History Of Intrauterine Growth Restriction Research Articles

Assessment of Infantile Psychomotor Development Status in 6 and 12-Month-Old IUGR Infants: A Historical Cohort Study

Intrauterine growth restriction (IUGR) is responsible for different post-natal adverse outcomes. This study aimed to evaluate the post-natal psychomotor development status in 6 and 12-month-old IUGR infants who received early preventive interventions. A historical cohort study was done at an Iranian Hospital (2019). The case group included one-year-old infants with a history of IUGR at birth. This group was visited every 2 months to evaluate their growth and neurodevelopmental status. Their parents had also received some training to improve their infant's sensory and motor skills. The control group comprised one-year-old healthy infants with a history of appropriate for gestational age (AGA) at birth. Data related to psychomotor developmental indices based on the ASQ questionnaire at 6 and 12-month for both groups was extracted from subjects' records. Infants' psychomotor development status was compared between groups. Forty-one infants with a history of IUGR and 43 healthy control infants were included in this study. There were significant differences between 2 groups associated with abnormalities in all evaluated psychomotor skills, including gross motor (P=0.014), problem-solving ability (P=0.049), communication (P=0.031), fine motor (P=0.016) and personal-social (P=0.016) at 6 months. After one year of family-based interventions for the case group, significant differences between groups were notable in only fine motor (P=0.016) and personal-social skills (P=0.031). At 12 months, the psychomotor disorders related to gross motor, problem-solving ability, and communication were significantly alleviated in the IUGR group. Early preventive family-based interventions can improve the neurodevelopmental outcomes in 12-month-old IUGR infants.

Machine Learning-Based Approach to Predict Intrauterine Growth Restriction.

Creating a prediction model incorporating multiple risk factors for intrauterine growth restriction is vital. The current study employed a machine learning model to predict intrauterine growth restriction. This cross-sectional study was carried out in a tertiary hospital in Bandar Abbas, Iran, from January 2020 to January 2022. Women with singleton pregnancies above the gestational age of 24 weeks who gave birth during the study period were included. Exclusion criteria included multiple pregnancies and fetal anomalies. Four statistical learning algorithms were used to build a predictive model: (1) Decision Tree Classification, (2) Random Forest Classification, (3) Deep Learning, and (4) the Gradient Boost Algorithm. The candidatepredictors of intrauterine growth restriction for all models were chosen based on expert opinion and prior observational cohorts. To investigate the performance of each algorithm, some parameters, including the area under the receiver operating characteristic curve (AUROC), accuracy, precision, and sensitivity, were assessed. Of 8683 women who gave birth during the study period, 712 were recorded as having intrauterine growth restriction, with a frequency of 8.19%. Comparing the performance parameters of different machine learning algorithms showed that among all four machine learning models, Deep Learning had the greatest performance to predict intrauterine growth restriction with an AUROC of 0.91 (95% confidence interval, 0.85-0.97). The importance of the variables revealed that drug addiction, previous history of intrauterine growth restriction, chronic hypertension, preeclampsia, maternal anemia, and COVID-19 were weighted factors in predicting intrauterine growth restriction. A machine learning model can be used to predict intrauterine growth restriction. The Deep Learning model is an accurate algorithm for predicting intrauterine growth restriction.

Biopsychosocial characteristics of children admitted with failure to thrive.

The aim of this study was to characterise and compare the biopsychosocial characteristics of children admitted with failure to thrive (FTT), subdivided into those with underlying medical complexities (categorised as organic FTT - OFTT) and those with none (categorised as non-organic FTT - NOFTT), with a focus on the medical, nutritional, feeding skills and psychosocial domains. A retrospective review of medical records was conducted in children admitted with FTT from January 2010 to December 2020. Descriptive statistics were used for data analysis. A total of 353 children were included, with the mean age of presentation 0.82 ± 2.05 years (OFTT 1.16 ± 2.50 years, NOFTT 0.49 ± 1.41 years, P = 0.002). Approximately, half of the children were classified as having OFTT. These children had lower birth weights, were more likely to have a history of intrauterine growth restriction and had longer hospital stays. The NOFTT group had significantly more abnormal feeding strategies identified in their caregivers, whereas the OFTT group had more delayed feeding skills and oral aversion. There was no significant difference in psychosocial domains, with both groups having a comparably high risk of abuse and neglect. The classification of FTT as non-organic or organic based purely on psychosocial parameters did not reflect the complex nature of FTT within our local population. These groups had different medical variables, and caregiver feeding strategies. A multidisciplinary team approach is recommended for the assessment and intervention for children with FTT to address these domains and the complex interactions between them.

