Length Z-scores Research Articles

Different Catch-Up Growth Patterns in Very Preterm and Small for Gestational Age Infants.

This study aimed to describe the growth pattern in preterm infants and identify factors influencing catch-up growth. A total of 288 preterm infants were divided into groups based on the degree of prematurity, sex, and size for gestational age. Growth in head circumference, length, weight-for-length, and weight was compared between groups at corrected age of 0, 3, 6, 9, 12, 18, and 24 months. Logistic regression analysis was conducted to determine risk factors for catch-up growth. At a corrected age of 24 months, the proportions of preterm infants with z-scores less than -2 for head circumference, length, weight-for-length, and weight were less than the expected 2.3% at 0.9%, 1.7%, 2.1%, and 1.7%, respectively. The head circumference, length, weight-for-length, and weight z-scores at corrected ages of 24 months were lower in the small for gestational age (SGA) group than in the non-SGA group (P < .05). The weight-for-length z-scores were higher in the late preterm birth infants than in the very preterm birth infants at a corrected age of 24 months (P < .05). At a corrected age 24 months, the proportion of male with weight z-scores <-2 was lower than that of female (P < .05). The differences in proportion of the z-scores (head circumference, length, weight-for-length, and weight) <-2 at a corrected age of 24 months among different gestational age groups and intrauterine growth status groups were not statistically significant (P > .05). We found that the factors influencing catch-up growth in preterm infants varied at different corrected age stages, and the impact of factors during hospitalization gradually diminished as the infants grew.

Birth outcomes following bictegravir exposure during pregnancy.

Bictegravir is increasingly prescribed as a co-formulated tablet with tenofovir alafenamide and emtricitabine to pregnant persons with HIV (PWH) despite limited pregnancy and birth outcome data. We sought to provide birth outcome data following exposure to bictegravir during pregnancy. We conducted a descriptive analysis of infants born to pregnant PWH 18-45 years of age enrolled in at least one Pediatric HIV/AIDS Cohort Study (PHACS)-affiliated study who received bictegravir for ≥7 days during pregnancy and completed follow-up through delivery. The outcomes of interest were gestational age at birth, preterm birth (<37 weeks' gestation), gestational-age adjusted birth weight (BWZ) and length (BLZ) z-scores, small for gestational age (SGA, birthweight <10th percentile), congenital anomalies, neonatal deaths in the first 28 days of life, and infant HIV status. A total of 177 infants born to 170 unique PWH were exposed to bictegravir for ≥7 days during gestation; 55% were exposed to bictegravir from the time of conception. Median gestational age at birth was 38.1 weeks. The prevalence of preterm birth was 15.8% and SGA was 9.3%. Mean BWZ and BLZ were -0.48 and 0.03. No neonatal deaths or perinatal HIV transmissions were reported. Among 126 infants exposed to first-trimester bictegravir, 7 (5.6%) had major congenital anomalies with no specific pattern suggestive of a syndrome. These findings provide preliminary data without significant safety concerns for fetal bictegravir exposure in this United States cohort. Comparative data and continued surveillance of outcomes among infants exposed to bictegravir during gestation are warranted.

Nutrition Supply and Growth Post Nutrition Support Team Activity in Neonatal Intensive Care Unit.

For neonates admitted to the neonatal intensive care unit (NICU), appropriate nutritional assessment and intervention are important for adequate growth. In this study, we aimed to determine whether there were changes in the nutritional supply and growth status of premature infants hospitalized in the NICU after the introduction of the Nutrition support team (NST). This study retrospectively analyzed premature infants admitted to the NICU for over 14 days. The average daily calorie, protein, and fat supply at 1 and 2 weeks after birth were compared before and after NST, and growth was evaluated by changes in length, weight, and head circumference z-scores at birth and 28 days after birth. A total of 79 neonates were included in the present study, with 32 in the pre-NST group and 47 in the post-NST group. The average daily energy supply during the first (p=0.001) and second (p=0.029) weeks postnatal was significantly higher in the post-NST group than in the pre-NST group. Lipid supply for the first week was significantly higher in the post-NST group than in the pre-NST group (p=0.010). The change in the z-score for length was significantly higher in the post-NST group than in the pre-NST group (p=0.049). Nutrient supply and length z-score change increased significantly at 28 days after birth in the post-NST group. These results suggest that calorie calculators and NST activity can promote adequate growth and development in neonates.

