal growth, suggesting it may not have a direct role in postnatal growth.

Serum Vasostatin-1 Level is Increased in Women with Preeclampsia.

To evaluate the serum vasostatin-1 levels in preeclamptic and non-preeclamptic pregnant women. Thirty consecutive women with mild preeclampsia and sixty consecutive women with severe preeclampsia were compared with ninety gestational age-matched (±1 week) non-preeclamptic pregnant women with an appropriate-for-gestational-age (AGA) fetus. Mean serum vasostatin-1 was significantly higher in women with preeclampsia than gestational age-matched controls. Mean serum vasostatin-1 was significantly higher in the mild preeclampsia group compared to its gestational age-matched control group, and in the severe preeclampsia group compared to its gestational age-matched control group. There was no significant difference in mean serum vasostatin-1 levels between the mild and severe preeclampsia groups, and in severe early- and severe late-onset preeclampsia groups. Serum vasostatin-1 had positive correlations with systolic and diastolic blood pressure. Serum vasostatin-1 was significantly higher in women with preeclampsia compared to those of the gestational age-matched controls. There was no significant difference in mean serum vasostatin-1 levels between the mild and severe preeclampsia groups and severe early- and severe late-onset preeclampsia groups.

Prospective observational study to assess the Somatic Growth in Very Low Birth Weight infants

Background: The birth weight is the first weight measured; an infant with low birth weight is more likely to have poor somatic growth during childhood and develop markers of metabolic risk factors at his/her later age. Objectives: To evaluate the somatic growth of very low birth weight (VLBW) infants at discharge and 40 weeks postmenstrual age and to compare the growth of small for gestational age (SGA) and appropriate for gestational age (AGA) babies. Methods: This prospective observational study was conducted over a period of one year at the neonatal unit and high-risk follow-up clinic of a tertiary care hospital. VLBW babies (weight less than 1500 g), admitted within 72 hours of life and discharged alive, were followed up prospectively. The baseline data were collected before discharge from the hospital and babies were followed up till the 40 weeks post-menstrual age. Results: Out of 53 babies enrolled, one baby had a congenital malformation, six died during NICU stay, and four were not followed up. Finally, 42 babies were followed for 40 weeks. The mean gestational age was 30 ± 2.5 weeks and mean birth weight was 1199 ± 216 gm. The mean Z scores for weight, length and head circumference at birth were -0.88, -0.59, and -0.64, respectively. These changed to -1.12, -1.12, and -1.11, respectively at the time of discharge and -1.69, -1.03, and -0.73, respectively at post-menstrual age of 40 weeks. Both SGA and AGA infants exhibited a growth lag during hospital stay as indicated by a fall in Z scores for all three parameters from birth to discharge. Exclusive enteral feeding is feasible for VLBW infants without any difference in growth compared to babies given short term parenteral nutrition. Despite aggressive enteral feeding, only one baby had NEC and none of the babies developed late onset sepsis. Conclusions: In our study, both SGA and AGA infants exhibited a growth lag during hospital stay as indicated by a fall in Z scores for all three parameters from birth to discharge. Exclusive enteral feeding is feasible for VLBW infants without any difference in growth compared to babies given short-term parenteral nutrition. Also, rapid progression of feeds did not have any significant adverse effects in our study population.

Circulating SPINT1 Is Reduced in a Preeclamptic Cohort with Co-Existing Fetal Growth Restriction.

Fetal growth restriction (FGR), when undetected antenatally, is the biggest risk factor for preventable stillbirth. Maternal circulating SPINT1 is reduced in pregnancies, which ultimately deliver small for gestational age (SGA) infants at term (birthweight < 10th centile), compared to appropriate for gestational age (AGA) infants (birthweight ≥ 10th centile). SPINT1 is also reduced in FGR diagnosed before 34 weeks’ gestation. We hypothesised that circulating SPINT1 would be decreased in co-existing preterm preeclampsia and FGR. Plasma SPINT1 was measured in samples obtained from two double-blind, randomised therapeutic trials. In the Preeclampsia Intervention with Esomeprazole trial, circulating SPINT1 was decreased in women with preeclampsia who delivered SGA infants (n = 75, median = 18,857 pg/mL, IQR 10,782–29,890 pg/mL, p < 0.0001), relative to those delivering AGA (n = 22, median = 40,168 pg/mL, IQR 22,342–75,172 pg/mL). This was confirmed in the Preeclampsia Intervention 2 with metformin trial where levels of SPINT1 in maternal circulation were reduced in SGA pregnancies (n = 95, median = 57,764 pg/mL, IQR 42,212–91,356 pg/mL, p < 0.0001) compared to AGA controls (n = 40, median = 107,062 pg/mL, IQR 70,183–176,532 pg/mL). Placental Growth Factor (PlGF) and sFlt-1 were also measured. PlGF was significantly reduced in the SGA pregnancies, while ratios of sFlt-1/SPINT1 and sFlt1/PlGF were significantly increased. This is the first study to demonstrate significantly reduced SPINT1 in co-existing FGR and preeclamptic pregnancies.

