Preterm Appropriate For Gestational Age Research Articles

Postnatal functional integrity of the brainstem auditory pathway in late preterm infants born of small-for-gestation age: how different from those born of appropriate-for-gestation.

It is unclear whether there is any postnatal abnormality in brainstem auditory function in late preterm small-for-gestational-age (SGA) infants. We investigated the functional integrity of the brainstem auditory pathway at 4months after term in late preterm SGA infants and defined differences from appropriate-for-gestational age (AGA) infants. The maximum length sequence brainstem evoked response (MLS BAER) was recorded and analyzed in 24 SGA (birthweight < 3rd centile) infants and 28 AGA infants (birthweight > 10th centile). All infants were born at 33-36-week gestation without major perinatal and postnatal problems. We found that I-V interval in SGA infants was shorter than in AGA infants at higher click rates and significantly shorter at the highest rate of 910/s. Of the two smaller intervals, I-III interval was significantly shorter in SGA infants than in AGA infants at higher click rates of 455 and 910/s clicks, whereas III-V interval was similar in the two groups. The III-V/I-III interval ratio in SGA infants tended to be greater than in AGA infants at all rates and was significantly greater at 455 and 910/s clicks. The slope of I-III interval-rate functions in SGA infants was moderately smaller than in AGA infants. Conclusions: The main and fundamental difference between late preterm SGA and AGA infants was a significant shortening in the MLS BAER I-III interval in SGA infants at higher click rates, suggesting moderately faster neural conduction in the caudal brainstem regions. Postnatal neural maturation in the caudal brainstem regions is moderately accelerated in late preterm SGA infants. What is Known: • At 40weeks of postconceptional age, late preterm SGA infants manifested a mild delay in neural conduction in the auditory brainstem. What is New: • At 56weeks of postconceptional age, late preterm SGA infants manifested moderately faster neural conduction in the caudal brainstem regions. • Postnatal neural maturation is moderately accelerated in the caudal brainstem regions of late preterm SGA infants.

Growth patterns of preterm and small for gestational age children during the first 10 years of life.

Preterm and small for gestational age (SGA) remain significant public health concerns worldwide. Yet limited evidence exists on their growth patterns during childhood from low-or middle-income countries. We investigated the postnatal growth patterns of preterm and SGA compared to term appropriate for gestational age (AGA) children from birth to 10-11y, and examined the impact of birth status on child nutritional status during the school age years. Children born to women who participated in a double-blinded randomized controlled trial of preconception micronutrient supplementation in Vietnam were classified into three groups: preterm AGA (n = 130), full-term SGA (n = 165) and full-term AGA (n = 1,072). Anthropometric data (weight and height) were collected prospectively at birth, 3, 6, 12, 18, 24 months and at 6-7 and 10-11y. We used ANOVA and multiple regression models to examine the differences in growth patterns from birth to 10-11y as well as child undernutrition and overnutrition by birth status. Children who were born preterm exhibited rapid postnatal growth, but still had lower HAZ at 1y and 2y and showed catch up to the AGA group at 6y. Compared to those born AGA, SGA infants had higher risk of thinness (BMIZ < -2) at 2y and 6y (adjusted Odds Ratio, AOR [95% CI] 2.5 [1.0, 6.1] and 2.6 [1.4, 4.6], respectively); this risk reduced at 10-11y (1.6 [0.9, 2.8]). The risk of stunting (HAZ < -2) was also 2.4 [1.5, 3.8] and 2.3 times [1.2, 4.1] higher in SGA than AGA group at ages 2y and 6-7y, respectively, with no differences at 10y. Although preterm children had higher rates of thinness and stunting at 2y compared to AGA children, these differences were not statistically significant. No associations were found between preterm or SGA and overweight /obesity at age 10-11y. Children who were born term-SGA continued to demonstrate deficits in weight and height during childhood whereas those born preterm showed catch-up growth by age 6-7y. Additional efforts to reduce the burden of these conditions are needed, particularly during school-age and early adolescents when children are exposed to challenging environments and have higher demands for nutrition.

Comparative Growth Outcomes in Very Low Birth Weight Infants: Evaluating Different Feeding Strategies.

