Larger Head Circumference Research Articles

Assessment of Anthropometric Measurements as Predictors of Car Seat Screening Failure.

Objective The objective of this study was to determine whether anthropometric measurements such as head circumference (HC), body mass index (BMI), and body surface area (BSA) can predict car seat tolerance screen (CSTS) failure. We hypothesized that subjects with larger HC and lower BMI/BSA would have increased risk of failure. Study Design We performed retrospective medical record review of infants born in 2013 who qualified for CSTS due to being born preterm (< 37 weeks) or low birth weight (LBW). We performed bivariate analyses of clinical and demographic risk factors including anthropometrics to identify predictors of CSTS failure. Results In this study, 19 of 366 subjects failed their CSTS (5.3%). There were no significant differences in HC, length, BSA, BMI, or ratio of HC to length, BMI, or BSA between those who passed versus failed. On subgroup analysis of preterm infants, the significant predictor of failure was multiple gestation (p = 0.024). In the term LBW cohort, requiring nasal canula (NC) (p = 0.03) and having limited or no prenatal care (PNC) (p = 0.0006) were both significant predictors of failure. Conclusion Neither absolute measurements nor the ratios of HC to body measurements predicted CSTS outcome. Multiple gestation was a significant predictor of failure in preterm infants, while NC requirement and poor PNC were predictors in LBW term infants.

P274 Neuro-Cardiac-Guided TMS (NCG TMS): A new and cost-effective method for accurately localizing the DLPFC in the treatment of depression

Question The efficacy of rTMS in the treatment of major depressive disorder (MDD) has been well established in recent years in multi-center RCT’s as well as meta-analyses. Most studies to date have employed the ‘5-cm’ rule for targeting stimulation of the Dorsolateral Prefrontal Cortex (DLPFC). New variations and improvements of this targeting technique include a ‘6-cm’ rule, the Beam-F3 method, and neuronavigated rTMS. Furthermore, it has been proposed that the efficacy of rTMS in MDD is more related to stimulating the area that is functionally connected to the subgenual anterior cingulate cortex (sgACC) rather then to specific cortical areas (Fox et al., 2012). Therefore, we set-out to develop and test a new method that employs knowledge about the functional role of the sgACC to establish in real time if the right cortical area is targeted. Method Several studies have shown that areas in the ventromedial prefrontal cortex (VMPFC; including the subgenual and rostral ACC) are involved in processing of emotional information as well as the regulation of heart rate in response to emotional stimuli. Therefore, based on the notion that rTMS aims to transsynaptically stimulate the sgACC, we used electrocardiogram (ECG) R-peak triggered single pulse TMS to various frontal locations to establish the location that most consistently resulted in a lengthening of the R-R latency (reflective of a heart rate deceleration). This method of Neuro-Cardiac-Guided TMS or NCG TMS thus could be the equivalent of what the Motor Threshold is for the motor system, but then for the DLPFC with heart rate as an output. Results First preliminary results using a burst of 10 Hz TMS stimulation demonstrated that in a subject with a relatively large head circumference, no response was found at the ‘5 cm’ site (corresponding to FC4 in this subject), whereas the F4 location did result in a consistent heart rate deceleration. More data are currently being collected using a single pulse R-peak triggered approach and data will be presented. Conclusions In the treatment of MDD, Neuro-Cardiac-Guided TMS has the potential to become the equivalent of the ‘motor threshold’ for the DLPFC, and thereby would be a cost-effective and easy to use method for localizing the right stimulation target in the treatment of MDD, and also serve as a real-time control of adequate coil contact in patients undergoing rTMS treatment.

Retinal haemorrhages in a university hospital: not always abusive head injury.

