Asymmetric Small For Gestational Age Research Articles

Evaluation of neonatal outcomes according to the specific absorption rate values of phones used during pregnancy.

The aim was to compare neonatal outcomes according to cell phone specific absorption rate (SAR) levels and daily time spent on cell phones by pregnant women. Women who gave birth at Konya City Hospital between September 2020 and February 2021 were included in this retrospective study. Gestational ages, birth weight, birth length, head circumference, sex, 5-minute APGAR scores, neonate postpartum resuscitation requirement, delivery type, the model of phone used by the pregnant women, and the average time spent on the phone during a day were recorded. To determine the relation between the SAR values of the phones used and delivering a small for gestational age (SGA) baby, receiver operating characteristic curve analysis was performed. In total 1495 pregnant women were included. The rate of delivering a SGA fetus was significantly higher in women who used phones with higher SAR values (p=0.001). The cut-off value for the SAR level was 1.23 W/kg with 69.3% sensitivity and 73.0% specificity (area under the curve: 0.685; 95% confidence interval: 0.643-0.726). No correlation was found between time spent on the phone and SGA birth rate. Although both phone SAR values and time spent on the phone were higher in the symmetrical SGA group compared to the asymmetrical SGA group, the difference was not significant (p>0.05). Although the women who had preterm delivery had higher phone SAR values and had spent more time on the phone compared to those who had term deliveries, the difference was again not significant (p>0.05). As the SAR values of cell phones used during pregnancy increased, there was a trend towards delivering a SGA baby.

Echocardiographic assessment of brain sparing in small-for-gestational age infants and association with neonatal outcomes

Brain sparing is an adaptive phenomenon (redistribution of blood flow to the brain) observed in fetuses exposed to chronic hypoxia, who are at risk of intrauterine growth restriction. Here, we assessed the blood flow distribution during the early neonatal period (< 7 days of life) using echocardiography, and evaluated the impact of brain-sparing on postnatal course and neurodevelopmental outcomes. This retrospective study included 42 small-for-gestational age (SGA) infants [further classified into asymmetric SGA (a-SGA, n = 21) and symmetric SGA (s-SGA, n = 21) groups according to their birth head circumference percentiles], and 1: 2 matched appropriate-for-gestational age (AGA) infants (n = 84) admitted to the neonatal intensive care unit. Left ventricular (LV) stroke volume, LV cardiac output (LVCO), upper body blood flow (UBBF), and UBBF/LVCO ratio (%) were significantly higher in both a-SGA and s-SGA infants than in AGA infants. Both a-SGA and s-SGA groups consisted predominantly of infants with higher UBBF/LVCO (%). A UBBF/LVCO ≥ 58.2% (3rd interquartile range) was associated with a later need for rehabilitative therapy after discharge. In summary, brain-sparing effect may continue during the early postnatal life in SGA infants, and may be a promising marker to detect future adverse neurodevelopmental outcomes.

Reference values and growth curves of length for weight and head circumference for weight among Chinese newborns

