Objective: To investigate the diagnostic consistency and the risk factors for extrauterine growth restriction (EUGR) assessed by the Fenton 2013 preterm growth charts (Fenton 2013) and the growth charts by International Fetal and Newborn Growth Consortium for the 21st Century (IG-21). Methods: This multicenter retrospective cohort study included 5 591 preterm infants with a gestational age (GA) at birth of less than 32 weeks admitted to 19 member hospitals of the Neonatal Perinatal Collaborative Network of Suxinyun from 2019 to 2024. Clinical data including baseline characteristics, complications, feeding practices and anthropometrics were processed and analyzed. EUGR was assessed using both the Fenton 2013 and the IG-21. A decrease in weight Z-score at discharge compared to admission by more than 1 was defined as longitudinal EUGR, and discharge weight below the P10 for the corresponding corrected GA was defined as cross-sectional EUGR. Diagnostic consistency was assessed using the Kappa coefficient between the 2 standards, and diagnostic performance of the 2 standards was compared using the McNemar test. Risk factors for EUGR under different definitions were analyzed using univariate analysis and multivariate Logistic regression analysis. Results: A total of 5 591 preterm infants were included, with a GA at birth of (29.7±1.6) weeks and a birth weight of (1 360±315) g and at discharge with a corrected GA of (36.3±2.0) weeks and weight of (2 246±370) g. Detection rates of cross-sectional and longitudinal EUGR diagnosed by Fenton 2013 were both higher than those by IG-21 (37.0% (2 214/5 991) vs. 23.7% (1 324/5 591), 61.1% (3 662/5 991) vs. 30.7% (1 714/5 591), χ2=326.77 and 1 358.05, both P<0.001). Using Fenton 2013 as a reference, IG-21 demonstrated superior diagnostic value and consistency in identifying cross-sectional EUGR compared with longitudinal EUGR (sensitivity of 100.0% (3 377/3 377) vs. 99.6% (1 922/1 929), specificity of 59.8% (1 324/2 214) vs. 46.6% (1 707/3 662), positive predictive value of 79.1% (3 377/4 267) vs. 49.6% (1 922/3 877), negative predictive value of 100.0% (1 324/1 324) vs. 99.6% (1 707/1 714), accuracy of 84.1% (4 701/5 591) vs. 64.9% (3 629/5 591), and Kappa 0.64 vs. 0.37, all P<0.001). In multivariate Logistic regression models, risk factors common to EUGR across both standards included smaller GA at birth, lower birth weight, boy, early-onset sepsis, late-onset sepsis and the elder age at full enteral feeding (all P<0.05). Hemodynamically significant patent ductus arteriosus remained an independent risk factor for longitudinal EUGR regardless of whether by the Fenton 2013 or IG-21 standard (adjust odds ratio (aOR)=1.25 and 1.27, 95%CI 1.09-1.42 and 1.11-1.45). In addition, under the IG-21 standard, severe bronchopulmonary dysplasia was an independent risk factor for cross-sectional EUGR (aOR=1.54, 95%CI 1.00-2.38), while severe necrotizing enterocolitis was an independent risk factor for longitudinal EUGR (aOR=2.18, 95%CI 1.01-4.73). Conclusions: IG-21 showed lower detection rates of both cross-sectional and longitudinal EUGR than Fenton 2013, suggesting greater clinical applicability of IG-21 by reducing overdiagnosis while maintaining sensitivity for predicting complications. Across both standards, cross-sectional EUGR facilitates early identification of growth restriction, whereas longitudinal EUGR better tracks dynamic growth patterns and complications of preterm infants.

