Infant Growth Parameters Research Articles

Axial Length and Ocular Development of Premature Infants without ROP.

Purpose To investigate the ocular parameters of premature infants without ROP at gestational age (GA) more than 28 weeks and their relationship with growth parameters. Methods 76 preterm infants without ROP and 65 term infants were involved to undergo portable slit lamp, RetCam3, ultrasonic A-scan biometry, and cycloplegic streak examination at their 40 weeks' postconceptional ages (PCA). Ocular parameters of infants' right eye and growth parameters were used for analysis. Results All the infants were examined at 40 weeks' PCA. No significant difference was found between male and female in axial length of preterm infants (p = 0.993) and term infants (p = 0.591). Significant differences were found in axial length (AL), anterior chamber depth (ACD), lens thickness (LT), and vitreous depth (VD) between preterm and term infants. No significant correlation was found between AL and spherical equivalent in preterm infants' group. In preterm group, AL was significantly correlated with gestational age (GA), birth weight (BW), and head circumference (HC). Conclusions Preterm infants had shorter AL, shallow ACD, thicker LT, and thinner VD compared to term infants. Refractive error in preterm infants at GA between 28 to 37 weeks was not related to axial length. Among all the growth parameters of preterm infants, GA, BW, and HC had effect on axial length.

Maternal excess gestational weight gain and infant waist circumference: a 2-y observational study.

The purpose of this study was to examine the effects of gestational weight gain (GWG) and infant feeding practices on infant growth parameters in infants from 6 to 24 mo of age. Forty mother-infant pairs were recruited after delivery and followed up to 24 mo postpartum. GWG was calculated as prepregnancy weight subtracted from weight at delivery. Infant weight velocity was calculated as the change in weight between consecutive visits divided by the intervening time. Infant feeding practices were measured by interview and infant growth and waist circumference by standard anthropometry. Infants born to mothers with excess GWG were heavier at birth (3,521 ± 91 vs. 3,196 ± 97 g, P = 0.02) and had an average 2.16 ± 1.1 cm (P = 0.03) larger waist circumference throughout the 24 mo compared with infants born to mothers with appropriate GWG. Waist circumference increased by 0.12 and 2.0 cm for every 1 unit increase in GWG and infant birth weight. Infants born to women who exceeded the Institute of Medicine (IOM)-recommended guidelines for GWG were heavier at birth and had a significantly higher waist circumference up to 2 y of age. Strategies to control maternal excess GWG and thus the outcome on infant birth weight and waist circumference should be pursued.

Breastfeeding and infant growth parameters among a prospective cohort of Malawian women who underwent immediate postpartum implant or copper intrauterine device insertion

Objectives: We aimed to compare 3-month postdelivery breastfeeding and infant growth parameters between women who underwent immediate postpartum implant or copper intrauterine device (Cu-IUD) insertion. Methods: This is a secondary analysis of a prospective cohort study of 171 Malawian women who underwent immediate postpartum insertion of the implant or Cu-IUD between September 2014 and March 2015. The study's primary objective was to compare contraceptive continuation rates between implant and Cu-IUD users 1 year postdelivery. For this secondary analysis, we used Fisher's Exact Test and t tests to compare the breastfeeding and infant growth parameters of women with a singleton pregnancy and live infant at their 3-month postdelivery survey. Results: Some 122 women (71%) completed the 3-month postdelivery survey, and 108 women (61%) were eligible for this secondary analysis: 10 Cu-IUD and 98 implant users. All women (100%) reported that they were breastfeeding, with no significant difference in exclusive breastfeeding (90% for Cu-IUD vs. 93% for implant, p=.55). There were also no significant differences in infant weight (6.3 kg for Cu-IUD vs. 6.2 kg for implant, p=.69), length (60.8 cm for Cu-IUD vs. 59.6 cm for implant, p=.42) or head circumference (40.9 cm for Cu-IUD vs. 41.2 cm for implant, p=.74). Conclusions: Almost all women were still exclusively breastfeeding at 3 months postdelivery, with no differences in infant growth between implant and Cu-IUD users, although sample size limited our power. The high rate of exclusive breastfeeding at 3 months in both groups suggests that both options should be offered to postpartum women who want to prevent short interpregnancy intervals.