Objective: To establish the reference values and growth curves of length for weight and head circumference for weight among Chinese newborns in order to provide a reference for the assessment of body proportionality at birth. Methods: A cross-sectional design was applied. A total of 24 375 singleton live birth newborns with gestational ages at birth of 24+0 to 42+6 weeks were recruited from June 2015 to November 2018 from 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha, and Shenzhen, excluding those with maternal or newborn conditions that may impact the establishment of the reference values. The generalized additive model for location, scale, and shape was employed to establish reference values in terms of percentile and growth curves of length for weight and head circumference for weight for male and female newborns. The random forest machine learning method was employed to analyze the importance of variables between the established reference values in this study and the previous published weight/length, body mass index (BMI), ponderal index (PI), weight/head circumference, length/head circumference in the assessment of symmetrical and asymmetrical small for gestational age (SGA) newborns. Results: A total of 24 375 newborns with 13 197 male infants (preterm birth 7 042 infants and term birth 6 155 infants) and 11 178 female infants (preterm birth 5 222 infants and term birth 5 956 infants) were included in this study. The reference values in terms of percentile (P3, P10, P25, P50, P75, P90, P97) and growth curves of length for weight and head circumference for weight were obtained for male and female newborns with gestational ages of 24+0 to 42+6 weeks. The median birth lengths corresponding to the birth weights of 1 500, 2 500, 3 000, and 4 000 g were 40.4, 47.0, 49.3 and 52.1 cm for males and 40.4, 47.0, 49.2, and 51.8 cm for females, respectively; the median birth head circumferences were 28.4, 32.0, 33.2 and 35.2 cm for males and 28.4, 32.0, 33.1, and 35.1 cm for females, respectively. The differences of length for weight between males and females were minimum, with the difference range of -0.3 to 0.3 cm at P50; the differences of head circumference for weight between males and females were minimum, with the difference range of 0 to 0.2 cm at P50. Based on the match between birth length and birth weight for classifying symmetrical and asymmetrical SGA, length for weight and PI contributed the most, accounting for 0.32 and 0.25, respectively; based on the match between birth head circumference and birth weight, head circumference for weight and weight/head circumference contributed the most, accounting for 0.55 and 0.12, respectively; based on the match between birth length or head circumference with birth weight, head circumference for weight and length for weight contributed the most, accounting for 0.26 and 0.21, respectively. Conclusion: The establishment of the new standardized growth reference values and growth curves of length for weight and head circumference for weight among Chinese newborns are useful for clinical practice and scientific research.

Neonatal hypoglycaemia and body proportionality in small for gestational age newborns: a retrospective cohort study

Small for gestational age (SGA) newborns are at risk of developing neonatal hypoglycaemia. SGA newborns comprise a heterogeneous group including both constitutionally small and pathologically growth restricted newborns. The process of fetal growth restriction may result in brain sparing at the expense of the rest of the body, resulting in disproportionally small newborns. The aim of this study was to discover whether body proportionality influences the risk of developing neonatal hypoglycaemia in SGA newborns. A retrospective cohort study was performed in 402 newborns who were SGA without additional risk factors for hypoglycaemia. Body proportionality was classified in two ways: (1) using symmetric (sSGA) or asymmetric (aSGA), defined as head circumference (HC) below or above the 10th percentile, respectively; (2) using cephalization index (HC/birth weight), standardized for gestational age. Hypoglycaemia was observed in 50% of aSGA and 40.9% of sSGA newborns (P-value 0.12). Standardized CI in newborns with hypoglycaemia was higher compared to newborns without hypoglycaemia (median 1.27 (1.21–1.35) versus 1.24 (1.20–1.29); (P 0.002)). Multivariate logistic regression analyses showed both CI and standardized CI to be associated with the occurrence of hypoglycaemia (OR 1.48 (1.24–1.77) and OR 1.44 (1.13–1.83), respectively). The majority of hypoglycaemic events (96.1%) occurred in the first 6 h after birth. Conclusion: Body proportionality might be of influence, depending on the classification used. Larger prospective studies with a clear consensus definition of body proportionality are needed.What is Known:• Neonatal hypoglycaemia is an important complication in newborns.• Small for gestational age (SGA) newborns are more vulnerable to hypoglycaemia.What is New:• Higher incidence of hypoglycaemia was not observed in asymmetric SGA compared to symmetric SGA, but standardized cephalization index was associated with increased likelihood of hypoglycaemia.• Consensus-based definitions of body proportionality in newborns are needed.

