Head Circumference Percentile Research Articles

Gestational age-specific centile charts for anthropometry at birth for south Indian infants

To construct centile charts for birth weight, length and head circumference for infants born from 24 to 42 weeks of gestation and to compare with the other national and international growth charts. Observational descriptive study. All consecutively live born singleton infants from 24 to 42 weeks of gestation. Data were retrieved for the birth weight, length and head circumference of infants born from July 1999 to October 2009. Smoothened percentile curves were created separately for the male and female infants by Lambda Mu Sigma (LMS) method. The new curves were compared with the other Indian and international growth charts. Raw and smoothened curves for weight, length and head circumference centiles at birth were created from 31,391 (males: 16,054 and females: 15,337), 28,812, (males: 14,730 and females: 14,082), and 28,790 (males: 14,724 and females: 14,066) infants, respectively. Females infants were lighter than the male infants, especially from 35 weeks onwards. On comparing the study curves with the other Indian growth curves, for infants less than 35 weeks, the mean birth weight for the study infants were similar or lower and for infants greater than 35 weeks, they were higher. On comparison of our weight centiles with the international data, across all gestations and across all centiles, our birth weights are lower. The updated centile charts in this study may be used as reference charts for the birth weight, length and head circumference for the local population. Using earlier growth charts or the Western charts would misclassify the infants at birth into SGA or LGA.

Child Neurology: Epilepsy of infancy with migrating focal seizures

Epilepsy of infancy with migrating focal seizures is a rare, infantile epileptic encephalopathy characterized by normal early development, refractory focal seizures arising independently from both hemispheres, and severe psychomotor retardation. In the revised terminology by the International League Against Epilepsy, it has been classified as an “electro-clinical syndrome” of “unknown cause” with onset in infancy.1 Affected infants have progressive psychomotor retardation and decline of head circumference percentile. We present a 6-month-old boy diagnosed with this entity and discuss the approach to an infant with unexplained refractory seizures. A 6-month-old boy presented with developmental delay and focal seizures. He was the second child born to a third-degree consanguineous couple. His perinatal period had been uneventful and he had attained social smile by the age of 6 weeks. He started having seizures at the age of 2 months. The seizures consisted of deviation of eyes and head along with tonic posturing of arm or leg of either side and associated flushing. The seizures usually lasted for 1–2 minutes. The initial frequency was 2–3 per day but gradually over the next 4 months, it increased to 50–60 per day. He had been treated with phenobarbitone, phenytoin, carbamazepine, topiramate, and levetiracetam without success. He had lost social smile, and not gained any new developmental milestones. Family history was not significant. Examination revealed a well-thriving baby with head circumference of 40 cm (<−2 SD). There were no neurocutaneous markers or dysmorphic features. The neurologic examination revealed reduced interaction and alertness, normal cranial nerves including fundus, and normal tone with brisk tendon reflexes and extensor …

The associations between ethnicity and outcomes of infants in neonatal intensive care units

ObjectiveTo determine the associations between maternal ethnicity and outcomes of infants born between 22 and 31 weeks' gestation and admitted to neonatal intensive care units in New South Wales and...

The management of sagittal synostosis using endoscopic suturectomy and postoperative helmet therapy

Suturectomy as a treatment for craniosynostosis was largely replaced in the late twentieth century by more extensive, but predictable, cranial remodeling procedures. Recent technical innovations, such as using the endoscope combined with postoperative orthotic reshaping, have led to a resurgence of interest in suturectomy as a safer, less invasive method. A retrospective chart review was performed for all cases of sagittal synostosis treated with endoscopic sagittal suture strip craniectomy and helmet therapy between 2004 and 2008. Data collected included gestational age, genetic evaluations and syndromic status, age at operation, duration of procedure, need for blood transfusions, length of hospital stay, preoperative and postoperative head circumference percentile and cranial index, duration of helmet use, length of follow-up, complications, and revisions. Fifty-six patients with isolated sagittal synostosis were treated using endoscopic suturectomy and completed helmet therapy. Mean age at time of procedure was 3.24 months. Mean operative duration was 45.32 minutes. Mean hospital stay was 1.39 days. There were 2 transfusions and no deaths. The mean length of follow-up was 2.34 years. Helmet therapy was instituted for a mean of 7.47 months. Head circumference percentile increased from 61.42% to 89.27% over 2 years of follow-up. Cranial index increased from a preoperative mean of 0.69 to 0.76 over 2 years of follow-up. Reoperations for synostosis included 1 sagittal suture refusion and 2 cases in which other sutures fused. Sagittal synostosis can be safely treated with endoscopic suturectomy and helmet therapy. Improvements in cranial volume and shape are comparable to open procedures and are enduring.