Association between Prepregnancy Body Mass Index and Gestational Weight Gain with Size, Tempo, and Velocity of Infant Growth: Analysis of the Newborn Epigenetic Study Cohort.

The first 1000 days of life is a critical period of infant growth that has been linked to future adult health. Understanding prenatal factors that contribute to variation in growth during this period could inform successful prevention strategies. Prenatal and maternal characteristics, including prepregnancy obesity and gestational weight gain were evaluated in relation to weight growth trajectories during the first 24 months of life using the SuperImposition by Translation and Rotation (SITAR) method, which provides estimates of infant size, timing to peak velocity, and growth velocity. The study sample included 704 mother-infant dyads from a multiethnic prebirth cohort from the Southeastern United States. The total number of weight measures was 8670 (median number per child = 14). Several prenatal and maternal characteristics were linked with infant growth parameters. The primary findings show that compared to women with a prepregnancy BMI between 18 and 24.9, women with a prepregnancy BMI ≥40 had infants that were 8% larger during the first 24 months, a delayed tempo of around 9 days, and a slower velocity. Mothers who had greater than adequate gestational weight gain had infants that were 5% larger even after controlling for prepregnancy BMI and several other covariates. The findings contribute new data on the associations between gestational weight gain and aspects of early growth using the SITAR method, and support a growing consensus in the literature that both prepregnancy BMI and gestational weight gain relate independently to risk for greater postnatal weight growth.

Improving the Process of Enteral Nutrition Preparation With Milk Technicians: Perceptions of Cost, Time, and Quality.

Neonatal intensive care nurses have historically been responsible for preparing enteral feedings--a costly and time-consuming process that may require leaving the bedside. To address these concerns, the Milk Technician Program was implemented at a major military treatment facility. Milk technicians were specially trained and responsible for handling, storing, and preparing enteral feeds. To determine effectiveness of the Milk Technician Program, changes in length of time required to first attain full feeds, cost of feeding preparation, adherence to feeding preparation procedures, and nurse and milk technician role variables were evaluated. A pre-/postdesign was used to compare length of time to full enteral feedings and cost. A plan-do-study-act design was used to evaluate protocol adherence and to identify and evaluate nurse and milk technician role variables. Data were collected via surveys, direct observations, and retrospective chart reviews to determine the overall effectiveness of this intervention. The average time for extremely and very preterm infants (<28 to 31 weeks) to first reach full feeds decreased from 32 to 19 days, t (33.1) = 2.33, P = .026, d = 0.704. Estimated feeding preparation cost savings for all infants admitted to the unit was $767 per day. Observed milk technician adherence to preparation procedures was 95.5%. Most nurses reported that the program saved time (97%) and all milk technicians reported improved job satisfaction. Nurses expressed concerns about accuracy and safety of preparation. Milk technicians reported concerns with communication, supplies, and lack of perceived support. Milk technicians offer significant benefit to infants and nurses in the neonatal intensive care unit, including reducing time for infants to reach full feeds, saving nurses' time, and reducing costs. Further research is needed to identify ideal educational backgrounds for milk technicians and to directly measure the effect of milk technicians on hospital length of stay and infant growth parameters.