From Wolf-Hirschhorn syndrome to NSD2 haploinsufficiency: a shifting paradigm through the description of a new case and a review of the literature

BackgroundWolf-Hirschhorn syndrome (WHS) is a well-defined disorder, whose core phenotype encompasses growth restriction, facial gestalt, intellectual disability and seizures. Nevertheless, great phenotypic variability exists due to the variable extent of the responsible 4p deletion. In addition, exome sequencing analyses, recently identified two genes, namely NSD2 and NELFA, whose loss-of-function variants contribute to a clinical spectrum consistent with atypical or partial WHS.The observation of patients exhibiting clinical features resembling WHS, with only mild developmental delay and without the typical dysmorphic features, carrying microdeletions sparing NSD2, has lead to the hypothesis that NSD2 is responsible for the intellectual disability and the facial gestalt of WHS. While presenting some of the typical findings of WHS (intellectual disability, facial gestalt, microcephaly, growth restriction and congenital heart defects), NSD2-deleted children tend to display a milder spectrum of skeletal abnormalities, usually consisting of clinodactyly, and do not exhibit seizures.We describe the clinical picture of a child with WHS due to a de novo mutation of NSD2 and discuss the clinical and diagnostic implications.Case presentationA 6-year-old boy was evaluated for a history of intrauterine growth restriction, low birth weight, neonatal hypotonia, and psychomotor delay. No episodes of seizure were reported. At physical examination, he displayed marphanoid habitus, muscle hypotrophy and facial dysmorphisms consisting in high frontal hairline, upslanting palpebral fissures and full lips with bifid ugula. Cryptorchidism, shawl scrotum, mild clinodactyly of the right little finger and bilateral syndactyly of the II and III toes with sandal gap were also noted. The radiographic essay demonstrated delayed bone age and echocardiography showed mild mitral prolapse. Whole genome sequencing analysis revealed a heterozygous de novo variant of NSD2 (c.2523delG).ConclusionsFull WHS phenotype likely arises from the cumulative effect of the combined haploinsufficiency of several causative genes mapping within the 4p16.3 region, as a contiguous genes syndrome, with slightly different phenotypes depending on the specific genes involved in the deletion.When evaluating children with pictures resembling WHS, in absence of seizures, clinicians should consider this differential diagnosis.

215 Impact of Maternal Diabetes on Neonatal Body Composition, Energy Homeostasis and Hypothalamic Salivary Gene Expression

OBJECTIVES/GOALS: Infants of diabetic mothers (IDMs) may exhibit decreased oral intake, requiring nasogastric feedings and prolonged hospitalization. We hypothesize that increased insulin exposure and resulting overgrowth in utero disrupts hypothalamic regulation of food intake, correlates to body composition and impacts feeding in IDMs. METHODS/STUDY POPULATION: Infants born at ≥ 35 weeks gestation to mothers with gestational or type II diabetes (IDM cohort), and normoglycemic mothers (control cohort) were recruited. Infants born to mothers with Type I DM or preeclampsia and with a history of intrauterine growth restriction, opioid exposure, or major congenital anomalies were excluded. Salivary expression of known hunger signaling genes 5AMP-activated protein kinase (AMPK), Neuropeptide Y receptor Y2 (NPY2R), leptin (LEP), ghrelin (GHRL), proopiomelanocortin (POMC), and adiponectin (ADIPOQ) were quantified using RT-qPCR. Body composition was assessed via skinfold measurements and compared and correlated between cohorts. Feeding outcomes were recorded. RESULTS/ANTICIPATED RESULTS: 23 infants were recruited in each cohort. POMC and AMPK were expressed by 71% and 88% of infants respectively in both cohorts. NPY2R was expressed by 79% and 83% of the diabetic cohort and normoglycemia cohort respectively, while GHRL was expressed by 75% and 79% of the diabetic cohort and normoglycemia cohort, respectively. LEP and ADIPOQ were not reliably expressed in either cohort. Infants with a higher body fat percentage were less likely to express NPY2R (OR= 0.76). There was no significant association between body fat percentage and expression of AMPK, POMC, or GHRL. Only 3 IDMs were noted by providers to exhibit poor oral intake, limiting our ability to correlate gene expression and body composition with feeding outcomes. DISCUSSION/SIGNIFICANCE: Non-invasive assessment of hunger signaling gene expression is possible through salivary analysis of AMPK, POMC, NPY2R, and GHRL. Given the paucity of IDMs with poor feeding in our study, future studies should target IDMs requiring feeding support to understand mechanisms driving aberrant feeding behavior.