German head circumference references for infants, children and adolescents in comparison with currently used national and international references

To present valid head circumference (HC) percentiles from early infancy to 18 years and to compare them with percentiles currently used in Germany by Prader, as well as to international WHO and CDC references. Nationally representative sample of 17,158 children and adolescents aged 0.25-17.98 years (KiGGS study 2003-2006) with standardized HC measurement. HC references were created using Cole's LMS method. The median growth of HC is largest in the first year of life. Adult HC is reached at age 16 years in girls, while in boys, HC growth continues through age 17 years and adult HC have to be derived from future KiGGS follow-up examinations. KiGGS percentiles are quite similar from early infancy to early school age compared to older Prader references, but higher thereafter (maximum difference of median HC: girls 1.4 cm, boys 0.9 cm). KiGGS percentiles are also higher than WHO and CDC percentiles over most of the compared age range, but differences are less pronounced compared to Prader. The KiGGS HC references presented here for boys and girls aged 4 months through 17 years are more valid than currently used German references. Because of the similarity of KiGGS and the currently used reference by Prader in early infancy, the currently used Prader reference for 0-4 months could complement KiGGS to cover the entire age range from birth to the end of adolescence.

Revised birth centiles for weight, length and head circumference in the UK-WHO growth charts

Background: The adoption in May 2009 by the UK of the WHO 2006 standard necessitated the provision of UK-based birth centiles for pre-term infants. The pre-existing British 1990 reference birth centiles, used in the UK since 1995, had been biased by the inclusion of post-natal data.Aim: To describe the construction of new UK birth centiles for weight, length and head circumference, based on British 1990 reference data, but excluding post-natal data.Subjects and methods: Birth data from the five original studies, collected between 1983–1993, were pooled and analysed by the LMS method, for the sexes separately. In addition, sex-specific composite centiles were constructed for infants born at term (37–42 completed weeks).Results: The birth data included 9443 weights, 985 lengths and 1841 head circumferences, covering 23–44 weeks gestation. The analysis provided LMS tables defining reference centiles for weight and head circumference from 23–42 weeks and for length from 26–42 weeks. The term centiles are for use at age 0 on the post-natal 0–1 year chart.Conclusion: These new centiles, replacing those of the British 1990 reference, are more accurate than their predecessors which were biased due to the inclusion of post-natal data.

Infantile Cerebral and Cerebellar Atrophy Is Associated with a Mutation in the MED17 Subunit of the Transcription Preinitiation Mediator Complex

Primary microcephaly of postnatal onset is a feature of many neurological disorders, mostly associated with mental retardation, seizures, and spasticity, and it typically carries a grave prognosis. Five infants from four unrelated families of Caucasus Jewish origin presented soon after birth with spasticity, epilepsy, and profound psychomotor retardation. Head circumference percentiles declined, and brain MRI disclosed marked cereberal and cerebellar atrophy with severe myelination defect. A search for a common homozygous region revealed a 2.28 Mb genomic segment on chromosome 11 that encompassed 16 protein-coding genes. A missense mutation in one of them, MED17, segregated with the disease state in the families and was carried by four of 79 anonymous Caucasus Jews. A corresponding mutation in the homologous S.cerevisiae gene SRB4 inactivated the protein, according to complementation assays. Screening of MED17 in additional patients with similar clinical and radiologic findings revealed four more patients, all homozygous for the p.L371P mutation and all originating from Caucasus Jewish families. We conclude that the p. L371P mutation in MED17 is a founder mutation in the Caucasus Jewish community and that homozygosity for this mutation is associated with infantile cerebral and cerebellar atrophy with poor myelination.