Retinal haemorrhages (RH) and subdural haematomas (SDH) are frequently seen in abusive head trauma (AHT). The aim of our study is to show that they are suggestive, but not pathognomonic for AHT. We performed an observational retrospective study on children, aged 1-18months old, admitted to the Antwerp University Hospital with RH. History, physical examination, medical course, coagulation and metabolic tests, skeletal survey, head circumference, retinal findings, cerebral imaging, and evaluation reports by social services or civil/criminal courts were collected. Twenty-nine children with RH were included. Twenty three of them were found suspect of AHT. Three children of this group showed intraparenchymal haematomas/infarctions, 5 interhemispheric blood, 6 cerebral oedema, 7 ventricle compression, and 4 papilloedema. Seven of the 16 children with diffusion-weighted MRI images showed diffuse lesions. In 2 of the 6 children not suspect for AHT, an aetiology was found. None of the 4 remaining children showed the above-mentioned abnormalities. Three of these 4 cases showed an accelerated growth of the head circumference months before presentation. The majority of the children in all groups showed 'too numerous to count' (>20) RH (12 of the 23 'suspect' children, and 4 of the 6 'non-suspect' children). Results showed no differences between the groups concerning the location, distribution, or size of the RH. Infants with RH and/or SDH are not necessarily victims of AHT. Cerebral imaging and retinal findings can help differentiate suspect from non-suspect cases. Infants with a large head circumference could be predisposed to RH or SDH.

Can we predict obstetric anal sphincter injury?

ObjectiveThe aim of the study was to identify primiparous pregnant women with a higher risk for obstetric anal sphincter injuries (OASIS) based on obstetric characteristics (risk factors). Study designIn the retrospective case control study primiparous women were examined using endoanal ultrasonography (EUS) for OASIS identification 6–12 weeks after delivery. Obstetric characteristics for OASIS were collected from the mothers’ medical records. The univariate analysis of maternal (age at delivery, maternal height, weight, BMI), infant (length, weight and head circumference) and birth (pregnancy duration, labour and delivery duration, episiotomy, vacuum extraction and oxytocin augmentation) risk factors, Pearson correlations and information gain were carried out. The cut-off values for the aforementioned risk factors divided the patients into groups with higher and lower risk of OASIS. ResultsThe data of 84 primiparous women with OASIS, and 58 without, were analysed. Those newborns born to women in the OASIS group were heavier (P<0.05), with the cut-off at 3420g (72% probability of OASIS), had a larger head circumference (P<0.001), cut-off at 36cm (84% probability of OASIS), and were longer (P<0.05), cut-off at 50.5cm (74% probability of OASIS). The maternal age and body mass index (BMI) were risk factors for OASIS (P<0.05 and P<0.05, respectively) with a probability of 83% in women younger than 27.5 years and a 78% probability if BMI was higher than 28kg/m2. The incidence of OASIS was not higher in women with episiotomy or vacuum extraction, but it was higher in oxytocin augmentation (P<0.031). ConclusionThe findings can assist in identification of pregnant women with a higher risk of OASIS who require special attention at delivery to prevent it. In high risk women EUS is indicated to identify and treat possible OASIS as early as possible in order to prevent anal incontinence.

A Large Head Circumference is More Strongly Associated With Unplanned Cesarean or Instrumental Delivery and Neonatal Complications Than High Birthweight

(Am J Obstet Gynecol. 2015;213:833.e1–e.12) Perinatal outcomes are known to be affected by fetal size. A cross-sectional study based on electronic medical records was undertaken to study whether obstetric outcomes are affected more by fetal head circumference (HC) than by birthweight (BW).