To assess the growth pattern of preterm, very low birth weight (VLBW) appropriate for gestational age (AGA) infants on three different feeding regimens. This prospective open label three-arm parallel randomized controlled trial was conducted at neonatal intensive care unit, Kasturba Hospital, Manipal. One hundred twenty VLBW (weight between 1000-1500g and gestational age 28-32 wk) preterm AGA infants admitted from April 2021 through September 2022 were included. Three feeding regimens were compared: Expressed breast milk (EBM); EBM supplemented with Human milk fortifier (HMF); EBM supplemented with Preterm formula feed (PTF). Primary outcome measure was assessing the growth parameters such as weight, length, head circumference on three different feeding regimens at birth 2, 3, 4, 5 and 6 wk/discharge. Secondary outcomes included incidence of co-morbidities and cost-effectiveness. Of 112 infants analyzed, Group 2 supplemented with HMF showed superior growth outcomes by 6th wk/discharge of intervention, with mean weight of 2053±251g, mean length of 44.6±1.9cm, and mean head circumference of 32.9±1.4cm. However, infants in Group 3, supplemented with PTF, registered mean weight of 1968±203g, mean length of 43.6±2.0cm, and mean head circumference of 32.0±1.6cm. Infants exclusively on EBM presented with mean weight of 1873±256g, mean length of 43.0±2.0cm and mean head circumference of 31.4±1.6cm. Addition of 1 g of HMF to 25 ml of EBM in neonates weighing 1000-1500 g showed better weight gain and head circumference at 6 wk/discharge, which was statistically significant. However, no significant differences in these parameters were observed at postnatal or 2, 3, 4, and 5 wk.

A retrospective study on the physical growth of twins in the first year after birth.

This study analyzed the physical growth of small for gestational age (SGA) and appropriate for gestational age (AGA) twins up to one year after birth. Weight, length, and head circumference data of 0-1 year-old twins were collected from the Child Health Care System from 2010 to 2019. Physical data were presented as Z-scores. Five parameters - growth level of weight, body length, head circumference, growth velocity, and body proportion (weight for length) were compared in twins. A total of 3,909 cases were collected (22.61% SGA, 77.39% AGA). 1. In both groups, WAZ (Weight for age z-score), HCZ (Head circumference for age z-score), and LAZ (Length for age z-score) increased more rapidly in the first 6 months. By one year of age, WAZ, HCZ, and LAZ had reached the normal range, but none had reached the average level of normal singleton children. 2. The mean values of WAZ, HCZ, and LAZ in the AGA group were between -1 and 0, and between -2 and - 1 in the SGA group, in the first year after birth. The SGA group lagged significantly behind the AGA group. The LAZ score of SGA and AGA was lower than the WAZ and HCZ scores. 3. The proportion of preterm AGA was the largest in twins, and the growth rate of preterm AGA was the fastest. Preterm twins had greater growth potential than term twins. However, the growth level of preterm SGA was always low. 4. The WFLZ (Weight for length z-score) in each group was approximately close to 0. The WFLZ of SGA was smaller than that of AGA twins at most time points. After 4 months of age, the WFLZ of twins had a downward trend. The WFLZ of preterm SGA approached -1 at approximately 1 year old. The physical growth of SGA and AGA in twins in the first year can reach the normal range but cannot reach the average level of normal singleton children. More attention should be paid to SGA in twins, especially preterm SGA. We should give proper nutritional guidance after 4 months of age to ensure the appropriate body proportion (weight for length) of SGA in twins. www.chictr.org.cn, CTR2000034761.

Early-Onset Fetal Growth Restriction Increases Left Ventricular Sphericity in Adolescents Born Very Preterm.