Effects of Early Enteral to Parenteral Protein Ratios on Brain Volume and Somatic Growth in Very Low Birth Weight Infants

To evaluate whether a higher proportion of enteral vs parenteral protein ratio (E:P ratio) in the first 28days after birth is associated with increased brain volume and somatic growth in very low birth weight (VLBW; birth weight <1500 g) infants. This was a retrospective analysis of a subcohort of VLBW infants (n=256, gestational age mean 28.07 [SD 2.17] weeks, birth weight 1038.80 [SD 262.95] grams) from the Cincinnati Infant Neurodevelopment Early Prediction Study, a regional prospective study of infants born at ≤32weeks' gestation. Brain magnetic resonance imaging was obtained at term-equivalent age. Macronutrient intake and growth metrics for the first 28days were collected retrospectively. The primary outcome was total brain tissue volume. The relationships between E:P ratio, total and regional brain tissue volumes, and somatic growth were analyzed by multivariable linear regression models; composite variables were used to adjust for potential confounders including pregnancy risk factors and initial severity of illness. Higher E:P ratio was associated with increased total brain tissue volume but was not associated with change in head circumference z score. In secondary analyses, higher E:P ratio was associated with increased weight velocity. There were no significant associations between E:P ratio and change in weight or length z scores or regional brain volumes. Higher E:P ratio in the first 28days was positively associated with total brain volume and weight gain. Promoting the provision of enteral over parenteral protein may improve brain and somatic growth in VLBW infants.

Risk Assessment of Cognitive Impairment at 2 Years of Age in Infants Born Extremely Preterm Using the INTERGROWTH-21st Growth Standards

To assess the risk of cognitive impairment among infants born extremely preterm using the INTERGROWTH-21st standards. We analyzed anthropometric data at birth and 36weeks postmenstrual age (PMA) from infants born extremely preterm (24-26weeks of gestation) admitted to US neonatal units between 2008 and 2018. To determine INTERGROWTH-21st z-score values that indicate an increased risk of cognitive impairment at 2years of age (Bayley cognitive score <85), we employed classification and regression trees and redefined growth failure (weight, length, and head circumference z-scores at 36weeks PMA) and growth faltering (weight, length, and head circumference z-score declines from birth to 36weeks PMA). Among 5393 infants with a mean gestational age of 25weeks, growth failure defined as a weight z-score of -1.8 or below at 36weeks PMA and growth faltering defined as a weight z-score decline of 1.1 or greater from birth to 36weeks PMA indicated a higher likelihood of cognitive impairment. A length z-score less than -1 at 36weeks PMA had the highest sensitivity to detect cognitive impairment at 2years (80%). A head circumference z-score decline of 2.43 or greater from birth to 36weeks PMA had the highest specificity (86%). Standard definitions had fair to low sensitivity and specificity for risk detection of cognitive impairment. Length and head circumference z-scores had the highest sensitivity and specificity for risk detection of cognitive impairment. Monitoring these growth parameters could guide earlier individualized interventions with potential to reduce cognitive impairment. ClinicalTrials.gov ID Generic Database: NCT00063063.

Premodulator microbiome alterations associated with postmodulator growth outcomes in pediatric cystic fibrosis: Can we predict outcomes?

