Normal Birth Weight Counterparts Research Articles

Birth Weight was Favorably Associated With Physical Fitness in Childhood After Adjustment for Several Perinatal Factors

The purpose was to examine the potential associations of birth weight and infant growth with physical fitness (PF) components in childhood. A random sample of 5125 dyads of children aged 8-9years and their mothers were evaluated. Telephone interviews were carried out with the use of a standardized questionnaire for the collection of maternal lifestyle factors. Mothers were asked to provide information contained in their medical booklets and pregnancy ultrasound records. Data from 5 PF tests were used to assess cardiorespiratory fitness, speed, and body strength. Linear regression analysis was applied to assess the associations between birth weight and infant growth with PF test performances and logistic regression analysis to evaluate the associations of normal weight versus low birth weight and normal versus accelerated infant growth with PF tests performance categories (low vs high/average). Birth weight was favorably associated with cardiorespiratory fitness (b = 0.12 stage increase per SD increase in birth weight, P = .047), lower body strength (b = 1.07, P = .037), upper body strength (b = 0.10, P = .038), and speed (b = -0.04, P = .001), and infant growth was associated with upper body strength (b = 0.21cm increase per SD increase in infant weight gain, P < .001) after adjusting for children's body mass index and several perinatal factors. Low birth weight children had 35% increased odds for low performances in PF tests compared with their normal birth weight counterparts. Low birth weight negatively affects childhood PF, and hence, it could play an unfavorable role in the future health of the offspring.

Birth weight and prediabetes in a nationally representative sample of US adolescents.

Prediabetes affects about 20% of adolescents in the United States. Previous studies have shown that low and high birth weight impairs glucose homeostasis in adults; however, limited research has examined this relationship in adolescents. To investigate association of birthweight with prediabetes in US adolescents using data from NHANES 2005-2016 and examine whether sex and obesity moderate this relationship. Adolescents, aged 12-15 years without diagnosed/undiagnosed diabetes and extreme birthweight (n=1396), were classified as low birth weight (LBW), normal birthweight (NBW) and high birth weight (HBW). Logistic regression examined relationship of birthweight with odds of prediabetes. Likelihood ratio test tested interactions of birthweight with sex and obesity measures. In this nationally representative cross-sectional study, LBW adolescents had significantly higher odds of prediabetes compared to NBW counterparts (Odds ratio [95% confidence interval]=1.93 (1.10, 3.38); p < .05). Sex and obesity moderated the association, such that the strength of the relationship of LBW with increased prediabetes odds was greater among male adolescents (Odds ratio [95% confidence interval]=2.40 (1.02, 5.67); p < .05) and those with overweight/obesity (Odds ratio [95% confidence interval]=2.13 (1.01, 4.49); p < .05). Findings imply that the adverse effects of LBW on glucose homeostasis could be manifested early in life. Further, the higher odds of prediabetes among LBW adolescents who are male or have overweight/obesity underscore the heightened need for prediabetes screening of these subgroups.

511 Late-Breaking: Dietary Glycine Supplementation During Growing and Finishing Phases Increases Body Weight and Improves Meat Quality of Intrauterine Growth Restricted Pigs

Abstract Glycine is required for maximum growth and development for growing pigs. Traditional swine diets are deficient in glycine. This is concerning for intrauterine growth restricted (IUGR) pigs (20–25% of all pigs born) as they are born with low bodyweights and underdeveloped skeletomuscular systems. Therefore, IUGR piglets are culled at birth, as they are unlikely to survive and unable to reach market weight at the same rate as normal birthweight (NBW) littermates. Additionally, IUGR pigs are not fed to market weight due to undesirable carcass attributes at slaughter such as increased subcutaneous fat deposition and decreased overall desirable protein yield. This study was designed to test the hypothesis that providing dietary glycine supplementation in traditional corn- and-soybean meal-based diets would improve the growth rate of IUGR pigs between weaning (age 21d) and market weight (age 188d). Fourteen IUGR pigs (birthweight = 0.98±0.03 kg, mean ± SEM) and 20 NBW pigs (birthweight = 1.44±0.02 kg, mean ± SEM) were obtained at weaning and used for this study. Pigs from each birthweight group were randomly assigned to 1% glycine + 0.19% corn starch treatment group or 1.19% alanine group (isonitrogenous control). Data were analyzed by using 2-way ANOVA and Duncan multiple comparison test. At 188 d of age, glycine supplemented IUGR pigs were 4.4 kg heavier (P &amp;lt; 0.05) than control IUGR pigs, and had similar (P &amp;gt;0.05) body weights to those NBW counterparts. Feed intake did not differ among the treatment groups (P &amp;gt;0.05). Additionally, glycine supplementation improved markers of meat quality in IUGR pig carcasses compared to control IUGR carcasses, including decreased backfat thickness, increased loineye area, and increased overall muscle score (P &amp;lt; 0.05). Overall, results of this study show that dietary glycine supplementation to IUGR pigs post-weaning has positive effects on lean tissue gain and meat quality. (Supported by USDA-NIFA)

