Poor Growth Outcomes Research Articles

Markers of Environmental Enteric Dysfunction Are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia

Markers of Environmental Enteric Dysfunction Are Associated with Poor Growth and Developmental Outcomes among Young Children in Lusaka, Zambia

8304 Growth trajectories of children born preterm and full-term with low birth weight to preschool ages; a nationwide study

Abstract Disclosure: E. Kang: None. J. Cha: None. J. Na: None. S. Ryu: None. Y. Choi: None. J. Kim: None. Context: Children born preterm (PT) and full-term with low birth weight (FT-LBW) are known to be at considerable risk of poor growth outcomes. Objective: To investigate the growth trajectories of children born PT and FT-LBW from birth to preschool ages. Methods: A total of 1,150,508 newborns were included in the study, comprising 41,454 children born PT and 38,250 children born FT-LBW, who participated in the first three rounds (4-6, 9-12, 18-24 months) of the National Health Screening Program for Infants and Children (NHSPIC). Growth measurements were obtained from the NHSPIC database and converted into the Z-scores. Growth data at two, four, and six years of age were measured as outcome variables. The impact of being born small on poor growth outcomes was investigated using a generalized estimating equation and Cox proportional hazards regression analysis. Results: The median birth weight of three groups was 2.3kg for PT, 2.4kg for FT-LBW, and 3.2kg for FT control group, respectively. The incidence of short stature defined as height Z-score < -2 standard deviation score (SDS) and failure to thrive (BMI Z-score < -2 SDS) was highest in FT-LBW group, followed by the PT group, and control group. At four years of age, the incidence rates were 6.0% vs. 5.2% vs. 1.9% for short stature and 4.6% vs. 3.9% vs. 1.7% in FTT. The β estimate of height outcome was lower in both the PT and FT-LBW groups with -0.326 SDS in PT and -0.456 SDS in FT-LBW group. Conclusion: The FT-LBW group was consistently shorter and lighter throughout the preschool period than the PT group. This highlights the significance of growth monitoring in high-risk populations. Presentation: 6/3/2024

PSVI-14 Effects of poor maternal nutrition during gestation on first generation offspring oxidative status in skeletal muscle

Abstract Poor maternal nutrition (restricted- and over-nutrition) during gestation negatively impacts offspring pre- and post-natal growth. Previous work has identified decreased muscle mass and increased adiposity, leading to poor quantity and quality of animal protein products. Alterations in oxidative status, such as the imbalance of antioxidant activity and the production of free radicals, can result in oxidative stress damaging lipid membranes, proteins, and DNA. Changes in oxidative status may contribute to the poor growth outcomes observed in offspring from poorly nourished dams. Therefore, the objective of this research was to determine the effects of poor maternal nutrition during gestation on the oxidative status in offspring skeletal muscle in sheep. We hypothesized that offspring of restricted- and over-fed ewes would have decreased antioxidant activity and increased products of oxidative stress in skeletal muscle. To test this hypothesis, multiparous Dorset ewes (n = 46) pregnant with twins were fed 100% (CON), 60% (RES), or 140% (OVER) of total nutrient requirements (NRC) from d 30 of gestation until parturition. Following parturition, ewes were fed a control diet throughout lactation. At d 282 of age semitendinosus (STN) samples were collected from rams at necropsy, and at d 284 of age muscle biopsies from STN were collected from ewes. Data were analyzed in SAS using PROC MIXED with fixed effects of maternal diet and offspring sex. Data were considered significant at P ≤ 0.05. The activity of the endogenous antioxidant superoxide dismutase (SOD) was decreased by 45% and 33% in RES and OVER offspring, respectively, compared with CON (P ≤ 0.01). Offspring sex did not alter STN SOD activity (P = 0.35). Muscle glutathione peroxidase (GPx) activity was decreased in RES offspring by 20% compared with CON (P ≤ 0.04), but neither differed from OVER offspring (P ≥ 0.24). Ewes had 34% greater GPx activity compared with rams (P < 0.0001). Offspring from RES and OVER ewes had 77% and 87% greater concentrations of malondialdehyde (MDA), a marker of lipid peroxidation, when compared with CON (P < 0.0001). Ewes had 29% greater MDA concentrations compared with rams (P = 0.05). Protein carbonyl (PC), a marker of protein oxidation, concentrations were 36% and 38% greater in RES and OVER offspring, respectively, compared with CON (P ≤ 0.01). The decrease in antioxidant activities and increase in products of protein and lipid oxidation in offspring from poorly nourished dams suggests dysregulation in skeletal muscle oxidative status that may contribute to the negative consequences observed in offspring. Future work should focus on determining the mechanistic role of skeletal muscle oxidative stress in the decreased quantity and quality of animal protein products and identifying potential strategies to mitigate alterations in oxidative status as a result of poor maternal nutrition during gestation.