Congenital Zika virus syndrome in Brazil: a case series of the first 1501 livebirths with complete investigation

In November, 2015, an epidemic of microcephaly was reported in Brazil, which was later attributed to congenital Zika virus infection. 7830 suspected cases had been reported to the Brazilian Ministry of Health by June 4, 2016, but little is known about their characteristics. We aimed to describe these newborn babies in terms of clinical findings, anthropometry, and survival. We reviewed all 1501 liveborn infants for whom investigation by medical teams at State level had been completed as of Feb 27, 2016, and classified suspected cases into five categories based on neuroimaging and laboratory results for Zika virus and other relevant infections. Definite cases had laboratory evidence of Zika virus infection; highly probable cases presented specific neuroimaging findings, and negative laboratory results for other congenital infections; moderately probable cases had specific imaging findings but other infections could not be ruled out; somewhat probable cases had imaging findings, but these were not reported in detail by the local teams; all other newborn babies were classified as discarded cases. Head circumference by gestational age was assessed with InterGrowth standards. First week mortality and history of rash were provided by the State medical teams. Between Nov 19, 2015, and Feb 27, 2015, investigations were completed for 1501 suspected cases reported to the Brazilian Ministry of Health, of whom 899 were discarded. Of the remainder 602 cases, 76 were definite, 54 highly probable, 181 moderately probable, and 291 somewhat probable of congenital Zika virus syndrome. Clinical, anthropometric, and survival differences were small among the four groups. Compared with these four groups, the 899 discarded cases had larger head circumferences (mean Z scores -1·54 vs -3·13, difference 1·58 [95% CI 1·45-1·72]); lower first-week mortality (14 per 1000 vs 51 per 1000; rate ratio 0·28 [95% CI 0·14-0·56]); and were less likely to have a history of rash during pregnancy (20·7% vs 61·4%, ratio 0·34 [95% CI 0·27-0·42]). Rashes in the third trimester of pregnancy were associated with brain abnormalities despite normal sized heads. One in five definite or probable cases presented head circumferences in the normal range (above -2 SD below the median of the InterGrowth standard) and for one third of definite and probable cases there was no history of a rash during pregnancy. The peak of the epidemic occurred in late November, 2015. Zika virus congenital syndrome is a new teratogenic disease. Because many definite or probable cases present normal head circumference values and their mothers do not report having a rash, screening criteria must be revised in order to detect all affected newborn babies. Brazilian Ministry of Health, Pan American Health Organization, and Wellcome Trust.

Birth Size Characteristics and Risk of Brain Tumors in Early Adulthood: Results from a Swedish Cohort Study.

Despite extensive research on the effect of birth size characteristics on childhood brain tumors, very few studies have evaluated the effect of birth size characteristics on the risk of adult brain tumor, and they have provided inconsistent results. All individuals born in Sweden between 1973 and 1995 who were still alive and cancer free at their 15th birthday were included in the study (n = 2,032,727). At the end of the study period (December 31, 2010), the study participants were 15 to 37 years old. Incident cases of primary brain tumors were identified through the Swedish Cancer Register. No association was observed between any birth size characteristics and glioma, although an indication of increased glioma risk associated with high birth weight, or being large for gestational age at birth, was found among men [relative risk (RR) = 1.36, 95% confidence interval (CI), 0.97-1.90; RR = 1.44, 95% CI, 0.99-2.09, respectively]. An increased risk of meningioma was observed among individuals born with a large head circumference (RR = 1.76, 95% CI, 1.01-3.05). Large head circumference was also associated with an elevated risk of neuroma (RR = 1.86, 95% CI, 0.94-3.68). Being born small for gestational age was also related to a higher risk of neuroma (RR = 2.50, 95% CI, 1.31-4.78). Selected birth size characteristics were associated with increased risk of some brain tumor subtypes in young adults. We have presented additional evidence suggesting that birth size characteristics are associated with subsequent primary brain tumor risk in young adults. Cancer Epidemiol Biomarkers Prev; 25(4); 678-85. ©2016 AACR.