EP188: Novel HECW2 variant presenting with tachypnea and multisystemic congenital malformations

HECW2, otherwise known as NEDL2, encodes for a member of the HECT family of E3 ubiquitin ligases and stabilizes p73, a key mediator in neurodevelopment. HECW2 is primarily expressed in the brain, heart, and lungs. Heterozygous variants have been associated with developmental delays, intellectual disability, epilepsy, hypotonia, scoliosis and dysmorphic features. Systemic complications which have been reported include cardiomyopathy, skeletal abnormalities including pectus excavatum, and various brain abnormalities including white matter disease, cortical atrophy, ex-vacuo ventriculomegaly, and thinning of the corpus callosum. While many reported cases of HECW2-related disorder have been from de novo variants, there have been reports of familial inheritance with variable expressivity. To date, there have been no reported cases of HECW2-related disorder presenting with persistent tachypnea. A newborn male with a history of intrauterine growth restriction born at 39 2/7 weeks gestation to a 31 year old G4P0212 mother and a 35 year old father presented in the perinatal period with unexplained persistent tachypnea, difficulty feeding, persistent diaphoresis and failure to thrive. Pectus excavatum was noted at birth and initial evaluation for the persistent tachypnea showed multiple vertebral anomalies, congenital scoliosis and mild cardiomegaly on chest X-ray. Renal ultrasound demonstrated left central calyceal dilation. Echocardiogram and CT heart with contrast demonstrated multiple abnormalities including anomalous pulmonary venous return with right upper pulmonary vein draining into the superior vena cava (SVC), secundum atrial septal defect (ASD), dilated main pulmonary artery, right atrium and ventricle, mild right and left ventricular hypertrophy, mild tricuspid regurgitation and mild to moderate pulmonary regurgitation. CT imaging also demonstrated severe tracheobronchomalacia associated with left mainstem bronchus compression resulting in air trapping within the left lung. Cardiac catheterization was attempted for possible closure of the patient’s secundum ASD, but was unsuccessful due to inability to capture retroaortic rim. Diagnostic evaluation during catheterization demonstrated mild pulmonary hypertension, normal pulmonary vascular resistance (PVR) and a Qp:Qs of 1.9:1 consistent with pulmonary overcirculation. Tachypnea and significantly increased work of breathing persisted despite initiation of furosemide diuresis to manage pulmonary overcirculation. The patient ultimately required BiPap for respiratory support, though tachypnea persisted. A G-tube was placed to ensure safe formula administration. Additional physical exam findings included hypotonia, macrocephaly, infraorbital creases with almond-shaped eyes, ocular hypertelorism, broad nasal bridge and tip, mild retrognathia, arachnodactyly with larger hands and feet compared to growth centiles and Y-shaped gluteal fold. Family history was remarkable for White ancestry. A maternal half-sister was healthy. A 2 year old brother had speech delay. The patient’s father had a history of mild congenital scoliosis, heart murmur and intellectual disability. The patient’s mother had a history of anemia, heart murmur and learning delays. There was no history of genetic conditions, recurrent pregnancy loss, or infant death. Chromosomal microarray analysis (CMA) demonstrated no clinically significant findings (ISCN: arr[hg19](1-22x2,(X,Y)x1). Trio exome sequencing with mitochondrial analysis, performed from a peripheral blood sample, demonstrated a paternally inherited likely pathogenic variant in HECW2 (NM_020760.1:c.2581 C>T) in exon 11. While this variant has not been previously published as benign or pathogenic, in silico analysis demonstrated a potential deleterious effect of the arginine to tryptophan substitution on structure and/or function. Mitochondrial analysis was negative/normal. We present the first documented case of HECW2-related disorder presenting with perinatal tachypnea. The patient’s hypotonia, feeding difficulties, dysmorphic features, pectus excavatum, vertebral malformations, scoliosis, and cardiac involvement correlate with previously described manifestations of HECW2-related disorder.

53746 Body Composition and Metabolic Profiles in Infants of Diabetic Mothers (IDM) as Predictors of Hunger Signaling Gene Expression

ABSTRACT IMPACT: This study aims to advance the understanding of the biological mechanisms associated with feeding disturbances in infants born to diabetic mothers through non-invasive salivary gene expression analyses and body composition measurements at birth. OBJECTIVES/GOALS: To determine if non-invasive salivary gene expression analyses and body composition measurements at birth could elucidate biological mechanisms associated with aberrant feeding behaviors and disrupted metabolic profiles commonly seen in infants born to diabetic mothers. METHODS/STUDY POPULATION: This prospective cohort study enrolls subjects born at ≥35 weeks’ gestation without a history of intrauterine growth restriction or major congenital anomalies. The diabetic cohort is defined as infants born to mothers with gestational diabetes or type 2 diabetes. The primary outcome is salivary expression of the hunger signaling genes, AMPK and NPY2R. Secondary outcomes include infant body composition measurements, obtained by skinfold measurement and/or air displacement plethysmography, and salivary expression of the adipokines, leptin, ghrelin, and adiponectin. Multiple logistic regression will be used to determine which factors are associated with AMPK and NPY2R expression. RESULTS/ANTICIPATED RESULTS: We propose that poor oral intake seen in infants of diabetic mothers may be due to alterations in the expression of hunger signaling genes (decreased expression of AMPK; increased expression of NPY2R) resulting in a diminished feeding drive in these large for gestational age infants. In addition, infant adiposity and the expression of genes involved in the adipoinsular axis will be inversely proportional to feeding volume intake. Namely, increased neonatal fat mass will be associated with increased expression of leptin and decreased expression of ghrelin and adiponectin. DISCUSSION/SIGNIFICANCE OF FINDINGS: Infants of diabetic mothers are at higher risk of poor oral feeding in the newborn period. This study aims to elucidate the link between neonatal body composition, adipoinsular axis, and hunger signaling to explain this unique feeding phenotype.