Increased incidence of childhood lymphoma in children with a history of small for gestational age at birth.

The aim of this study was to evaluate whether children that were born small for gestational age (SGA) have an increased risk for childhood neoplasm. A population-based cohort analysis comparing the risk for long-term childhood neoplasms (benign and malignant) in children that were born SGA vs. those that were appropriate for gestational age (AGA), between the years1991-2014. Childhood neoplasms were predefined based on ICD-9 codes, as recorded in the hospital medical files. Kaplan-Meier survival curves were constructed to compare cumulative oncological morbidity in both groups over time. Cox proportional hazards model was used to control for confounders. During the study period 231,973 infants met the inclusion criteria; out of those 10,998 were born with a diagnosis of SGA. Children that were SGA at birth had higher incidence of lymphoma (OR 2.50, 95% CI 1.06-5.82; p value = 0.036). In addition, cumulative incidence over time of total childhood lymphoma was significantly higher in SGA children (Log Rank = 0.030). In a Cox regression model controlling for other perinatal confounders; SGA at birth remained independently associated with an increased risk for childhood lymphoma (adjusted HR 2.41, 95% CI 1.03-5.56, p value = 0.043). Being delivered SGA is associated with an increased long-term risk for childhood malignancy and specifically lymphoma.

Growth of exclusively breastfed small for gestational age term infants in the first six months of life: a prospective cohort study

BackgroundCompared to their appropriate-for-gestational-age (AGA) peers, small-for-gestational-age (SGA) infants are prone to growth deficits. As the first 6 months of exclusive breastfeeding is generally recommended, it is essential to understand how this intervention might impact SGA infants’ growth. This study aims to assess growth of exclusively breastfed SGA term infants in the first 6 months of life.MethodsA prospective cohort study was conducted on term infants born in Dr. Sardjito General Hospital and two private hospitals in Yogyakarta, Indonesia. SGA was defined as birth weight less than the 10th percentile according to Fenton criteria. Weight, length, and head circumference (HC) were measured at birth and monthly until 6 months old.ResultsA total of 39 AGA and 17 SGA term infants who were exclusively breastfed in their first 6 months were included and followed. In SGA compared to AGA, birth weight, length, and HC (mean ± SD) were significantly lower (p < 0.001). During the first 6 months, the SGAs grew in weight and length in parallel with the AGAs. At sixth months of age, the weight and length (mean ± SD) of the SGAs were significantly lower compared to the AGAs (p < 0.001). However, HC (mean ± SD) of SGAs grew significantly faster than the AGAs (p < 0.005). At sixth months of age, there were no significant differences in HC between the two groups (p = 0.824).ConclusionsIn the first 6 months, exclusively breastfed SGA term infants, in contrast to weight and length, only show catch up growth in HC, leading to HC comparable to their AGA peers at the age of 6 months.

“ASSESSMENT OF GESTATIONAL AGE BY NEW BALLARD'S SCORE AND ITS CORRELATION WITH FOOT LENGTH”