Poor neurodevelopment, nutritional and physical growth outcomes among children born to mothers with nodding syndrome

IntroductionNodding syndrome (NS), a poorly understood severe neurological disorder develops in children. In Uganda, some NS cases have grown into child-bearing adults. Babies born to mothers with NS may be prone to impaired neurodevelopmental outcomes. Cognitive deficits in mothers with NS may further inhibit care offered to their children hence compromising neurocognitive development, physical growth, and behaviour. ObjectivesThe study aimed to determine the neurodevelopmental, behavioural, nutritional, and physical growth outcomes of children whose mothers have nodding syndrome. MethodsA comparative cross-sectional study was conducted between May 2021 and April 2022 in Northern Uganda. Children aged 0-5 years of mothers with NS were compared to those of mothers without NS, matched by age, gender and neighbouring residence. Neurodevelopment, behaviour, nutrition, and physical growth were assessed using standardized measures and t-tests employed for group comparisons of outcomes. ResultsOverall,106 children participated. Fifty-three (53) were offspring of mothers with NS and 53 of mothers without NS; having a mean age of 26.9 (2.22) and 27.5(2.12) months respectively. Children whose mothers have NS had significantly lower neurodevelopmental scores than those of NS-unaffected mothers in fine motor (37.5(12.1) vs 44.2(14.3), p = 0.011), receptive language (37.8(10.8) vs 43.9(12.9), p = 0.010), overall cognitive development (74.36(17.8) vs 83.34(19.6), p = 0.015), and attention (0.64(0.20) vs 0.76(0.15), p = 0.001). There were no differences in the behaviour scores. Children of mothers with NS also had significantly lower weight-for-age z scores (WAZ) (p = 0.003) and length/height-for-age z scores (LAZ/HAZ) (p = 0.001); with 19(35.9 %) of them stunted. ConclusionChildren whose mothers have NS have poorer neurodevelopmental, nutritional, and physical growth outcomes. Interventions to improve outcomes in these children are warranted.

Effects of sanitation on child growth in Serbian Roma communities

Abstract Poor sanitation may be associated with growth faltering, but empirical evidence on the association between household sanitation infrastructure and child nutrition has been mixed. This article assessed whether sanitation infrastructure is associated with growth penalties for Roma children. Design This is a Roma nationally representative population-based study. Proxies of child nutritional outcomes included children’s height-for-age Z scores below two standard deviations from the median of WHO’s reference population. Multiple and logistic regressions estimated the association between the type of toilet usage, outcomes, and sociodemographic determinants. Setting Data were from UNICEF’s fifth and sixth Multiple Indicator Cluster Surveys for Serbian Roma settlements. Subjects Children aged 0–24 (n = 1,150) and 25–59 (n = 2,024) months born to women aged 15–48 years were included in this study. Results About 16% of children resided in households with no toilet service, and 23% of children were stunted. Roma children aged 25–59 months in households with no toilet service and in rural areas were more likely to be stunted and of significantly shorter stature than their counterparts. Children up to 24 months of age were not affected by the type of toilet, likely due to protective effects of breastfeeding. Child’s age, number of siblings, and birth spacing negatively influenced growth outcomes, while maternal age, birthweight above 2.5 kg, and being a female mitigated against poor growth outcomes. Conclusions The relationship between the type of toilet and growth outcomes among Roma children varied with age and area: having no toilet and living in rural areas were associated with compromised child growth for children aged 25–59 months. Maternal and child characteristics additionally accounted for children’s growth.

Impact of Junk Food Consumption Pattern on the Nutritional Status of Adolescents Aged between 13 and 18 Years

Nutrition is the cornerstone for human health and growth throughout the life cycle. Today, about one-third of the world’s population suffers from a lack of proper nutrition, making it one of the most severe issues facing the worldwide society. Fast food consumption is common among adolescents globally, and it is increasing in low and middle-income countries. This present study aimed to compare the nutritional status and fast-food consumption patterns of adolescent girls aged between 13 and 18 years. It is a cross-sectional and descriptive study that included 100 adolescents, assessed the anthropometry, and elicited information on activity patterns, dietary profile, and fast-food consumption patterns by structured interview schedule. The results revealed that the junk food consumption impacts the health and nutritional status of school-aged adolescents, perhaps contributing to poor growth outcomes. This study offers new insight for formulating research studies for future researchers.