A novel PIK3R1 mutation of SHORT syndrome in a Chinese female with diffuse thyroid disease: a case report and review of literature

BackgroundSHORT syndrome is a rare genetic disease named with the acronyms of short stature, hyper-extensibility of joints, ocular depression, Rieger anomaly and teething delay. It is inherited in an autosomal dominant manner confirmed by the identification of heterozygous mutations in PIK3R1. This study hereby presents a 15-year-old female with intrauterine growth restriction, short stature, teething delay, characteristic facial gestalts who was identified a novel de novo nonsense mutation in PIK3R1.Case presentationThe proband was admitted to our department due to irregular menstrual cycle and hirsutism with short stature, who had a history of intrauterine growth restriction and presented with short stature, teething delay, characteristic facial gestalts, hirsutism, and thyroid disease. Whole-exome sequencing and Sanger sequencing revealed c.1960C > T, a novel de novo nonsense mutation, leading to the termination of protein translation (p. Gln654*).ConclusionsThis is the first case report of SHORT syndrome complicated with thyroid disease in China, identifying a novel de novo heterozygous nonsense mutation in PIK3R1 gene (p. Gln654*). The phenotypes are mildly different from other cases previously described in the literature, in which our patient presents with lipoatrophy, facial feature, and first reported thyroid disease. Thyroid disease may be a new clinical symptom of patients with SHORT syndrome.

SUN-LB16 Clitoromegaly in Premature Infants: Is It Truly Pathologic?

Background: Normative data for clitoral size in premature infants are limited. Consequently, the potential for over-diagnosis is high; leading to unnecessary investigations, increased healthcare costs and parental stress. Several proposed mechanisms, e.g., persistence of fetal adrenal zone activity to term gestation, point to the transient physiologic nature of clitoromegaly in premature infants. Studies of normative data have shown a negative correlation between birth weight and clitoral size. We hypothesized that 1) the majority of clitoromegaly in premature infants is not associated with hormonal dysfunction and 2) lower birth weight and lower gestational age increase the likelihood of a formal consult in premature infants with perceived clitoromegaly. Methods: A retrospective chart review of female infants born at our institution from January 2012 to December 2018 with perceived clitoromegaly was conducted. Birth history, demographic and laboratory data were collected. Patients were divided into two groups: ‘formal consult’ and ‘no formal consult’ for clitoromegaly. True clitoromegaly was defined as clitoral length >9 mm or clitoral width >6 mm. Patients not meeting these criteria or those with clitoral edema, prominent clitoral hood were classified under false clitoromegaly. In the ‘no formal consult’ group, the documented discharge examination was used to assess persistence of clitoromegaly. Uni- and multi-variable logistic regression were used to determine factors that increased the likelihood of a formal consult. Results: 29 patients met inclusion criteria; 15 in the ‘formal consult’ group and 14 in the ‘no formal consult’ group. No significant differences were found between the groups in terms of birth weight, gestational age, race, ethnicity and maternal factors. History of IUGR (intrauterine growth restriction) was more common in the ‘formal consult’ group (60%) vs. ‘no formal consult’ group (21%) (p=0.04). Only 3/15 patients in the ‘formal consult’ group had true clitoromegaly; all 3 had normal 17-hydroxyprogesterone levels, and only 1 patient had transient elevation in androgen levels (androstenedione, deoxycortisol and testosterone). Of the ‘no formal consult’ group, only 3/14 patients had clitoromegaly noted on discharge; outcome was unknown for 1. Multi-variable logistic regression showed that lower gestational age (p=0.04) and history of IUGR (p=0.03), even after adjusting for birth weight, increased the likelihood of a formal consult. Conclusion: In summary, the majority of perceived clitoromegaly in premature infants is not associated with hormonal dysfunction. Lower gestational age and a history of IUGR increase the likelihood of a formal consult for clitoromegaly in these patients. Approximately half of the patients were noted to have false clitoromegaly indicating inconsistencies in examination technique and need for provider education.

Genetic risk assessment of thrombophilia in patients with adverse obstetric outcomes.