Birthweight determines intestinal microvasculature development and alters endothelial nitric oxide synthase density in young piglets.

Blood supply to enterocytes dictates intestinal health and nutrient absorption. These two aspects are impaired in low birthweight (LBW) piglets, but whether the perfusion to intestinal tissues is implicated as well is still unknown. Thus, structural changes in the microvasculature of LBW and normal birthweight (NBW) piglets were investigated during early postnatal development. Additionally, the presence of endothelial nitric oxide synthase (eNOS) in the intestinal mucosa was assessed given its important role to assure perfusion. A total of 22 pigs (11 LBW and 11 NBW) were sacrificed at days 0, 3, 8 and 19 of life. Body weight and intestinal length were recorded and a piece of the small intestine was sampled for immunohistochemical analysis of von Willebrand Factor (vWF, an endothelial cell marker) and eNOS. LBW piglets had a relatively (to body weight) longer intestine than their NBW counterparts. Age did not affect microvasculature, which was more abundant (85% larger vWF-positive area) in NBW than LBW pigs. However, an interaction age*BW was observed for eNOS-IR, showing that eNOS presence peaked in NBW piglets on the first day of life and subsequently decreased. This pattern was not observed in LBW piglets. The less abundant intestinal endothelial mass and the different pattern of eNOS expression observed in LBW piglets suggests microcirculation as a contributing factor in the impaired digestive functioning and gut health of LBW pigs. However, revealing whether the origin of this alteration is prenatal or postnatal, for example due to a lower milk intake, needs further study.

Characteristics of the gut microbiota colonization, inflammatory profile, and plasma metabolome in intrauterine growth restricted piglets during the first 12 hours after birth.

Intrauterine growth restriction (IUGR) predisposes newborns to inflammatory and metabolic disturbance. Disequilibrium of gut microbiota in early life has been implicated in the incidence of inflammation and metabolic diseases in adulthood. This study aimed to investigate the difference in gut microbiota colonization, cytokines and plasma metabolome between IUGR and normal birth weight (NBW) piglets in early life. At birth, reduced (P < 0.05) body, jejunum, and ileum weights, as well as decreased (P < 0.05) small intestinal villi and increased (P < 0.05) ileal crypt depth were observed in IUGR piglets compared with their NBW counterparts. Imbalanced inflammatory and plasma metabolome profile was observed in IUGR piglets. Furthermore, altered metabolites were mainly involved in fatty acid metabolism and inflammatory response. At 12 h after birth and after suckling colostrum, reduced (P < 0.05) postnatal growth and the small intestinal maturation retardation (P < 0.05) continued in IUGR piglets in comparison with those in NBW littermates. Besides, the gut microbiota structure was significantly altered by IUGR. Importantly, the disruption of the inflammatory profile and metabolic status mainly involved the pro-inflammatory cytokines (IL-1β and IFN-γ) and amino acid metabolism. Moreover, spearman correlation analysis showed that the increased abundance of Escherichia-Shigella and decreased abundance of Clostridium_sensu_stricto_1 in IUGR piglets was closely associated with the alterations of slaughter weight, intestinal morphology, inflammatory cytokines, and plasma metabolites. Collectively, IUGR significantly impairs small intestine structure, modifies gut microbiota colonization, and disturbs inflammatory and metabolic profiles during the first 12 h after birth. The unbalanced gut microbiota mediated by IUGR contributes to the development of inflammation and metabolic diseases.

Associations between birthweight and overweight and obesity in school-age children.