Objective: To assess the status of undernutrition and appropriate catch-up growth in extremely preterm infants within 24 months of corrected age (CA). Methods: A retrospective cohort study was conducted. A total of 422 extremely preterm infants born at Shenzhen Maternity and Child Healthcare Hospital, Women and Children's Medical Center, Southern Medical University from January 2017 to December 2022 and followed up until 24 months of CA were enrolled. The extremely preterm infants were grouped by gestational age at birth (<25, 25-26, 27 weeks), birth weight (<500, 500-749, 750-999,≥1 000 g), weight for gestational age (large for gestational age (LGA), appropriate for gestational age (AGA), small for gestational age (SGA)) and sex. Weight data within 24 months of CA were collected every 3 months. Nutritional insufficiency, growth rate, and achievement of adequate catch-up growth were analyzed during the period from 0 to 24 months of CA. Z-score method was used to analyze data. Fenton 2013 preterm growth charts (Fenton 2013) were used before 40 weeks of corrected gestational age, and World Health Organization child growth standards (2006) fitted Z-scores were applied from 40 weeks of CA. Changes in weight Z-scores of extremely preterm infants from 0 to 24 months of CA were observed and compared, the occurrence of moderate to severe malnutrition and growth retardation was determined, nutritional insufficiency was assessed, and growth rate as well as the achievement of appropriate catch-up growth were analyzed. The Lambda-mu-sigma method combined with the Z-score fitting model was used to fit and analyze the distribution characteristics of weight percentiles in extremely preterm infants. The Chi-square test was used to compare differences among groups. Results: A total of 422 extremely preterm infants were included, with a gestational age at birth of 26.3(25.4, 27.2) weeks and a birth weight of (880±177) g. Among them, 238 were males and 184 were females; 36 cases (8.5%) were LGA, and 16 cases (3.8%) were SGA. During follow-up within 24 month of CA, 89 cases (21.1%) developed moderate to severe malnutrition. When compared separately among different birth weight and gestational age at birth groups, there had both statistically differences in the incidence of moderate to severe malnutrition (χ²=42.94 and 9.17, both P<0.05). The incidence was the highest in the birth weight <500 g group and the <25 weeks gestational age at birth group, while it was the lowest in the birth weight ≥1 000 g group and the 27 weeks gestational age at birth group in their respective groups. Growth retardation occurred in 5.2% (22/422). However, there had statistically differences in the incidence of growth retardation among different birth weight and gestational age at birth groups, in each grouped time interval (χ²=21.61 and 4.30, both P<0.05). The proportions of rapid growth were relatively high in the 0-3 months and 3-6 months of CA groups, which were 96 cases (27.4%) and 98 cases (26.6%), respectively. Overall, appropriate catch-up growth was achieved in 341 cases (80.8%) from 0 to 24 months of CA. There had statistically differences in the completion rate of appropriate catch-up growth among different birth weight and gestational age at birth groups (χ²=23.65 and 7.08, both P<0.05). The completion rate was the highest in the birth weight <500 g group and the <25 weeks of gestational age at birth group, while it was the lowest in the birth weight ≥1 000 g group and the 27 weeks of gestational age at birth group. Conclusions: The lower the birth weight and gestational age of extremely preterm infants, the higher the incidence of moderate to severe malnutrition and the lower the achievement rate of adequate catch-up growth within 24 months of CA. The period of 0-6 months of CA is the critical window for catch-up in extremely preterm infants.

Fetal growth velocity as a predictor of small for gestational age at birth and adverse perinatal outcomes: systematic review and meta-analysis.