Growth references for height, weight, and head circumference for Argentine children with achondroplasia

In order to prepare growth references for height, weight, and head circumference for Argentine children with Achondroplasia, 228 children (114 boys) aged 0-18 years attending the Growth Clinic at Hospital Garrahan were measured between 1992 and 2009. Centiles were calculated by LMS, a method for summarizing growth data which adjusts for skewness. Curves for centiles are obtained using the formula: [Formula: see text], where Z (α) is the normal equivalent deviate for tail area α; C100α is the weight or height centile corresponding to Z (α), t is age in years, and L(t) is (skewness)(t), M(t) is median, S (t) is coefficient variation and C(100α) (t) indicates the corresponding values of each curve at age t. Boys and girls centiles for height were similar to USA references in infancy and childhood but lower than that references at adolescence. Final height was 1.7 and 5.1 cm below USA achondroplasia references in girls and boys, respectively. Head circumference centiles were, at all ages, lower than USA references in both genders. Countries need national references for clinical growth assessment of their local population. Likewise, specific local growth references for children with some genetic conditions (such us achondroplasia) are valuable tools for detecting additional conditions affecting growth, for estimating final height and for evaluating the impact of growth-promoting treatments. references presented here can also be used in other countries with similar ethnographics characteristics.

Generating expected growth curves and Z-scores for premature infants

To establish a standard for expected growth of premature infants and generate Z-scores based on the standard. Multiple regression and analysis of variance were used to evaluate whether the 10th, 50th, and 90th percentiles of birth weight, head circumference, and length from other studies were statistically different from the percentiles from Riddle. Z-scores were generated from the 10th, 50th, and 90th percentiles. The growth charts from Mead-Johnson, Babson, Williams, Alexander, Usher, Yudkin, and Fenton were not coincident with the values reported by Riddle. The percentiles reported by Thomas were statistically coincident with the percentiles reported by Riddle. The regression equations for the 10th, 50th, and 90th percentile for weight, head circumference, and length provide expected growth of premature infants. The equations can be used to generate expected growth curves and Z-scores for weight, head circumference, and length of premature infants.

Mutations in LTBP4 Cause a Syndrome of Impaired Pulmonary, Gastrointestinal, Genitourinary, Musculoskeletal, and Dermal Development

We report recessive mutations in the gene for the latent transforming growth factor-beta binding protein 4 (LTBP4) in four unrelated patients with a human syndrome disrupting pulmonary, gastrointestinal, urinary, musculoskeletal, craniofacial, and dermal development. All patients had severe respiratory distress, with cystic and atelectatic changes in the lungs complicated by tracheomalacia and diaphragmatic hernia. Three of the four patients died of respiratory failure. Cardiovascular lesions were mild, limited to pulmonary artery stenosis and patent foramen ovale. Gastrointestinal malformations included diverticulosis, enlargement, tortuosity, and stenosis at various levels of the intestinal tract. The urinary tract was affected by diverticulosis and hydronephrosis. Joint laxity and low muscle tone contributed to musculoskeletal problems compounded by postnatal growth delay. Craniofacial features included microretrognathia, flat midface, receding forehead, and wide fontanelles. All patients had cutis laxa. Four of the five identified LTBP4 mutations led to premature termination of translation and destabilization of the LTBP4 mRNA. Impaired synthesis and lack of deposition of LTBP4 into the extracellular matrix (ECM) caused increased transforming growth factor-beta (TGF-beta) activity in cultured fibroblasts and defective elastic fiber assembly in all tissues affected by the disease. These molecular defects were associated with blocked alveolarization and airway collapse in the lung. Our results show that coupling of TGF-beta signaling and ECM assembly is essential for proper development and is achieved in multiple human organ systems by multifunctional proteins such as LTBP4.

