Growth Velocity Of Head Circumference Research Articles

Identifying possible inaccuracy in reported birth head circumference measurements among infants in the US Zika Pregnancy and Infant Registry.

The US Zika Pregnancy and Infant Registry (USZPIR) monitors infants born to mothers with confirmed or possible Zika virus infection during pregnancy. The surveillance case definition for Zika-associated birth defects includes microcephaly based on head circumference (HC). We assessed birth and follow-up data from infants with birth HC measurements <3rd percentile and birthweight ≥10th percentile to determine possible misclassification of microcephaly. We developed a schema informed by literature review and expert opinion to identify possible HC measurement inaccuracy using HC growth velocity and longitudinal HC measurements between 2 and 12 months of age. Two or more HC measurements were required for assessment. Inaccuracy in birth HC measurement was suspected if growth velocity was >3 cm/month in the first 3 months or HC was consistently >25th percentile during follow-up. Of 6,799 liveborn infants in USZPIR, 351 (5.2%) had Zika-associated birth defects, of which 111 had birth HC measurements <3rd percentile and birthweight ≥10th percentile. Of 84/111 infants with sufficient follow-up, 38/84 (45%) were classified as having possible inaccuracy of birth HC measurement, 19/84 (23%) had HC ≥3rd percentile on follow-up without meeting criteria for possible inaccuracy, and 27/84 (32%) had continued HC <3rd percentile. After excluding possible inaccuracies, the proportion of infants with Zika-associated birth defects including microcephaly decreased from 5.2% to 4.6%. About one-third of infants in USZPIR with Zika-associated birth defects had only microcephaly, but indications of possible measurement inaccuracy were common. Implementation of this schema in longitudinal studies can reduce misclassification of microcephaly.

Effect of SARS-CoV-2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study.

IntroductionOur objective was to compare the fetal growth velocity and fetal hemodynamics in pregnancies complicated and in those not complicated by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection.Material and methodsProspective case‐control study of consecutive pregnancies complicated by SARS‐CoV‐2 infection during the second half of pregnancy matched with unaffected women. The z scores of head circumference, abdominal circumference, femur length, and estimated fetal weight were compared between the two groups. Fetal growth was assessed by analyzing the growth velocity of head circumference, abdominal circumference, femur length, and estimated fetal weight between the second‐ and third‐trimester scans. Similarly, changes in the pulsatility index of uterine, umbilical, and middle cerebral arteries, and their ratios were compared between the two study groups.ResultsForty‐nine consecutive pregnancies complicated, and 98 not complicated, by SARS‐CoV‐2 infection were included. General baseline and pregnancy characteristics were similar between pregnant women with and those without SARS‐CoV‐2 infection. There was no difference in head circumference, abdominal circumference, femur length, and estimated fetal weight z scores between pregnancies complicated and those not complicated by SARS‐CoV‐2 infection at both the second‐ and third‐trimester scans. Likewise, there was no difference in the growth velocity of all these body parameters between the two study groups. Finally, there was no difference in the pulsatility index of both maternal and fetal Doppler scans throughout gestation between the two groups.ConclusionsPregnancies complicated by SARS‐CoV‐2 infection are not at higher risk of developing fetal growth restriction through impaired placental function. The findings from this study do not support a policy of increased fetal surveillance in these women.

Customized Human Milk Fortification Based on Measured Human Milk Composition to Improve the Quality of Growth in Very Preterm Infants: A Mixed-Cohort Study Protocol.

Adequate nutrition of very preterm infants comprises fortification of human milk (HM), which helps to improve their nutrition and health. Standard HM fortification involves a fixed dose of a multi-nutrient HM fortifier, regardless of the composition of HM. This fortification method requires regular measurements of HM composition and has been suggested to be a more accurate fortification method. This observational study protocol is designed to assess whether the target HM fortification method (contemporary cohort) improves the energy and macronutrient intakes and the quality of growth of very preterm infants, compared with the previously used standard HM fortification (historical cohorts). In the contemporary cohort, a HM multi-nutrient fortifier and modular supplements of protein and fat are used for HM fortification, and the enteral nutrition recommendations of the European Society for Paediatric Gastroenterology Hepatology and Nutrition for preterm infants will be considered. For both cohorts, the composition of HM is assessed using the Miris Human Milk analyzer (Uppsala, Sweden). The quality of growth will be assessed by in-hospital weight, length, and head circumference growth velocities and a single measurement of adiposity (fat mass percentage and fat mass index) performed just after discharge, using the air displacement plethysmography method (Pea Pod, Cosmed, Italy). ClinicalTrials.gov registration number: NCT04400396.