The effect of Zinc on the growth of preterm baby in Baghdad, Iraq

Background: Zinc is an essential trace nutrient, has important function to play in growth. Many studies have indicated that a negative Zinc balance exist in preterm and small for gestational age infants until approximately 37 weeks of gestation. Several workers have recorded an improved Zinc status, good weightgain and better linear growth velocities in preterm infants supplement with Zinc. Aim of study: The current study evaluates the effect of zinc supplementation on growth parameters of premature infants. Also to determine the role of zinc therapy in treatment of acute diarrhea in children aged 3 months - 2 years. Methods: This randomized clinical trial study was done in Imamein Kadhemain Medical City, pediatric department, in the period from 1st December 2013 to 30th july2014. One hundred hospital born preterm infant with gestational age <37 weeks, whose were admitted to the hospital , when they were ready for discharge ,they randomly assigned to receive Zinc & multivitamins (50 neonates) ormultivitamins only (50 neonates). Multivitamin are vitamin A, vitamin D, iron & folic acid. The Zinc group received it in a dose of2 mg/kg/day. Weight, length and head circumference were followed up after 4 weeks. Results: In this study no significant difference in weight, length and head circumference between the zinc group & control group at the start but a significant difference were found at 4 weeksfollow up (P<0.05). Conclusion: Zinc supplementation for preterm babies was found effective to enhance the growth in early weeks of life, while in regard to difference in growth according to types of feeding there is no significant difference.

Efficacy of maternal tenofovir disoproxil fumarate in interrupting mother‐to‐infant transmission of hepatitis B virus

The efficacy and safety of maternal tenofovir disoproxil fumarate (TDF) in reducing mother-to-infant hepatitis B virus (HBV) transmissions is not clearly understood. We conducted a prospective, multicenter trial and enrolled 118 hepatitis B surface antigen (HBsAg)- and hepatitis B e antigen-positive pregnant women with HBV DNA ≥7.5 log10 IU/mL. The mothers received no medication (control group, n = 56, HBV DNA 8.22 ± 0.39 log10 IU/mL) or TDF 300 mg daily (TDF group, n = 62, HBV DNA 8.18 ± 0.47 log10 IU/mL) from 30-32 weeks of gestation until 1 month postpartum. Primary outcome was infant HBsAg at 6 months old. At delivery, the TDF group had lower maternal HBV DNA levels (4.29 ± 0.93 versus 8.10 ± 0.56 log10 IU/mL, P < 0.0001). Of the 121/123 newborns, the TDF group had lower rates of HBV DNA positivity at birth (6.15% versus 31.48%, P = 0.0003) and HBsAg positivity at 6 months old (1.54% versus 10.71%, P = 0.0481). Multivariate analysis revealed that the TDF group had lower risk (odds ratio = 0.10, P = 0.0434) and amniocentesis was associated with higher risk (odds ratio 6.82, P = 0.0220) of infant HBsAg positivity. The TDF group had less incidence of maternal alanine aminotransferase (ALT) levels above two times the upper limit of normal for ≥3 months (3.23% versus 14.29%, P = 0.0455), a lesser extent of postpartum elevations of ALT (P = 0.007), and a lower rate of ALT over five times the upper limit of normal (1.64% versus 14.29%, P = 0.0135) at 2 months postpartum. Maternal creatinine and creatinine kinase levels, rates of congenital anomaly, premature birth, and growth parameters in infants were comparable in both groups. At 12 months, one TDF-group child newly developed HBsAg positivity, presumably due to postnatal infection and inefficient humoral responses to vaccines. Treatment with TDF for highly viremic mothers decreased infant HBV DNA at birth and infant HBsAg positivity at 6 months and ameliorated maternal ALT elevations. (Hepatology 2015;62:375-386.

The Effect of Herbal Tea Containing Fennel Seed on Breast Milk Sufficiency Signs and Growth Parameters of Iranian Infants

Background: Breastfeeding is an economic and valuable method to protect infant's health during the life and provides unique biological and emotional effects for mothers and infants. Objectives: This study aimed to determine the effect of herbal tea containing Fennel seed on breast milk sufficiency signs and growth parameters of Iranian infants in medical health centers of Tehran University of Medical Sciences, Tehran, Iran. Patients and Methods: This study was a randomized clinical trial performed on 78 girl infants aged 0-4 months who were exclusively breastfed. After getting informed consent infants were randomly assigned into the intervention group (received herbal tea containing 7.5 g Fennel seed powder in addition to 3 grams black tea three times a day) and the control group (received herbal tea containing 3 grams black tea powder three times a day). Before and during four weeks of study, signs of breast milk sufficiency were evaluated through measuring the growth parameters and the number of wet diapers in a day, frequency of defecation and infant breastfeeding times. Results: Before intervention, there was no significant difference between weight, height, head circumference, the number of wet diapers and frequency of defecation times between the two groups (P > 0.05), but the number of breastfeeding times of control group was more than the Fennel group. After fourth weeks, Fennel significantly increased weight from (5261.0256 ± 1167.65801) to (6393.3333 ± 1083.42132), head circumference from (38.6103 ± 2.20033) to (40.1538 ± 2.00510), the number of wet diapers from (5.5000 ± 1.05131) to (8.5421 ± 1.21182), the frequency of defecation times from (1.7692 ± 1.03139) to (2.6410 ± 1.14655) and the number of breastfeeding times from (9.9359 ± 1.85380) to (16.7399 ± 1.63766) (P < 0.001), but it had no effect on height (P = 0.066). Conclusions: Herbal tea containing fennel seed improved breast milk sufficiency signs.