BackgroundInfants exposed to hyperglycemia in pregnancy (HIP) in utero are known to have higher risks of macrosomia at birth and obesity in adulthood, but longitudinal growth patterns in early childhood remain poorly characterized. This study aimed to examine HIP-associated differences in early childhood growth trajectories.MethodsIn the population-based prospective Jiangsu Birth Cohort (JBC) study, 8780 children (23.3% HIP exposed) were included. Linear mixed models were used to assess the associations of maternal HIP with repeated growth measures in children. Latent class mixed models (LCMM) were used to identify trajectories for weight-for-age (WAZ), length/height-for-age (LAZ) and weight-for-length z-scores (WFL). Models were fitted to the full 0–36-month age range, with measurements at ages 0, 3, 6, 8, 12, 18, 24, 30, and 36 months, respectively. Adjusted associations between maternal HIP and child trajectory classes were evaluated with modified Poisson regression.ResultsA higher proportion of LGA in the HIP-exposed group was observed. During the follow-up period from birth to 36 months, maternal HIP was associated with lower WAZ (aβ = − 0.075, 95% CI: − 0.117, − 0.034), LAZ (aβ = − 0.054, 95% CI: − 0.099, − 0.009), and WFL (aβ = − 0.061, 95% CI: − 0.100, − 0.022) in children. HIP was also correlated with reduced weight and body mass index (BMI) growth velocity at 0–3 and 6–8 months. Three distinct trajectory groups were identified, namely, moderate-stable, high-decreasing and low-increasing group. HIP exposed children were more likely to follow the high-decreasing WFL trajectory (aRR = 1.14, 95% CI: 1.01, 1.29).ConclusionsMaternal HIP was associated with slower growth in early childhood and an increased likelihood of following a high-decreasing growth trajectory, suggesting its potential long-term implications for child growth regulation.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12916-025-04521-0.

Objective: Recombinant human growth hormone (rhGH) became available for clinical trials, and growth hormone deficiency has been treated more safely and effectively since 1985. Growth hormone therapy enables patients to attain an adult height consistent with their genetic target height.The present study was undertaken to evaluate patients’ characteristics, their response to therapy, factors influencing outcome, and side effects of treatment.Method: A retrospective file review was conducted. Out of 149 patients followed up with a GHD diagnosis, 92 patients whose files were accessible and who received treatment for at least 1 year were included in the study. Patients’ chronological ages, ages at diagnosis, sex, pretreatment bone ages (BA), pubertal stages, annual growth velocities, auxological data during treatment, and side effects were recorded.Results: Age at diagnosis, sex, etiologic distributions, and auxological data were found to be similar to the results of Western countries. Height gain was found to be significant in the first year of treatment, and then growth velocity declined gradually. Age at the initiation of GH treatment has been shown to be negatively correlated with the response to therapy, emphasizing the need for early diagnosis and treatment of the condition. No significant adverse effects were observed throughout the 16-year follow-up period.Conclusion: Early detection of pathological short stature, particularly Growth Hormone Deficiency (GHD), and the initiation of treatment at an early stage, lead to a superior final height outcome. Patients with GHD can be treated both effectively and safely with recombinant growth hormone therapy

The growth charts for individuals with Down syndrome (DS) available to-date were developed from a cohort of patients from the USA. As diet and environmental factors play a key role on auxological attainment, the growth of patients from the Mediterranean area should be assessed by means of dedicated centiles. Accordingly, we aimed to develop growth charts from a wide Italian population and to provide a metabolic validation for the BMI distribution outlined. Retrospective, bicentric study. We gathered auxological and biochemical data from two cohorts of Italian children and adolescents with DS assessed every 6- to 12-months between 1992 and 2024. 526 patients were enrolled. We longitudinally retrieved the auxological data recorded in the setting of 2796 clinical evaluations. By assessing height, weight and BMI with reference to age, we outlined the age-dependent distribution of each parameter and developed syndrome-specific growth charts. When comparing our charts with the USA ones, the latter showed a statistically greater upward trendline in weight and BMI. Eventually, we assessed the distribution of triglycerides, cholesterol, glycated hemoglobin and uric acid with reference to the BMI. A higher BMI centile was statistically associated with greater triglycerides, cholesterol, and uric acid levels, and we identified the 90th centile of BMI as a risk threshold for dyslipidemia and hyperuricemia. We developed DS-specific growth charts from a wide Italian population. The comparison with the USA percentiles outlined statistically significant differences in the distribution of weight and BMI, thus highlighting the need of dedicated charts for individuals from the Mediterranean area.