The gut microbiota plays an important role in childhood growth. Our longitudinal cohort includes children with cystic fibrosis (CwCF) treated with highly effective modulator therapy. We aimed to elucidate early premodulator microbial signatures associated with postmodulator weight for CwCF later in childhood. Stool samples were collected from CwCF at 13 days to 60 months. Metagenomic sequencing determined differentially abundant taxa. Children with body mass index or weight for length Z-scores within 1 standard deviation of the mean (SD) were considered normal weight, those >1 SD were classified as risk of overweight while children <1 SD were considered undernourished, although no CwCF met this latter criterion here. Multivariate regression models were applied to identify significant associations between metadata and microbial taxonomic relative abundances. One hundred and eighty-nine stool samples were analyzed from 39 CwCF. We identified statistically significant differences in early microbiome patterns among those at risk of being overweight compared to those who were normal weight when adjusted for age, sex, CF mutation, and early feeding method. Early microbiome was a stronger driver of growth status than current modulator use. Among those at risk of overweight, several taxa that were consistently in lower abundance included Eggerthella lentha, Ruminococcus, Bacteroides, with increase in abundance of Bacteroides stercoris. The early microbiome strongly predicts growth in the setting of modulator use for CwCF and we identify microbiome signatures associated with risk of being overweight. We highlight the possibility for interventions or early alternations to nutritional guidance for prevention of comorbid complications.

Elucidating the dynamics and impact of the gut microbiome on maternal nutritional status during pregnancy, effect on pregnancy outcomes and infant health in rural Pakistan: study protocol for a prospective, longitudinal observational study

IntroductionUndernutrition during pregnancy is linked to adverse pregnancy and birth outcomes and has downstream effects on the growth and development of children. The gut microbiome has a profound influence on...

Race as social determinant of growth and body composition among infants born very preterm.

Racism leads to disparities in health outcomes. Our objective was to determine if black race was independently associated with differences in fat accretion at discharge in a large cohort of very preterm infants (32 weeks of gestation or less). De-identified demographic, anthropometric and body composition data were collected from seven neonatal units around the United States. Weight, length, and head circumference z-scores at birth and at the time of body composition assessment or hospital discharge were calculated. The median gestational age and birthweight for this cohort (n = 888) were 29 weeks [IQR, 27-30] and 1167 g [SD, 354], respectively. The study population included 53% black preterm infants. Birthweight was lower in black preterm infants compared with white infants (1112 ± 334 g vs. 1228 ± 366 g; p < 0.0001). After adjusting for birthweight, gestational age, and birthweight-for-age z-score, black preterm infants had more weight gain (adjusted mean difference: 0.5 g/kg/day; p = 0.03) but not higher BF% z-scores at hospital discharge (adjusted mean: 1.2 vs. 1.3; p = 0.14) than white infants. After adjusting for covariates, black race was associated with higher weight gain velocity but not higher BF% z-scores. This study presents findings from a large-scale multicenter cohort. Racial differences were observed in birth weight and the rate of weight gain; however, these differences were not associated with dissimilarities in body composition outcomes. Understanding nutrition and growth outcomes across racial groups is necessary to combat racial disparities in the neonatal intensive care unit (NICU).

The Effect of Baby-Led Weaning and Traditional Complementary Feeding Trainings on Baby Development: Study Protocol

Aim: In this study, it was aimed to evaluate the risks of self-feeding, transition to early solids and home meals, choking, anemia and obesity in 6-and 12-month-old infants who were introduced to complementary feeding with the trainings of traditional complementary feeding (TCF) and baby-led weaning (BLW) methods. Material and Method: This study is an experimental and randomized controlled study conducted to examine the effect of the trainings of the TCF and BLW methods on the transition to complementary feeding. The population of the study consisted of 73 infants aged 4 and 5 months who 62 were assigned to intervention groups by stratified randomization method. The study was conducted according to the CONSORT-2010 checklist. Five complementary feeding modular trainings with 8 sessions, appropriate for the age of the baby in months, were carried out in both intervention groups. In both groups, the trainings were maintained until the baby was 4 months to 12 months old. The outcomes consisted of height, weight gain, LAZ (Length for age z-score), WAZ (Weight for age z-score), and WLZ (Weight for length z-score) scores at 12 months, iron intake, hemoglobin, hematocrit, and ferritin levels, micronutrients, choking risk, growth retardation, transition time to solid foods, family meals and self-feeding, behaviors of transition to complementary feeding and developmental assessment parameters. Practice Implications: This study, the trainings given are expected to give an idea about the extent to which they affect the infant's body weight, growth and development, iron and micronutrient intake, obesity, choking and growth retardation risks..