Left ventricular shape alterations predict cardiovascular outcomes and have been observed in children born preterm and after fetal growth restriction (FGR). The aim was to investigate whether left ventricular shape is altered in adolescents born very preterm and if FGR has an additive effect. Adolescents born very preterm due to verified early-onset FGR and two control groups with birthweight appropriate for gestational age (AGA), born at similar gestational age and at term, respectively, underwent cardiac MRI. Principal component analysis was applied to find the modes of variation best explaining shape variability for end-diastole, end-systole, and for the combination of both, the latter indicative of function. Seventy adolescents were included (13-16years; 49% males). Sphericity was increased for preterm FGR versus term AGA for end-diastole (36[0-60] vs -42[-82-8]; p = 0.01) and the combined analysis (27[-23-94] vs -51[-119-11]; p = 0.01), as well as for preterm AGA versus term AGA for end-diastole (30[-56-115] vs -42[-82-8]; p = 0.04), for end-systole (57[-29-89] vs -30[-79-34]; p = 0.03), and the combined analysis (44[-50-145] vs -51[-119-11]; p = 0.02). No group differences were observed for left ventricular mass or ejection fraction (all p ≥ 0.33). Sphericity was increased after very preterm birth and exacerbated by early-onset FGR, indicating an additive effect to that of very preterm birth on left ventricular remodeling. Increased sphericity may be a prognostic biomarker of future cardiovascular disease in this cohort that as of yetshows no signs of cardiac dysfunction using standard clinical measurements.

Breastfeeding practices based on the gestational age and weight at birth in the first six months of life in a population-based cohort of infants from North India.

Short and long term benefits of early Initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) in the first six months of life are well established and recommended globally. However, reliable estimates of breastfeeding practices and impact of breastfeeding counselling interventions according to gestational age and weight at birth are not available in low and middle income countries. To assess the impact of breastfeeding counselling on EIBF and EBF during the first 6 months of life according to gestational age and weight at birth. We analysed the data collected from the Women and Infants Integrated Interventions for Growth Study (WINGS), an individually randomized factorial design trial. Mothers were counselled on EIBF during third trimester of pregnancy. They were supported throughout the first 6 months to continue EBF by early problem identification, frequent home visits and assistance in expressing breastmilk when direct breastfeeding was not possible. Breastfeeding practices were ascertained through 24 h recalls at infant ages 1, 3 and 5 months for both the intervention and control groups by an independent outcome ascertainment team. The World Health Organization (WHO) definitions were used for classification of infant breastfeeding practices. Generalized linear models of the Poisson family with a log-link function were used to estimate the effect of interventions on breastfeeding practices. The relative measures of effect on breastfeeding practices were estimated in term appropriate for gestational age (T-AGA), term small for gestational age (T-SGA), preterm AGA (PT-AGA), preterm SGA (PT-SGA) infants. Amongst all infants irrespective of gestational age and weight at birth, EIBF was (51.7%) higher amongst the intervention group (IRR 1.38, 95% CI 1.28-1.48) compared with the control group. The proportion of exclusively breastfed infants at ages 1 month (IRR 1.37, 95% CI 1.28-1.48), 3 months (IRR 2.13, 95% CI 1.30-1.44) and 5 months (IRR 2.78, 95% CI 2.58-3.00) were higher in intervention group than control group. We identified significant interaction (p value for interaction <0.05) between intervention and infant size and gestation at birth on exclusive breastfeeding at 3 and 5 months of age. Subgroup analysis showed that the impact of the intervention was greater on exclusive breastfeeding in PT- SGA infants at 3 months (IRR 3.30, 95% CI 2.20-4.96) and 5 months of age (IRR 5.26, 95% CI 2.98-9.28). This is one of the first studies wherein impact of breastfeeding counselling interventions in the first 6 months of life was assessed according to infant size and gestation at birth wherein gestational age was reliably estimated. The impact of this intervention was higher in preterm and SGA babies compared to other infants. This finding is important as preterm and SGA infants have a higher burden of mortality and morbidity during early infancy. Intensive breastfeeding counselling to these vulnerable infants is likely to improve overall breastfeeding rates and reduce the adverse outcomes.Clinical Trial Registration: [http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=19339%26EncHid=%26userName=societyforappliedstudies], identifier [#CTRI/2017/06/008908].