Administration of antenatal corticosteroid is associated with reduced fetal growth velocity: a longitudinal study

Objective To elucidate whether antenatal administration of corticosteroids in pregnancies with threatened preterm labor affects growth velocity. Methods A cohort of 262 pregnancies exposed to antenatal corticosteroids longitudinally studied and delivered from 36 weeks (cases) were compared to an unexposed group of 270 women (controls). Methods Fetal growth was assessed analyzing the growth velocity of head circumference (HC), abdominal circumference (AC), femur length (FL) and estimated fetal weight (EFW). Growth velocity (GV) was calculated as the difference in the Z-score between the biometric measurements recorded at the time of steroids administration and at 36 week of gestation, divided by the time interval (expressed in days) between the two scans and multiplied by 100. Similarly, changes in the Pulsatility Index (PI) of uterine, umbilical (UA), middle cerebral (MCA) arteries and cerebroplacental ratio (CPR) during the same time interval were also computed. Results Median gestational age at steroid administration (30.2 weeks vs 30.4) and follow-up ultrasound (36.4 weeks vs 36.4) were similar between cases and controls. In pregnancies exposed to antenatal corticosteroids, growth velocity in the HC (−0.61 vs. 0.12; p ≤ 0.001), AC (−0.55 vs. −0.04; p ≤ 0.001) and EFW (−0.89 vs. 0.06; p ≤ 0.001) were lower when compared to pregnancies not exposed to steroid therapy, while there was no difference in the growth velocity of FL (−0.05 vs 0.19; p = .06) or in any of the Doppler parameters explored. Conclusion In pregnancies exposed to antenatal steroid therapy, there is a significant reduction in fetal growth velocity not otherwise associated with changes in cerebroplacental Dopplers.

Preterm Infant Growth Velocity Calculations: A Systematic Review.

Clinicians assess the growth of preterm infants and compare growth velocity using a variety of methods. We determined the numerical methods used to describe weight, length, and head circumference growth velocity in preterm infants; these methods include grams/kilogram/day (g/kg/d), grams/day (g/d), centimeters/week (cm/week), and change in z scores. A search was conducted in April 2015 of the Medline database by using PubMed for studies that measured growth as a main outcome in preterm neonates between birth and hospital discharge and/or 40 weeks' postmenstrual age. English, French, German, and Spanish articles were included. The systematic review was conducted by using Preferred Reporting Items for Systematic Reviews and Meta-analyses methods. Of 1543 located studies, 373 (24%) calculated growth velocity. We conducted detailed extraction of the 151 studies that reported g/kg/d weight gain velocity. A variety of methods were used. The most frequently used method to calculate weight gain velocity reported in the 1543 studies was g/kg/d (40%), followed by g/d (32%); 29% reported change in z score relative to an intrauterine or growth chart. In the g/kg/d studies, 39% began g/kg/d calculations at birth/admission, 20% at the start of the study, 10% at full feedings, and 7% after birth weight regained. The kilogram denominator was not reported for 62%. Of the studies that did report the denominators, the majority used an average of the start and end weights as the denominator (36%) followed by exponential methods (23%); less frequently used denominators included birth weight (10%) and an early weight that was not birth weight (16%). Nineteen percent (67 of 355 studies) made conclusions regarding extrauterine growth restriction or postnatal growth failure. Temporal trends in head circumference growth and length gain changed from predominantly cm/wk to predominantly z scores. The lack of standardization of methods used to calculate preterm infant growth velocity makes comparisons between studies difficult and presents an obstacle to using research results to guide clinical practice.

Growth of Infants with Intestinal Failure or Feeding Intolerance Does Not Follow Standard Growth Curves.

Objective. Infants with intestinal failure or feeding intolerance are nutritionally compromised and are at risk for extrauterine growth restriction. The aim of the study was to evaluate growth velocities of infants with intestinal failure and feeding intolerance for the first three months of age and to determine growth percentiles at birth and at 40-week postmenstrual age (PMA). Methods. A chart review of infants followed by the Texas Children's Hospital Intestinal Rehabilitation Team was conducted from April 2012 to October 2014. Weekly weight, length, and head circumference growth velocities were calculated. Growth data were compared to Olsen growth curves to determine exact percentiles. Results. Data from infants (n = 164) revealed that average growth velocities of 3-month-old infants (weight gain, 19.97 g/d; length, 0.81 cm/week; head circumference, 0.52 cm/week) fluctuated and all were below expected norms. At discharge or death, average growth velocities had further decreased (length, 0.69 cm/week; head circumference, 0.45 cm/week) except for weight, which showed a slight increase (weight, 20.56 g/d). Weight, length, and head circumference percentiles significantly decreased from birth to 40-week PMA (P < 0.001). Conclusions. Growth of infants with intestinal failure or feeding intolerance did not follow standard growth curves.