Background:Extra-uterine growth restriction (EUGR) in premature infants remains a major challenge for neonatologists worldwide. In the neonatal intensive care unit (NICU), suboptimal nutrition and the fear of advancing feeds are key contributors. Updated feeding protocols that support rapid but safe feeding advancement, breast milk fortification, and close monitoring of growth parameters are essential to achieving optimal nutritional outcomes and preventing long-term neurodevelopmental impairment. Objective: To determine the frequency of extra-uterine growth restriction (EUGR) among premature infants in Benghazi and identify associated risk factors. Method: This cross-sectional study was conducted in Benghazi. Medical records of 107 premature infants were obtained from the neonatal clinic. All preterm infants born at &lt;34 weeks’ gestation and weighing ≤1500 grams were included. Growth measurements at birth, discharge, and 40 weeks corrected age were plotted on Fenton growth charts. Weight &lt;10th percentile was

Monitoring strategy and efficacy of GnRH analogue therapy in girls with central precocious puberty and early puberty.

The main aims of the PhD work were to examine the biological and birth status of children treated with growth hormone, to develop national height-for-age growth charts, to analyse their growth patterns, and to identify the key factors influencing their growth trajectory. The data of 123 children with growth hormone deficiency (85 boys and 38 girls) and 45 children with Turner syndrome, who attended the endocrinology clinic at the North Buda St. John’s Centre Hospital, were retrospectively reviewed. The analyses of the biological status of children treated with growth hormone revealed that, compared to other European nations, hormone treatment for children in Hungary was initiated later and after a more pronounced height deficiency. However, early hormone replacement was critical for achieving target height. Additionally, we presented previously unavailable data on the biological status of Hungarian girls with Turner syndrome, which are highly relevant to assessing treatment efficiency. In our examination of birth status, we were the first who applied the MDN-percentile matrix in children treated with growth hormone. This approach confirmed that the method is effective in identifying children who are likely to require growth hormone treatment in the future. Furthermore, the application of this method revealed that a significant proportion of children with growth hormone deficiency fell into the "PN-LWR category", which was associated with the highest rates of stillbirth and infant mortality. It is worth to explore whether a common underlying cause might be responsible, of which the impaired GH production is a milder outcome. Using the Preece–Baines I model, we were the first to develop disease-specific height-for-age growth references for boys and girls with growth hormone deficiency, both nationally and internationally. Additionally, we were the first to create height-for-age growth references for GH-treated girls with Turner syndrome in Hungary. We were also the first to analyse growth trajectories among growth hormone-treated children by categorizing them by their growth rate. Furthermore, in our investigation of the factors influencing growth, the existing scientific literature was validated and extended by incorporating variables that had previously received little attention. The results of our analyses may contribute to the early diagnosis of children requiring growth hormone treatment, allow for more precise monitoring of growth by using disease-specific growth references, assist in the planning of treatment protocols, and optimize treatment strategies, ultimately improving the long-term health outcomes and quality of life for these children.

Growth charts are essential for monitoring child growth. The availability of multiple international and national charts, along with increasing interest in locally developed references, may have influenced global trends in their application. This study aimed to describe global trends in the use of national versus international child growth charts, with a focus on prevailing research themes, chart types, and variations across regions and time periods. We conducted a bibliometric analysis and scoping review of studies on child growth charts published between January 1, 2007, and October 25, 2022, in PubMed and Scopus. The search used the primary key words "child," "growth chart," and "nutritional status" in titles and abstracts. Bibliometric analysis with VOSviewer (Centre for Science and Technology Studies, Leiden University, Leiden, The Netherlands) mapped research themes and key word co-occurrence, while the scoping review synthesized evidence on the use of various growth chart types across regions and time periods, following PRISMA-ScR guidelines. From 3014 identified articles across 120 countries, 975 were included in the review. Key word network analysis revealed "childhood obesity" as a dominant theme in nutrition research related to growth charts. Most studies originated from China, India, and the United States, with limited representation from Africa. International charts remained predominant, with 83.6% of studies using the International Obesity Task Force (IOTF), World Health Organization (WHO) 2006, WHO 2007, or Centers for Disease Control and Prevention (CDC) 2000 references. However, a growing trend toward the development and use of national growth charts was observed in approximately 47 countries, particularly in the past decade. Childhood obesity has emerged as a central focus of research using growth charts. Although international charts continue to be the most widely applied, there is an increasing tendency toward national chart development and utilization. Further studies are needed to assess how national growth charts compare with international standards in evaluating children's nutritional status.

