Appropriate Weight For Gestational Age Research Articles

Incidence and Predictors of Bronchopulmonary Dysplasia Development and Severity Among Preterm Infants Born at 32 Weeks of Gestation or Less.

Background As the most common chronic lung disease (CLD) related to premature birth, bronchopulmonary dysplasia (BPD) is associated with long-term lung disease along with cardiovascular and neurodevelopmental disorders. However, data on the incidence and predictors of BPD in Qatar are lacking. Objectives In this study, we aimed to determine the incidence of BPD among infants born at ≤ 32 weeks gestational age (GA) at our neonatal unit, and identify risk factors for the development of BPD and moderate-severe BPD. Methods This was a retrospective observational cohort study conducted at a single site: a level-III neonatal intensive care unit (NICU) in Qatar. We included 1539 neonates born at ≤ 32 weeks of gestation with birth weights of ≤ 1500 grams who were admitted to the NICU between 2017 and 2020. Univariate and multivariate logistic regression analyses were performed to identify potential factors and predictors and their possible associations with the development of BPD and moderate-severe BPD. We also applied BPD classifications to determine the variability in the incidence of BPD in our cohort according to various definitions (2001 National Institute of Child Health and Human Development (NICHD) Diagnostic Criteria, 2016 Revisions of NICHD Criteria, and 2019 Neonatal Research Network Jensen Grading). Results A total of 451 infants (29.3%) had BPD (BPD group) while 1088 (70.7%) did not (non-BPD group), and the overall incidence of BPD was 29.3%. The most relevant risk factors associated with a higher risk of developing BPD identified in the multivariate logistic regression analysis were appropriate weight for gestational age (adjusted OR (aOR) 3.67, 95%CI 2.02-6.67, P < 0.001), presence of patent ductus arteriosus (PDA) (aOR 2.61, 95%CI 1.86-3.66, P < 0.001), late-onset sepsis (aOR 2.16; 95%CI 1.29-3.62; P = 0.003), and use of invasive ventilation (aOR 1.90; 95%CI 1.35-2.69; P < 0.001). The most relevant independent risk factors associated with a higher risk for developing moderate-severe BDP were postnatal steroids (aOR 7.12, 95%CI 3.77-13.44, P < 0.001), use of inhaled nitric oxide (aOR 3.65, 95%CI 1.48-9.01, P = 0.005), use of invasive ventilation (aOR 2.13, 95%CI 1.13-4.00, P = 0.019), late-onset sepsis (aOR 2.07, 95%CI 1.10-3.91, P = 0.025), and male sex (aOR 2.04, 95%CI 1.24-3.36, P = 0.005). The difference in the distribution of BPD severity across the three different definitions of NICHD was significant (P < 0.001). Conclusion The results of this study showed that the incidence of BPD remained high in infants born at ≤ 32 weeks of gestational age and birth weight <1500 g with appropriate weight for gestational age. The presence of PDA at birth or first echocardiography, late-onset sepsis, and use of invasive ventilation were significant risk factors for the incidence of BPD. The identification of risk factors will contribute to the implementation of lung-protective strategies for at-risk infants who may benefit from potential preventive therapy.

#305 : Preparation of Epididymal/Testicular Spermatozoa; Technical Aspects and Its Impact on Success