Relation of FTO gene variants to fetal growth trajectories: Findings from the Southampton Women's survey

IntroductionPlacental function is an important determinant of fetal growth, and fetal growth influences obesity risk in childhood and adult life. Here we investigated how FTO and MC4R gene variants linked with obesity relate to patterns of fetal growth and to placental FTO expression. MethodsSouthampton Women's Survey children (n = 1990) with measurements of fetal growth from 11 to 34 weeks gestation were genotyped for common gene variants in FTO (rs9939609, rs1421085) and MC4R (rs17782313). Linear mixed-effect models were used to analyse relations of gene variants with fetal growth. ResultsFetuses with the rs9939609 A:A FTO genotype had faster biparietal diameter and head circumference growth velocities between 11 and 34 weeks gestation (by 0.012 (95% CI 0.005 to 0.019) and 0.008 (0.002–0.015) standard deviations per week, respectively) compared to fetuses with the T:T FTO genotype; abdominal circumference growth velocity did not differ between genotypes. FTO genotype was not associated with placental FTO expression, but higher placental FTO expression was independently associated with larger fetal size and higher placental ASCT2, EAAT2 and y + LAT2 amino acid transporter expression. Findings were similar for FTO rs1421085, and the MC4R gene variant was associated with the fetal growth velocity of head circumference. DiscussionFTO gene variants are known to associate with obesity but this is the first time that the risk alleles and placental FTO expression have been linked with fetal growth trajectories. The lack of an association between FTO genotype and placental FTO expression adds to emerging evidence of complex biology underlying the association between FTO genotype and obesity.

Growth Velocity of Infants From Birth to 5 Years Born in Maku, Iran.

Background:Growth velocity standards are essential for proper evaluation of child growth. The goal of this study was to construct weight, height and head circumference growth velocity charts for infants.Methods:This study includes 256 infants (124 boys and 132 girls) born in Maku, Northwest of Iran, and monitored from birth until they were 5 years. The weights and heights of the subjects were recorded at birth, one, two, four, six months and 1, 1.5, 2, 3, 4 and 5 years of age, while the head circumferences were measured until they were 1.5 years old. In this study, the LMS method using LMS chart maker software, was utilized to obtain growth velocity centiles.Results:Growth velocity charts for weight, height and head circumference (5th, 50th, 95th percentiles) were obtained. The velocity growth charts decreased rapidly from birth to 2 years and then remained relatively constant up to 5 years for both sexes. The growth velocity of boys was higher than girls through the first year of age but became equal at 12 months of age and no significant difference was seen up to 5 years.Conclusion:Growth velocity studies are really sparse in Iran. In this study, longitudinal data were used to obtain growth velocity centiles. Furthermore, the weight and height velocities of infants from Shiraz, southern Iran, and U.K were compared.

Decreased Head Circumference Velocity as Related to Developmental Deficit in Infancy

We evaluated the significance of head circumference growth velocity as related to developmental deficits during infancy. Head circumferences, lengths, and developmental diagnoses were retrieved in a standard manner at ≥ 2 time points from 437 infants with developmental deficits, and 3909 normally developing infants. Infants' ages ranged from 1-24 months, with final diagnoses ascertained at age 24 months. Increased velocity during the first 2 months in typical infants was evident in the study group during the period 2-4 months. A differential head circumference growth velocity was observed, and infants diagnosed with motor delay presented decreased velocity between ages 2-4 months, compared with infants receiving other nonmotor developmental diagnoses. These differences remained after controlling for birth weight and length. No significant sex effect was evident. Infants with developmental deficits demonstrate delayed acceleration of head circumference velocity, compared with typical infants in the first 2 months. Infants with motor delay manifest decreased velocity, compared with infants presenting other developmental deficits. These differences may be related to delayed white matter maturation.

Head Circumference in Children with Pervasive Development

Macrocephaly has been considered an early sign in children later diagnosed with pervasive development disorders (PDD). The data nevertheless remain controversial. This study aimed to evaluate head circumference (HC) and HC growth velocity (GV) in the first 36 months in children diagnosed with PDD. We analysed HC in 11 periods in 90 children diagnosed with PDD and 198 controls using a multiple logistic regression model. We found lower HC values in the female PDD population. We found male Asperger disorder (AS) and male autistic disorder (AD) children to have higher HC values than the control male children. Differences between AD and AS were not significant. We found a higher GV in the first six months for all PDD groups compared to control children, although with statistical significance only for AD. We therefore emphasize the importance of HC in the evaluation of children suspected to have PDD, as it corresponds to an early sign and also a cheap, objective and reliable parameter.