Vitamin B12 is essential for DNA synthesis and is necessary for the development of the central nervous system. Vitamin B12 deficiency occurs in babies who are exclusively breast-fed by mothers with insufficient stores of vitamin B12. In vitamin B12 deficiency, the clinical features are mainly hematological and neurological. Megaloblastic anemia is the characteristic feature of vitamin B12 insufficiency. Rare haematological manifestations include pancytopenia and hemolytic anemia. The other clinical spectrum of vitamin B12 deficiency comprises vomiting, lethargy, failure to thrive, hypotonia, and retrogression of developmental milestones. We reported a 7-month-old infant with vitamin B12 deficiency who presented with loss of weight and regression of social smile since one month of age. Her weight, length, and head circumference were in the less than 3rd centile range according to the World Health Organisation (WHO) growth chart. She had severe pallor, hyperpigmentation of palms, soles, and knuckles, brownish depigmented brown sparse hair, and hepato-splenomegaly of 4 cm each. The laboratory results revealed Hb of 3.5gm/dl, Mean Corpuscular Volume (MCV) of 99fl, thrombocytopenia, normal ferritin levels, and peripheral smear showed polychromatophils, 19 nucleated Red Blood Cell (RBCs)/100White Blood Cells (WBCs), macrocytes, leucocytes shift to the left with 21% hypersegmented neutrophils, suggestive of hemolytic anemia. Vitamin B12 levels were 146pg/ml [N=200-900 pg/ml]. The baby started smiling 2 days after the vitamin B12 injection, gained 700 g during the follow-up of 3 months, and the pigmentation disappeared from the palms and soles.

BackgroundPhenylketonuria (PKU) is an inherited metabolic disorder where the body cannot break down phenylalanine (Phe), leading to its harmful accumulation if left untreated. Concerns have been raised about growth and risk of overweight in PKU patients, with conflicting research findings. This retrospective study aims to assess growth patterns and the prevalence of overweight and obesity in Danish children and adults with PKU by comparing them with Danish growth charts and prevalence rates.ResultsData were collected from medical records of 291 Danish patients from the National PKU Clinic at Rigshospitalet in Copenhagen, including data on age, sex, PKU phenotype, Phe levels, and anthropometric measurements from their last clinic visit. Weight status for children was classified according to Danish guidelines, while World Health Organization criteria were used for adults. All data analyses were carried out separately for children and adults. A total of 291 PKU patients were included, 116 children and 175 adults. Children had normal growth patterns compared to Danish growth charts. The rates of overweight and obesity among children were 15% and 1%, respectively, while 32% of adults were overweight, and 28% were obese. Adults with classic PKU were significantly more obese and had higher BMI levels compared to other phenotypes. Additionally, a slight positive correlation was noted between high Phe levels and the risk of being overweight.ConclusionsChildren with phenylketonuria following a restricted diet achieve normal growth. However, overweight and obesity rates rise with age, particularly in adults with the most severe phenotype, suggesting disease severity may influence weight gain. The potential link between high phenylalanine levels and overweight requires further investigation. These findings highlight the need for ongoing weight and metabolic monitoring, as well as strategies to support weight management in adults with phenylketonuria.