Replacement of fishmeal with a microbial single-cell protein induced enteropathy and poor growth outcomes in barramundi (Lates calcarifer) fry.

Fish meal (FM) replacement is essential for the sustainable expansion of aquaculture. This study focussed on the feasibility of replacing FM with a single-cell protein (SCP) derived from methanotrophic bacteria (Methylococcus capsulatus, Bath) in barramundi fry (Lates calcarifer). Three isonitrogenous and isoenergetic diets were formulated with 0%, 6.4% and 12.9% inclusion of the SCP, replacing FM by 0%, 25% and 50%. Barramundi fry (initial body weight 2.5 ± 0.1 g) were fed experimental diets for 21 days to assess growth performance, gut microbiome composition and gut histopathology. Our findings revealed that both levels of SCP inclusion induced detrimental effects in barramundi fry, including impaired growth and reduced survival compared with the control group (66.7% and 71.7% survival in diets replacing FM with SCP by 25% and 50%, respectively; p < .05). Both dietary treatments presented mild necrotizing enteritis with subepithelial oedema and accumulation of PAS positive, diastase resistant droplets within hepatocytes (ceroid hepatopathy) and pancreatic atrophy. Microbiome analysis revealed a marked shift in the gut microbial community with the expansion of potential opportunistic bacteria in the genus Aeromonas. Reduced overall performance in the highest inclusion level (50% SCP) was primarily associated with reduced feed intake, likely related to palatability issues, albeit pathological changes observed in gut and liver may also play a role. Our study highlights the importance of meticulous optimization of SCP inclusion levels in aquafeed formulations, and the need for species and life-stage specific assessments to ensure the health and welfare of fish in sustainable aquaculture practices.

Effect of maternal aflatoxin exposure on growth and morbidity of infants 0 to 3 months

Aflatoxin exposure has been implicated in adverse human health outcomes in areas where the toxin is prevalent in foods [1]. Consequently, many people may be chronically exposed to large amounts of the toxin worldwide. The effect of aflatoxin exposure is felt more in developing countries and this may be attributed to high levels of malnutrition coupled with chronic exposure to high levels of the toxin in their diets [2]. Consumption of high levels of aflatoxins has been associated with aflatoxicosis resulting in death, while chronic dietary exposure to aflatoxins is associated with liver and other cancers and poor growth outcomes in young children [3]. Exposure of infants to aflatoxins may be detrimental to their normal growth and other aspects of health later in life. Early linear growth retardation is associated with poor cognitive development, reduced physical productivity, a greater risk of poor pregnancy outcomes later in life, including low birth weight babies and a greater risk of obesity, coronary heart disease, diabetes and hypertension later in life [3]. Therefore, protection of fetuses, infants and young children from the effects of aflatoxins through maternal exposure would not only reduce the risk of them not realizing their cognitive potential, but also contribute to reducing the risk of non-communicable diseases whose prevalence is on the rise, not just in developed countries, but also in developing countries.

Growth trajectories of children born preterm and full term with low birth weight to preschool ages: A nationwide study.

Preterm (PT) and full term with low birth weight (FT-LBW) children are at a high-risk of poor growth outcomes. To investigate the growth trajectories of PT and FT-LBW children from birth to preschool ages. This study included 1,150,508 infants (PT, 41,454; FT-LBW, 38,250) who underwent the first three rounds (4-6, 9-12, and 18-24 months) of the National Health Screening Program for Infants and Children (NHSPIC). Growth measurements were obtained from the NHSPIC database and converted into Z-scores. Growth data at 2, 4, and 6 years old were measured as outcome variables. The impact of being born small on poor growth outcomes was investigated using a generalized estimating equation and Cox proportional-hazards regression analysis. The median birth weights of the PT, FT-LBW, and full term (FT) groups were 2.3, 2.4, and 3.2 kg, respectively. The incidence of short stature (height Z-score < -2 standard deviation score [SDS]) and failure to thrive (FTT) (body mass index (BMI) Z-score < -2 SDS) was the highest in the FT-LBW group, followed by the PT and FT groups. At 4 years old, the incidence rates were 6.0% vs. 5.2% vs. 1.9% for short stature and 4.6% vs. 3.9% vs. 1.7% for FTT. The β estimate of height outcome was lower in both the PT (-0.326 SDS) and FT-LBW (-0.456 SDS) groups. The FT-LBW group was consistently shorter and lighter throughout the preschool period than the PT group, highlighting the significance of growth monitoring in high-risk populations.