Relationships between birthweight and future obesity risk remain unclear. To assess associations between birthweight and later obesity in a nationally representative cohort of early school-aged children. We used linear and logistic regression to evaluate 10186 term- or preterm children in the Early Childhood Longitudinal Study-Kindergarten Cohort 2011 for relationships between birthweight and later obesity and change in BMI z-score from kindergarten-to-second grade. All analyses were adjusted for sex, race/ethnicity, parental education and household income. Compared to children born normal birthweight (NBW), high birthweight (HBW) term children and large-for-gestational-age (LGA) preterm children had significantly greater BMI z-scores from kindergarten-to-second grade (p<0.001). Term children born HBW had higher odds of obesity by kindergarten (adjusted odds ratios [aOR] 1.91, p<0.0001). Among preterm children, odds of obesity was higher among LGA children starting in first grade (aOR 2.34, p<0.05) and among small-for-gestational age children in second grade (aOR 2.26, p<0.05). Compared to NBW children, HBW children had greater change in BMI z-score between kindergarten-first grade (p<0.01). High birthweight term and LGA preterm children had increased adjusted odds of obesity in school-age compared to their NBW counterparts. Physicians may provide counselling early in life for families of large infants to help prevent future obesity.

Effects of Intrauterine Growth Restriction and Female Sex on Future Blood Pressure and Cardiovascular Disease.

It is well-established that the age-related increase in blood pressure is augmented after menopause. Yet, the prevalence of hypertension is enhanced in low birth weight women relative to normal birth weight counterparts by 60years of age suggesting that adverse influences during fetal life heighten cardiovascular risk in later life. A changing hormonal milieu may contribute to increased cardiovascular risk that occurs after the menopausal transition. Low birth weight is associated with early age at menopause. A recent study indicates that a shift towards testosterone excess following early reproductive senescence may contribute to the etiology of age-dependent increases in blood pressure in a rodent model of low birth weight. This review will highlight current findings related to postmenopausal hypertension and discuss potential mechanisms that may contribute to the enhanced cardiovascular risk that develops with age in low birth weight women.

Low birthweight increases risk for cardiovascular disease hospitalisations in a remote Indigenous Australian community – a prospective cohort study

Objectives:To investigate the association between low birthweight (LBW; <2,500 grams) and cardiovascular disease (CVD) hospitalisations in adult life in a remote Indigenous Australian community. Methods:This was a prospective cohort of 852 participants with recorded birthweight using community‐wide health screening examinations conducted between 1992 and 1999 and hospitalisation records up to 2012. Cox proportional hazard models assessed the association between LBW and hypertension, major CVD (heart failure, myocardial infarction and stroke) and any CVD hospitalisations. Results:There were 236 participants (28%) who had a low birthweight. The LBW group had a higher risk of developing any CVD (HR = 1.43, 95%CI 1.01–2.03), major CVD (HR = 1.51, 95%CI 0.93–2.47) and hypertension (HR = 1.83, 95%CI 1.09–2.96) than the normal birthweight (NBW) group (≥2,500 g). Women with LBW had more than 2.6 times the risk of a hospitalisation associated with hypertension compared to their NBW counterparts (HR = 2.61, 95%CI 1.38–4.93), but this relationship was not seen in men. Conclusions and implications:LBW increased the risk of cardiovascular disease hospitalisations in adult life in this group. Further CVD prevention initiatives should continue to include LBW as a key predictor of CVD in this community. The mechanisms of gender influence on the hypertension relationship are unknown and require further investigation in indigenous populations worldwide.

A cross-sectional study of determinants of birth weight of neonates in the Greater Accra region of Ghana.

BackgroundBirth weight is a major determinant of infant morbidity and mortality. Fetal undernourishment means an increased risk of dying during a baby’s early months and years. Birth weight has emerged as the leading indicator of infant health and welfare and the central focus of infant health policy. The issues have not been comprehensively evaluated in part due to lack of or limited empirical data. To this end, this study is aimed to evaluate the effects of maternal determinants on the birth weights of neonates in two major hospitals.ResultsLow birth weight neonates were significantly (p < 0.001) associated with low gestation at birth (34.8 ± 3.8) while mothers of low birth weight neonates had significantly (p = 0.034) lower body mass index (27.3 ± 5.4) than their normal birth weight counterparts (29.0 ± 6.3). Gestation at birth (p < 0.001), diastolic blood pressure (p = 0.008) was the only significant determinant of birth weight.ConclusionAn increase in gestation at birth by 1 week results in over twice more likelihood of a normal birth weight while a rise in diastolic blood pressure is less likely to give rise to a normal birth weight neonate.

Motor Coordination Difficulties in Extremely Low Birth Weight Survivors Across Four Decades.