Abstract We present a novel case of gastrointestinal strictures in a young girl with Satoyoshi syndrome (SS), highlighting multi‐system features of alopecia universalis, painful muscle cramps with dystonia, aberrant growth velocity, and skeletal abnormalities. This case demonstrates an unusual pattern of patchy mucosal fibrosis throughout the gastrointestinal tract, alongside duodenal and rectal strictures, with only mild inflammation. While serial endoscopic dilatations and systemic corticosteroids resulted in symptomatic benefit, trial of a Janus kinase‐1 inhibitor (upadacitinib) did not prevent the development of a subsequent rectal stricture. As the pathogenesis of SS remains undefined and treatment modalities are experimental, the observed fibrostenotic complications may point towards new underlying disease mechanisms.

Children with atopic dermatitis (AD) appear to have higher skin permeation, which may increase the risk of systemic adverse events following administration of potent topical corticosteroids, such as clobetasol propionate (CP). However, the assessment of dermal absorption in a controlled clinical trial in children is not feasible. Using model-based approaches, this study aimed to characterise stratum corneum (SC) and systemic exposure to CP following topical application of the cream formulation, and to investigate its effects on circulating cortisol levels and growth velocity in children with AD. Physiologically-based pharmacokinetic (PBPK) and pharmacokinetic-pharmacodynamic (PKPD) modelling were utilised to describe the dermal absorption of CP in a virtual cohort of paediatric patients (1 - < 18 years old). Based on a skin impairment model for lesional and non-lesional skin, CP concentrations in the SC and in plasma were described over time. Simulation scenarios were then implemented to evaluate the effect of varying treatment conditions on the systemic exposure to CP, cortisol levels and growth velocity. Subsequently, clinical case scenarios were simulated to illustrate typical cases of AD in the paediatric population. Surface area had the largest impact on the local and systemic concentrations of CP, while body site and age had a minor effect. When comparing similar surface areas and site of application, the dose, dosing regimen (o.d. vs. b.i.d.) and occlusion had no clinically relevant effect on the local and systemic exposure. Assuming a uniform application (1.2 mg/cm2), CP cream can be applied on up to 20% of the body surface area in children with AD over a period of 2 weeks. The short-term use of CP cream had no effect on the growth velocity of children with AD. Surface area affected by AD should be considered when assessing the risk of systemic side effects. CP can be applied up to 20% of the BSA of a child (> 1 year old) without clinically relevant changes to circulating cortisol levels. In contrast to the systemic effects of oral corticosteroids, the short-term use of CP has no impact the growth velocity of paediatric subjects with AD.

Osteogenesis imperfecta (OI) is a heterogenous type 1 collagenopathy characterized by recurrent fractures, decreased bone mass, and shorter stature. Bisphosphonates reduce fracture incidence in children with OI but do not improve growth velocity. C-type natriuretic peptide (CNP) is produced in the growth plate (also in the brain and heart) and positively regulates linear bone growth; people with OI have been shown to have a reduced serum level of CNP. This pilot study evaluated whether a CNP analog combined with alendronate (ALN) improves growth and bone mineral density in oim/oim (OIM) mice, a model of moderate-to-severe Type III OI. Two-week-old OIM and WT mice received weekly ALN and one of three CNP regimens: 10 μg/kg three days/week (low), 20 μg/kg three days/week (medium), or 20 μg/kg five days/week (high). Controls received saline. Faxitron images were taken at two, eight, and 14 weeks (sacrifice) to assess fracture incidence and measure femoral length and vertebral height. Microcomputed tomography (micro-CT) was used to assess bone microstructural parameters of the femur ex vivo. The high-dose group had no fractures post-sacrifice; one fracture each was observed in the low and medium dose groups. Femoral length increased in all treated groups, with the high dose group showing the greatest increase (8.2%, significant) in OIM mice. Vertebral height increased in all treated groups; low and high dose groups had greater, comparable increases than the medium group in OIM mice. All treated groups showed increased trabecular bone mineral density (BMD). Cortical tissue mineral density (TMD), BMD, and thickness were also elevated in all treated groups compared to controls. In conclusion, CNP analog adjuvant treatment enhanced linear growth and bone quality without compromising fracture reduction, providing benefits not seen with bisphosphonates alone. These results will inform optimal dosing for future studies. A full murine study is planned to further evaluate therapeutic potential for translation to humans.