Growth and neurodevelopment outcome in symmetric versus asymmetric small for gestational age term infants

Few studies compared growth and neurodevelopment outcome between asymmetric (aSYM) and symmetric (SYM) small for gestational age (SGA) term infants. We aimed at evaluating their respective outcome at 9 months postnatal age. A cohort study including infants born in 2010 to 2011 with a birth weight <5th centile and a head circumference (HC) below (SYM) or above (aSYM) the 5th centile. Catch-up growth was defined as weight, height and HC ⩾-2 s.d. of World Health Organization reference values. Neurodevelopment was evaluated with Brunet-Lezine test items. Of 6586 infants, 194 were SGA: 38.7% SYM and 61.3% aSYM. The aSYM group showed better catch-up growth (85% versus 70%, P=0.03) with larger HC (44.9±1.6 versus 43.7±1.2 cm, P<0.0001). No difference in neurodevelopmental screening was observed between SGA groups, but infants without any catch-up growth were at higher risk of delayed outcome. Term SGA infants must be closely followed, regardless of their characteristics, to improve their outcome.

Effect of vaginal delivery on anal sphincter function in Asian primigravida: a prospective study.

The true incidence of obstetric anal sphincter injuries (OASI) among Asian primigravida is not known. This study aimed to evaluate OASI in Sri Lankan primigravida. One hundred and one consecutive primigravida in their last trimester were recruited from antenatal clinics at a tertiary care centre in Sri Lanka and followed up 6weeks and 6months after delivery. They were assessed using anorectal manometry (3D-ARM) and endoanal ultrasound (3D-EAUS) on both occasions. Seventy-three (75.3%) had vaginal delivery without instrumentation, whereas 3 (3.1%) each delivered using forceps or vacuum. Twelve (12.4%) had emergency caesarean sections and 6 (6.2%) had elective caesarean sections. None had clinically identified anal sphincter injuries. EAUS identified IAS defects in 3 (5.1%) and EAS defects in 28 (47.5%). Both resting (p = 0.3) and squeeze (p = 0.001) pressures had decreased following childbirth. Multivariate analysis identified antepartum RP and postpartum EAS defects to be associated with RP reduction (χ(2)(4)=17.825, p < 0.0005) and antepartum SP and postpartum EAS defects to be associated with SP reduction (χ(2)(5)=31.517, p < 0.0005). Episiotomy was protective, whereas delivering after 40weeks' gestation and delivering a baby with a longer length increased the risk of SP reduction. EAS defects (χ(2) (6)=23.502, p = .001) were more common in mothers who had labour augmented by oxytocin and in those who delivered a baby with a larger head circumference. Labour induction and delivering a longer baby were protective for EAS defects. Several risk and protective factors for the structural and functional damage of sphincters were identified. These findings will help to formulate a policy to minimize future obstetric anal sphincter injuries.

IGSF1 Deficiency: Lessons From an Extensive Case Series and Recommendations for Clinical Management.

Mutations in the immunoglobulin superfamily, member 1 (IGSF1) gene cause the X-linked IGSF1 deficiency syndrome consisting of central hypothyroidism, delayed pubertal testosterone rise, adult macroorchidism, variable prolactin deficiency, and occasionally transient partial GH deficiency. Since our first reports, we discovered 20 new families with 18 new pathogenic IGSF1 mutations. We aimed to share data on the largest cohort of patients with IGSF1 deficiency to date and formulate recommendations for clinical management. We collected clinical and biochemical characteristics of 69 male patients (35 children, 34 adults) and 56 female IGSF1 mutation carriers (three children, 53 adults) from 30 unrelated families according to a standardized clinical protocol. At evaluation, boys were treated with levothyroxine in 89%, adult males in 44%, and females in 5% of cases. Additional symptoms in male patients included small thyroid gland volume (74%), high birth weight (25%), and large head circumference (20%). In general, the timing of pubertal testicular growth was normal or even premature, in contrast to a late rise in T levels. Late adrenarche was observed in patients with prolactin deficiency, and adult dehydroepiandrosterone concentrations were decreased in 40%. Hypocortisolism was observed in 6 of 28 evaluated newborns, although cortisol concentrations were normal later. Waist circumference of male patients was increased in 60%, but blood lipids were normal. Female carriers showed low free T4 (FT4) and low-normal FT4 in 18% and 60%, respectively, delayed age at menarche in 31%, mild prolactin deficiency in 22%, increased waist circumference in 57%, and a negative correlation between FT4 concentrations and metabolic parameters. IGSF1 deficiency represents the most common genetic cause of central hypothyroidism and is associated with multiple other characteristics. Based on these results, we provide recommendations for mutational analysis, endocrine work-up, and long-term care.