Effect of Zinc Intake on Growth in Infants: A Meta-analysis

A systematic review and meta-analysis of available randomized controlled trials (RCTs) was conducted to evaluate the effect of zinc (Zn) intake on growth in infants. Out of 5500 studies identified through electronic searches and reference lists, 19 RCTs were selected after applying the exclusion/inclusion criteria. The influence of Zn intake on growth was considered in the overall meta-analysis. Other variables were also taken into account as possible effect modifiers: doses of Zn intake, intervention duration, nutritional status, and risk of bias. From each select growth study, final measures of weight, length, mid upper arm circumference (MUAC), head circumference, weight for age z-score (WAZ), length for age z-score (LAZ), and weight for length z-score (WLZ) were assessed. Pooled β and 95% confidence interval (CI) were calculated. Additionally, we carried out a sensitivity analysis. Zn intake was not associated with weight, length, MUAC, head circumference, and LAZ in the pooled analyses. However, Zn intake had a positive and statistically effect on WAZ (β = 0.06; 95%CI 0.02 to 0.10) and WLZ (β = 0.05; 95%CI 0.01 to 0.08). The dose–response relationship between Zn intake and these parameters indicated that a doubling of Zn intake increased WAZ and WLZ by approximately 4%. Substantial heterogeneity was present only in length analyses (I2 = 45%; p = 0.03). Zn intake was positively associated with length values at short time (four to 20 weeks) (β = 0.01; CI 95% 0 to 0.02) and at medium doses of Zn (4.1 to 8 mg/day) (β = 0.003; CI 95% 0 to 0.01). Nevertheless, the effect magnitude was small. Our results indicate that Zn intake increases growth parameters of infants. Nonetheless, interpretation of these results should be carefully considered.

Higher versus lower protein intake in formula-fed low birth weight infants.