Multimodal Sensory Stimulation among Very Low Birth Weight Preterm Newborns: A Quasi-experimental Study at a Tertiary Care Hospital in Agartala, Tripura, India

Introduction: There is a continuous search for an effective intervention to help preterm low birth weight neonates overcome their poor growth and developmental outcomes. Most researchers have examined the effect of Oromotor Stimulation (OMS) on feeding performance. Studies exploring Multimodal Sensory Stimulation (MSS) on various outcome parameters are sparse and reveal inconsistent results. Aim: To analyse the effectiveness of MSS in improving weight gain, length of hospitalisation, and feeding performance in preterm Very Low Birth Weight (VLBW) neonates. Materials and Methods: This quasi-experimental study was conducted between June 2021 and December 2022 in the Paediatrics Department of Agartala Government Medical College, Agartala, Tripura, India. A total of 104 hospitalised neonates with gestational age from 28 to less than 37 weeks and birth weight from 1000 to less than 1500 grams (VLBW) were included in the study. All neonates received standard care and Kangaroo Mother Care (KMC). On the advice of some faculties, several of them also received MSS. All neonates were divided into two groups: those who received MSS and those who did not, and they were monitored until discharge. Mean hospitalisation length, weight gain, and transition time were derived and statistically analysed using Chi-square and Mann-Whitney U tests. Results: In the present study, the mean gestational age was 32.04±1.75 and 32.679±1.19 weeks, and the M:F ratio was 1.43:1 and 1.30:1 in the MSS-given and MSS-not given groups, respectively. Mean weight gain was significantly higher in the MSS-given group (97.00±123.09 g versus- 23.42±43.96 g). Mean hospitalisation length was longer in the MSS-given group, but transition time did not differ significantly across the groups. Conclusion: Multimodal sensory stimulation is effective in promoting weight gain in preterm VLBW neonates.

A Virus-like Particle-Based F4 Enterotoxigenic Escherichia coli Vaccine Is Inhibited by Maternally Derived Antibodies in Piglets but Generates Robust Responses in Sows.

F4-positive enterotoxigenic Escherichia coli is associated with diarrhea and poor growth outcomes in neonatal and newly weaned piglets and is thus a major economic and welfare burden in the swine industry. Vaccination of sows with F4 fimbriae protects against the neonatal disease via passive transfer of maternal immunity. However, this strategy does not protect against infection post-weaning. Consequently, prevention and treatment methods in weaner pigs heavily rely on the use of antimicrobials. Therefore, in order to reduce antimicrobial consumption, more effective prophylactic alternatives are needed. In this study, we describe the development of a capsid virus-like particle (cVLP)-based vaccine targeting the major F4 fimbriae subunit and adhesion molecule, FaeG, and evaluate its immunogenicity in mice, piglets, and sows. cVLP-display significantly increased systemic and mucosal antibody responses towards the recombinant FaeG antigen in mice models. However, in piglets, the presence of anti-F4 maternally derived antibodies severely inhibited the induction of active humoral responses towards the FaeG antigen. This inhibition could not be overcome, even with the enhanced immunogenicity achieved via cVLP display. However, in sows, intramuscular vaccination with the FaeG.cVLP vaccine was able to generate robust IgG and IgA responses that were comparable with a commercial fimbriae-based vaccine, and which were effectively transferred to piglets via colostrum intake. These results demonstrate that cVLP display has the potential to improve the systemic humoral responses elicited against low-immunogenic antigens in pigs; however, this effect is dependent on the use of antigens, which are not the targets of pre-existing maternal immunity.