BACKGROUND – Foot length has been studied by various authors as proxy measurement which can be measured easily in sick and preterm newborns. This study was done to nd the correlation of foot length with gestational age and other anthropometric measurements (birth weight, head circumference and crown heel length). AIMS AND OBJECTIVES1. To study the correlation of foot length and gestational age among the neonates. 2. To study the correlation between foot length and other variables (gestational age, birth weight, head circumference and crown heel length) among the newborns. 3. To study if foot length can be used as a proxy measurement to gestational age and birth weight assessment. MATERIAL: A study sample of 350 live newborns born at MMIMSR, Mullana, Ambala was selected by simple random sampling technique METHODS: Study sample of 350 newborns was selected by simple random sampling technique born at MMIMSR, Mullana, Ambala from April 2020 to May 2021. Babies with limb deformities were excluded from the study group. Babies were grouped into term, preterm and post-term and gestational age was assessed by New Ballard score. These three groups were categorized in to small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA) using Fenton growth chart. Correlation of foot length with gestational age and other anthropometric parameters were statistically analysed by correlation and regression analysis. RESULTS- In the study, male newborns were 55.1% and female were 44.9%. Of the 350 newborns, preterms were 32.9%, terms were 65.4% and post-term 1.7%. In the study group, 30.8% were low birth weight babies, 63.4% had birth weight in the range of 2.5- 4 kg and 0.9% had birth weight &gt;4 kg. The mean foot length was 7.301 cm with a range of 4.6-8.4 cms. Foot length correlated signicantly (p &lt; 0.05) with crown heel length, birth weight, gestational age and head circumference in the neonates. Maximum correlation was observed with crown heel length (r = 0.916) which indicates strong positive association between them, followed by birth weight (r = 0.912), gestational age(r = 0.902) and head circumference (r = 0.875). CONCLUSION- Foot length is a easy and reliable anthropometric measurement to assess birth weight and gestational age in neonates, especially who are ill. Foot length can be reliably measured by peripheral heath care workers and could be used effectively for identifying and referring high risk newborns.

Brain-Derived Neurotrophic Factor Levels in Cord Blood from Growth Restricted Fetuses with Doppler Alteration Compared to Adequate for Gestational Age Fetuses.

Background and Objectives: Fetal growth restriction (FGR) is a severe obstetric disease characterized by a low fetal size entailing a set of undesired consequences. For instance, previous studies have noticed a worrisome association between FGR with an abnormal neurodevelopment. However, the precise link between FGR and neurodevelopmental alterations are not yet fully understood yet. Brain-derived neurotrophic factor (BDNF) is a critical neurotrophin strongly implicated in neurodevelopmental and other neurological processes. In addition, serum levels of BDNF appears to be an interesting indicator of pathological pregnancies, being correlated with the neonatal brain levels. Therefore, the aim of this study is to analyze the blood levels of BDNF in the cord blood from fetuses with FGR in comparison to those with weight appropriate for gestational age (AGA). Materials and Methods: In this study, 130 subjects were recruited: 91 in group A (AGA fetuses); 39 in group B (16 FGR fetuses with exclusively middle cerebral artery (MCA) pulsatility index (PI) < 5th percentile and 23 with umbilical artery (UA) PI > 95th percentile). Serum levels of BDNF were determined through ELISA reactions in these groups. Results: Our results show a significant decrease in cord blood levels of BDNF in FGR and more prominently in those with UA PI >95th percentile in comparison to AGA. FGR fetuses with exclusively decreased MCA PI below the 5th percentile also show reduced levels of BDNF than AGA, although this difference was not statistically significant. Conclusions: Overall, our study reports a potential pathophysiological link between reduced levels of BDNF and neurodevelopmental alterations in fetuses with FGR. However, further studies should be conducted in those FGR subjects with MCA PI < 5th percentile in order to understand the possible implications of BDNF in this group.

Effect of hypertensive disorders of pregnancy on peripheral venous blood cell count in preterm infants with a gestational age of 28-34 weeks.

To study the effect of hypertensive disorders of pregnancy on peripheral venous blood cell count in preterm infants with a gestational age of 28-34 weeks. A total of 227 preterm infants with a gestational age of 28-34 weeks who were admitted to the Department of Pediatrics, the First Hospital Affiliated to Kunming Medical University, from January to December 2020, and whose mothers had hypertensive disorders of pregnancy were enrolled as the study group. A total of 227 preterm infants with a gestational age of 28-34 weeks who were admitted during the same period and whose mothers did not have hypertensive disorders of pregnancy were enrolled as the control group. According to maternal blood pressure during pregnancy, the study group was divided into three subgroups: gestational hypertension (n=75), mild preeclampsia (n=81), and severe preeclampsia (n=71). According to the birth weight of the preterm infants, the study group was divided into two subgroups: small for gestational age (SGA) (n=113) and appropriate for gestational age (AGA) (n=114). Peripheral blood cell count on day 1 after birth was compared between the study and control groups, as well as between the subgroups of the study group. Compared with the control group, the study group had significantly lower white blood cell count, absolute neutrophil count, and blood platelet count (P<0.05) and significantly higher incidence rates of leucopenia and neutropenia (P<0.05). The subgroup analysis showed that the mild preeclampsia and severe preeclampsia subgroups had significantly lower white blood cell count, absolute neutrophil count, and blood platelet count than the gestational hypertension subgroup (P<0.05), and that the SGA subgroup had significantly lower white blood cell count, absolute neutrophil count, and blood platelet count than the AGA subgroup (P<0.05). Hypertensive disorders of pregnancy can affect the peripheral venous blood cell count of preterm infants, which is more significant in infants with maternal preeclampsia and SGA infants.