The ideal quantity of dietary protein for formula-fed low birth weight infants is still a matter of debate. Protein intake must be sufficient to achieve normal growth without negative effects such as acidosis, uremia, and elevated levels of circulating amino acids. To determine whether higher (≥ 3.0 g/kg/d) versus lower (< 3.0 g/kg/d) protein intake during the initial hospital stay of formula-fed preterm infants or low birth weight infants (< 2.5 kilograms) results in improved growth and neurodevelopmental outcomes without evidence of short- and long-term morbidity.To examine the following distinctions in protein intake. 1. Low protein intake if the amount was less than 3.0 g/kg/d. 2. High protein intake if the amount was equal to or greater than 3.0 g/kg/d but less than 4.0 g/kg/d. 3. Very high protein intake if the amount was equal to or greater than 4.0 g/kg/d.If the reviewed studies combined alterations of protein and energy, subgroup analyses were to be carried out for the planned categories of protein intake according to the following predefined energy intake categories. 1. Low energy intake: less than 105 kcal/kg/d. 2. Medium energy intake: greater than or equal to 105 kcal/kg/d and less than or equal to 135 kcal/kg/d. 3. High energy intake: greater than 135 kcal/kg/d.As the Ziegler-Fomon reference fetus estimates different protein requirements for infants based on birth weight, subgroup analyses were to be undertaken for the following birth weight categories. 1. < 800 grams. 2. 800 to 1199 grams. 3. 1200 to 1799 grams. 4. 1800 to 2499 grams. The standard search methods of the Cochrane Neonatal Review Group were used. MEDLINE, CINAHL, PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library) were searched. Randomized controlled trials contrasting levels of formula protein intake as low (< 3.0 g/kg/d), high (≥ 3.0 g/kg/d but < 4.0 g/kg/d), or very high (≥ 4.0 g/kg/d) in formula-fed hospitalized neonates weighing less than 2.5 kilograms were included. Studies were excluded if infants received partial parenteral nutrition during the study period or were fed formula as a supplement to human milk. Studies in which nutrients other than protein also varied were added in a post-facto analysis. The standard methods of the Cochrane Neonatal Review Group were used. Five studies compared low versus high protein intake. Improved weight gain and higher nitrogen accretion were demonstrated in infants receiving formula with higher protein content while other nutrients were kept constant. No significant differences were seen in rates of necrotizing enterocolitis, sepsis, or diarrhea.One study compared high versus very high protein intake during and after an initial hospital stay. Very high protein intake promoted improved gain in length at term, but differences did not remain significant at 12 weeks corrected age. Three of the 24 infants receiving very high protein intake developed uremia.A post-facto analysis revealed further improvement in all growth parameters in infants receiving formula with higher protein content. No significant difference in the concentration of plasma phenylalanine was noted between high and low protein intake groups. However, one study (Goldman 1969) documented a significantly increased incidence of low intelligence quotient (IQ) scores among infants of birth weight less than 1300 grams who received a very high protein intake (6 to 7.2 g/kg). Higher protein intake (≥ 3.0 g/kg/d but < 4.0 g/kg/d) from formula accelerates weight gain. However, limited information is available regarding the impact of higher formula protein intake on long-term outcomes such as neurodevelopmental abnormalities. Available evidence is not adequate to permit specific recommendations regarding the provision of very high protein intake (> 4.0 g/kg/d) from formula during the initial hospital stay or after discharge.

A Double-Blind Randomised Controlled Trial of Fish Oil-Based versus Soy-Based Lipid Preparations in the Treatment of Infants with Parenteral Nutrition-Associated Cholestasis

Background: Infants receiving prolonged parenteral nutrition (PN) are at risk of PN-associated cholestasis (PNAC). This can progress to hepatic failure and death if PN cannot be discontinued. Fish oil-based parenteral lipid preparation (FOLP) has been shown to be beneficial in case studies. Objectives: (1) To evaluate whether FOLP could halt or reverse the progression of PNAC compared with soy-based parenteral lipid preparation (SLP) and (2) to assess the effects of FOLP on liver function and physical growth. Methods: Design: double-blind randomised controlled trial. Setting: level III neonatal intensive care unit. Participants: infants with PNAC (plasma-conjugated bilirubin concentration ≥34 µmol/l or 2 mg/dl) expected to be PN-dependent for >2 weeks. Intervention: to receive either FOLP or SLP at 1.5 g/kg/day. Primary outcome measure: reversal of PNAC within 4 months after commencement of lipid treatment; secondary outcomes: rate of change of weekly liver function tests, infant growth parameters, blood lipid profile and episodes of late-onset sepsis. Results: A total of 9 infants were randomised to the FOLP group and 7 to the SLP group. There was no significant difference in reversal of PNAC at 4 months between groups. Rates of increase of plasma-conjugated bilirubin and alanine aminotransferase in the SLP group were significantly greater than the FOLP group (13.5 vs. 0.6 µmol/l per week and 9.1 vs. 1.1 IU/l per week, respectively, p = 0.03). Increased enteral nutrition was associated with significant improvement of PNAC in infants receiving FOLP compared with SLP (-8.5 vs. -1.6 µmol/l per 10% increase in enteral nutrition, respectively). The study was terminated prematurely. Conclusions: progression of PNAC in PN-dependent infants can be halted by replacing SLP with FOLP and reversed by increasing the proportion of enteral nutrition in infants receiving FOLP. Replacement of SLP with FOLP in PN-dependent infants who develop PNAC may be considered.