446 The Effects of Maternal Diet During Gestation on Oxidative Status of Offspring

Abstract Poor maternal nutrition during gestation is common in livestock production and includes both nutrient restriction and over-nutrition. Poor maternal nutrition affects offspring pre- and post-natal growth including decreases in muscularity and increases in adiposity which results in poor quantity and quality of animal products. Oxidative stress, when free radicals exceed the capacity of antioxidants, damages lipid membranes, proteins, and DNA. Oxidative stress may contribute to the poor growth outcomes observed in offspring from poorly nourished dams. Therefore, the objective of this research was to determine the effects of poor maternal nutrition during gestation on offspring circulating oxidative status in sheep. We hypothesized that offspring of restricted- and over-fed ewes would have an altered oxidative status in circulation. To test this hypothesis, multiparous Dorset ewes (n = 45) pregnant with twins were fed 100% (CON), 60% (RES), or 140% (OVER) of National Research Council requirements from d 30 of gestation until parturition. At parturition, ewes were fed a control diet such that the nutritional insult only occurred during gestation. Blood samples were collected from offspring by jugular venipuncture at d 112 and d 224 of age to evaluate oxidative status in circulation. Data were analyzed in SAS 9.4 using PROC MIXED with fixed effects of offspring sex and maternal diet with sampling timepoint as repeated measure. Data were considered significant at P &amp;lt; 0.05. In offspring plasma, superoxide dismutase, an endogenous antioxidant, activity was 17% greater in CON offspring compared with RES and OVER (P ≤ 0.04). Malondialdehyde (MDA), a marker of lipid peroxidation, concentration was not different at d 112 but RES animals had 10% lesser concentration of MDA than CON at d 224 (P ≤ 0.02). Protein carbonyl (PC), a marker of protein oxidation, concentration was 9% greater in CON animals than RES and OVER (P = 0.01). Additionally, PC concentrations were 19% greater at d 224 compared with d 112 (P ≤ 0.001). These results indicate that at the chosen timepoints, RES and OVER offspring had less antioxidant activity but also less indication of oxidative damage. Overall, the alterations in antioxidant activity and oxidative damage suggest dysregulation in circulating oxidative status that may contribute to the negative consequences of poor maternal nutrition during gestation. Future work should focus on the impacts of poor maternal nutrition on oxidative stress in muscle.

Managing Microplastics in the Kingston, Ontario, Community: A Novel One Health Innovation

The adverse impacts of microplastics on human health, non-human animals, and the environment are long-standing issues that affect communities across Canada and worldwide. The slow degradation of plastics and their bioaccumulation in plants, animals, and ecosystems can lead to poor growth outcomes and physiological side effects. Comprehensive initiatives that address the "Reduce, Reuse, Recycle" principles for plastic are urgently needed. To support Kingston City Council's mission to reduce plastic and waste contamination in waterways, this proposed initiative aims to redirect plastic bags from entering the environment and repurpose them into sleeping bags.

Associations Between Social Support and Symptoms of Antenatal Depression with Infant Growth and Development Among Mothers Living with HIV in Tanzania.

Children born to mothers living with HIV may experience greater risk of poor growth and development outcomes than their HIV-unexposed peers. Few studies have examined the relationship between maternal depression and social support with infant growth and development in the context of HIV. We conducted a prospective cohort study of 2,298 pregnant women living with HIV in Dar es Salaam, Tanzania, assessing antenatal depression (Hopkins Symptoms Checklist-25) and social support (Duke-UNC Functional Social Support Questionnaire) at 12-27 weeks of gestation. At one-year age, infant anthropometry and caregiver-reported infant development were assessed. Generalized estimating equations were used to assess mean differences (MD) and relative risks (RR) for growth and developmental outcomes. Symptoms consistent with maternal antenatal depression had 67% prevalence and were associated with infant wasting (RR 2.61; 95% confidence interval (CI) 1.03-6.65; z = 2.02; p = 0.04), but no other growth or developmental outcomes. Greater maternal social support was not associated with infant growth outcomes. Greater affective support was associated with better cognitive (MD 0.18; CI 0.01-0.35; z = 2.14; p = 0.03) and motor (MD 0.16; CI 0.01-0.31; z = 2.04; p = 0.04) development scores. Greater instrumental support was associated with better cognitive (MD 0.26; CI 0.10-0.42; z = 3.15; p < 0.01), motor (MD 0.17; CI 0.02-0.33; z = 2.22; p = 0.03), and overall (MD 0.19; CI 0.03-0.35; z = 2.35; p = 0.02) development scores. Depressive symptoms were associated with greater risk of wasting, while social support was associated with better infant development scores. Strategies to improve mental health and social support for mothers living with HIV during the antenatal period may benefit infant growth and development.

Investigating Relations between the NICU Speech Environment and Weight Gain in Infants Born Very Preterm.