Head circumference in ELBW babies is associated with learning difficulties and cognition but not ADHD in the school-aged child.

This study examines whether a small head circumference (HC) and low head-circumference growth velocity (HGV) during the first year of life predict consequences at school age in learning, cognition, and concentration. A total of 124 extremely-low-birthweight (ELBW) infants (birthweight 500 to 999 g) born between 1977 and 1986 were eligible for follow-up at the corrected ages of 4, 8, and 12 months and 2, 4, and 6 years. Infants were categorized as having a small HC (< 3% or 3 to 10%) on the basis of the 1990 British growth data which allowed standardized z-scores to be calculated for HC, independent of gestation and corrected age. HGV measurements were calculated using differences in the HC z-scores. In 1995, parents of 87 children agreed to participate in a study of learning and attention at school age. Attention-deficit-hyperactivity disorder (ADHD) was assessed using the Du Paul Rating Scale. Academic performances were based on a teacher questionnaire dealing with aspects of reading, writing, mathematics, and spelling. A child was considered to have a learning difficulty if academic problems were present in at least one of these four areas. Intellectual ability was assessed using the McCarthy Scale at 6 years. HC < 3% and 3 to 10% at 8 months' corrected age was strongly associated with school-aged learning problems (P=0.004), with a moderate specificity (70%), positive predictive value (PPV) (67%), and sensitivity (67%). HGV < or = 10% from birth to 4 months was also associated with learning problems at school age (P=0.01) with a higher specificity (98%) and PPV (88%) but lower sensitivity (20%). A logistic regression analysis was performed with the risk for learning difficulties at 8 months as the dependent variable. Sex, gestation, birthweight, multiple births, and a history of intraventricular hemorrhage did not substantially alter the unadjusted odds ratio (4.7; 95% CI 1.9 to 13.6). Maternal age and education did not confound the relation. No association was found between HC or HGV and ADHD. HC < 3% at 4 months (P<0.02), 8 months (P=0.02), and 12 months (P=0.04), and HGV between birth and 4 months (P<0.01) were significantly associated with low cognitive ability at 6 years.

Head circumference in ELBW babies is associated with learning difficulties and cognition but not ADHD in the school‐aged child

This study examines whether a small head circumference (HC) and low head‐circumference growth velocity (HGV) during the first year of life predict consequences at school age in learning, cognition, and concentration. A total of 124 extremely‐low‐birthweight (ELBW) infants (birthweight 500 to 999 g) born between 1977 and 1986 were eligible for follow‐up at the corrected ages of 4, 8, and 12 months and 2, 4, and 6 years. Infants were categorized as having a small HC (&lt;3% or 3 to 10%) on the basis of the 1990 British growth data which allowed standardized z ‐scores to be calculated for HC, independent of gestation and corrected age. HGV measurements were calculated using differences in the HC z ‐scores. In 1995, parents of 87 children agreed to participate in a study of learning and attention at school age. Attention‐deficit–hyperactivity disorder (ADHD) was assessed using the Du Paul Rating Scale. Academic performances were based on a teacher questionnaire dealing with aspects of reading, writing, mathematics, and spelling. A child was considered to have a learning difficulty if academic problems were present in at least one of these four areas. Intellectual ability was assessed using the McCarthy Scale at 6 years. HC &lt;3% and 3 to 10% at 8 months’corrected age was strongly associated with school‐aged learning problems (P=0.004), with a moderate specificity (70%), positive predictive value (PPV) (67%), and sensitivity (67%). HGV ?10% from birth to 4 months was also associated with learning problems at school age (P=0.01) with a higher specificity (98%) and PPV (88%) but lower sensitivity (20%). A logistic regression analysis was performed with the risk for

Growth Failure and Altered Body Composition Are Established by One Month of Age in Infants with Bronchopulmonary Dysplasia