Background and Aims: The introduction of ICSI 30 years ago paved the way for epididymal/testicular spermatozoa to be used to fertilise oocytes in couples undergoing ART. Currently, spermatozoa is recovered from the epididymis or testis using varying approaches, including micro-surgery and fine-needle aspiration, mostly in men with obstructive and nonobstructive azoospermia. The samples delivered to the laboratory for processing are of varying quality with regards to amount of material/tissue, presence of spermatozoa, and other cells. The success of processing the tissue can have a direct impact on the outcome of the subsequent ICSI and our aim for this review was to identify ways to improve the preparation techniques for epididymal/testicular samples. Ethics approval was obtained from WSLHD HREC Ref 5583QA. Methods: The review included 527 ICSI cycles for 311 patients (2016-2022) where epididymal/testicular spermatozoa had been used. Approaches for sample preparation included mini-gradient centrifugation and removal of red blood cells using erythrocyte lysis buffer (ELB). In cases with severe oligoasthenozoospermia (105 cycles, 79 patients), a phosphodiesterase inhibitor (PI) was added to induce motility. Results: Employing mini-gradient centrifugation or adding ELB did not result in lost spermatozoa for any cases, but vastly reduced sample debris allowing for easier identification of spermatozoa. Fertilisation rate after ICSI was 57.9±1.2%. Motile spermatozoa were found and injected in all 105 samples after addition of PI and the fertilisation rate after ICSI was 55.3±2.7. To date cycles with PI have resulted in 26 live births with no abnormalities and all infants were of appropriate weight for gestational age. Conclusions: Employing precise preparation techniques for epididymal/testicular samples is paramount to allow for timely identification of motile spermatozoa for ICSI and assure optimal overall outcome. Sharing and discussing successful approaches with the wider embryology community allows for discussion and refining of techniques which can benefit all.

Early neurological and motor function in infants born moderate to late preterm or small for gestational age at term: a prospective cohort study

BackgroundThere are inconsistent findings regarding neurological and motor development in infants born moderate to late preterm and infants born small for gestational age at term. The primary aim of this study was to compare neurological and motor function between preterm, term SGA and term AGA infants aged three to seven months corrected age using several common assessment tools. The secondary aim was to investigate their motor function at two years.MethodsIn this prospective cohort study, we included 43 infants born moderate to late preterm with gestational age 32–36 + 6 weeks, 39 infants born small for gestational age (SGA) at term with a birthweight ≤ 10th centile for gestational age, and 170 infants born at term with appropriate weight for gestational age (AGA). Neurological and motor function were assessed once in infancy between three to seven months corrected age by using four standardised assessment tools: Hammersmith Infant Neurological Examination (HINE), Test of Infant Motor Performance, General Movements Assessment and Alberta Infant Motor Scale. The Ages and Stages Questionnaire (ASQ-2) was used at two years.ResultsAt three to seven months corrected age, mean age-corrected HINE scores were 61.8 (95% confidence interval (CI): 60.5 to 63.1) in the preterm group compared with 63.3 (95% CI: 62.6 to 63.9) in the term AGA group. Preterm infants had 5.8 (95% CI: 2.4 to 15.4) higher odds for HINE scores < 10th percentile. The other test scores did not differ between the groups. At two years, the preterm group had 17 (95% CI: 1.9 to 160) higher odds for gross motor scores below cut-off on ASQ-2 compared with the term AGA group.ConclusionsThe present study found subtle differences in neurological function between preterm and term AGA infants in infancy. At two years, preterm children had poorer gross motor function. The findings indicate that moderate prematurity in otherwise healthy infants pose a risk for neurological deficits not only during the first year, but also at two years of age when compared with term AGA children.