Prenatal Head Growth and White Matter Injury in Hypoplastic Left Heart Syndrome

Children with hypoplastic left heart syndrome (HLHS) have an increased prevalence of central nervous system (CNS) abnormalities. The extent to which this problem is due to CNS maldevelopment, prenatal ischemia, postnatal chronic cyanosis and/or multiple exposures to cardiopulmonary bypass is unknown. To better understand the etiology of CNS abnormalities in HLHS, we evaluated 68 neonates with HLHS; in 28 cases, both fetal ultrasound and echocardiogram data were available to assess head size, head growth and aortic valve anatomy (atresia or stenosis). In addition, we evaluated neuropathology in 11 electively aborted HLHS fetuses. The mean head circumference percentile in HLHS neonates was significantly smaller than HLHS fetuses (22 +/- 2% versus 40 +/- 4%, p < 0.001). A significant decrease in head growth, defined as a 50% reduction in head circumference percentile, was observed in half (14/28) of HLHS fetuses and nearly a quarter (6/28) were already growth restricted (<or=10%) at the time of initial evaluation. Brains from HLHS fetuses demonstrated chronic diffuse white matter injury of varying severity. These patterns of prenatal head growth and brain histopathology identify a spectrum of abnormal CNS development and/or injury in HLHS fetuses.

Exposure to Oxygen and Head Growth in Infants with Bronchopulmonary Dysplasia

Infants with bronchopulmonary dysplasia (BPD) are known to have developmental delays, but a direct link between oxygen (O (2)) exposure and brain growth has not been explored. Our objective was to test the hypothesis that the use of O (2) is associated with delays in head growth (DHG) in premature infants with BPD. We conducted a retrospective study on a cohort of infants with BPD (birthweight [BW] < 1500 g, gestational age < 34 weeks). The study population was divided into two groups based on their head circumference (HC) measured at birth. Group 1 represented infants with birth HC > or = 50% for their age on growth chart, and Group 2 represented infants with birth HC < 50% for their age. We recorded HC at hospital discharge and at 6 months of age; and the amount of DHG was calculated (DHG = current age in weeks - the age that matches the 50th percentile for current HC). Regression analysis was conducted to determine the relationship between the duration of O (2) use and DHG in both groups, controlling for BW, discharge weight, gender, and duration of mechanical ventilation (MV). Data were expressed in mean +/- standard error of mean. A total of 137 sequential infants with BPD were studied; of them 65 infants were included in group 1 and 72 infants were included in group 2. The 2 groups did not differ in GA, gender total O (2) days, and total days on MV. At hospital discharge there was no difference between groups in terms of DHG (78% versus 83%, respectively). At 6 months of age, there were more infants in group 2 who had DHG (44% versus 67%, respectively; P < 0.01). In group 1, the amount of DHG correlated only with BW ( P = 0.05). It did not correlate with discharge weight, gender, duration of O (2) use, or duration of MV. In group 2, the amount of DHG correlated only with the duration of O (2) use ( P = 0.04) It did not correlate with BW, discharge weight, gender, or duration of MV. Each 10 days of O (2) use in group 2 was associated with 1.5 +/- 0.1 days of DHG. We concluded that duration of O (2) use is associated with a delay in head growth in infants born with HC < 50th percentile. This study does not clarify whether the use of O (2) is a marker of severity of illness or a contributing factor to DHG in infants with BPD. The mechanisms for this relation require further exploration.

Index of Suspicion

Index of Suspicion

Intrauterine growth standards in a developing country: a study of singleton livebirths at 28–42 weeks' gestation

This study aimed to develop fetal growth charts for the population of Greater Beirut, Lebanon, and compare them with previously established references. A survey of consecutive singleton livebirths admitted to normal nurseries and neonatal intensive care units of major hospitals, through the database project of the National Collaborative Perinatal Neonatal Network was used as a design. The study was conducted in nine major healthcare institutions serving the population of Beirut and its suburbs. A total of 24 767 singleton livebirths delivered between 28 and 42 weeks' gestation, with known data on gender, gestational age and anthropometric characteristics were recorded between 1 April 1999 and 31 March 2002. Growth charts were developed by plotting birthweight, length and head circumference percentiles against gestational age for male and female infants separately. Overall, 1348 (5.4%) pregnancies were delivered before 37 weeks' gestation and 1227 (4.9%) were low birthweight. Male infants were delivered slightly earlier than their female counterparts and the mean birthweight, length and head circumference were consistently higher in males. A total of 2247 (9.1%) infants were small-for-gestational-age, with a male-to-female sex ratio of 1.03. Using previously established growth references that overestimated small-for-gestational-age prevalence resulted in a greater proportion of false positives. The opposite was true for growth references that underestimated small-for-gestational-age prevalence. The current growth charts present useful tools for assessing the general health status of newborn infants delivered at sea level in the urban areas of Lebanon and other East Mediterranean countries.