Longitudinal study of the newborn small for gestational age. Growth recovery and conditioning factors

Background: small-for-gestational-age (SGA) newborns present a higher morbidity and mortality rate when compared to infants born appropriate for gestational age (AGA), as well as insufficient growth, with height far from their target and in some cases a low final height (< -2 SDs). Objective: the aim of this study was to determine when catch-up growth (CUG) in height occurs in these children, and which factors are associated with lack of CUG. Material and methods: this is a retrospective study of SGAs born between 2011 and 2015 in a secondary hospital. Anthropometric measurements were taken consecutively until CUG was reached, and fetal, placental, parental, newborn, and postnatal variables were studied. Results: a total of 358 SGAs were included from a total of 5,585 live newborns. At 6 and 48 months of life, 93.6 % and 96.4 % of SGAs achieved CUG, respectively. By subgroups, symmetric SGAs performed worse than asymmetric SGAs with CUG in 84 % and 92 % at 6 and 48 months of life, respectively. The same occurred in the subgroup of preterm SGAs with respect to term SGAs, with worse CUGs of 88.2 % and 91.2 % at 6 and 48 months of life, respectively. Prematurity, symmetrical SGA, intrauterine growth retardation (IUGR), preeclampsia, previous child SGA, perinatal morbidity, and comorbidity during follow-up were associated with absence of CUG. Conclusions: the majority of SGAs had CUG in the first months of life. The worst outcomes were for preterm and symmetric SGAs.

Factors Associated with Catch-up Growth in Term, Asymmetrical Small-for-Gestational Age Infants in the First Year of Life.

IntroductionCatch-up growth (CUG) in small-for-gestational age (SGA) infants is essential for their overall development. Knowledge about the factors influencing CUG might be critical in their effective management. Hence this study was performed with the aim of identifying factors that may influence CUG in SGA infants.MethodsAsymmetrical SGA infants born at term were included in the study as per defined criteria, and their demographic details were recorded. Anthropometric data, feeding practice details, and intercurrent illnesses data were collected on follow-up at 6 weeks, 6 months, and 12–15 months of age. Catch-up growth weight was defined as improvement of weight to the normal range of −2 to +2 weight-for-age Z score (WAZ). Analysis was carried out using SPSS Expand 17 software. Chi-square test was used to find association between variables. Logistic regression analysis was used to measure effect. A P value of less than 0.05 was taken as significant.ResultsOut of 324 SGA infants born at term, 119 completed 12–15-month follow-up, of which 69.7% had achieved CUG weight. Exclusive breastfeeding >4 months, continued breastfeeding until 12–15 months, and absence of diarrheal episodes were positively associated with CUG. Pregnancy-induced hypertension, gestational diabetes, and maternal overweight/obesity were negatively associated with CUG. Maternal education status, conception age, gravida status, mode of delivery, vitamin D and iron supplementation, and intercurrent respiratory infections were not associated with CUG. On multivariate analysis, continued breastfeeding and absence of diarrheal episodes were independent factors associated with CUG.ConclusionBreastfeeding practice, especially continued breastfeeding, and the absence of diarrheal illness are the key determinants for achieving CUG weight in term SGA infants, particularly in settings where resources are limited.

Growth pattern of skinfold thicknesses in term symmetric & asymmetric small for gestational age infants.

Background & objectives:A etiologically symmetric and asymmetric small for gestational age (SGA) infants are two distinct entities. In view of absence of longitudinal information on growth pattern of skinfold thicknesses (SFTs) among Indian infants, this study was conducted to assess the auxological dynamics of SFTs (sub-cutaneous fat) of symmetric and asymmetric SGA infants.Methods:Triceps, sub-scapular, biceps, mid-axillary and anterior thigh SFTs among full-term, 100 symmetric SGA, 100 asymmetric SGA and 100 appropriate for gestational age (AGA) infants were measured at one, three, six, nine and 12 months. Ponderal Index (PI) was used to categorize infants into symmetric SGA (PI ≥2.2 g/cm3) and asymmetric SGA (PI <2.2 g/cm3). Intra-group (symmetric vs. asymmetric), inter-group (SGA vs. AGA) and gender differences were quantified.Results:SFTs among symmetric, asymmetric SGA infants increased to attain peak by six months. Maximum fat deposition in SGA infants was noticed for triceps, minimum for mid-axillary SFT. Mean triceps and sub-scapular skinfolds were measured higher in symmetric SGA than in asymmetric infants. SGA infants had significantly (P≤0.05) thinner SFTs than AGA. Growth velocity for SFTs, among symmetric and asymmetric SGA, was measured maximum between one and three months, threreafter it declined and relatively, steepness of fall was maximum for mid-axillary SFT followed by sub-scapular SFT.Interpretation & conclusions:Thinner SFTs obtained for symmetric and asymmetric SGA as compared to AGA infants reveal their compromised adiposity and nutritional status. Comparatively, higher SFTs in symmetric than in asymmetric SGA infants appear to suggest that the former have a tendency to accumulate more fat, than the latter during infancy.