Purpose To build extra-axial cerebrospinal fluid (eaCSF) growth charts that define key diagnostic criteria for benign enlargement of the subarachnoid space (BESS) by providing an age-related reference benchmark to aid in assessing atypical eaCSF development. Materials and Methods In this retrospective study, T1-weighted (T1w) MRIs from patients scanned at a pediatric health care system between January 2004 and December 2023 were accessed to form a clinical control group. Nine scans from patients diagnosed as having BESS by a board-certified pediatric neuroradiologist were also reviewed. T1w scans were segmented into various tissue types, including eaCSF. Growth charts of eaCSF were modeled using the clinical control group. The results of patients with confirmed BESS were then benchmarked against these charts to test the performance of the eaCSF growth charts. Generalized additive models of location, scale, and shape (GAMLSS) were used. Results eaCSF measurements were obtained for 1205 patients (619 females; age range, 0.19-19.6 years). eaCSF evolved dynamically with age, steadily decreasing from birth to 2 years, then trending upwards in childhood. Seven of the nine patients with a clinical diagnosis of BESS had eaCSF measurements above the 97.5th percentile for at least one measurement. Percentile scores distinguished patients with BESS from controls with areas under the curve of > 0.95. Conclusion MRI-derived eaCSF measurements evolved dynamically throughout early life. Patients with atypical CSF development could be differentiated from clinical controls using computational measurements paired with normative modeling. ©RSNA, 2025.

Bridgman solidification experiments are carried out on Fe–C–Mn–Si peritectic steels to clarify how growth velocity ( V ) and alloy composition govern microstructural evolution. At velocities of 10–120 μm s −1 , the microstructures exhibit competitive growth between primary δ dendrites, are subsequently enveloped by γ ‐austenite in the interdendritic regions. The primary dendrite arm spacing (PDAS) decreases systematically with increasing V but coarsens unexpectedly at intermediate growth rates in the presence of silicon. Experimental measurements are benchmarked against PDAS scaling models to assess predictive accuracy. Particular attention is given to the role of Si in modifying interfacial morphology and mushy zone characteristics. The results demonstrate that elevated Si levels, when coupled with faster growth velocities, extend the mushy zone length and are associated with increased susceptibility to interdendritic solidification cracking. These findings provide mechanistic insight into crack formation in peritectic steels and highlight composition–processing interactions critical for continuous casting practice.