Effect of Progestin Compared With Combined Oral Contraceptive Pills on Lactation

To estimate the effect of progestin-only compared with combined hormonal contraceptive pills on rates of breastfeeding continuation in postpartum women. Secondary outcomes include infant growth parameters, contraceptive method continuation, and patient satisfaction with breastfeeding and contraceptive method. Postpartum breastfeeding women who desired oral contraceptives were randomly assigned to progestin-only and combined hormonal contraceptive pills. At 2 and 8 weeks postpartum, participants completed in-person questionnaires that assessed breastfeeding continuation and contraceptive use. Infant growth parameters including weight, length, and head circumference were assessed at 8 weeks postpartum. Telephone questionnaires assessing breastfeeding, contraceptive continuation, and satisfaction were completed at 3-7 weeks and 4 and 6 months. Breastfeeding continuation was compared between groups using Cox proportional hazards regression. Differences in baseline demographic characteristics and in variables between the two intervention groups were compared using χ tests, Fisher exact test, or two-sample t tests as appropriate. Breastfeeding continuation rates at 8 weeks (progestin-only 63.5%; combined hormonal 64.1%), contraceptive continuation, and infant growth parameters did not differ between users of progestin-only and combined hormonal contraceptive pills. Infant formula supplementation and maternal perception of inadequate milk supply were associated with decreased rates of breastfeeding in both groups. Choice of combined hormonal or progestin-only contraceptive pills administered 2 weeks postpartum did not adversely affect breastfeeding continuation. ClinicalTrials.gov, www.clinicaltrials.gov, NCT01465022.

&lt;b&gt;Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil&lt;/b&gt;

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

Longitudinal anthropometric assessment of infants born to HIV-1-infected mothers, Belo Horizonte, Southeastern Brazil

OBJECTIVE: To evaluate the growth parameters in infants who were born to HIV-1-infected mothers. METHODS: The study was a longitudinal evaluation of the z-scores for the weight-for-age (WAZ), weight-for-length (WLZ) and length-for-age (LAZ) data collected from a cohort. A total of 97 non-infected and 33 HIV-infected infants born to HIV-1-infected mothers in Belo Horizonte, Southeastern Brazil, between 1995 and 2003 was studied. The average follow-up period for the infected and non-infected children was 15.8 months (variation: 6.8 to 18.0 months) and 14.3 months (variation: 6.3 to 18.6 months), respectively. A mixed-effects linear regression model was used and was fitted using a restricted maximum likelihood. RESULTS: There was an observed decrease over time in the WAZ, LAZ and WLZ among the infected infants. At six months of age, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.02, 0.59, and 0.63 standard deviations, respectively. At 12 months, the mean differences in the WAZ, LAZ and WLZ between the HIV-infected and non-infected infants were 1.15, 1.01, and 0.87 standard deviations, respectively. CONCLUSIONS: The precocious and increasing deterioration of the HIV-infected infants' anthropometric indicators demonstrates the importance of the early identification of HIV-infected infants who are at nutritional risk and the importance of the continuous assessment of nutritional interventions for these infants.

Energetics during reproduction: A doubly labeled water study of lactating baboons

Understanding the costs and regulation of reproduction in primates requires understanding the separate but linked effects of energy availability and total energy expenditure (TEE). We compared variation in TEE and energy intake (EI) between two periods, early lactation and after the resumption of sexual cycling, for eight females from two groups of normally reproducing colony-living baboons (Papio h. anubis). Total energy expenditure was assessed using the doubly labeled water method. TEE was correlated with maternal mass both during early lactation and after the resumption of cycling. TEE after the resumption of cycling was positively related to infant growth rates; mothers with rapidly growing infants had higher energy expenditure. TEE was however unrelated to maternal rank and only weakly associated with reproductive parameters such as delay to conception. EI in early lactation was related to infant mass and interbirth intervals, but unrelated to infant growth or reproductive parameters once cycling had resumed. Energy availability (EA; the difference between intake and expenditure) differed significantly between subordinate and dominant females during early lactation, was highly variable among individuals as a function of body composition, and is suggested to follow a nonlinear relationship as a complex function of social status, lactation stage, infant growth, and female fertility. Thus, as a consequence of reduced energy availability, subordinate females in this captive context may experience reproductive delays even though the total energy expenditure after the return of cycling was similar between high and low ranking females.