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.

ISUOG Practice Guidelines: role of ultrasound in twin pregnancy.

The natural history of growth in patients with Hunter syndrome: Data from the Hunter Outcome Survey (HOS).

Hunter syndrome (mucopolysaccharidosis type II) affects growth but the overall impact is poorly understood. This study investigated the natural history of growth and related parameters and their relationship with disease severity (as indicated by cognitive impairment). Natural history data from males followed prospectively in the Hunter Outcome Survey registry and not receiving growth hormone or enzyme replacement therapy, or before treatment start, were analysed (N=676; January 2014). Analysis of first-reported measurements showed short stature by 8years of age; median age-corrected standardized height score (z-score) in patients aged 8-12years was -3.1 (1st, 3rd quartile: -4.3, -1.7; n=68). Analysis of growth velocity using consecutive values found no pubertal growth spurt. Patients had large head circumference at all ages, and above average body weight and body mass index (BMI) during early childhood (median z-score in patients aged 2-4years, weight [n=271]: 1.7 [0.9, 2.4]; BMI [n=249]: 2.0 [1.1, 2.7]). Analysis of repeated measurements over time found greater BMI in those with cognitive impairment than those without, but no difference in height, weight or head circumference. Logistic regression modelling (data from all time points) found that increased BMI was associated with the presence of cognitive impairment (odds ratio [95% CI], 3.329 [2.313-4.791]), as were increased weight (2.365 [1.630-3.433]) and head circumference (1.749 [1.195-2.562]), but not reduced height. Unlike some other MPS disorders, there is no evidence at present for predicting disease severity in patients with Hunter syndrome based on changes in growth characteristics.

Newborn birth weight, length, and head circumference for gestational age in Guangzhou based on the INTERGROWTH-21st standard: a multiyear hospital liveborn cohort study

BackgroundWHO's INTERGROWTH-21st Project published an international standard for newborn size using a rigorous method. We aimed to examine the frequency of small and large birth weight, length, and head circumference for gestational age for live births in Guangzhou, China. MethodsData for all singleton live births in 2009–12 were obtained from the Guangzhou Maternal-Fetal Medical Database. The database, maintained by the Key Laboratory for Major Obstetric Diseases of Guangdong, contains information on sex, gestational age (ultrasound-based estimate), birth weight, length, head circumference, diagnoses, and interventions. We classified the newborn infants between 33 and 42 weeks gestation into centile categories according to the international standard. Our study protocol was approved by the medical ethics committee of the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China. FindingsOf 16 965 singleton live births, 308 (1·8%, 95% CI 1·6–2·0) were below the third centile for their birth weight for gestational age, 808 (4·8%, 4·4–5·1) were below the tenth centile, 1140 (6·7%, 6·3–7·1) were in the 90–97th centile, and 455 (2·7%, 2·4–2·9) were above the 97th centile. For length for gestational age, 422 (2·5%, 95% CI 2·1–2·8) were below the third centile, 696 (4·1%, 3·8–4·5) were in the third to tenth centile, 1603 (9·4%, 8·9–9·9) were in the 90–97th centile, and 628 (3·7%, 3·3–4·1) were above the 97th centile. For head circumference for gestational age, 1940 (11·4%, 95% CI 10·8–12·1) were below the third centile, 2046 (12·1%, 11·5–12·6) were in the third to tenth centile, 849 (5·0%, 4·5–5·4) were in the 90–97th centile, and 510 (3·0%, 2·6–3·4) were above the 97th centile. InterpretationThe birth weight and length for gestational age patterns for newborns in Guangzhou are as expected. The surprisingly high rates of live births below the tenth centile and low rates of live births above the 90th centile of head circumference imply the need to re-assess fetal head growth in the population and to ensure adequate care during pregnancy. FundingMinister of Science and Technology of Guangdong Province.