126. Sex and growth specific characteristics of small for gestational age neonates: A prospective cohort study

Introduction Male bearing pregnancies and asymmetric fetal growth are associated with preeclampsia (PE). However, this has not been studied in small for gestational age (SGA) neonates, a group that is also associated with PE. Objective To provide insight regarding risk factors and differences in neonatal outcome for SGA neonates based on sex and growth symmetry. Methods Data from the Screening for Pregnancy Endpoints (SCOPE) study were used with 5628 nulliparous participants, of which 633 pregnancies were complicated with SGA and 3376 women had uncomplicated pregnancies. SGA pregnancies were grouped based on fetal sex (male/female) and growth symmetry [ponderal index below (asymmetric) and above (symmetric) the 10th percentile for gestation]. Association between risk factors for SGA, SGA subgroups and uncomplicated pregnancies were assessed with multinominal analyses. Results Of all asymmetric neonates, 24.2% were SGA, while 7.4% of all symmetric neonates were SGA. Of all SGA neonates, 45.8% showed asymmetric growth, while 5.5% of neonates with a customised birthweight >90th percentile (p 90th percentile) umbilical Doppler resistance index (RI) at 20 weeks’ gestation was more common in SGA females (9.6% vs 17.8% p = 0.003) but did not differ between symmetric and asymmetric SGA neonates. The presence of abnormal uterine artery Doppler RI at 20 weeks’ gestation did not differ between SGA subgroups. In each SGA subgroup PE incidence was increased (28.2% in symmetric SGA, 26.1% in asymmetric SGA, 27.2% in SGA male and 25.3% in SGA female bearing pregnancies) compared to non-SGA pregnancies (4.2%). The incidence of PE did not differ between SGA subgroups. Discussion A quarter of asymmetric neonates are SGA. Asymmetric SGA associates with male neonates. In contrast with literature, PE was associated with both symmetric and asymmetric growth in SGA neonates.

Progression of waist–hip circumference ratio in full-term symmetric and asymmetric small for gestational age infants

Background: Children born as small for gestational age (SGA) tend to develop central adiposity and may have chances of developing metabolic syndrome. Waist–hip circumference ratio (WHR) is considered as a good indicator of central/truncal obesity. The complete absence of information on growth dynamics of WHR among Indian symmetric and asymmetric SGA infants has prompted us to undertake this study. Aim: The aim was to study the pattern of growth of waist circumference, hip circumference, and WHR of symmetric and asymmetric SGA infants. Materials and Methods: Waist and hip circumference of full-term 100 symmetric SGA, 100 asymmetric SGA, and 100 appropriate for gestational age (AGA) infants was measured at 1, 3, 6, 9, and 12 months in Growth Laboratory/Clinic of the Department. Student's unpaired t-test was used to assess intragroup (symmetric vs. asymmetric), intergroup (SGA vs. AGA), and gender differences. Results: A consistent increase in the mean waist and hip circumference was noticed among symmetric and asymmetric SGA and AGA infants of two sexes. Male infants of both SGA groups possessed similar waist and hip circumference at 1 month. Whereafter, asymmetric SGA males had a larger waist and lesser hip circumference than symmetric infants. Asymmetric SGA females possessed larger waist circumference throughout infancy, while hip circumference measured larger only till 3 months as compared to symmetric females. Conclusion: SGA infants of two types and gender exhibited compromised auxological attainments for waist and hip circumference compared to normal babies. Higher WHR recorded in asymmetric SGA than symmetric SGA and AGA babies appear to suggest that asymmetric infants may have greater tendency to develop central obesity, subsequently.