ObjectivesTo investigate the incidence of inherited thrombophilias in patients with adverse obstetric outcomes and to compare detection rates of thrombophilias between standard blood tests and a novel genetic test.MethodsThis is a case-control prospective study performed in Hospital Sant Joan de Déu in Barcelona, Spain. Cases had a history of intrauterine growth restriction requiring delivery before 34 weeks gestation, placental abruption before 34 weeks gestation, or severe preeclampsia. Controls had at least two normal, spontaneously conceived pregnancies at term, without complications or no underlying medical disease. At least 3 months after delivery, all case and control women underwent blood collection for standard blood tests for thrombophilias and saliva collection for the genetic test, which enables the diagnosis of 12 hereditary thrombophilias by analyzing genetic variants affecting different points of the blood coagulation cascade.ResultsThe study included 33 cases and 41 controls. There were no statistically significant differences between cases and controls in the standard blood tests for thrombophilias in plasma or the TiC test for genetic variables. One clinical-genetic model was generated using variables with the lowest P values: ABO, body mass index, C_rs5985, C_rs6025, and protein S. This model exhibited good prediction capacity, with an area under the curve of almost 0.7 (P <0.05), sensitivity of almost 67%, and specificity of 70%.ConclusionAlthough some association may exist between hypercoagulability and pregnancy outcomes, no significant direct correlation was observed between adverse obstetric outcomes and inherited thrombophilias when analyzed using either standard blood tests or the genetic test. Future studies with a larger sample size are required to create a clinical-genetic model that better discriminates women with a history of adverse pregnancy outcomes and an increased risk of poor outcomes in subsequent pregnancies.

Developmental Outcomes of Children Exposed to Maternal Sickle Cell Disease (SCD)

▪ BACKGROUNDPregnant women with SCD have an increased risk of both maternal and fetal complications, including preeclampsia, venous thromboembolism, and cardiomyopathy, as well as an increased risk of intrauterine growth restriction, preterm birth, low birth weight, and fetal demise. While in general children with a history of intrauterine growth restriction are at risk for abnormal neurodevelopment as well as later obesity and metabolic syndrome, the long-term developmental outcomes of children without SCD but exposed to maternal SCD are unknown. Better data about the long-term developmental outcome for children of mothers with SCD will provide guidance about the utility of disease modifying therapy during pregnancy. The objective of this study is to explore outcomes for children born to mothers with SCD using data from the Boston Birth Cohort (BBC). METHODSThe BBC is a prospective birth cohort established in 1998 at the Boston Medical Center (BMC) that recruits preterm cases (born at less than 37 weeks gestation) and full term controls. The BBC enrolls predominantly urban, low-income minority mothers and their children 24-72 hours after delivery at the BMC and follows the children from birth up to age 21 years. Data is collected on maternal preconception medical conditions, pregnancy complications, and pregnancy exposures through structured interviews at the time of enrollment and medical record extraction. Data on child development is collected from medical records and structured interviews performed by trained study staff at their scheduled pediatric appointments. Approximately 38% of study participants self-identify as black/African American, 22% as Hispanic, 19% as Haitian, and 8.5% as white. From maternal electronic medical record data capturing 147,827 emergency room and outpatient visits contributed by 5,972 subjects, we identified all women with ICD-9-CM codes for sickle cell disease (282.60-64, 282.68, 282.69, 282.41, 282.42) and probable (two or more 282.62 codes) sickle cell anemia. We then linked maternal and child data on the basis of a unique family-level study ID. Information on child development was obtained from electronic medical record data, based on the presence of relevant ICD-9-CM hospital diagnosis codes from pediatric outpatient, inpatient, and emergency room visits. RESULTSWe identified 93 women who had at least one of the ICD-9 codes for SCD. For this report we have included only those forty-one women who were coded at least twice with a 282.62 diagnosis (Hemoglobin SS disease with crisis). Six (15%) had poor fetal growth during their pregnancy, while eight (20%) were diagnosed with preeclampsia or antepartum hypertension. Among these mothers with available questionnaire and medical record extraction data (n = 38), 7 (18%) delivered their children before 37 weeks gestation, and 6 (16%) had children weighing less than 2500 grams at birth. Twenty mothers had children who received pediatric care at the Boston Medical Center, with ages ranging from 2 to 9 years of age; one was diagnosed with SCA, while 19 are unaffected carriers. Among the 19 children without SCD with available follow-up data, 5 (26%) carried a diagnosis code of overweight/obesity; their mothers were seen for an average of 73 medical visits (SD 50) during their pregnancy. Five children, without any overlap with the children diagnosed with obesity, were diagnosed with failure to thrive; while not statistically significantly different, their mothers had fewer medical encounters (mean 55, SD 37). Five children were diagnosed with delayed milestones, two of whom were late preterm (35 and 33 weeks gestation); two of these children were diagnosed with obesity and two with failure to thrive. DISCUSSIONThis exploratory, descriptive study represents the first data on long-term outcomes of children without SCD who were exposed to maternal SCD in utero . While we are limited by small sample size, finding that 26% of children born to mothers with SCD have developmental delay is a significant concern. This compares to the overall cohort where 12% of control children and 39% of preterm cases have been found to have developmental delay. Future studies will include medical record review of mothers to identify additional mothers with confirmed SCD in the cohort and exploration of additional predictors of these concerning outcomes. [Display omitted] DisclosuresLanzkron:Prolong: Research Funding; HRSA: Research Funding; Bayer: Research Funding; Global Blood Therapeutics: Research Funding; Pfizer: Research Funding; PCORI: Research Funding.