To compare levels of motor coordination difficulties in a cohort of extremely low birth weight (ELBW; <1000 g) survivors and normal birth weight (NBW) controls from childhood until age 36. The stability of motor coordination in ELBW and NBW adults from their 20s to their 30s was also assessed. This study uses a prospectively followed population-based birth cohort of ELBW survivors born between 1977 and 1982 in Ontario, Canada, to compare motor coordination at age 8, age 22 to 26, and age 29 to 36 in ELBW survivors relative to a matched group of NBW controls across a number of different measures. After adjusting for neurosensory impairment, ELBW survivors had significantly higher levels of motor coordination difficulties than their NBW counterparts at age 8, 22 to 26, and 29 to 36. Self-reported motor coordination remained relatively stable from age 22 to 26 to age 29 to 36 in both groups. ELBW survivors display higher levels of motor coordination difficulties than NBW controls in childhood through their mid 30s. Motor coordination seems to be stable from age 22 to 36 in both groups, suggesting that the presence of motor problems in ELBW survivors can have important implications for functional outcomes in adulthood.

Neurodevelopmental outcomes of infants born prematurely.

Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.

Still cautious: Personality characteristics of extremely low birth weight adults in their early 30s

Extremely low birth weight survivors (ELBW; <1000g) display a personality style characterized by cautiousness, shyness, and risk aversion in their 20s. We examined whether non-impaired ELBW survivors were still more cautious than their normal birth weight (NBW) peers at ages 30–35 and assessed the stability of this personality characteristic across approximately a decade in the oldest known cohort of ELBW survivors. Of the 154 participants tested at ages 22–26, 111 (i.e., 72%) of them returned approximately 10years later [i.e., 69% (49/71) ELBW and 75% (62/83) NBW], and once again they completed the Eysenck Personality Questionnaire-Revised (EPQ-R). We created the same theoretically and empirically derived composite measure of cautiousness at each visit by summing the EPQ-R psychoticism scale (reverse scored) and the EPQ-R lie scale. We found that ELBW adults reported higher cautiousness than their NBW counterparts at ages 30–35. We also found that levels of cautiousness remained stable over approximately 10years in both groups. Our findings suggest that individuals born at ELBW were more cautious than NBW peers and that this personality characteristic remained stable into their early 30s. The present study appears to be the first empirical demonstration of personality stability among adult ELBW survivors.

Developmental defects of enamel in primary teeth and association with early life course events: a study of 6–36 month old children in Manyara, Tanzania

BackgroundChildren with low birth weight show an increased prevalence of developmental defects of enamel in the primary dentition that subsequently may predispose to early childhood caries (ECC).Focusing 6–36 months old, the purpose of this study was to assess the frequency of enamel defects in the primary dentition and identify influences of early life course factors; socio-demographics, birth weight, child’s early illness episodes and mothers’ perceived size of the child at birth, whilst controlling for more recent life course events in terms of current breastfeeding and oral hygiene.MethodsA cross-sectional study was conducted in the high fluoride area of Manyara, northern Tanzania including 1221 child-mother pairs who attended Reproductive and Child Health (RCH) clinics for immunization and/or growth monitoring. After the primary caregivers had completed face to face interviews at the health care facility, children underwent oral clinical examination whereby ECC and developmental defects of enamel were recorded using field criteria. All erupted teeth were examined and the enamel defects were assessed on buccal surfaces according to the modified DDE Index.ResultsThe prevalence of enamel defects was 33.3%. Diffuse opacities were the most common defects identified (23.1%), followed by hypoplasia (7.6%) and demarcated opacities (5.0%). The most frequently affected teeth were the upper central incisors (29.0% - 30.5%), whereas lower central incisors (4.3% to 4.5%) were least frequently affected. Multiple logistic regression analysis, adjusting for confounding the factors revealed that having normal birth weight (equal or more than 2500 g) associated with lower odds of having enamel hypoplasia [OR 0.2 (95% CI 0.1-0.7)]. No statistically significant association occurred between birth weight and diffuse opacities, demarcated opacities or combined DDE.ConclusionChildren with the history of low birth weight were more likely than their normal birth weight counterparts to present with enamel hypoplasia. In view of the frequent occurrence of enamel defects and the fact that hypoplasia may constitute a risk factor for future ECC, enamel defects should be included as a dental health indicator in epidemiological studies of children in northern Tanzania.