Hypophosphatemic rickets and short stature.

An 18-month-old male presented with gross motor delay and poor growth (weight z-score -2.21, length z-score -4.26). Radiographs showed metaphyseal irregularities suggesting metaphyseal dysplasia and sagittal craniosynostosis. Biochemical evaluation supported hypophosphatemic rickets [serum phosphorus 2.3mg/dL (reference range (RR) 4.3-6.8), alkaline phosphatase 754 unit/L (RR 156-369)] due to renal phosphate wasting (TmP/GFR 4.3mg/dL, normal for age 4.3-6.8), with C-terminal fibroblast growth factor 23 (FGF23) 125 RU/mL (>90 during hypophosphatemia suggests FGF23-mediated hypophosphatemia). Treatment was initiated with calcitriol and phosphate. Genetic analysis showed a pathogenic variant of FGF23: c.527G > A (p.Arg176Gln) indicative of autosomal dominant hypophosphatemic rickets (ADHR). Consistent with reports linking iron deficiency with the ADHR phenotype, low ferritin was detected. Following normalization of ferritin level (41ng/mL) with oral ferrous sulfate replacement, biochemical improvement was demonstrated (FGF23 69 RU/mL, phosphorus 5.0mg/dL and alkaline phosphatase 228 unit/L). Calcitriol and phosphate were discontinued. Three years later, the patient demonstrated improved developmental milestones, linear growth (length Z-score -2.01), radiographic normalization of metaphyses, and stabilization of craniosynostosis. While the most common cause of hypophosphatemic rickets is X-linked hypophosphatemia, other etiologies should be considered as treatment differs. In ADHR, normalization of iron leads to biochemical and clinical improvement.

Introduction of Solid Foods in Preterm Infants and Its Impact on Growth in the First Year of Life-A Prospective Observational Study.

The aim of this study was to investigate whether age at introduction of solid foods in preterm infants influences growth in the first year of life. This was a prospective observational study in very low birth weight infants stratified to an early (<17 weeks corrected age) or a late (≥17 weeks corrected age) feeding group according to the individual timing of weaning. In total, 115 infants were assigned to the early group, and 82 were assigned to the late group. Mean birth weight and gestational age were comparable between groups (early: 926 g, 26 + 6 weeks; late: 881 g, 26 + 5 weeks). Mean age at weaning was 13.2 weeks corrected age in the early group and 20.4 weeks corrected age in the late group. At 12 months corrected age, anthropometric parameters showed no significant differences between groups (early vs. late, mean length 75.0 vs. 74.1 cm, weight 9.2 vs. 8.9 kg, head circumference 45.5 vs. 45.0 cm). A machine learning model showed no effect of age at weaning on length and length z-scores at 12 months corrected age. Infants with comorbidities had significantly lower anthropometric z-scores compared to infants without comorbidities. Therefore, regardless of growth considerations, we recommend weaning preterm infants according to their neurological abilities.

Growth patterns by birth size of preterm children born at 24-29 gestational weeks for the first 3 years.