Longitudinal growth dynamics of term symmetric and asymmetric small for gestational age infants

Background: Available information on auxological attainments of symmetric and asymmetric SGA (small for gestational age) infants presents conflicting views. The complete absence of longitudinal data on growth patterns of both types of Indian SGA infants prompted us to undertake this study. Aim: To study distance and velocity growth pattern of weight and crown-heel length (CHL) of symmetric and asymmetric SGA infants. Subjects & Methods: Weight and CHL amongst full-term 100 symmetric SGA, 100 asymmetric SGA and 100 AGA infants from upper socio-economic strata were mixed-longitudinally measured at birth, 1, 3, 6, 9 and 12 months in the Department of Pediatrics, PGIMER, Chandigarh, India. Results: The symmetric SGA infants measured significantly lighter and shorter than asymmetric infants. SGA infants of both types and sexes possessed significantly (p ≤ 0.001) lower weight and length values than AGA, normal Indian and western infants. Weight and CHL growth velocities demonstrated inconsistent trends. Peak growth velocity for weight and CHL of symmetric, asymmetric SGA and AGA infants was attained between 1-3 months. Average z-scores for weight and CHL were found to be lesser amongst symmetric SGA as compared to asymmetric infants, revealing compromised catch-up growth. Conclusion: The poorer postnatal auxological attainments of SGA infants as compared to normal infants reveals continuation of effect of intra-uterine nutritional insult during infancy, which measured significantly more in symmetric than asymmetric SGA infants.

Ischemia-Modified Albumin May Be a Novel Marker for Predicting Neonatal Neurologic Injury in Small-For-Gestational-Age Infants in Addition to Neuron-Specific Enolase.

Aim This study aims to evaluate hypoxia/ischemia and oxidant stress, and negative neurodevelopmental outcomes in small-for-gestational-age (SGA) infants. Material and Methods Two study groups were established as SGA and appropriate-for-gestational-age (AGA) infants. SGA infants were allocated asymmetric and symmetric SGA infants. Serum levels of neuron-specific enolase (NSE), ischemia-modified albumin (IMA), malondialdehyde (MDA), total antioxidant capacity (TAC), and total oxidant status (TOS) were determined and oxidative stress indexes (OSI) were calculated in all groups. Results Overall, 83 infants were diagnosed SGA, and 85 infants were determined AGA. TOS and OSI levels were significantly higher and TAC levels were significantly lower in SGA group (p < 0.05). MDA and IMA levels were significantly higher in SGA group (p < 0.05). NSE levels in SGA infants were significantly higher (p < 0.05). NSE and IMA were significantly higher in symmetric SGA infants (p < 0.05). TOS, OSI, MDA, TAC levels were not significantly different in SGA infants with abnormal neurological findings (p > 0.05); NSE and IMA levels were significantly higher in SGA group with abnormal neurological findings (p < 0.05). Conclusion SGA infants expose to hypoxia and oxidative stress led to neuronal damage. We suggest that in addition to NSE, IMA blood levels might be a sensitive novel marker for predicting the severity of neuronal damage.

Sonographic weight estimation in small for gestational age fetuses

Purpose: To determine the accuracy of sonographic weight estimation (WE) for small for gestational age (SGA) fetuses, and to further differentiate the evaluation between fetuses being symmetric and asymmetric SGA.