Low birth weight and health expenditures from birth to late adolescence

The aim of this paper is to analyze the impact of low birth weight (LBW) and very low birth weight (VLBW) on health care utilization in childhood and early adolescence. Using Austrian health insurance administrative panel data linked to the Austrian birth register, we estimate the effects of LBW and VLBW in comparison to normal birth weight (NBW) on the number of days spent in the hospital and on expenditures for medical assistance and medical drugs among children and young adults between birth and 21 years of age. To account for the time-invariant heterogeneity of mothers, we control for sibling fixed effects. We find that, in comparison to their NBW counterparts, LBW infants spend more days hospitalized and more is spent on medical drugs (particularly on anti-infectives) for them in their first year of life. Although the absolute differences in health service utilization between NBW and LBW groups diminish over time, LBW newborns still spend more days hospitalized, and their medical drug and medical assistance expenses are significantly higher in early childhood. During compulsory schooling, we observe a shift toward diseases of the nervous system and mental and behavioral disorders among children born with LBW. Some of these effects persist until early adulthood. We argue for further counseling efforts for expectant mothers on the determinants and risk factors of LBW. Moreover, pre-school screenings especially tailored to LBW infants with a particular focus on mental health and behavioral disorders can be easily integrated in the existing postnatal mother-child care program in Austria to mitigate the consequences of negative conditions during pregnancy.

Economic Outcomes in Young Adulthood for Extremely Low Birth Weight Survivors

The goal was to compare educational attainment and labor market outcomes in young adulthood (21-26 years of age) for a Canadian, population-based cohort of 149 extremely low birth weight (ELBW) (<1000 g) survivors and a normal birth weight (NBW) cohort of 133 young adults from the same geographic area who were matched to the ELBW cohort in childhood. We estimated the effects of ELBW status, according to gender, on continuous outcomes through least-squares regression and those on binary outcomes through logistic regression. We controlled for family background and considered neurosensory impairment and IQ as mediating variables. Controlling for family background, ELBW male subjects were less likely to complete high school or to attend a university than were their NBW counterparts, and their educational attainment was reduced by >1 year. Among subjects who were working, weekly earnings were ∼27% lower. ELBW female effects on education were not significant, but ELBW female subjects were less likely than NBW subjects to be employed or in school and they also seemed to experience lower earnings. Our findings suggested that ELBW survivors are somewhat less productive as adults, on average, than are subjects born NBW and that effects are not confined to subjects with severe neurosensory impairments. In accord with other studies, however, we found that productivity deficits for most ELBW subjects were not large.

Shyness and Timidity in Young Adults Who Were Born at Extremely Low Birth Weight

Recent studies have noted personality differences among adult survivors of very preterm birth, including higher neuroticism and cautiousness and lower extraversion. We attempted to replicate and extend these recent studies by examining personality characteristics across multiple components of personality that traditionally define personality structure in a birth cohort of young adults born at extremely low birth weight (501-1000 g), the smallest and most at-risk infants. We assessed 71 (76% of the original birth cohort) extremely low birth weight and 83 (74% of the original cohort) term normal birth weight young adults by using well-validated personality measures, indexing 4 traditional components of personality: temperament (Cheek and Buss shyness and sociability and Eysenck neuroticism and extraversion), motivation (Carver and White behavioral inhibition and behavioral activation), cognitive and affective (Coopersmith self-esteem and University of California, Los Angeles, loneliness), and socialization (Eysenck psychoticism and lie). All of the participants were right-handed and free of neurosensory and psychiatric impairments. Extremely low birth weight adults reported significantly higher shyness, behavioral inhibition, and socialization (a measure of prosocial behavior defined by risk aversion and adherence to societal mores) and lower sociability and emotional well-being than their normal birth weight counterparts, replicating and extending the findings of previous studies. Young adults who were born at extremely low birth weight and without major impairments are more cautious, shy, and risk aversive and less extraverted than their normal birth weight counterparts, possibly placing them at risk for future psychiatric and emotional problems.