Concerns are prevalent about preterm infant long-term growth regarding plotting low on growth charts at discharge, stunting, underweight, high body fat and subsequent cardiometabolic morbidities. To examine (a) longitudinal growth patterns of extremely and very preterm infants to 3 years corrected age (CA) (outcome), categorised by their birthweight for gestational age: small, appropriate and large for gestational age (SGA, AGA and LGA, respectively) (exposure); and (b) the ability of growth faltering (<-2 z-scores) to predict suboptimal cognitive scores at 3 years CA. Post-discharge head, length, weight and weight-4-length growth patterns of the PreM Growth cohort study infants born <30 weeks and < 1500 g, who had dietitian and multi-disciplinary support before and after discharge, were plotted against the World Health Organization growth standard. Infants with brain injuries, necrotising enterocolitis and bronchopulmonary dysplasia were excluded. Of the included 405 infants, the proportions of infants with anthropometric measures > - 2 z-scores improved with age. The highest proportions <-2 z-scores for length (24.2%) and weight (24.0%) were at 36 gestational weeks. The proportion with small heads waslow by 0 months CA (1.8%). By 3 years CA, only a few children plotted lower than -2 z-scores for length, weight-4-length and weight (<6%). After zero months CA, high weight-4-length and body mass index > + 2 z-scores were rare (2.1% at 3 years CA). Those born SGA had higher proportions with shorter heights (16.7% vs. 5.2%) and lower weights (27.8% vs. 3.5%) at 3 years CA compared to those born AGA. The ability of growth faltering to predict cognitive scores was limited (AUROC 0.42, 95% CI 0.39, 0.45 to 0.52, 95% CI 0.41, 0.63). Although children born <30 weeks gestation without major neonatal morbidities plot low on growth charts at 36 weeks CA most catch up to growth chart curves by 3 years CA.

How do Age at the Surgery and Birth Weight Influence Post-Operative Anthropometric Parameters in Infants with Surgical Closure of Large Ventricular Septal Defects? A Prospective Cohort Study from a Lower-Middle-Income Country.

Closure of the large ventricular septal defects (VSD) in infancy can lead to normalization of growth, but data are limited. Our study is done to assess the growth pattern in different age groups of children and lower birth weight babies after shunt closure. This is a prospective observational study that included infants with isolated large VSD operated in infancy. Anthropometric data were collected at baseline and at follow-up, and growth patterns were analyzed. 99 infants were included in the study. The mean age and weight at the time of surgery were 6.97 ± 2.79months and 5.07 ± 1.16kg, respectively. The mean follow-up duration was 8.99 ± 2.31months. The weight for age (W/A) was the most adversely affected parameter preoperatively, and there was significant improvement noted in the mean Z score for W/A after shunt closure (-3.67 ± 1.18 vs. -1.76 ± 1.14, p = 0.0012). There was improvement in Z-scores for length for age (L/A) and weight for length (W/L), although it was not statistically significant. The infants from all the age groups had statistically significant growth in the anthropometric parameters. The rate of weight gain was maximum in the infants operated below 8months of age (2-4months = 3588g, 5-6months = 3592g, 7-8months = 3606g, 9-10months = 2590g, 11-12months = 2250g). Low birth weight and normal birth weight infants had similar Z-scores at the time of surgery and at follow-up in all 3 anthropometric parameters, and birth weight did not affect pre- as well as post-operative growth parameters. Suboptimal improvement in weight and length was seen in 40 and 20% of babies even after successful surgical repair, respectively. Growth failure in infants with a large VSD can be multifactorial. Early surgical closure of the shunt can lead to early normalization of growth parameters and faster catch-up growth. Few babies may fail to demonstrate a positive growth response even after timely surgical correction, and may be related to intrauterine and genetic factors or faulty feeding habits.