Neonatal outcomes from in vitro fertilization-conceived pregnancies

Background In vitro fertilization (IVF) shows potential to improve pregnancy success, especially for infertile couples. This technique has some risks for neonates in the perinatal period and may affect their future health.&#x0D; Objective To investigate the characteristics and clinical outcomes of neonates from IVF-conceived pregnancies.&#x0D; Methods This retrospective study was conducted in neonates from IVF-conceived pregnancies from January to December 2021 at Bunda Women’s and Children’s Hospital, Jakarta. We gathered data from medical records about maternal age and morbidity, gravidity, gestational age, method of delivery, multiple gestation, also neonates’ significant profiles like prematurity, birth weight, Apgar score, and morbidities in perinatal period. We would like to investigate the characteristics and clinical outcomes of neonates born from IVF-conceived pregnancies program.&#x0D; Results There were 361 neonates whose mothers underwent IVF included in this study. Most mothers were ?35 years (70.9%) and on their first pregnancy (69.2%). Maternal complicating factors were premature contractions (16.6%), premature rupture of membranes (8.3%), and twin pregnancy (31.5%). About 98.6% of deliveries were performed by caesarean section and from IVF-conceived pregnancies program most 61.2% neonates were born at full term gestation (61.2%). Preterm deliveries occurred at a mean gestational age of 34.4 (SD 2.4) weeks. Subjects’ mean birth weight was 2,800.2 (SD 640.3) grams, with 26.3% in the low-birth-weight category. Most neonates (93.0%) were appropriate weight for gestational age and had good Apgar scores in the first minute (92.2%) and fifth minute (99.7%). However, 24.3% of neonates needed intensive care (NICU) with morbidities. The longest length of NICU stay was 100 days, with mortality of 7.9% of NICU-treated infants.&#x0D; Conclusion In our setting, most neonates from the IVF program were born with good outcomes, although preterm birth rate, low birth weight, need for NICU care, and mortality rate were quite high. Further study is needed to evaluate long-term outcomes of IVF neonates.

Visual Performance and Perceptual–Motor Skills of Late Preterm Children and Healthy Controls Using the TVPS-3rd and VMI-6th Editions

Background: The visual system is key to the learning process, preterm births are commonly followed by visual dysfunctions and other neurological conditions. Objective: to measure, analyze and compare the visual efficacy, visual–perceptual, and visual–motor skills of 20 late preterm children (34–36 weeks) born by caesarean section and appropriate weight for gestational age with 20 healthy controls born at full term by natural birth, age 5 to 12 years, from Querétaro, México. Methods: This was an observational, transverse, and prospective study. Parametric and non-parametric tests were performed using the SPSS 25.0. The visual acuity at distance and near, the phoria state, and the degree of stereopsis were analyzed. The Test of Visual-Perceptual Skills, Third Edition, was used to assess the overall performance, basic, sequencing, and complex processes. Fine motor skills were evaluated using the Visual–Motor Integration Test of Beery, Sixth Edition. Results: Visual acuity at distance and near (p&lt;0.001), stereopsis (p&lt;0.001), and the amount of exophoria at distance (p=0.01) showed statistically significant differences between the groups. The overall performance (p=0.006), basic processes (p=0.001), sequencing processes (p=0.02), and General and Motor VMI (p&lt;0.001 and 0.002, respectively) presented lower values in children born preterm. Conclusion: This research showed that even late preterm children present visual deficiencies and are at risk of delays on perceptual–motor skills. Early evaluation of their visual and motor abilities should be considered in order to help improve their cognitive functioning.

Diagnostic models for the detection of intrauterine growth restriction and placental insufficiency severity based on magnetic resonance imaging of the placenta.

We aimed to provide diagnostic models based on different parameters of placental magnetic resonance imaging (MRI) to detect intrauterine growth restriction (IUGR), as well as the severity of placental insufficiency. We included 44 foetuses with appropriate weight for gestational age (AGA) and 46 foetuses with documented IUGR, defined as the estimated foetal weight (EFW) below the 10th centile. Using Doppler ultrasound, IUGR cases were divided into 2 groups: 1) IUGR with severity signs: EFW < 3rd centile, or cerebroplacental ratio < 5th centile, or abnormal umbilical/uterine artery pulsatility index; and 2) non-severe IUGR without any of this criterion. For all these participants, placental MRI was performed in the third gestational trimester, and its parameters were compared between AGA and IUGR, as well as between the severe and non-severe IUGR groups. Two diagnostic models consisting of significant predictors were developed, and their performance was investigated with accuracy metrics. The severity signs were detected in 25 (54.3%) IUGR cases. The diagnostic model for the differentiation of IUGR from AGA revealed an acceptable performance (area under the curve [AUC] of 0.749) and consisted of 2 variables: 1) the largest size of infarct ≥ 25 mm (odds ratio [OR] = 5.01, p = 0.001), and 2) thickness : volume ratio ≥ 0.043 (OR = 3.76, p = 0.027); while, the logistic regression model for detection of the severity signs was even better, with AUC = 0.862, and comprised of 2 predictors: 1) placental infarct percent ≥ 10% (OR = 26.73, p = 0.004), and 2) placental globular shape (OR = 5.40, p = 0.034). Placental MRI parameters can differentiate IUGR from AGA, and more precisely, assess the severity of placental insufficiency in IUGR foetuses.