Lack of Effect on Prematurity, Birth Weight, and Infant Growth from Exposure to Protease Inhibitors In Utero and After Birth

To determine whether an association exists between exposure in utero and after birth to highly active antiretroviral therapy (HAART) containing protease inhibitors and prematurity, birth weight, and infant growth parameters. Retrospective cohort study. Tertiary, university-affiliated hospital in Montreal, Canada. Cohort of 206 pairs of mothers who had human immunodeficiency virus (HIV) and had been treated with HAART between 1997 and 2005, of whom 176 had regimens containing protease inhibitors, and their infants, as well as a control group of 206 infants born to non-HIV-infected mothers and thus not exposed to HAART. Demographic and clinical characteristics were retrieved from patients' medical records and the hospital's HIV database. Duration of HAART use, rates of prematurity and low birth weight, and infant growth parameters during the first 2 years of the child's life were evaluated. Median duration of HAART use for the women before delivery was 18 weeks (range 4-36 wks) and for infants, started within the first 8-12 hours of life, was 6 weeks (range 2-6 wks). In infants exposed to HAART, the 10.6% rate of prematurity (11.1% with and 7.1% without protease inhibitors) was not significantly higher than that in the control group (7.8%). Moreover, the 9.9% rate for small for gestational age (9.8% with and 10.3% without protease inhibitors) was also not significantly higher than that in the control group (5.3%). The 176 mothers and infants exposed to protease inhibitors had a median follow-up of 5 years. Stillbirth or death was not observed. At delivery, the weight, length, and head circumference of the 176 infants exposed to protease inhibitors were similar to those of the control group. During the first 2 years of life, premature infants were in the lower percentiles of growth; however, they followed normal Centers for Disease Control and Prevention growth curves matched for age and sex. Significantly higher rates of prematurity and low birth weight were not demonstrated in infants exposed in utero to HAART with protease inhibitors. Moreover, these children reached normal growth percentiles during the first 2 years of life.

Placental insufficiency in early gestation is associated with hypospadias

The association of growth retardation and hypospadias is well established. Fetal testosterone secretion is under the influence of placental human chorionic gonadotropin during first 14 weeks of gestation. We hypothesized that placental insufficiency may disrupt the supply of nutrients and human chorionic gonadotropin to the fetus leading to both growth retardation and hypospadias. To validate this hypothesis, we analyzed extremely low-birth-weight male infants with or without hypospadias for fetal growth parameters. One hundred four male newborn infants with birth body weight of less than 1500 g admitted to a neonatal intensive care unit over a 4-year period were retrospectively reviewed, recording the presence and type of hypospadias, fetal growth parameters, infant growth parameters at birth, placental weight, placental histopathology, cord information, and maternal morbidity. These data of patients with hypospadias were compared with those of controls. Of the 104 extremely to very low-birth-weight male infants, 16 (15.3%) had hypospadias, and 10 (62.5%) of those had severe proximal hypospadias. Sixty-two controls who did not have hypospadias and whose body weight was less than 1500 g were identified. The incidence of hypospadias in full-term male birth in the hospital was 12 (0.30%) in 3959 births. Birth body weight and their SD for gestational age were lower in patients with hypospadias compared with those for controls (824 +/- 160 vs 1255 +/- 145 g). Placenta-to-fetal ratio (0.323 +/- 0.07 vs 0.229 +/- 0.03) and gestational age were significantly higher in the patients with hypospadias. Histopathologic study of the maternal placenta obtained from the patients with hypospadias revealed pronounced degenerative changes, infarction, and calcification, whereas these abnormalities were rare in controls. The significant association between the occurrence of hypospadias and early growth retardation with higher placenta-to-fetal ratio and placental abnormalities suggest that placental dysfunction in early gestation may play an important role in the development of hypospadias.