Usefulness of Mean Gastric Emptying Time in Late Preterm and Term AGA and SGA Newborns to Determine Feeding Frequency—An Observational Study

Objectives The primary objective is to calculate and compare mean gastric emptying time in appropriate for gestational age (AGA) and small for gestational age (SGA) newborns. The secondary objective is to compare mean gastric emptying time in SGA babies with or without antenatal Doppler changes and to measure gastric spheroidal volume at various intervals in AGA and SGA newborns with or without antenatal Doppler changes. Methods This prospective observational study was carried over 3 months from November 2022 to January 2023. A total of 30 newborns were enrolled and their gastric spheroidal volume was calculated by ultrasound pre-feed and post-feed every 30 minutes till it reached within 10% of pre-feed volume which was taken as gastric emptying time. Mean gastric emptying time was compared among AGA and SGA newborns and amongst SGA with or without antenatal Doppler changes. Results Mean gastric emptying time of AGA was 124 ± ± 25.01 minutes and for SGA was 132 ± 29.57 minutes which was statistically nonsignificant. Mean gastric emptying time when compared between SGA neonates with or without antenatal Doppler changes was similar ( P value .43). The gastric spheroidal volume was significantly smaller in SGA newborns compared to their AGA counterparts in pre-feed state ( P value .01) and it persisted till 60 minutes post feed ( P value .028); however, the mean gastric emptying time is similar in both the groups. Conclusion Mean gastric emptying time of AGA and SGA newborns is similar and hence a feeding interval of 1.5 to 2.5 hours is appropriate for these late preterm and term newborns. Antenatal Doppler changes in SGA babies did not alter their gastric emptying time hence similar feeding frequency can be used in both.

Classification and Special Nutritional Needs of SGA Infants and Neonates of Multiple Pregnancies.

Data regarding the nutritional management of preterm small for gestational age (SGA) infants are scarce. In the recent report of ESPGHAN, the recommended energy for very preterm infants during hospitalization has been increased, yet this may not fit the needs of all preterm infants. It is important to distinguish fetal growth-restricted (FGR) infants from constitutional SGA infants, as well as preterm SGA from preterm AGA infants, since they may have different nutritional needs. Preterm FGR infants, and specifically infants < 29 weeks' gestation, accumulate nutrient deficits due to intrauterine malnutrition, prematurity, morbidities, delayed initiation of feeding, and feeding intolerance. Therefore, these infants may need more aggressive nutrition for optimal catch-up growth and neurologic development. However, a balance should be kept between optimal and excessive catch-up growth, since the combination of intrauterine malnutrition and excessive postnatal growth has been linked with later adverse metabolic consequences. Furthermore, multiple gestation is often complicated by FGR and prematurity. There is controversy in the definition of FGR in multiple gestations, and it should be noted that FGR in multiple gestation usually differs etiologically from FGR in singletons. The aim of this review is to summarize existing knowledge regarding the nutritional needs of preterm FGR and FGR infants of multiple gestation.

Serum PCSK9 levels in infants with deviant birth weight: a biomarker of the lipoprotein metabolism

Objective Proprotein Convertase Subtilisin/Kexin-Type 9 (PCSK9), a modulator of low-density lipoprotein (LDL) cholesterol metabolism, has been reported to be a promising biomarker for evaluating lipoprotein metabolism; however, evidence in infants is limited. In the current study, we sought to investigate potential differences in serum PCSK9 levels between infants with deviant birth weight and controls. Methods We enrolled 82 infants, classified into 33 small (SGA), 32 appropriate (AGA), and 17 large for gestation (LGA) infants. Serum PCSK9 was measured on routine blood analysis within the first postnatal 48 h. Results PCSK9 was significantly higher in SGA as compared to AGA and LGA infants [322 (236–431) as compared to 263 (217–302) and 218 (194–291) ng/ml respectively, p = .011]. In comparison to term AGA infants, PCSK9 was significantly elevated in preterm AGA and SGA infants. We also found a significantly higher level of PCSK9 in term female SGA infants as compared to term male SGA infants [325 (293–377) as compared to 174 (163–216) ng/ml, p = .011]. PCSK9 was significantly correlated with gestational age (R = –0.404, p < .001), birth weight (R = –0.419, p < .001), total cholesterol (R = 0.248, p = .028) and LDL cholesterol (R = 0.370, p = .001). SGA status (OR 2.56, p = .004, 95% CI 1.83–4.28) and prematurity (OR 3.10, p = .001, 95% CI 1.39–4.82) were strongly related to serum PCSK9 levels. Conclusion PCSK9 levels were significantly associated with total and LDL cholesterol. Moreover, PCSK9 levels were higher in preterm and SGA infants, suggesting that PCSK9 might be a promising biomarker for evaluating infants with increased later cardiovascular risk. Highlights What’s already known? Proprotein Convertase Subtilisin/Kexin-Type 9 (PCSK9) is a promising biomarker for evaluating lipoprotein metabolism; however, evidence in infants is limited. Infants that were born with a deviant birth weight have a unique lipoprotein metabolism profile. What this study adds? Serum PCSK9 levels were significantly associated with total and LDL cholesterol. PCSK9 levels were higher in preterm and small for gestation infants, suggesting that PCSK9 might be a promising biomarker for evaluating infants with increased later cardiovascular risk.