Perinatal Outcome and Histopathological Evaluation of Placentas in Intrauterine Growth Restriction (IUGR) Pregnancies

Introduction: Intrauterine growth restriction (IUGR) is a condition in which fetus fails to achieve its inherent growth potential. It is the second most common cause of perinatal mortality and morbidity following prematurity. Objectives: Objectives of this study were to see the perinatal outcome and histopathological changes in placenta in IUGR pregnancies. Material & Methods: 100 cases of IUGR were taken up for study along with 50 controls. Ultrasonography was done to evaluate the uteroplacental insufficiency. Placental weight and morphology and histopathology of placenta was done. Results: Prevalence of IUGR was more in younger age group 49%, primigravida 58%, low socio economic status 96% and rural background 77%. History of IUGR in previous pregnancy was 30%. Abnormal color Doppler was found in 47%. Placental weight was less in IUGR and histopathology of placenta showed fibrinoid necrosis in 48% and syncytial knots 44%. Neonatal mortality in the study came out to be 12%. Conclusion: Regular antenatal care is necessary to pick up IUGR pregnancies and once diagnosed ultrasonography for fetal growth and color Doppler help to decide the optimal time for delivery.

Cardiovascular adaptation to extrauterine life after intrauterine growth restriction

A comprehensive echocardiographic study was performed in 25 neonates with intrauterine growth restriction and 25 adequate-for-gestational-age neonates. Compared with controls, neonates with intrauterine growth restriction had more globular ventricles, lower longitudinal tricuspid annular motion, and higher left stroke volume without differences in the heart rate. Neonates with intrauterine growth restriction also showed subclinical signs of diastolic dysfunction in the tissue Doppler imaging with lower values of early (e') diastolic annular peak velocities in the septal annulus. Finally, the Tei index in the tricuspid annulus was higher in the intrauterine growth restriction group. Neonates with history of intrauterine growth restriction showed cardiac remodelling and signs of systolic and diastolic dysfunction. Overall, there was a significant tendency to worse cardiac function results in the right heart. The adaptation to extrauterine life occurred with more globular hearts, higher stroke volumes but a similar heart rate compared to adequate-for-gestational-age neonates.

Examination of renal function in infants with a history of intrauterine growth restriction up to 36 weeks gestation compared to infants with normal growth

Background: Intrauterine growth restriction (IUGR) will increase the risk of impairment of renal function in the future. Objective: To assess renal function in infants with a history of IUGR up to 36 weeks gestation compared to infants with normal growth. Method: Laboratory examination of urine microalbumin, urine creatinine and a cystatin C blood test were done on day 7 after birth in infants with a history of IUGR and in infants with normal growth up to 36 weeks gestation and compared. Results: On day 7 after birth, mean urine microalbumin levels of IUGR and normal weight infants were 15.83 ± 31.32 mg/ml and 1.9 ± 0.97 mg/ml respectively (p 0.05). Conclusions: Mean urine albumin level, mean urine creatinine level and mean urine albumin/creatinine ratio of IUGR infants were significantly higher than those of normal weight infants. There was no significant difference between the mean cystatin C levels of IUGR infants and normal weight infants. (Keywords: Renal function of infants with IUGR, microalbumin, creatinine, cystatin C) Sri Lanka Journal of Child Health , 2017; 46 (2): 152-154

Birth Weight for Gestational Age Centile Charts for Low-risk Population of Islamabad Capital Territory: A Hospital-based Study and Cross-country Comparison