Nutritional status and clinical outcomes of brain tumor surgery in pediatric intensive care unit: A prospective cohort study

To determine whether nutritional status affects mortality and length of stay in the pediatric intensive care unit (PICU) after brain tumor surgery. Subjects aged 2 months to 13 years with brain tumor surgery were included in the study. Z-scores of BMI for age, weight for age, and weight for length were calculated at admission. Undernutrition was defined as Z-score<-2. Nutritional intake was measured daily by a clinical nutritionist. Outcomes to be measured included duration of hospitalization and mortality. Regression analyses was used to investigate the relationship between nutritional variables and outcomes. A total of 63 patients met the inclusion criteria. Undernutrition at admission was found in 33% of subjects based on Z-scores of BMI and weight for length. The mortality rate was 17.5%. Calorie and protein intake was <50% of the target in 50.7% and 42.8 % of children, respectively. Undernutrition by weight for age Z-score, BMI for age and weight for length Z-scores, and low protein intake increased mortality risk by 5, 5.9 and 4.7 times, respectively. The risk of shorter PICU-free days was independently 80% and 90% lower in those receiving <50% of protein and calorie requirements. Undernutrition at admission is prevalent in children undergoing brain tumor surgery and is associated with a higher risk of mortality. Caloric and protein intake during hospitalization is generally low, leading to longer PICU stay.

Association between phthalate metabolite mixture in neonatal cord serum and birth outcomes

Prenatal exposure to phthalates (PAEs) is ubiquitous among Chinese neonates. PAEs entering the body will be transformed to various hydrolyzed and oxidated PAE metabolites (mPAEs). PAEs and mPAEs exposure may lead to adverse birth outcomes through disruption of multiple hormone signaling pathways, induction of oxidative stress, and alterations in intracellular signaling processes. In this study, the concentrations of 11 mPAEs in 318 umbilical cord serum samples from neonates in Jinan were quantified with HPLC-ESI-MS. Multiple linear regression, Bayesian kernel machine regression, and quantile g-computation models were utilized to investigate the effects of both individual mPAE and mPAE mixture on birth outcomes. Stratified analysis was performed to explore whether these effects were gender-specific. mPAE mixture was negatively associated with birth length (BL) z-score, birth weight (BW) z-score, head circumference (HC) z-score, and ponderal index (PI). Mono(2-ethylhexyl) phthalate (MEHP) manifested negative associations with BL(z-score), BW(z-score), HC(z-score), and PI, whereas mono(2-carboxymethylhexyl) phthalate (MCMHP) was negatively associated with BW(z-score) and PI within the mPAE mixture. Stratified analysis revealed that the negative associations between mPAE mixture and four birth outcomes were attenuated in female infants, while the positive impact of mono(2-ethyl-5carboxypentyl) phthalate (MECPP) on BL(z-score) and BW(z-score) could be detected only in females. In summary, our findings suggest that prenatal exposure to phthalates may be associated with intrauterine growth restriction, and these effects vary according to the gender of the infant.

EFFECT OF ORAL VITAMIN D3 ON THYMIC INDEX IN MALNOURISHED CHILDREN

Objectives: To compare the thymic Index, vitamin D3 level, and T cell receptor excision circle (TREC) of healthy and malnourished infants. To evaluate the effect of oral vitamin D3 supplementation on the Thymic Index and TREC in malnourished children. Material and Methods: This quasi-experimental study (non-equivalent control group design) included 44 infants within the age range of 2 to 6 months. The cases were 22 malnourished infants, and 22 were healthy infants (controls) based on WHO Z scores classification (weight for length). Weight, age, thymic Index (TI), Vitamin D levels, and TRECs were recorded for cases and controls(pre-test). The cases were given Vitamin D supplementation for 8 weeks. The weight for length (z-score), thymic Index (TI), vitamin D levels, and TRECs were checked in these malnourished children on follow-up (post-test). Thymic Index (TI) was checked by ultrasonography (length multiplied by breadth). ELISA was performed to check Vitamin D levels and RT-PCR was done to compare TRECs. Results: The malnourished infants had a mean thymic index of 8.015 ±3.2192 as compared to controls of 11.667 ±3.2730. Post Vit D supplementation TI increased (8.459 ±3.2191) in cases. Weight, length, and Z scores were found to be directly related to TI values. Pre and Post supplementation TI were strongly correlated to each other (r= 0.985, p= &lt;0.001). The thymic index increased significantly (p= 0.001) after intervention. There was a statistically non-significant rise in TRECS (809 vs 4242) (p= 0.075) after vitamin D supplementation. The Pearson Correlation showed no significant correlation of TRECS to any of the variables including the Thymic index. Conclusion: TI (thymic size) and vitamin D levels increase with vitamin D supplementation in malnourished children. However, Vitamin D supplementation has no significant effect on TRECS. Keywords: Malnourished, Vitamin D3, T cell receptor excision circles, Thymic Index, TRECs.