Children born preterm, especially those born very preterm (<32 weeks of gestational age [GA]) are at risk for poor growth and adverse neurodevelopmental outcomes. Adverse growth and neurodevelopmental outcomes in preterm children have been attributed, in part, to the aversive sounds and relative speech paucity of the neonatal intensive care unit (NICU). Experimental studies that directly expose preterm infants to speech sounds in the NICU find significant improvements in health factors relevant to neurodevelopment. Few studies have examined whether natural variations in the speech environment of the NICU are related to short-term health outcomes in preterm infants. Such data are important for optimizing the sound environment of the NICU. Our objective was to examine relations between the NICU speech environment and the rate of weight gain during hospitalization. Participants were infants born very preterm (n = 20). The speech environment of each infant was assessed at 32 to 36 weeks of postmenstrual age using an automatic speech-counting device. Average rates of weight gain (g/kg/d) were ascertained over the same period. Calories were derived from charted intake (kcals/kg/d). Linear regressions examined caloric intake and speech counts as predictors of infant weight gain. Infant weight gain was significantly predicted by caloric intake and speech exposure, each uniquely accounting for approximately 27% variance (total R 2 = 60.2%; p < 0.001). Speech counts were uncorrelated with rates of family visitation, time in incubator, or health acuity. While future research should establish causality and direction of effects, enhancing speech exposure in the NICU may be beneficial for physical growth. NICU care plans should consider opportunities to increase speech exposure. · Preterm infants who experienced greater amounts of speech in the NICU gained significantly more weight than preterm infants who were exposed to lower amounts of speech during the same developmental period (32-36 weeks of postmenstrual age).. · Caloric intake and speech counts accounted for almost 60% of variance in infant weight gain between 32 and 36 weeks of postmenstrual age.. · Speech counts were not significantly correlated with family visitation, how long infants resided in incubators, or health acuity.. · Findings suggest that the NICU speech environment may play an important role in the physical health of preterm infants; however, more studies are needed to determine the directionality of the observed associations..

Prolonged Enteral Tube Feeding in Infants With a Functional Single Ventricle Is Associated With Adverse Outcomes After Fontan Completion

To define the baseline characteristics of long-term tube-fed (TF) single ventricle patients, investigate associations between long-term enteral tube feeding and growth, and determine associations with long-term outcomes after Fontan procedure. We performed a retrospective cohort study of patients in the Australia and New Zealand Fontan Registry undergoing treatment at the Royal Children's Hospital, the Children's Hospital at Westmead, Royal Melbourne Hospital, and Royal Prince Alfred Hospital from 1981 to 2018. Patients were defined as TF or non-tube-fed (NTF) based on enteral tube feeding at the age of 90days. Feeding groups were compared regarding body mass index (BMI) trajectory, BMI at last follow-up, and long-term incidence of severe Fontan failure. Of 390 patients (56 [14%] TF, 334 [86%] NTF), TF was associated with right ventricular dominance, hypoplastic left heart syndrome, Norwood procedure, increased procedures prior to Fontan, extracardiac conduit Fontan, Fontan fenestration, and atrioventricular valve repair/replacement. TF patients were less likely to be in the higher compared with lowest 0-6month BMI trajectory (P<.01; P=.03), had lower 6month weight-for-age z-scores (P<.01) and length-for-age z-scores (P=.01). TF were less likely to be overweight/obese at pediatric follow-up (hazard ratio [HR]=0.31, 95% CI: 0.12-0.80; P=.02) and more likely to be underweight at adult follow-up (HR=16.51; 5% CI: 2.70-101.10; P<.01). TF compared with NTF was associated with increased risk of severe Fontan failure (HR=4.13; 95% CI=1.65-10.31; P<.01). Prolonged infant enteral tube feeding is an independent marker of poor growth and adverse clinical outcomes extending long-term post-Fontan procedure.

Nationwide Long-Term Growth and Developmental Outcomes of Infants for Congenital Anomalies in the Digestive System and Abdominal Wall Defects With Surgery in Korea.