Pediatric respiratory hospitalizations in small for gestational age neonates born at term.

This study investigates the risk for long-term respiratory hospitalizations of offspring born small for gestational age (SGA) at term. A retrospective population-based cohort analysis was performed to examine the risk of long-term respiratory hospitalizations between SGA compared to appropriate for gestational age (AGA) newborns. The analysis included all term singleton deliveries occurring between 1991 and 2014 at a single tertiary medical center. Fetuses with congenital malformations, multiple gestation, cases of perinatal mortality and large for gestational age (LGA) were excluded. A Kaplan-Meier survival curve was used to compare cumulative morbidity incidence up to the age of 18 years, and a Cox hazards regression model was used to control for confounders. During the study period 216,671 deliveries met the inclusion criteria; of them 4.8% (n = 10,450) were diagnosed as SGA neonates. During the follow-up period, the rate of hospitalization due to respiratory morbidity was significantly higher in the SGA group as compared to the AGA group (5.2% vs. 4.7%, OR = 1.13, 95% confidence interval [CI] = 1.03-1.24, p = 0.011). The Kaplan-Meier survival curve demonstrated a significantly higher cumulative incidence of respiratory morbidity in the SGA group (log-rank p = 0.026). In the Cox hazards regression model, controlled for relevant clinical confounders, SGA was found to be an independent risk factor for long-term pediatric respiratory morbidity (adjusted hazard ratio [HR] = 1.1, 95% CI = 1.001-1.19, p = 0.049). Being delivered SGA at term is an independent long-term risk factor for pediatric respiratory hospitalization.

Comparison of Lipid Profiles from Cord Blood of Appropriate and Small for Gestational Age Babies in a Tertiary Care Hospital: A Case-control Study

Introduction: Hyperlipidemia and its complications are common health issues in the current era with multifactorial in origin. Foetal malnutrition results in neuroendocrine, pancreatic, and adipose tissue dysfunction, ultimately increasing food intake and decreasing energy utilisation. It leads to an increase in adiposity and insulin resistance and ultimately increase adult diseases in later life. Aim: To compare the lipid profiles of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) babies. Materials and Methods: This case-control study was conducted in the Department of Paediatrics, Obstetrics and Gynaecology of Karwar Institute of Medical Sciences, Karwar, Karnataka, India over a period from December 2020 to March 2021. A total of 133 deliveries were recruited randomly and babies were divided into cases including those small for gestational age and controls including those appropriate for gestational age. Data was analysed and described using descriptive (mean, standard deviation, and range) and inferential statistics (Students’ t-test). Results: There were 99 Appropriate for Gestational Age (AGA) and 34 small for Gestational Age (SGA) babies studied. This study found that SGA-babies had statistically significantly lower gestational age (37.69±2.45 weeks) at birth compared to AGA-babies (Mean 38.55±1.11 weeks) t=-2.351 p=0.022. The mean Total Cholesterol (TC) level (63.62±40.48 mg/dL) was higher in SGA-babies compared to AGA-babies (48.69±2.29 mg/dL) and this difference was statistically significant (p-value=0.007). The mean High Density Lipoprotein (HDL) levels of SGA and AGA babies were comparable with no statistical significance (21.82±13.26mg/ dL of SGA; 21.49±14.64mg/dL of AGA; p-value 0.907). The mean Very Low Density Lipoprotein (VLDL) level (17.11±25.35 mg/dL) was higher in SGA-babies compared to AGA-babies (9.47±9.35 mg/dL) and this difference was statistically significant (p-value=0.012). Conclusion: Levels of all lipids were found to be higher in SGA- babies than in AGA-babies.