Long-term growth failure and altered body composition are common consequences of bronchopulmonary dysplasia (BPD). We hypothesized that these chronic findings are preceded by uncompensated, acute early growth failure. The purpose of this study was to evaluate the effects of developing bronchopulmonary dysplasia on body composition and growth of very-low-birth-weight (VLBW) infants during the first six postnatal weeks. Arm muscle and fat accretion and changes in weight, length and head circumference were evaluated in 16 very-low-birth-weight infants who developed bronchopulmonary dysplasia and compared with 16 birth-weight-matched control infants without bronchopulmonary dysplasia. During the 1st wk, both groups experienced similarly low nutritional intakes, wasting of arm muscle and fat stores, and reduced weight, length and head circumference growth velocities, compared with intrauterine growth standards. Between wk 2 and 4, infants with developing bronchopulmonary dysplasia consumed less protein and energy (P < 0.05), accreted less arm fat and muscle (P < 0.05), and grew more slowly than control infants in all measured variables (P < 0.05). When infants with bronchopulmonary dysplasia had achieved full enteral feedings and had similar protein-energy intakes to control infants, they demonstrated similar rates of growth and arm muscle and fat accretion, but did not demonstrate catch-up growth. These data support the speculation that early reductions in muscle and fat accretion and growth velocity contribute to the long-term growth failure in infants with bronchopulmonary dysplasia. Prevention may require greater attention to defining and delivering optimal nutritional therapy to physiologically unstable premature infants in the immediate postnatal period.

GROWTH VELOCITY IN VERY LOW BIRTH WEIGHT INFANTS. ARE THE REFERENCE GROWTH CHARTS APPROPRIATE?

Growth of very low birth weight infants (VLBWI) is usually assesed by Standard Reference Curves (SRC). These chars are composed by prenatal growth curves up to term (cross sectional studies) followed by post natal longitudinal growth charts of fullterm healthy babies. Our purpose was to compare the growth velocity of SRC with the lenght, weight and head circumference growth velocity of a population of 35 VLBWI with low neonatal morbidity and adequate weight for gestational age, who were followed up for one year of corrected age. Birth weight of this population was (x̄ ± SD): 1290 ± 150, lenght: 38.3 ± 2.8, head circumference: 26.3 ± 1.3 and gestational age: 30 ± 1.3 weeks. The accelerated growth period of the three parameters showed a quadratic regression (parabola), with its acme retarded 4 weeks compared to SRC for weight and 5 weeks for head circumference and body lenght, its magnitude being significantly greater (p < 0.01) in the SRC (for weight and lenght) than in the VLBWI (350g ± 80 vs 270 ± 90 and 1.3 ± 0.2 vs 1.02 ± 0.1). Total accumulated growth at one year was similar in both curves.Increased growth velocity in VLBWI lasted until six months of corrected age and not up to full term only as in SRC. Our results suggest that for clinical assessement of rapid growth period in premature infants, SRC do not adequately reflect changes in growth velocity during this critical period.

Area of lateral ventricles measured on cranial ultrasonography in preterm infants: reference range.

Serial ultrasound imaging of the brain was carried out in 87 preterm infants of 27 to 36 weeks' gestational age while they were in the special care nursery and during their first postnatal year. None had evidence of intracranial disease during the neonatal period and 94% had good neurodevelopmental outcome at 2 years of age. Lateral ventricle area measurements were plotted against independent variables including postnatal age and head circumference at the time of the examination. The measurements increased as age and head circumference increased. During the first six weeks of life the mean (SD) postnatal head circumference growth velocity (rate of growth) was 0.53 (0.13) cm/week and the mean postnatal ventricular area growth velocity was 0.39 (0.19) mm2/week. A reference range for lateral ventricle area values was developed from these serial measurements in infants with documented good short term developmental outcome.

Velocity of head growth during the perinatal period.

Growth velocity of head circumference was studied longitudinally in different gestational age groups of 222 appropriate-weight-for-dates (AFD) and 94 small-for-dates (SFD) healthy infants during the first 5 months of life. Term AFD and SFD infants showed a steady slowing of growth rate of head circumference from birth. In contrast, preterm AFD infants of less than 36 weeks' gestation showed an increasing velocity of growth followed by slowing, with maximum velocity occurring between 30 and 40 days after birth. The shorter the postconceptional age at birth the later maximum velocity occurred. However, those preterm AFD infants of between 30 and 33 weeks' gestation who were given a high caloric feed showed a similar velocity curve to that of infants of 34-37 weeks of gestation. Cross-sectional data were used to estimate growth velocity of head circumference in the fetus. Two conclusions emerged. First, there is a slowing of head growth velocity from 31 weeks' gestation in utero, and second, term infants show a marked increase in volocity after birth. Though the occurrence of maximum velocity of head growth is delayed in the preterm infant, the net effect is such that at a given postconceptional age his head circumference is greater than that of the term infant, at least within the first 5 postnatal months.