Continuous Neuromuscular Blockade for Bronchopulmonary Dysplasia.

Bronchopulmonary dysplasia (BPD) is the most common late morbidity for premature infants. Continuous neuromuscular blockade (CNMB) is suggested for the most unstable phase of BPD, despite no outcome data. We explored the association between duration of CNMB for severe BPD and mortality. Medical record review of children <5 years old admitted from 2016 to 2022 with BPD and one or more course of CNMB for ≥14 days. Twelve children received a total of 20 episodes of CNMB for ≥14 days (range 14-173 d) during their hospitalization. Most (10/12) were born at <28 weeks' gestation and most (11/12) with birth weight <1,000 g; 7/12 were of Black race/ethnicity. All were hospitalized since birth. Most (10/12) were initially transferred from an outside neonatal intensive care unit (ICU), typically after a >60-day hospitalization (9/12). Half (6/12) of them had a ≥60-day stay in our neonatal ICU before transferring to our pediatric ICU for, generally, ≥90 days (8/12). The primary study outcome was survival to discharge: 2/12 survived. Both had shorter courses of CNMB (19 and 25 d); only one child who died had a course ≤25 days. Just two infants had increasing length Z-scores during hospitalization; only one infant had a final length Z-score > - 2. In this case series of infants with severe BPD, there were no survivors among those receiving ≥25 days of CNMB. Linear growth, an essential growth parameter for infants with BPD, decreased in most patients. These data do not support the use of ≥25 days of CNMB to prevent mortality in infants with severe BPD. · This is a case series of neuromuscular blockade for severe BPD.. · Neuromuscular blockade did not improve linear growth.. · Ten out of 12 infants who were on prolonged neuromuscular blockade died..

Head circumference at birth and postnatal growth trajectory in vulnerable groups from Argentina.

To investigate the association between the anthropometric status at birth and brain and bone growth during the first year of life. According to the brain-sparing hypothesis, we expect catch-up to be faster in head circumference (HC) than in body length. This is a longitudinal design that included Argentinian infants under 12 months of age with at least three anthropometric records. We classified study participants into four growth status categories according to z-scores for HC (HCZ) and length (LAZ) at birth, with z-score = -2 as a threshold. We used the Count model to describe growth trajectories in HC and length in the first year of life according to the growth status at birth. Recovery indicator for HC and length was taken as the time until the predicted growth trajectory surpassed the threshold curve predicted by z-score = -2 for age. Growth models included 3399 infants. There were significant differences in the growth parameters between groups in all cases (p < 0.05). Within the group with a low HCZ and a low LAZ at birth, HC recovery was faster than length. In the case of a low z-score for only one of the variables, newborns with a low HCZ recovered faster than individuals born with a low LAZ. The postnatal growth pattern in HC and length is associated with the growth status of HC and length at birth. As we hypothesized, the fastest postnatal recovery occurs for HC in cases of intrauterine delayed growth.