Maternal childhood trauma is associated with offspring body size during the first year of life

Maternal childhood trauma (MCT) is an important factor affecting offspring size at birth. Whether the effect of MCT persists during the subsequent development remains unclear. We present the results of a semi-longitudinal investigation examining the physical growth of infants born to mothers with high (HCT) and low (LCT) childhood trauma during the first year of life. One hundred healthy mother-infant dyads were included based on following criteria: exclusive breastfeeding, birth on term with appropriate weight for gestational age. MCT was assessed using the Early Life Stress Questionnaire. The weight, length, and head circumference of the infant were taken at birth, 5 and 12 months postpartum. Separate MANCOVA models were run for infant size at each age. We found an association between MCT and infant size at 5 and 12 months. The children of mothers with HCT had higher weight and greater head circumference than the children of mothers with LCT. These results suggest that MCT might contribute to developmental programming of offspring growth during the first year of life. From an evolutionary perspective, the larger size of HCT mother's offspring might represent an adaptation to potentially harsh environmental conditions. This effect might be mediated by epigenetic changes to DNA and altered breast milk composition.

ODP378 Biliary Sludge in a Neonate with Congenital Hypothyroidism

Abstract Background Most cases of congenital hypothyroidism are asymptomatic. When signs are evident, they are nonspecific. Characteristic clinical findings, including prolonged jaundice are seen in less than 5% of affected neonates. Clinical Case Female newborn, full term, appropriate weight for gestational age, five days old, Kramer zone 3 jaundice. The laboratory ruled out hemolysis, blood group incompatibility and TORCH infections. Hepatobiliary ultrasound showed biliary sludge. The screening for congenital hypothyroidism reported a TSH value of 38 mlU/L; the free T4 value was analyzed and was low. With the diagnosis of congenital hypothyroidism, levothyroxine therapy was started. The biliary sludge disappeared two weeks after initiation of hormone therapy. Conclusion It is important to exclude other causes of biliary sludge formation, such as sepsis, parenteral nutrition, hemolytic disease, metabolic diseases, some drugs and pyloric stenosis. Congenital hypothyroidism may be associated with biliary sludge formation; thyroid hormones have an inhibitory effect on the contractility of the sphincter of Oddi. Presentation: No date and time listed

ODP374 Abdominal Distention as a Unique Sign of Congenital Hypothyroidism

Abstract Background Most neonates with congenital hypothyroidism have a normal appearance at birth. Infrequent clinical presentations have been reported, including abdominal distention as the only sign, which remit with the initiation of levothyroxine therapy. Clinical Case Female newborn, full-term, appropriate weight for gestational age, six days old, who presented abdominal distension, without vomiting and with normal meconium elimination. No visceromegaly or abdominal masses were palpated. With the diagnosis of sepsis, treatment was started with ampicillin and amikacin, decompressive nasogastric tube and intravenous fluids. Abdominal X-ray showed intestinal distension. The requested cultures were negative. On the seventh day of life a TSH level of 89 mlU/L was reported; the free T4 value was analyzed and was found to be low. With the diagnosis of congenital hypothyroidism, levothyroxine therapy was indicated, and the abdominal distension remitted one week after initiation of therapy. Conclusion Most cases of congenital hypothyroidism are asymptomatic; abdominal distension, as the only sign of congenital hypothyroidism, is caused by the lower intestinal motility frequently observed in congenital hypothyroidism. Presentation: No date and time listed

Lung function in young adults born small for gestational age at term.