Fatty acids composition of human milk fed to small for gestational age infants

Objectives: To test the null hypothesis that mothers of asymmetric small for gestational age (SGA) infants produce milk with fatty acids composition similar to that of lactating mothers of appropriate-for-gestational-age (AGA) infants.Methods: We obtained human milk (HM) from 2 groups of lactating volunteers that gave birth to asymmetric SGA (study group) or AGA infants (control group). Each mother was asked to contribute by manual expression at least one of 3 samples: first 72 hours after labor (colostrum), day 2-7 postpartum (transitional milk) and 14 days post partum (mature milk). After lipid extraction using Folch's cold-extraction procedure fatty acids were analyzed using gas chromatography.Results: A total of 108 samples were obtained in 60 women. In univariate analysis, there were no significant differences in any of the fatty acids concentrations examined between groups. This remained true when timing of the sample (colostrum, transitional or mature milk) or gestational age were introduced as confounders in analysis of variance (general linear model).Conclusion: Fatty acid composition of human milk is not affected by whether or not the infant was fetal growth restricted. We suggest that mothers of SGA infants may be reassured about the fat quality of their milk.

Sonographic Weight Estimation in Small-for-Gestational-Age Fetuses.

To determine the accuracy of sonographic weight estimation (WE) for small-for-gestational-age (SGA) fetuses, and to further differentiate the evaluation between symmetric and asymmetric SGA fetuses. The accuracy of WE in SGA fetuses (n = 898) was evaluated using 14 sonographic models and was further differentiated between symmetric (n = 750) and asymmetric (n = 148) SGA fetuses. SGA fetuses were considered to be asymmetric with a head circumference to abdominal circumference ratio above the 95th percentile. The accuracy of the different formulas was compared using means of percentage errors (MPE), medians of absolute percentage errors (MAPE), and proportions of estimates within 10 % of actual birth weight. RESULTS for the subgroup of asymmetric SGA fetuses differed significantly from the subgroup of symmetric SGA fetuses. MPE values were closer to zero with most of the formulas in the asymmetric SGA group. Apart from the Siemer, Shepard, Merz and Warsof equations, all formulas showed an underestimation of fetal weight in asymmetric SGA fetuses. In contrast, in the symmetric SGA group, all of the formulas commonly used for fetuses in a normal weight range showed a systematic overestimation of fetal weight. Overall the best accuracy was achieved by using the Sabbagha equation (MPE 1.7 %; SD 9.0 %; MAPE: 6.0). An accurate WE in SGA fetuses is feasible using the Sabbagha formula. However, one has to be aware of the significant differences in WE between symmetric and asymmetric SGA fetuses.

Current pattern of Ponderal Indices of term small-for-gestational age in a population of Nigerian babies

BackgroundSmall-for-gestational age (SGA) newborns constitute a special group of neonates who may have suffered varying degrees of intrauterine insults and deprivation. Variations in birth weight, length and Ponderal Index (PI) depend on the type and degree of intrauterine insults the babies were exposed to. The objective of the study was to determine the current prevalence of term SGA births in a Nigerian Tertiary Hospital and the current pattern of Ponderal Indices among term SGA in a population of Nigerian babies.MethodsSubjects comprised of consecutive term singleton mother-baby pairs in the first 24 hours of life. It was a cross sectional study. The anthropometric parameters of each baby were recorded and the PI was also determined.ResultsOut of 1,052 live births during the study period (September to December, 2009), 825 were term, singleton babies. Five hundred and eight-one babies (70.4%) fall into the upper socio-economic classes 1 and II, 193 (23.4%) in the middle class and 51 (6.2%) were of the lower classes IV and V. None of the mothers indicated ingestion of alcohol or smoking of cigarette. Fifty-nine babies (7.2%) were small-for gestational age (SGA). Of the 59 SGA subjects, 26 (44.1%) were symmetrical SGA while 33 (55.9%) were asymmetrical SGA. There was no significant sex or socioeconomic predilection for either symmetrical or asymmetrical growth (p = 0.59, 0.73 respectively).ConclusionThe findings showed that proportionality in SGA fetuses is a continuum, with the PI depending on the duration of intrauterine insult and the extent of its effects on weight and length before delivery.