ABSTRACTObjectiveTo compare the predictive performance of intertwin estimated fetal weight (EFW) discordance and EFW centile calculated according to either the Fetal Medicine Foundation (FMF) singleton or twin‐specific fetal growth charts for adverse perinatal outcome in dichorionic and monochorionic twin pregnancies.MethodsThis was a retrospective multicenter cohort study of twin pregnancies managed between January 2013 and December 2023 at three tertiary fetal medicine centers in the UK, Italy and Belgium. Twin pregnancies in which an obstetric ultrasound exam was performed to obtain fetal biometry within 2 weeks before live birth or diagnosis of intrauterine fetal demise of one or both twins were included. Cases with anastomotic complications were excluded. The primary outcome was a composite adverse perinatal outcome (CAPO), defined as stillbirth (intrauterine fetal demise ≥ 22 weeks) of at least one cotwin and/or iatrogenic early preterm birth (delivery < 34 weeks) for fetal indications. The predictive performance of intertwin EFW discordance and of the EFW centile of the smaller twin, calculated using either singleton or twin‐specific FMF fetal growth charts, was assessed for CAPO. Predictive models were developed using logistic regression analysis and evaluated using the area under the receiver‐operating‐characteristics curve (AUC); pairwise comparisons between models were performed using DeLong's test.ResultsThe study analyzed 1294 dichorionic and 487 monochorionic twin pregnancies. For the prediction of CAPO, intertwin EFW discordance in dichorionic twins achieved an AUC of 0.93 (95% CI, 0.89–0.98), compared with 0.83 (95% CI, 0.77–0.90) (P = 0.001) and 0.87 (95% CI, 0.81–0.93) (P = 0.017) for EFW centile based on singleton and twin‐specific growth charts, respectively. Likewise, intertwin EFW discordance achieved an AUC of 0.95 (95% CI, 0.92–0.97) for predicting CAPO in monochorionic twins, outperforming EFW centile based on singleton charts (AUC, 0.80 (95% CI, 0.73–0.87); P < 0.001) and twin‐specific growth charts (AUC, 0.83 (95% CI, 0.76–0.90); P < 0.001). In clinical terms, at a 20% false‐positive rate (FPR), the sensitivity for CAPO in dichorionic twin pregnancies was 74%, 81% and 93% using singleton charts, twin‐specific charts and intertwin EFW discordance, respectively. Similarly, in monochorionic twin pregnancies, the sensitivity at a FPR of 20% was 75%, 79% and 98% using singleton charts, twin‐specific charts and intertwin EFW discordance, respectively.ConclusionsIntertwin EFW discordance is a more reliable predictor of the composite outcome of stillbirth in at least one cotwin and/or iatrogenic early preterm birth in twin pregnancies than is EFW centile based on either singleton or twin‐specific growth charts. This approach addresses the limitations of using different fetal growth reference charts that rely on arbitrary cut‐offs. Following external validation, the use of intertwin EFW discordance prediction algorithms may potentially enhance risk stratification to improve clinical outcomes in twin pregnancies. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

ABSTRACTBackgroundParasitic infections are prevalent among lambs in the subtropics, adversely affecting immunity, liver health and growth performance. To efficiently combat these issues, herbs as supplements are an effective approach.ObjectivesThe present study aims to evaluate the efficacy of lemongrass powder on growth performance, nutrient digestibility, blood biomarkers, liver enzymes, immune and endo‐parasitic status in lambs (Ovis aries).MethodsTen lambs (body weight [BW]: 16.67 ± 3.82 kg) were randomly assigned to two diets (5 lambs/diet) in a crossover design, consisting of two 35‐days feeding periods separated by a 14‐days washout interval. The basal diet had 14.90% crude protein and 10.57 mega joules of metabolizable energy/kg of dry matter (DM) and was considered the control diet (CL‐diet), and the lemongrass diet (LS‐diet) consisted of the basal diet + 0.50 g of lemongrass powder/kg of metabolic BW of a lamb. Feed, faeces and blood samples were collected during each feeding period.ResultsLambs receiving the LS‐diet presented a better propensity of DM consumption (p = 0.07), greater average daily gain (p = 0.06), while showing a better feed conversion ratio (p = 0.05) and higher growth velocity (p = 0.02) compared to the CL‐diet. In addition, lambs given the LS‐diet improved nutrient digestibility, serum high‐density lipoprotein cholesterol and albumin, while reducing serum triglycerides, low‐density lipoprotein cholesterol and globulin compared to the CL‐diet (p < 0.05). However, feeding the LS‐diet to lambs had no impact on serum total protein, immunoglobulin (Ig)‐M, alanine aminotransferase and gamma‐glutamyltransferase, while substantially improving serum IgG and reducing aspartate aminotransferase and alkaline phosphatase, thereby improving immunity and liver health. Lambs given the LS‐diet effectively suppressed stomach worms, Paramphistomum spp. and Eimeria spp. (p < 0.05).ConclusionsLemongrass powder as a supplement with a basal diet had a positive impact on growth velocity, digestibility, serum cholesterol levels, liver health, immunity and endo‐parasitic status in lambs.

Faltering weight in infants with cleft lip and palate.