Infants with congenital anomalies of the digestive system and abdominal wall defects requiring surgery are at risk of growth and developmental delays. The aim of this study was to analyze long-term growth and developmental outcomes for infants with congenital anomalies of the digestive system and abdominal wall defects who underwent surgery in Korea. We extracted data from the Korean National Health Insurance Service database for the years 2013-2019. Major congenital anomalies were defined according to the International Classification of Diseases-10 and surgery insurance claim codes. The χ² test and the Cochran-Armitage trend test were performed for data analysis. A total of 4,574 infants with major congenital anomalies in the digestive system and abodminal wall defects, who had undergone surgey, were reviewed. Anorectal obstruction/stenosis was the most prevalent anomaly (4.9 per 10,000 live births). The prevalence of congenital anomalies of the digestive system was 15.5 per 10,000 live births, and that of abdominal wall defects was 1.5 per 10,000 live births. Seven percent of infants with congenital anomalies in the digestive system died, of which those with diaphragmatic hernia had the highest mortality rate (18.8%). Among 12,336 examinations at 6, 12, 24, 36, 48, 60, and 72 months of age, 16.7% showed a weight below the 10th percentile, 15.8% had a height below the 10th percentile, and 13.2% had a head circumference below the 10th percentile. Abnormal developmental screening results were observed in 23.0% of infants. Infants with esophageal atresia with/without tracheoesophageal fistula most often had poor growth and development. Delayed development and cerebral palsy were observed in 490 (10.7%) and 130 (2.8%) infants respectively. Comparing the results of infants born in 2013 between their 24- and 72-month health examinations, the proportions of infants with poor height and head circumference growth increased by 6.5% and 5.3%, respectively, whereas those with poor weight growth and abnormal developmental results did not markedly change between the two examinations. Infants with congenital anomalies of the digestive system and abdominal wall defects exhibit poor growth and developmental outcomes until 72 months of age. Close monitoring and careful consideration of their growth and development after discharge are required.

S40 The Impact of Nutritional Counseling on Growth Velocity in Pediatric IBD Patients

Background: Approximately 1 in 4 patients with inflammatory bowel disease (IBD) will present with the disease during childhood. Pediatric IBD is linked to poor growth outcomes and pubertal delay in both Crohn’s disease (CD) and ulcerative colitis (UC). In up to 46% of pediatric CD patients, a decrease in height velocity is the first symptom to present, before any gastrointestinal. This decreased growth is likely multifactorial and related to decreased caloric intake, poor nutrient absorption, corticosteroid use, and chronic inflammation. In up to 17% of pediatric IBD patients with decreased growth velocity, these early delays can lead to permanent growth deficit. This study aimed to assess the effectiveness of nutritional counseling by a registered dietician on growth velocity in the pediatric IBD population at a major medical center. Methods: This study was conducted as a retrospective chart review. Charts of pediatric IBD patients that were seen at Golisano Children’s Hospital at the University of Rochester, Rochester, NY in the years 2020 and 2021 were collected using billing codes. In all, 140 total charts were reviewed, and 7 were excluded because they did not have an established IBD diagnosis. Demographic, growth velocity, and laboratory data were collected for each of the remaining 133 charts. Results: Of the pediatric IBD population sampled, 56% of patients were male, 44% were female, and the mean age of diagnosis was 11.2 years (SD = 3.74). 80.17% of patients had Crohn’s disease, 19.01% had ulcerative colitis, and 0.83% had an inconclusive IBD diagnosis. 40.60% of patients had at least one appointment or consultation with a dietician or a nutritionist, while 59.40% had not met with a dietician or a nutritionist. The mean height velocity* was 0.31 cm/month (SD = 0.35 cm/month), the mean weight velocity* was 0.63 kg/month (SD = 0.57 kg/month), and the mean BMI velocity* was 0.18 kg*month/m2 (SD = 0.22 kg*month/m2). In terms of height velocity*, there was no significant difference between those who had dietary consultations and those who did not (t(125) = 0.02, P = 0.99). Those who received a dietary consultation had a significantly higher weight velocity* (t(125) = 1.86, P = 0.03). The mean weight velocity for patients who received dietary consult was 0.7 kg/month (SD = 0.07) as compared to 0.54 kg/month (SD = 0.07) for patients who did not receive dietary consultation. Conclusion(s): These results suggest that consultation with a dietician or nutritionist has a significant effect on the growth potential, specifically the weight gain potential, of pediatric IBD patients. We did not see a significant increase in the height velocity, which may be due to the pre/early pubertal mean age of our data. Further multivariate analyses of the laboratory data that was collected are ongoing and may help to identify if any of the laboratory tests are strong predictors of growth or delay in growth. This could then allow physicians to identify patients that are at higher risk of poor growth outcomes and design more targeted interventions for these high-risk patients. Note: *in the 18 months following diagnosis.