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Association of fetal heart rate short term variability pattern during term labor with neonatal morbidity and small for gestational age status

ObjectiveTo assess the association of fetal heart rate short-term variability (STV) pattern during term labor with both neonatal composite morbidity (cord blood pH ≤ 7.10 and/or neonatal intensive care unit admission and/or Apgar score at 5 min <7) and small for gestational age (SGA) status. Study designRetrospective cohort in a single academic institution between January 2016 and December 2018. A total of 1896 women that delivered a singleton during labor in cephalic presentation after 37 weeks of gestation were included (948 women with SGA neonates and 948 women with appropriate weight for gestational age (AGA) neonates that were matched to women with SGA neonates based on maternal age, parity, induction of labor, gestational diabetes, gestational age at delivery and a history of one cesarean section using propensity score matching). STV was compared at labor onset (cervical dilation ≤ 4 cm), in the first stage of labor (cervical dilation = 6 cm) and in the second stage of labor (cervical dilation = 10 cm). A generalized linear mixed model was used to assess the association between SGA status, neonatal composite morbidity and STV. ResultsAfter adjustment for maternal origin, term, gestational diabetes, labor length, SGA status was not associated with any change in STV during labor (mean adjusted STV: −0.20 ms, 95 %CI[-0.58–0.17], p = 0.284 at labor onset, 0.29 ms, 95 %CI[-0.1– 0.68], p = 0.155, in the first stage of labor and 0.36 ms, 95 %CI[-0.02–0.74], p = 0.065 in the second stage of labor). In case of neonatal composite morbidity mean adjusted STV was lower in the first stage of labor (mean adjusted STV: −1.29 ms, 95 %CI[-2.1 – −0.43], p = 0.003) and in the second stage of labor (mean adjusted STV: −1.15 ms, 95 %CI[-1.96 – −0.34], p = 0.005). The results were similar with the addition of delivery mode and meconium-stained amniotic fluid in the model or non-reassuring fetal heart rate and meconium-stained amniotic fluid. ConclusionsThis work suggests that STV decrease during term labor is associated with fetal well-being, independently of fetal weight. This suggests that further prospective studies should consider the evaluation of this parameter in the prediction of neonatal compromise.

Maternal excess adiposity and serum 25-hydroxyvitamin D\u2009

BackgroundVitamin D status of pregnant women is associated with body composition of the offspring. The objective of this study was to assess whether the association between maternal vitamin D status and neonatal adiposity is modified by maternal adiposity preconception.MethodsHealthy mothers and their term appropriate weight for gestational age (AGA) infants (n = 142; 59% male, Greater Montreal, March 2016-2019) were studied at birth and 1 month postpartum (2-6 weeks). Newborn (24-36 h) serum was collected to measure total 25-hydroxyvitamin D [25(OH)D] (immunoassay); maternal pre-pregnancy BMI was obtained from the medical record. Anthropometry, body composition (dual-energy X-ray absorptiometry) and serum 25(OH)D were measured at 2-6 weeks postpartum in mothers and infants. Mothers were grouped into 4 categories based on their vitamin D status (sufficient 25(OH)D ≥ 50 nmol/L vs. at risk of being insufficient < 50 nmol/L) and pre-pregnancy BMI (< 25 vs. ≥25 kg/m2): insufficient-recommended weight (I-RW, n = 24); insufficient-overweight/obese (I-OW/O, n = 21); sufficient-recommended weight (S-RW, n = 69); and sufficient-overweight/obese (S-OW/O, n = 28). Partial correlation and linear fixed effects model were used while adjusting for covariates.ResultsAt birth, infant serum 25(OH)D mean concentrations were below 50 nmol/L, the cut-point for sufficiency, for both maternal pre-pregnancy BMI categories; 47.8 [95%CI: 43.8, 51.9] nmol/L if BMI < 25 kg/m2 and 38.1 [95%CI: 33.5, 42.7] nmol/L if BMI ≥25 kg/m2. Infant serum 25(OH)D concentrations at birth (r = 0.77; P < 0.0001) and 1 month (r = 0.59, P < 0.0001) were positively correlated with maternal postpartum serum 25(OH)D concentrations. Maternal serum 25(OH)D concentration was weakly correlated with maternal percent whole body fat mass (r = − 0.26, P = 0.002). Infants of mothers in I-OW/O had higher fat mass versus those of mothers in S-OW/O (914.0 [95%CI: 766.4, 1061.6] vs. 780.7 [95%CI: 659.3, 902.0] g; effect size [Hedges’ g: 0.42]; P = 0.04 adjusting for covariates) with magnitude of difference of 220.4 g or ~ 28% difference.ConclusionsMaternal and neonatal vitamin D status are positively correlated. In this study, maternal adiposity and serum 25(OH)D < 50 nmol/L are dual exposures for neonatal adiposity. These findings reinforce the importance of vitamin D supplementation early in infancy irrespective of vitamin D stores acquired in utero and maternal weight status.