420: Safety of newer antiepileptics in infants exposed through breast milk as measured by infant growth parameters

420: Safety of newer antiepileptics in infants exposed through breast milk as measured by infant growth parameters

Association of body mass index of HIV-1–infected pregnant women and infant birth weight, body mass index, length, and head circumference: the National Institute of Child Health and Human Development International Site Development Initiative Perinatal Study

This study assessed the relationship between the body mass index (BMI) of HIV-1-infected women and their infants' perinatal outcomes. The study population consisted of women enrolled in the NICHD International Site Development Initiative (NISDI) Perinatal Study with data allowing calculation of the BMI adjusted for length of gestation (adjBMI), who delivered singleton infants. Outcome variables included infant growth parameters at birth (weight, BMI, length and head circumference) and gestational age. Of 697 women from Argentina, the Bahamas, Brazil and Mexico who were included in the analysis, the adjBMI was classified as underweight for 109 (15.6%), normal for 418 (60.0%), overweight for 88 (12.6%) and obese for 82 (11.8%). Median infant birth weight, BMI, birth length and head circumference differed significantly according to maternal adjBMI (P</=0.0002). Underweight mothers gave birth to infants with lower weight, lower BMI, shorter length and smaller head circumference, while infants born to normal, overweight and obese mothers were of similar size.

Growth evaluation in infants with neonatal cholestasis

[corrected] Chronic liver diseases in childhood often cause undernutrition and growth failure. To our knowledge, growth parameters in infants with neonatal cholestasis are not available To evaluate the nutritional status and growth pattern in infants with intrahepatic cholestasis and extrahepatic cholestasis. One hundred forty-four patients with neonatal cholestasis were followed up at the Pediatric Gastroenterology Service of the Teaching Hospital, State University of Campinas, Campinas, SP, Brazil, in a 23-year period, from 1980 to 2003. The records of these patients were reviewed and patients were classified into two groups, according to their anatomical diagnosis: patients with intrahepatic cholestasis - group 1, and patients with extrahepatic cholestasis - group 2. Records of weight and height measurements were collected at 4 age stages of growth, in the first year of life: 1) from the time of the first medical visit to the age of 4 months (T1); 2) from the 5th to the 7th month (T2); 3) from the 8th to the 10th month (T3); and 4) from the 11th to the 13th month (T4). The weight-by-age and height-by-age Z-scores were calculated for each patient at each stage. In order for the patient to be included in the study it was necessary to have the weight and/or height measurements at the 4 stages. Analyses of variance and Tukey's tests were used for statistical analysis. Repeated measurement analyses of variance of the weight-by-age Z-score were performed in a 60-patient sample, including 29 patients from group 1 and 31 patients from group 2. The height-by-age data of 33 patients were recorded, 15 from group 1 and 18 from group 2 The mean weight-by-age Z-scores of group 1 patients at the 4 age stages were: T1=-1.54; T2=-1.40; T3=-0.94; T4=-0.78. There was a significant difference between T2 X T3 and T1 X T4. The weight-by-age Z-scores for group 2 patients were :T1=-1.04; T2=-1.67; T3=-1.93 and T4=-1.77, with a significant difference between T1 X T2 and T1 X T4. The mean weight-by-age Z-scores also showed a significant difference between group 1 and group 2 at stages T3 and T4. The mean height-by-age Z-scores at the four stages in group 1 were: T1=-1.27; T2=-1.16; T3=-0.92 and T4=-0.22, with a significant difference between T3XT4 and T1XT4. The scores for group 2 patients were: T1=-0.93; T2=-1.89; T3=-2.26 and T4=-2.03, with a significant difference between T1XT2 and T1XT4. The mean height-by-age Z-scores also showed a significant difference between group 1 and group 2 at T3 and T4 The weight and height differences between the groups became significant from the 3rd measurement onward, with the most substantial deficit found in the extrahepatic group. In this group, there is evidence that the onset of weight and height deficit occurs between the first and second evaluation stages.