Head circumference and brain size in autism spectrum disorder: A systematic review and meta-analysis

Macrocephaly and brain overgrowth have been associated with autism spectrum disorder. We performed a systematic review and meta-analysis to provide an overall estimate of effect size and statistical significance for both head circumference and total brain volume in autism. Our literature search strategy identified 261 and 391 records, respectively; 27 studies defining percentages of macrocephalic patients and 44 structural brain imaging studies providing total brain volumes for patients and controls were included in our meta-analyses. Head circumference was significantly larger in autistic compared to control individuals, with 822/5225 (15.7%) autistic individuals displaying macrocephaly. Structural brain imaging studies measuring brain volume estimated effect size. The effect size is higher in low functioning autistics compared to high functioning and ASD individuals. Brain overgrowth was recorded in 142/1558 (9.1%) autistic patients. Finally, we found a significant interaction between age and total brain volume, resulting in larger head circumference and brain size during early childhood. Our results provide conclusive effect sizes and prevalence rates for macrocephaly and brain overgrowth in autism, confirm the variation of abnormal brain growth with age, and support the inclusion of this endophenotype in multi-biomarker diagnostic panels for clinical use.

Cognitive ability in adolescents born small for gestational age: Associations with fetal growth velocity, head circumference and postnatal growth

BackgroundSmall size at birth may be associated with impaired cognitive ability later in life.The aim of this study was to examine the effect of being born small for gestational age (SGA), with or without intrauterine growth restriction (IUGR) on cognitive ability in late adolescence. Study designA follow-up study of a former cohort included 123 participants (52 males); 47 born SGA and 76 born appropriate for gestational age (AGA). Fetal growth velocity (FGV) was determined by serial ultrasound measurements during the third trimester. A control group matched for age and birthplace was included. The original Wechsler Adult Intelligence Scale (WAIS) was administered, and verbal, performance and full-scale Intelligence Quotient (IQ) scores were calculated. ResultsThere was no difference in IQ between adolescents born SGA and AGA. FGV or IUGR during the third trimester did not influence cognitive ability in late adolescence. Full-scale IQ was positively related to head circumference (HC) in adolescence (B: 1.30, 95% CI: 0.32–2.28, p=0.01). HC at birth and three months was positively associated with full-scale IQ. Catch-up growth in the group of SGA children was associated with a significantly increased height, larger HC, increased levels of insulin-like growth factor-I (IGF-I) and increased full-scale IQ compared to those born SGA without catch-up growth. ConclusionSGA and IUGR may not be harmful for adult cognitive ability, at least not in individuals born at near-term. However, known risk factors of impaired fetal growth may explain the link between early growth and cognitive ability in adulthood.

OP10.10: Large head circumference is more strongly associated with unplanned Caesarean delivery than high birthweight, in primiparous women

OP10.10: Large head circumference is more strongly associated with unplanned Caesarean delivery than high birthweight, in primiparous women

EP01.05: Large head circumference is more strongly associated with risk of maternal and fetal complications than birthweight

EP01.05: Large head circumference is more strongly associated with risk of maternal and fetal complications than birthweight

P01.07: Large head circumference is more strongly associated with unplanned Caesarean delivery than high birthweight

P01.07: Large head circumference is more strongly associated with unplanned Caesarean delivery than high birthweight

P01.08: Large head circumference versus high birthweight in the risk of instrumental delivery in “big babies”

P01.08: Large head circumference versus high birthweight in the risk of instrumental delivery in “big babies”

EP01.04: Large head circumference versus high birthweight in the risk of instrumental delivery in primiparae with “big babies”

EP01.04: Large head circumference versus high birthweight in the risk of instrumental delivery in primiparae with “big babies”