Early Acceleration of Head Circumference in Children with Fragile X Syndrome and Autism

Head circumference (HC) growth has been shown in several studies to be accelerated early in life in both fragile X syndrome (FXS) and autism spectrum disorders (ASDs), but the rates of growth have not been compared between those with only FXS and those with FXS and ASD (FXS + ASD). We hypothesized that individuals with FXS + ASD would have significantly larger HCs from individuals with only FXS and that there would be an early acceleration of HC in both the FXS-only and FXS + ASD groups. HC measurements were available retrospectively for 44 males, five and younger, with FXS, of whom 22 also had ASD. Measurements over time were available for 24 of the 44 children. HC percentiles were compared between the groups in two ways: by focusing on cross-sectional subsamples and by fitting hierarchical linear models to the full sample. Neither group differed significantly from the norm in the first year of life (p > 0.2). At 30 months, the FXS + ASD group was 27 percentile points above the norm (p = .0125), whereas the FXS-only group did not differ from the norm. At 60 months, the FXS-only group was 21 percentile points above the norm (p = .029), whereas the FXS + ASD group did not differ from the norm. The group difference in HC growth rate may differentiate brain development in individuals with FXS-only versus those with FXS + ASD.

Corrected head circumference centiles as a possible predictor of developmental performance in high‐risk neonatal intensive care unit survivors

The aim of this study was to evaluate the predictive value of corrected head circumference (HC) centiles at 2 years of age with respect to developmental performance in a series of high‐risk neonatal intensive care unit (NICU) survivors with microcephaly. The study used a retrospective review of the clinical files of children seen in a clinic devoted to the follow‐up of all high‐risk survivors of a hospital's level III NICU. All children with microcephaly (occipital‐frontal circumference below the 2nd centile for sex) at 2 years of age were identified. The HC obtained at 2 years was corrected to the ages for which the absolute HC corresponded to either the 50th or 2nd centile for the child's sex. Of 312 high‐risk patients followed, 38 (12.2%) were microcephalic. Fifteen performed below the 50th age‐corrected HC centile (severe developmental delay), 12 performed between the 50th and 2nd age‐corrected HC centile (moderate developmental delay), and 11 performed above the 2nd age‐corrected HC centile (mild developmental delay). The absolute value of HC measurement was not a predictor of developmental performance. Of all clinical factors evaluated, only coexisting epilepsy was found to be a significant predictor of less than the 50th age‐corrected HC centile developmental performance (Chi2=6.134, p=0.01). We conclude that in a high‐risk population, the presence of microcephaly implies developmental impairment, though neither the absolute HC measurement nor the corrected HC centile is predictive. Coexisting epilepsy in this context appears to worsen developmental outcome.

Corrected head circumference centiles as a possible predictor of developmental performance in high-risk neonatal intensive care unit survivors

The aim of this study was to evaluate the predictive value of corrected head circumference (HC) centiles at 2 years of age with respect to developmental performance in a series of high-risk neonatal intensive care unit (NICU) survivors with microcephaly. The study used a retrospective review of the clinical files of children seen in a clinic devoted to the follow-up of all high-risk survivors of a hospital's level III NICU. All children with microcephaly (occipital-frontal circumference below the 2nd centile for sex) at 2 years of age were identified. The HC obtained at 2 years was corrected to the ages for which the absolute HC corresponded to either the 50th or 2nd centile for the child's sex. Of 312 high-risk patients followed, 38 (12.2%) were microcephalic. Fifteen performed below the 50th age-corrected HC centile (severe developmental delay), 12 performed between the 50th and 2nd age-corrected HC centile (moderate developmental delay), and 11 performed above the 2nd age-corrected HC centile (mild developmental delay). The absolute value of HC measurement was not a predictor of developmental performance. Of all clinical factors evaluated, only coexisting epilepsy was found to be a significant predictor of less than the 50th age-corrected HC centile developmental performance (chi2=6.134, p=0.01). We conclude that in a high-risk population, the presence of microcephaly implies developmental impairment, though neither the absolute HC measurement nor the corrected HC centile is predictive. Coexisting epilepsy in this context appears to worsen developmental outcome.