Cardiac Blood Flow Measurements in Stable Full Term Small for Gestational Age Neonates

Cardiac blood flow measurements are useful in the haemodynamic management of neonates. Cardiac blood flows can be estimated with functional echocardiography as follows; flow in Superior Vena Cava (SVC), Right Ventricular Outflow (RVO) and Left Ventricular Outflow (LVO). Studies in preterm infants have shown that abnormal superior vena cava flow is associated with poor neurodevelopmental outcomes. To date, normative data on LVO, RVO and SVC flows has been established for term appropriate for gestational age neonates and preterm neonates, but no data is available on RVO, LVO and SVC flows for term small for gestational age neonates. To determine Right Ventricular Output (RVO), Left Ventricular Output (LVO) and Superior Vena Cava (SVC) flow after the transitional period in stable full term Small for Gestational Age (SGA) neonates. Observational study. A tertiary care, perinatal centre in western Maharashtra, India. Full term (37 to 41 weeks) small for gestational age (weight below 10th percentile for gestational age) infants who were born during the study period. RVO, LVO and SVC flows were measured by functional echocardiography on day 7 of life in stable full term SGA neonates from January 2011 to August 2011. Infants who required respiratory or cardiovascular support and intensive care unit admissions for any indication and those with a clinical suspicion of an infection within 48 hours after data collection were excluded from the study. Unpaired t-test was used to compare SVC flow between symmetric and asymmetric SGA neonates. Measurements of RVO, LVO and SVC in term SGA neonates on day 7 of life. We performed measurements in 52 term SGA neonates with a median (range) birth weight of 2.190 (1.600-2.410) kg. Fifty two measurements were analyzed on day 7. The mean (SD) RVO, LVO and SVC flows were 255.59 (57.42) , 214.61 (52.04) and 126.28 (31.23) mL/kg/min. This study provides RVO, LVO and SVC flow values in a cohort of stable term SGA neonates after the transitional period.

Development of birth weight for gestational age charts in a Sri Lankan setting - methodological issues.

This study was taken up to identify the main types of low birth weight (LBW) for the development of weight for gestational age charts relevant to the country/regional level for the formulation of preventive strategies. A sample of mothers registered by Public Health Midwives (PHMs) from two Medical Officers of Health (MOH) areas in Colombo district were followed up until delivery in five selected hospitals. Period of gestation (POG) was assessed between 10 and 12 weeks using ultrasonography. Records of 474 mother/newborn pairs were used for development of gestational age-related birth weight charts for each sex and POG. Mothers with one or more risk factors for LBW were excluded. Mothers with POG less than 38 weeks and more than 40 weeks were limited. Information on all possible risk factors contributing to LBW were assessed. Incidence of small for gestational age (SGA) assessed using the 10 th centile value for each POG, was 19.0% for males and 18.0% for females. Percentages of symmetrical and asymmetrical SGA newborns were 72.1% and 27.9%, respectively. The charts were developed paying attention to all methodological aspects that highlighted the key issues relevant to development of weight for gestational age charts in a developing country setting. As action was taken to minimize the biases introduced by such issues, the charts developed could be used for assessment of incidence and risk factors for SGA until charts based on national level data are available.