Complementary Feeding and Growth Among Low Birthweight Infants in the The Second Half of Infancy: Results From a Multi-Site Observational Cohort

ObjectivesThis study was designed to address the high prevalence of infant undernutrition among low birthweight (LBW, < 2.5kg) infants in the second half of infancy, and the dearth of evidence on the optimal transition and provision of complementary feeding and growth of LBW infants. The objectives were to understand the complementary feeding profile and growth outcomes in the second half of infancy; and to assess the relationship between poor nutritional status at the time of transition to complementary feeding and poor growth outcomes at one year.MethodsThe results presented in this abstract are part of the larger Low Birthweight Infant Feeding Exploration (LIFE) study conducted in India, Malawi and Tanzania. This was a formative, multi-site, observational cohort study that collected data on over 1100 moderately LBW infants throughout infancy. After the six month visit, mother-infant pairs were visited at nine and 12 months.ResultsA total of 1114 infants and their mothers were enrolled in the observational study. More than 95% of infants were fed breast milk at six, nine and 12 months of age. At nine and 12 months respectively, 48% and 31% of infants were not achieving a minimum acceptable diet, highlighting gaps in dietary diversity. A lack of dietary diversity was exacerbated among infants born to younger, less educated and/or multiparous mothers. Proteins were more limited than any other food group; only 66% and 70% of infants were fed animal source foods at nine and 12 months, respectively. Prevalence of stunting (>30%) increased from six to 12 months while underweight (26%) and wasting (10%) remained consistent; regional differences were observed. Importantly, poor growth outcomes at six months were predictive of those at 12 months even when adjusted for key covariates (stunting RR = 2.84, p < 0.001; underweight RR = 6.41, p < 0.001; wasting RR = 4.89, p < 0.001).ConclusionsGiven the gaps in the optimal quality of complementary feeding and predictive relationship between six and 12 month growth outcomes, efforts should be made to enhance the promotion of feeding counseling before and during the transition to complementary feeding and to address key barriers to the provision of a diverse diet. In addition, growth monitoring and proactive intervention at six months or earlier could serve to prevent poor outcomes at one year of life.Funding SourcesBill & Melinda Gates Foundation.

Low Birthweight Infant Feeding Practices and Growth Patterns in the First Six Months of Life in Resource-Limited Settings

ObjectivesThe Low Birthweight Infant Feeding Exploration (LIFE) study addresses the increased risk for mortality and poor health outcomes as well as the paucity of evidence on feeding and growth among low birthweight (LBW) infants in limited-resource settings. The objectives were to describe the feeding profile of low birthweight (LBW, < 2.5kg) infants in the first half of infancy; and to examine growth patterns and early risk factors of poor growth outcomes at six months.MethodsThe LIFE study was a formative, multi-site, observational cohort study. Data were collected during eight visits from birth to six months for more than 1100 moderately LBW infants recruited from 12 health facilities in four sites in India, Malawi and Tanzania.ResultsA total of 1114 infants and their mothers were enrolled in the observational study comprising19% preterm small-for-gestational age (SGA), 26% preterm appropriate-for-gestational age (AGA) and 55% term SGA infants with significant differences in prevalence of birth phenotypes by region. More than 90% of infants were fed breastmilk at each visit before six months; only 42% were exclusively breastfed up to six months. Among the pooled sample of LBW infants, 14% did not regain their birthweight by two weeks; and 33%, 26% and 10% were stunted, underweight and wasted at six months, respectively. Preterm-SGA infants [1.76 (p = 0.001) and 1.80 (p = 0.012)] and term-SGA infants [2.44 (p < 0.001) and 2.82 (p = 0.012)] had significantly greater risks for stunting and wasting at six months than preterm-AGA infants. There was no significant difference in the risk for underweight between the phenotypes. Infants not regaining birthweight by two weeks had 1.48 (p = 0.002) and 1.52 (p = 0.005) times greater risk for stunting and underweight at six months, respectively. There was no relationship between lack of birthweight regain by two weeks and wasting at six months. Finally, there was no relationship between exclusive breastfeeding up to six months and growth outcomes at 6 months.ConclusionsLBW infants are a heterogenous group. Birth outcomes and very early growth matter and should be prioritized in efforts to prevent growth failure and allocate scarce resources. Poor growth outcomes can be prevented with focused, proactive interventions at key timepoints.Funding SourcesBill & Melinda Gates Foundation.