Health status, cognitive and motor development of young children adopted from China, East Asia, and Russia across the first 6 months after adoption

We compared health status, anthropometric and psychological development of 123 children adopted before 18 months of age from China, East Asia (Vietnam, Taiwan, Thailand, South Korea, Cambodia), and Eastern Europe (mostly Russia). Data were collected close to the time of arrival, and 3 and 6 months later. Anthropometric measures included weight, height, and head circumference percentiles, and weight/height and height/age ratios (indices of acute and chronic malnutrition, respectively). We assessed cognitive (MDI) and motor (PDI) developments with the Bayley Scales of Infant Development (Bayley, 1993). At time of arrival, children presented physical, cognitive, and motor delays, as well as health problems. Growth parameters improved with time, but differently among the groups. East Asian children, in a better physical state at time of arrival, changed less than the others did across time. Children adopted from Russia globally had lower MDI than the others, while children adopted from East Asia had the highest PDI. Hierarchical linear modelling indicated that initial MDI was related to height/age ratio (index of chronic malnutrition), while its change over time was related to age at time of arrival. PDI was also related to height/age ratio, as well as to presence/absence of neurological signs at time of arrival. Infants with a higher risk index had lower MDI and PDI initial scores.

Head circumference and chronic positive pressure ventilation in children: a pilot study

We reviewed the cases of 11 children <12 years of age with complex medical conditions and respiratory failure requiring chronic positive pressure ventilation (CPPV). We conducted a within-group comparison of average head circumference (HC) percentiles with each child's age-expected 50th percentile value and a between-groups comparison with children with no history of ventilation. We examined the relationship between HC, peak levels of positive inspiratory pressure (PIP), and length of time on CPPV. We found that children on CPPV had an average HC value at the 71st percentile, significantly greater (p=0.009) than the age-expected 50th percentile; that children on CPPV had a greater (p=0.003) average HC percentile compared with children with complex medical conditions not on CPPV; and that peak levels of PIP had a moderately strong correlation to HC (r=0.689, p=0.019). We conclude that children on CPPV have larger than expected HC and HC appears related to the peak level of PIP. Research to further investigate the relationship between HC and CPPV in children appears to be warranted.

Migrating Partial Seizures in Infancy: Expanding the Phenotype of a Rare Seizure Syndrome

The constellation of early-onset, unprovoked, alternating electroclinical seizures and neurodevelopmental devastation was first described by Coppola et al. We report six new patients and the prospect of a more optimistic developmental outcome. Retrospective chart reviews were performed on six infants evaluated at the Children's Hospital of Philadelphia (five patients) and at Hershey Medical Center (one patient) who had electroclinically alternating seizures before age 6 months of age. Electroclinical characteristics and long-term follow-up were recorded. All had unprovoked, early-onset (range, 1 day to 3 months; mean, 25 days) intractable electroclinical seizures that alternated between the two hemispheres. Each patient underwent comprehensive brain imaging and neurometabolic workups, which were unrevealing. In all patients, subsequently intractable partial seizures developed and often a progressive decline of head circumference percentile occurred with age. Three demonstrated severe developmental delay and hypotonia. All survived, and 7-year follow-up on one patient was quite favorable. Our patients satisfied the seven major diagnostic criteria first described by Coppola et al. The prognosis of this rare neonatal-onset epilepsy syndrome from the original description and subsequent case reports was very poor, with 28% mortality, and the majority of survivors were profoundly retarded and nonambulatory. Our patient data validate the diagnostic criteria of this syndrome and further quantify a previously described observation of progressive decline of head circumference percentiles with age. Our data also suggest that the prognosis of this syndrome, although poor, is not as uniformly grim as the cases reported previously in the literature.