Longitudinal growth of head circumference in term symmetric and asymmetric small for gestational age infants

AimsTo study longitudinal growth pattern of head circumference of full-term symmetric and asymmetric small for gestational age (SGA) infants of the two sexes during first year of life. Study DesignMixed-longitudinal growth research design. SubjectsHead circumference amongst full-term 100 symmetric, 100 asymmetric as well as 100 appropriate for gestational age (AGA) infants was measured at birth, 1, 3, 6, 9 and 12months of age using standardized technique and instrument. ResultsThe mean head circumference of male symmetric SGA infants measured significantly (p≤0.001) smaller than asymmetric SGA infants while, in female symmetric SGA infants it measured shorter beyond 6months. As compared to AGA infants, head circumference in symmetric and asymmetric SGA infants measured significantly smaller in size. Growth velocity for head circumference amongst symmetric and asymmetric SGA male infants did not show statistically significant differences. Rate of head circumference growth remained significantly higher amongst female asymmetric SGA infants than the symmetric ones between 3 and 6months while, a reversal of trend was observed between 9 and 12months. ConclusionThe better growth attainments for head circumference of male and female asymmetric SGA infants than their symmetric SGA counterparts during first postnatal year of life may be attributed to the continuation of influence of “head sparing” experienced by asymmetric SGA babies during prenatal life.

Iron status at birth and at 4 weeks in term small-for-gestation infants in comparison with appropriate-for-gestation infants

Objective. To determine body iron stores at birth in term small-for-gestational age (SGA) infants as compared to appropriate-for-gestational age (AGA) infants.Methods. In this prospective study, mother–infant pairs with gestation of ≥37 weeks and birth weight of at least 1.5 kg were enrolled. Asymmetric SGA infants were taken as cases and term AGA infants as controls. Maternal, cord blood, and infant blood samples at 4 weeks were obtained for measurement of various iron indices – cord serum ferritin, serum ferritin at 4 weeks, and correlation among maternal and neonatal iron indices – Hb, serum iron, ferritin, and total iron binding capacity (TIBC).Results. There were 50 SGA and 50 AGA mother–infant pairs. Cord serum ferritin levels were low in SGA group as compared to AGA [median (IQR): 68 (30,136) vs. 141 (63,259), p = 0.007]. The proportion of infants with ‘low’ cord ferritin (<40 μg/l) were more in SGA [p = 0.05]. There was no correlation among various maternal and neonatal cord iron parameters. The serum ferritin levels at 4 weeks were similar in both the groups (p = 0.16).Conclusions. Term SGA infants have lesser total iron stores as compared to AGA infants at birth. Future studies can be designed to look at long-term neurodevelopmental outcome of the SGA babies with low as well as normal ferritin and also the role of early iron supplementation in term SGA neonates.

1080 Iron Status at Birth in Term Small-Forgestational Age Infants

Objectives: To determine body iron stores at birth in term small-for-gestational age (SGA) infants as compared to appropriate-for-gestational age (AGA) infants. Design: Prospective cohort study. Setting: Level III neonatal unit. Patients: Mother infant pairs with gestation of ≥37 weeks and birth weight of at least 1.5 kg were enrolled. Asymmetric SGA infants were taken as cases and gestation matched AGA infants as controls. Maternal and cord blood samples and infant blood samples during follow up were obtained for measurement of various iron indices. Outcomes: Primary- cord serum ferritin at birth, Secondary- proportion of infants with ‘low’ ferritin, serum ferritin in followup, and correlation among maternal and neonatal iron indices - Hb, serum Iron and total Iron binding capacity (TIBC). Results: There were 50 SGA and 50 AGA motherinfant pairs. Cord serum ferritin levels were less in SGA group as compared to AGA group [median (IQR): 68 (30,136) vs. 141 (63,259), p=0.007]. The proportion of infants with ‘low’ cord ferritin (defined as < 40 µg/L) were more in SGA group [17 (34%) vs. 9 (18%) in AGA group, p= 0.05]. Other iron indices were similar in both the groups. There was no correlation among various maternal and neonatal cord iron parameters. The serum ferritin levels at 28±3 days of age were also less in SGA group with a trend towards significance (p=0.06). Conclusions: Term asymmetric SGA infants have lesser total iron stores as compared to gestation matched AGA infants at birth. Implications: SGA infants need iron supplementation starting from early infancy.