ABSTRACTObjectiveTo establish birth weight percentile charts for gestational age based on prospectively collected data for Islamabad Capital Territory (ICT) urban/rural low-risk population presenting at Mother and Child Health (MCH) Center, Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan, and crosscountry comparison.Place and duration of studyThe study was conducted for a period of 6 months (January 2014—June 2014) at MCH Center Unit II, Shaheed Zulfiqar Ali Bhutto Medical University, Pakistan Institute of Medical Sciences (SZABMU-PIMS), Islamabad, Pakistan.Study designComparative cross-sectional study.Materials and methodsData of low-risk women from ICT urban/rural population presenting at MCH Center, PIMS were prospectively maintained, entered in Excel sheet, and later analyzed using Statistical Package for the Social Sciences version 21. The confounding factors that affect the fetal growth including gestational diabetes, hypertension, history of intrauterine growth restriction, and medical disorders were excluded. The 5th, 10th, 50th, 90th, and 95th centile birth weight charts were calculated for gestational age between 32 and 41 weeks and were compared with those of other countries. The gestational age was calculated by clinical obstetrician or estimates by early ultrasound if available.ResultsA total of 1,744 singleton live births were analyzed. The birth weights at 5th, 10th, 50th, 90th, and 95th centile were calculated at 32 to 41 weeks of gestation. Cross-country comparison of birth weight at 50th centile of ICT population is comparable with other countries till 37 weeks and lower after 37 weeks, except Indian population. The birth weight at 90th centile at all gestations (32—41 weeks) was comparable with other populations. However, the birth weight at 10th centile for ICT population is far below than the other countries except Indian population.ConclusionThe updated birth weight for gestational age centile charts may be utilized as reference charts for ICT population and may be extrapolated to Pakistani population until the availability of national database.How to cite this articleTasnim N, Hanif A, Aziz H. Birth Weight for Gestational Age Centile Charts for Low-risk Population of Islamabad Capital Territory: A Hospital-based Study and Cross-country Comparison. J South Asian Feder Obst Gynae 2017;9(2):169-172.

Prevalencia de restricción del crecimiento intrauterino en el Hospital Universitario San José, Popayán (Colombia), 2013

&lt;p&gt;&lt;strong&gt;Objetivo:&lt;/strong&gt; determinar la prevalencia de restricción del crecimiento intrauterino (RCIU) en el Hospital Universitario San José (HUSJ), describir sus características y hacer una exploración de los factores de riesgo asociados a RCIU.&lt;br /&gt;&lt;strong&gt;Materiales y métodos:&lt;/strong&gt; estudio de corte transversal en el que se incluyeron los recién nacidos vivos en un hospital universitario de referencia, ubicado en la región suroccidental de Colombia en el año 2013; se excluyeron aquellos con información inconsistente. Se definió recién nacido con restricción del crecimiento intrauterino (RCIU) como el neonato vivo con índice ponderal (Rohrer) menor al percentil 10, IP = [peso (en gramos) x 100] ÷ [longitud (en cm)]3. Para el tamaño de muestra se tuvo en cuenta una prevalencia esperada de RCIU del 4 %, un error tolerado del 2 %, corrección por población finita y por no respuesta del 20 %, obteniendo así un tamaño muestral de 400 sujetos. Se realizó un muestreo aleatorio sistemático. Se utilizó un cuestionario semiestructurado, que incluyó variables biológicas, sociales y demográficas. Se estimó la prevalencia de periodo de RCIU y se realizó exploración de los factores asociados a RCIU por medio de análisis bi y mutivariado. Se utilizó la prueba t de Student para variables continuas y chi cuadrado para categóricas.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados&lt;/strong&gt;: el análisis se realizó con 392 neonatos; se excluyeron 8, por inconsistencia en la información suministrada; se encontraron 79 neonatos con RCIU para una prevalencia del 20,15 %. En la exploración de los factores de riesgo se encontró una asociación positiva con RCIU y ganancia inadecuada de peso (OR = 2,35; IC 95 %: 1,15-4,82), antecedente de RCIU (OR = 3,26; IC 95 %: 1,08-9,78), amenaza de parto pretérmino (OR = 3,58; IC 95 %: 1,15-11,1), antecedente de cesárea (OR = 2,64; IC 95 %: 1,24-5,60), y una asociación negativa entre etnia mestiza y raza blanca (OR = 0,25; IC 95 %: 0,07-0,91).&lt;br /&gt;&lt;strong&gt;Conclusión:&lt;/strong&gt; la prevalencia encontrada fue del 20,15 %, la cual es mayor que la reportada en otras instituciones de este mismo nivel de complejidad.&lt;/p&gt;

Instability of Glucose Values in Very Preterm Babies at Term Postmenstrual Age

To determine if very preterm (VPT) babies are capable of maintaining glucose levels within normal ranges at or near term postmenstrual age. Glucose levels were intermittently or continuously monitored during 48 hours in a cohort of 60 VPT infants near hospital discharge. Hypoglycemic (≤45 mg/dL, 2.5 mmol/L) and hyperglycemic (≥140 mg/dL or 7.8 mmol/L, severe if ≥180 mg/dL or 10 mmol/L) episodes were considered relevant if they lasted longer than 30 minutes. Feeding regimes followed current practice. With intermittent capillary, 2 hypoglycemic values and another 3 that were abnormally high were detected. With continuous monitoring, 6 babies (10.0%) had isolated hypoglycemia ≤45 mg/dL (2.5 mmol/L) (3 of them reaching 40 mg/dL, 2.2 mmol/L), 14 (23.3%) had isolated hyperglycemia, and 8 (13.3%) had episodes of both. The mean duration of hypoglycemia per patient was 2.8 ± 2.9 hours and 4.68 ± 4.35 hours in the case of hyperglycemia, with 12 infants becoming severely hyperglycemic. Of the 12 severely hyperglycemic patients, 5 also developed severe hypoglycemia. No specific characteristics identified the hypoglycemic babies. A history of intrauterine growth restriction (P = .037) and female sex (P = .063) seemed to increase the risk of severe hyperglycemia. VPT infants continue to have abnormal glucose values, especially hyperglycemia, by the time of hospital discharge. No specific factors identify babies at higher risk for hypoglycemia, and intrauterine growth restriction and female sex seemed to predispose to hyperglycemia.