Late hyponatremia: its risk factors in preterm infants and short-term outcome

Background. Prematurity is one of the major health problems and common causes of neonatal mortality. One of the complications of premature infants is hyponatremia. The effect of hyponatremia on the prognosis of preterm infants has not been well studied. This study aimed to evaluate infants with late hyponatremia, its risk factors, and prognosis. Methods. This descriptive analytical study reviewed preterm infants (&lt;34 weeks) admitted to Al-Zahra or Children’s Hospital in Tabriz for one year (2019). Neonates diagnosed with hyponatremia after the second week were identified and evaluated for risk factors and short-term outcome. Results. A total of 186 neonates were studied. The mean gestational age of the neonates was 30 weeks (first and third quarters = 29-32 weeks). 101 (54.3%) infants were male. The route of delivery was the cesarean section in 60.7% of cases. Late hyponatremia was present in 50 (26.8 %) infants. Gestational age and birth weight were significantly lower in infants with hyponatremia than in the control group. Multivariate analysis showed that low birth weight, the use of prenatal steroids, and inappropriate weight for gestational age status independently predict the incidence of late hyponatremia. There was a significant relationship between the presence of prolonged late hyponatremia (over 7 days) and bronchopulmonary dysplasia and osteopenia of prematurity. However, no significant association was found between the presence of prolonged late hyponatremia in preterm infants with the length of hospital stay and in-hospital mortality. Conclusion. Based on the findings of this study, low birth weight, prenatal steroid use, and lack of appropriate weight for gestational age were risk factors for late hyponatremia in preterm infants. Prolonged hyponatremia is associated with bronchopulmonary dysplasia and osteopenia of prematurity

Differences in thyroid function between small for gestational age and those with appropriate weight for gestational age. Is thyroid function normal in small for gestational age newborns?

IntroductionSeveral studies conclude that small for gestational age (SGA) children have a higher number of comorbidities, as well as a different hormonal profile compared to those with appropriate weight for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Thyroid function in SGA children is still not completely known. ObjectivesTo compare the thyroid function of SGA children during the first 2 years of life with that in publications on thyroid function in other groups of infants, such as AGA and premature children, using the same methodology. MethodsA cohort of 38 SGA children was obtained, in which the thyrotropin (TSH) values in blood were measured at different points in the development of the SGA child. The results were compared with a population of AGA children from Zaragoza and a population of premature children from Barcelona by comparing the means using a 2-tailed test. ResultsA statistically significant difference (P < 0.05) was observed between the SGA children in our study and the AGA children older than 6 months, but not between the SGA children of the study and the population of premature infants. ConclusionsSGA children have higher TSH values compared to AGA children older than 6 months. Therefore, it seems reasonable to establish a screening and a follow-up protocol in those SGA with high risk to develop thyroid dysfunction.