Association between chronic diuretics and postnatal growth in preterm infants with bronchopulmonary dysplasia

BackgroundChronic diuretics such as thiazides and spironolactone are frequently used off-label in preterm infants with evolving or established bronchopulmonary dysplasia (BPD). Infants who are high risk for BPD are already predisposed to poor postnatal growth and the effect of chronic diuretics on postnatal growth is not well studied. ObjectiveExploratory study to determine the association between chronic diuretic exposure and short-term postnatal growth in preterm infants born at less than ≤ 29 weeks gestational age (GA). MethodsSingle-center retrospective cohort study in a level IV neonatal intensive care unit over a 2-year period (2021–22). Eligible infants exposed to chronic diuretics > 5 days for BPD (diuretic group) were compared to infants who were not (non-diuretic group). ResultsIn total, 53 infants (19 diuretic, and 35 non-diuretic group) were identified. The GA (25.3 vs 27.0 weeks) and birth weight (780 vs. 995 gs) were significantly lower in diuretic vs. non-diuretic group (p = 0.01). Diuretic group had higher intubation rate at birth, more days on non-invasive ventilation, higher incidence of moderate/severe BPD, and longer hospital stay (all p < 0.05). The GA adjusted z-scores for weight, length, and head circumference at birth, at 36-week corrected GA, and at discharge were similar in both groups. Also, the z-score change from birth at 36-week corrected GA, and at discharge were similar in both groups. There was no significant short-term change in weight z-score in the 2 weeks following chronic diuretic exposure. ConclusionsChronic diuretic exposure has no significant association with short-term postnatal growth in preterm infants.

Glucocorticoid use and varying doses on the long-term outcomes of offspring born to patients with systemic lupus erythematosus.

This study aims to assess the impact of non-fluorinated glucocorticoid use and varying doses on the long-term physical, neurological, and social-emotional development outcomes of offspring born to patients with systemic lupus erythematosus (SLE). The goal is to provide guidance on the appropriate dosage of glucocorticoids during pregnancy in SLE patients. We conducted a follow-up study on the offspring of SLE patients who had pregnancies and were admitted to our obstetrics department between January 1, 2016, and September 30, 2021. Patients who received immunosuppressants and dexamethasone were excluded from the study. The SLE patients were categorized into three groups based on their glucocorticoid use during pregnancy: hormone-free group, ≤ 10mg/day group, and > 10mg/day group (equivalent to prednisone). Most patients in the three groups were used hydroxychloroquine during pregnancy. We assessed the physical development status, including weight, height (length), and other relevant factors in three groups. Additionally, we utilized the Age and Stages Questionnaires, Third Edition (ASQ-3) to evaluate the development of communication, gross motor, fine motor, problem-solving, and personal-social. The social-emotional development status was assessed using the Age and Stages Questionnaires: Social-Emotional (ASQ: SE). We standardized the weight, height (length), body mass index, and ASQ-3 domain scores of children of different ages and genders into Z-scores for comparison. The results of this study demonstrated no statistically significant differences in the long-term physical development, neurological development, and social-emotional development outcomes of the offspring of SLE patients in three groups. However, while not reaching statistical significance, it was found that the offspring of the > 10mg/day group had lower height (length) Z-scores and communication Z-scores compared to the other groups. Conclusion: The use of non-fluorinated glucocorticoids during pregnancy and varying doses did not have a significant impact on the long-term physical, neurological, and social-emotional development outcomes of offspring born to SLE patients. However, the offspring of SLE patients treated with glucocorticoids > 10mg/day during pregnancy may be necessary to strengthen the monitoring of height (length) and communication skills in the long term. What is Known: • Fetal exposure to glucocorticoids can have implications for the development of multiple systems and may persist after birth, potentially increasing the risk of neurological abnormalities and other diseases. • There is limited research on the long-term development of offspring born to SLE patients, especially the patients treated with glucocorticoids. What is New: • The use of non-fluorinated glucocorticoids during pregnancy and varying doses did not have a significant impact on the long-term outcomes of offspring born to SLE patients. • The offspring of SLE patients treated with glucocorticoids >10 mg/day during pregnancy may be necessary to strengthen the monitoring of height (length) and communication skills in the long term.