Phonological productive processes in full-term schoolchildren and small for gestational age: a case-control study.

To characterize the use of phonological productive processes in a group of full-term children and small for gestational age and compare it with children appropriate for gestational age. Observational, analytical, case-control and non-paired study, nested in a cohort with the outcome of phonological disorder. We assessed 36 children according to the predetermined sample calculation, 24 (66.7%) without phonological disorders and 12 (33.3%) with phonological disorders. Of these, 24 (66.7%) children were classified as small for gestational age (SGA) and 12 (33%) as appropriate for gestational age (AGA). Phonological aspects of oral language were assessed by the ABFW children's language test (2004). The results were subjected to descriptive analysis and, in order to assess the existence of an association among categorical variables, we used Fisher's exact test for association. The SGA group revealed a significantly higher number of phonological processes that change the syllable structure when compared to the AGA group. We noted that the phonological processes present and unexpected for age in the SGA population were: fricative plosivation, liquid simplification, palatal posteriorization and frontalization, plosive and fricative deafening, in addition to simplifying the consonant cluster and simplifying the final consonant, which were the most frequent in both groups. Although no association was found between phonological disorders and SGA children, we have noted a greater use of productive phonological processes in this group.

Relationship between Birth Weight, Early Growth Rate, and Body Composition in 5- to 7-Year-Old Children

Background: Programing of body composition during intrauterine growth may contribute to the higher risk for cardio-metabolic disease in individuals born small or large for gestational age (SGA, LGA). Compensations of intrauterine growth by catch-up or catch-down postnatal growth may lead to adverse consequences like a thin-fat phenotype. Methods: The impact of (i) birth weight as well as (ii) the interaction between birth weight and catch-up or catch-down growth during the first 2 years of life on fat-free mass index (FFMI) and fat mass index (FMI) in 3,204 5–7-year-old children were investigated using Hattori’s body composition chart. Body composition results were compared to appropriate for gestational age (AGA) birth weight with the same body mass index (BMI). Results: In total, 299 children at age 5–7 years were categorized as SGA, 2,583 as AGA, and 322 as LGA. When compared to AGA-children, BMI at 5–7 years of age was higher in LGA-children (15.5 vs. 16.2 kg/m²; p < 0.001) but not different in SGA-children. Compared to AGA with the same BMI, LGA was associated with higher FMI and a lower FFMI in 5–7-year-old girls. This phenotype was also seen for both sexes with catch-down growth during the first 2 years of life whereas catch-up growth prevented the higher FMI and lower FFMI per BMI. By contrast, SGA was associated with a higher FFMI and lower FMI in 5–7-year-old boys compared to AGA boys with the same BMI. This phenotype was also seen with catch-down growth in both genders whereas catch-up growth in girls led to more gain in FMI per BMI. Conclusion: LGA with a compensatory catch-down postnatal growth may be a risk factor for the development of disproportionate gain in fat over lean mass whereas SGA with a catch-down postnatal growth seems to favor the subsequent accretion of lean over fat mass. A higher propensity of lean mass accretion during postnatal growth in boys compared to girls explains sex differences in these phenotypes.

Cholesterol Uptake Capacity in Cord Blood of Preterm Infants.

There is insufficient research on cholesterol uptake capacity (CUC) in preterm infants; therefore, the relationship between CUC and cholesterol transport in preterm infants is unclear. This study aimed to clarify the relationship between CUC and anthropometric measurements, high-density lipoprotein cholesterol (HDL-C) levels, and HDL-C subclasses in preterm infants. Fifty-eight preterm infants were divided into small-for-gestational age (n = 20) (SGA) and appropriate-for-gestational age (AGA) (n = 38). CUC was measured using a fully automated immunoassay system, HI-1000. HDL-C subclasses were measured using high-performance liquid chromatography. SGA showed significantly lower HDL-C and CUC levels than AGA. We found a positive correlation between CUC and birth weight, birth height, and birth head circumference in preterm infants. Moreover, CUC had a strong relationship with HDL-C and very large, large, and medium HDL-C in preterm infants. In preterm infants, CUC is associated with normal growth and may indicate the ability to transport cholesterol forward by large-or medium-size HDL.