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

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

Prevalence on the complement in offering food to newborns

Abstract Objectives: to identify the prevalence and determining factors of the complements in offering food to newborns. Methods: across-sectional study nested to a cohort study that assessed newborn care in four public maternity hospitals in Natal/Brazil. Sample was composed by 415 mothers and full-term newborns, with appropriate weight for gestational age and Apgar scores in 1st and 5th minutes ≥ 7. In order to analyze the determining factors, we used Poisson’s regression. Results: from 415 newborns, 51.3% received feeding complements (57.6% in the first hour of life), of which 92% was infant formula. Only 50.7% of those complement in offering food were prescribed by physicians. Colostrum deficiency was the main reason to be indicated (33.8%). Maternal age ≤ 20 years old (PR=0.64; CI95%=0.47-0.86) and between 2030 years old (PR=0.70; CI95%=0.57-0.87)comparing to women older than 30 were shown as protective factors, while being primiparous (PR=1.37; CI95%=1.11-1.60) and had cesarean section (PR=1.2; CI95%=1.00-1.45) as risk factors. Conclusion: maternal characteristics are associated with the complement in offering food to the newborn in the first hours of life. The high prevalence shows the need for interventions that minimize the inadequate offer of infant formula and promote exclusive breastfeeding before hospital discharge.

Insufficient Vitamin D Status at Birth Is Corrected by Vitamin D Supplementation (1000 IU/Day) With Increases in Lean Mass Evident at 12 Months of Age in Healthy Term Infants

ObjectivesThe primary objective was to test whether rapid correction of insufficient vitamin D status initiated in the neonatal period improves whole-body lean mass across infancy. MethodsThis was a double-blinded, parallel-group, randomized controlled trial (NCT02563015). Healthy term breastfed infants of appropriate weight for gestational age (AGA) were recruited from Montreal (March 2016–2019). Capillary blood was collected (24–36 h) for serum 25-hydroxyvitamin D [25(OH)D] measurement (Liaison, Diasorin Inc.). Infants with serum 25(OH)D < 50 nmol/L were randomized to receive 400 (group 1, n = 49) or 1000 IU/d (group 2, n = 49) until 12 mo of age. Those with 25(OH)D ≥ 50 nmol/L were recruited to form a reference group, receiving 400 IU/d (group 3, n = 41). Anthropometry, body composition (dual-energy x-ray absorptiometry), and 25(OH)D concentrations were assessed at 1, 3, 6, and 12 mo. Differences between trial and reference groups were tested using mixed model repeated measures ANOVA adjusting for maternal pregnancy weight gain, infant sex, skin color, actual age at assessment, and breastfeeding status. Data are mean ± SD. ResultsInfants (81 males, 58 females) were 39.6 ± 1.0 wk GA and 3388 ± 372 g at birth. By design, infants in group 1 and 2 had lower serum 25(OH)D concentrations at birth compared to group 3 (31.1 ± 9.3, 34.4 ± 12.0 vs. 68.0 ± 13.2 nmol/L, respectively, P < 0.0001). On average, both trial groups achieved and maintained vitamin D sufficiency (25(OH)D ≥ 50 nmol/L) from 3 to 12 mo. Lean mass was not different among groups at baseline, but at 12 mo was higher in group 2 compared to group 1 (7012.5 ± 904.6 vs. 6690.4 ± 1121.7 g, P = 0.0075; 4.8% difference), and not different from the reference group (7012.5 ± 904.6 vs. 6715.1 ± 784.6 g, P = 0.2882). Weight, length, and whole-body fat mass were not different among groups at any time-point. ConclusionsVitamin D supplementation (400 and 1000 IU/d) corrects insufficient stores, whereas the higher dosage of 1000 IU/d, modestly increases lean mass of otherwise healthy AGA term born infants by 12 mo of age without altering weight or length. These data concur with observations in weanling rats where increased vitamin D intakes elevated lean mass. The long-term benefits require further research. Funding SourcesFunded by Canadian Institutes of Health Research.