Better quality of mother–child interaction at 4 years of age decreases emotional overeating in IUGR girls

Background/Objectives: While most “fetal programming” area focused on metabolic disease, intrauterine growth restriction (IUGR) is also associated with a preference for less healthy food. Post-natal factors such as strained maternal–child interactions are equally related to obesogenic eating behaviors. We investigated if IUGR and the quality of the mother/child relationship affect emotional overeating in children. Subjects/Methods: Participants were 196 children from a prospective birth cohort (the MAVAN project). As part of the protocol at 4 years of age, mothers completed the Children Eating Behavior Questionnaire (CEBQ) and mother–child interactions were scored during a structured task. A GLM adjusted for BMI examined the interaction between the “Atmosphere” score (ATM) task, sex and IUGR on the emotional over-eating domain of the CEBQ. Results: There was a significant interaction of BWR vs. sex vs. ATM (P = .02), with no effects of IUGR, sex or ATM. The model was significant for girls with low ATM scores (B = −2.035, P = .014), but not for girls with high (P = 0.94) or boys with high (P = .27) or low (P = .19) ATM scores. Only in IUGR girls, 48 months emotional over-eating correlated with BMI at that age (r = 0.560, P = 0.013) and predicted BMI in the subsequent years (r = 0.654, P = 0.006 at 60 months and r = 0.750, P = 0.005 at 72 months). Conclusions: IUGR and exposure to a negative emotional atmosphere during maternal–child interactions predicted emotional overeating in girls but not in boys. The quality of mother–infant interaction may be an important target for interventions to prevent emotional overeating and overweight in early development, particularly in girls with a history of IUGR.

Predicting Surgical Intervention for Airway Obstruction in Micrognathic Infants

To determine which factors present in the neonatal period may predict subsequent need for surgical intervention in infants with micrognathia. Case series with chart review. Two, urban, tertiary pediatric hospitals. The otolaryngology databases from 2 institutions were queried for the diagnosis of micrognathia over a 10-year period, and 123 infants were identified (101 with Pierre Robin sequence and 21 with micrognathia without cleft palate). The presence or absence of surgical airway intervention during the first year of life was noted, as were associated diagnoses. Univariate and multivariate analyses were performed to identify risk factors for requiring a definitive airway intervention. Forty-eight (39%) micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of either tracheostomy (12 patients), mandibular distraction osteogenesis (MDO; 33 patients) or prolonged intubation prior to death (3 patients). Factors associated with a need for intervention included a history of intubation or tracheotomy in the first 24 hours of life (odds ratio [OR], 8.22; confidence interval [CI], 3.14-21.53), a history of intrauterine growth restriction (OR, 4.10; CI, 1.00-16.70), prematurity (<37 weeks of gestational age; OR, 2.38; CI, 1.02-5.56), and neurologic impairment (OR, 3.83; CI, 1.33-11.07). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR, 0.20; CI, 0.05-0.71). While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors that may predict which neonates with micrognathia are at increased risk for meriting early surgical intervention for respiratory and feeding problems.

Predicting Surgical Intervention in Micrognathic Infants

Objective: To determine which factors in the early neonatal period may predict subsequent need for surgical intervention in infants with micrognathia. Method: A retrospective case series of 123 infants from 2 tertiary pediatric referral centers over a 10-year period. Results: Forty-eight (39%) of micrognathic children required definitive airway intervention during infancy in this series. These interventions came in the form of tracheostomy (n = 12), mandibular distraction osteogenesis (MDO) (n = 33), or prolonged intubation prior to withdrawal of care (n = 3). Factors associated with a need for definitive airway intervention included a history of intubation or tracheotomy in the first 24 hours of life (OR: 8.22; CI: 3.14-21.54), a history of intrauterine growth restriction (OR: 4.1; CI: 1.00-16.71), neurologic impairment (OR: 3.83; CI: 1.33-11.06), and prematurity (&lt;37 weeks gestational age) (OR: 2.38; CI: 1.02-5.56). Those with isolated micrognathia without cleft palate were less likely to require intervention (OR: 0.2; CI: 0.05-0.71). Conclusion: While it is understood that the need for MDO or tracheostomy should be determined on a case-by-case basis, this study identifies a number of factors, which may predict which neonates with micrognathia are at increased risk for requiring early surgical intervention for respiratory and feeding problems.