Neurodevelopmental Outcomes of Infants Born Prematurely

Long-term follow-up of infants born prematurely is necessary to determine neurodevelopmental outcomes, particularly with the expansion of interest from major disabilities to high prevalence/low severity dysfunctions. Models of pathogenesis include changes due to developmental disruptions and to injury, the magnitude and type of change influenced by the infant's age, and central nervous system recovery and reorganization. Alterations in neurogenesis, migration, myelination, cell death, and synaptogenesis occur even in the absence of insult. Despite increased knowledge regarding these processes, the functional significance of brain abnormalities is unclear. Because of methodologic problems in follow-up studies, it is difficult to characterize outcome definitively. Nonetheless, an acceptable degree of agreement across studies is found with regard to specific neurodevelopmental outcomes: motor/neurologic function, visuomotor integrative skills, IQ, academic achievement, language, executive function, and attention-deficit hyperactivity disorder/behavioral issues. In general, children born prematurely have more problems in these areas than do their normal birth weight counterparts. Suggestions for improved analyses and clarification of outcomes include use of cluster analysis, structural equation modeling, growth curve analysis, developmental epidemiologic approaches, and better control of background variables using risk indexes and factor scores. Better assessment techniques measuring functions documented to be at higher risk of problems are discussed.

Gross motor skills of premature, very low-birthweight Chinese children.

We investigated whether premature, very low-birthweight (VLBW) Asian children without major handicap had poor motor skills compared with their normal birthweight counterparts. We compared a cohort of 42 preterm babies with birthweights <1500 g who participated in a developmental stimulation programme with 69 children of normal birthweight matched for age, gender and paternal education. VLBW children participated in the programme for 3 years and were followed to the age of 5-7 years. The VLBW cohort had significantly lower scores in B- and C-rated skills of the Peabody Developmental Motor Scales. Their total score was also significantly lower. This is in agreement with studies in other populations that found that VLBW children had lower motor scores and that early interventions failed to ameliorate this motor disadvantage.

Intellectual psycho-educational and functional status of low birth weight survivors beyond 5 years of age.

To determine the intellectual, psycho-educational and functional status of low birth weight (LBW) survivors (birth weight < or = 2000 gms) beyond 5 years of age and to compare their status with normal birth weight counterparts. This was cross-sectional study. On hospital based cohort on longitudinal follow-up at the High Risk and Well Baby Clinics of a teaching hospital. The demographic data of these children was recorded. A detailed physical examination was performed. The tests of cognition included the Stanford Binet and the Raven's Progressive Matrices. Academic achievement was evaluated by the Wide range achievement test-Revised (WRAT-R). Assessment of visuo motor integration was done by the Bender Gestalt Test. The proportion of children having soft neurological signs was determined. Vineland Social Maturity Scale was performed on all children. Fifty-nine LBW children and fifty-seven matched control children participated in the study. 27 of LBW children were examined at a mean age of 7.0 +/- 1.1 years (group I) and 32 were examined at a mean age of 10.6 +/- 1.2 years (group II). The LBW children as a group performed in the normal range on the tests of cognition and academic achievement, but were significantly disadvantaged (p < 0.005) as compared to controls. A higher percentage of LBW children had low scores on the Bender Gestalt. Test as compared to controls but the difference was not significant. A significantly higher proportion of LBW children of both the groups showed the presence of soft neurological signs as compared to controls. The social quotient as assessed by the vineland Social Maturity Scale was significantly lower in the LBW children as compared to controls. Thus, though the LBW children were performing in the normal range on various measures, comparison with the control group showed that they were clearly disadvantaged on nearly every measure tested, emphasizing the need for early detection and referral for special education.

Effects of intrauterine growth retardation and prematurity on spirometric flow values and lung volumes at school age in twin pairs.

Lung volumes and pulmonary expiratory flow values were investigated in 67 children from multiple pregnancies (30 twins, one set of triplets, one set of quadruplets) at the age of 7-15 years. At birth, 30 of 67 children (44%) had intrauterine growth retardation (IUGR, birth weight <-2 SD or birth weight difference between twin-pairs >1.3 SD). The median gestational age was 35 weeks (range, 28-38 weeks), and the median birth weight was 2,050 g (800-3,150 g). Lung functions were measured with a heated pneumotachograph. Data were standardized using height-based reference equations. No differences were found in lung volumes between children with IUGR and those children who had normal birth weight. Gestational age did not correlate with either airway flow rates or lung volumes. Maximum mid-expiratory flow (FEF50) did not correlate with standardized birth weight or with gestational age. In discordant twin pairs, the IUGR twins had significantly lower FEF50 than their normal birth weight counterparts (p=0.03, Z=-2.13). In the whole study group (67 children), children with IUGR had significantly lower FEF50 than children with normal birth weight (p=0.04; CI, 0.3-19.9). We propose that IUGR has the most pronounced effect on the growth of airways, and no detectable influence on lung volumes. This study confirms the crucial effect of appropriate intrauterine growth on subsequent growth on pulmonary airways.