Biometric measurements of the nasal area of newborns for the development of a nasal protector model: cross-sectional study.

To correlate the biometric measurements of the nasal area of premature and term newborns to provide parameters for a nasal protector model. A crosssectional descriptive study, carried out in the neonatal joint accommodation, intermediate and intensive care units of a hospital in Maceio, Alagoas, with a total of 300 newborns, divided into two groups: 150 term and 150 premature. Neonatal history data and 1200 digital photographs were used for biometric measurements. The groups were homogeneous regarding gender, weight and length of the newborn. The measurements of nasal width, distance from the wing of the nose to the right and left columella midline, right and left nasal introitus area, length of the right and left nasal dorsum were different when compared in groups according to gestational age and weight ranges - very low weight, low weight and appropriate weight for gestational age (p<0.05). The data obtained provide parameters for creating a nasal protector for newborns using prongs, considering anatomical aspects.

INCIDENCE OF SMALL FOR GESTATIONAL AGE NEONATES, ACCORDING TO THE FENTON AND INTERGROWTH-21ST CURVES IN A LEVEL II MATERNITY.

ABSTRACTObjective: To compare the incidence of small for gestational age infants among late preterm and term newborns, using the Fenton and Intergrowth-21st curves.Methods: Observational and retrospective study with newborns in a level II maternity. The study was approved by the Institution’s Ethics Committee. Live births from July 2007 to February 2009 with a gestational age from 34 to 41 weeks and seven days were included. Neonates with incomplete data were excluded. Appropriate weight for gestational age was assessed by the Fenton and Intergrowth-21st intrauterine growth curves, considering birth weight <10th percentile as small for gestational age. The degree of agreement between the two curves was assessed by the Kappa coefficient. Numerical variables were compared using the Student t-test or the Mann-Whitney. Categorical variables were compared using the chi-square test. Statistical analyzes were performed using SPSS17® software, considering significant, p<0.05.Results: We included 2849 newborns with a birthweight of 3210±483 g, gestational age of 38.8±1.4 weeks; 51.1% male. The incidence of small for gestational age in the full sample was 13.0 vs. 8.7% (p<0.001, Kappa=0.667) by the Fenton and Intergrowth-21st curves, respectively. Among late preterm, the incidence of small neonates was 11.3 vs. 10.9% (p<0.001; Kappa=0.793) and among full-term infants it was 13.1% vs. 8.5% (p<0.001; Kappa=0.656), respectively for the Fenton and Intergrowth-21st curves.Conclusions: The incidence of small for gestational age newborns was significantly higher using the Fenton curve, with greater agreement between the Fenton and Intergrowth-21st curves among late preterm, compared to full term neonates.

Diferencias en la función tiroidea de los pequeños para la edad gestacional y los de peso adecuado. ¿Es normal la función tiroidea de los recién nacidos pequeños para la edad gestacional?

IntroductionSeveral studies conclude that small for gestational age (SGA) children have a higher number of comorbidities, as well as a different hormonal profile compared to those with appropriate weight for gestational age (AGA). Thyroid hormones play an important role in growth and neurocognitive development. Thyroid function in SGA children is still not completely known. ObjectivesTo compare the thyroid function of SGA children during the first 2 years of life with that in publications on thyroid function in other groups of infants, such as AGA and premature children, using the same methodology. MethodsA cohort of 38 SGA children was obtained, in which the TSH values in blood were measured at different points in the development of the SGA child. The results were compared with a population of AGA children from Zaragoza and a population of premature children from Barcelona by comparing the means using a 2-tailed test. ResultsA statistically significant difference (P<.05) was observed between the SGA children in our study and the AGA children older than 6 months, but not between the SGA children of the study and the population of premature infants. ConclusionsSGA children have higher TSH values compared to AGA children older than 6 months. Therefore, it seems reasonable to establish a screening and a follow-up protocol in those SGA with high risk to develop thyroid dysfunction.