HYPOGLYCEMIA IN EXCLUSIVELY BREASTFED LOW BIRTH WEIGHT NEONATES

Background and Aim: Hypoglycemia is an important problem encountered in Low Birth Weight (LBW) neonates. Incidence and risk factors associated with hypoglycemia in low birth weight neonates on exclusive breast milk were studied. Material and Methods: A Prospective observational study was done between Jan-June 2022. Low birth weight neonates (≥1.8 kg &lt;2.5 kg) who were fed exclusively with breast milk were screened for hypoglycemia by measuring capillary blood glucose by glucometer strips at 1 , 2 , 6 , 12 , 24 , 48 and 72 hours of age. Results: 180 Low Birth Weight neonates were included in the study, of which 41 developed hypoglycemia with incidence of 22.7%. Majority of them (85.3%) were asymptomatic . 70.7 % of hypoglycemia episodes occurred in rst 24 hours of life. 58.5% neonates with hypoglycemia had only one episode while 31.7% and 9.8% had 2 and 3 or more episodes of hypoglycemia respectively. Incidence was more in Pre term (PT) (27.3%) compared to Full Term(FT) neonates (16.2%). Also Small for Gestational Age (SGA) neonates were more prone to hypoglycemia compared to Appropriate for Gestational Age (AGA) neonates (48.2 % against 18.4%) Incidence in PT SGA, FT SGA and PT AGA neonates was 27.9%,20.3 &amp; 18.4% respectively. Incidence was also more in neonates born to primigravida mothers and those delivered by cesarean section. Conclusion: Low birth weight Neonates especially late preterms and SGAneonates on exclusive breast milk should be monitored for hypoglycemia in rst 72 hours of life. Early initiation of breast feeding should be ensured to prevent hypoglycemia in them.

Clinical profile of low-birth-weight neonates admitted in NICU: a tertiary care hospital-based study

Background: LBW is defined as weight at birth less than 2.5kg irrespective of gestational age. LBW neonate remains at much higher risk of morbidity and mortality than normal birth weight baby. Morbidity and mortality among LBW babies are a major health problem in our country, so it’s important to identify risk factors. Methods: A prospective observational study was conducted on 153 extramural LBW neonates admitted in Neonatal intensive care unit of civil hospital, BJ medical college Ahmedabad from April 2021 to January 2022. Results: Out of 153 neonates, 94 (61.4%) were preterm, appropriate for gestational age and 59 (38.6%) were small for gestational age including 41 (26.8%) term and 18 (11.8%) preterm. 16 (10%) were extremely LBW neonates and 28 (18%) were very low birth weight neonates. 77 (53%) neonates were late preterm and term gestational age. Most common indication of NICU admission was respiratory distress syndrome in 53 (27.8%) followed by sepsis 35 (18.4%), neonatal hyperbilirubinemia 22 (11.6%), birth asphyxia 15 (7.8%) and prematurity+LBW 16 (8.4%). Conclusions: Majority of LBW babies were preterm AGA babies. Respiratory distress syndrome, sepsis, birth asphyxia, prematurity and neonatal hyperbilirubinemia are major causes of admission. While, Respiratory distress syndrome, sepsis and birth asphyxia were common causes of expires. Respiratory distress syndrome is most common cause of morbidity and mortality in low-birth-weight babies. Appropriate and effective use of oxygen delivery system, surfactant, safe, early and effective transportation of neonates should be advised.

Fetal growth restriction followed by very preterm birth is associated with smaller kidneys but preserved kidney function in adolescence

BackgroundPreterm birth and fetal growth restriction (FGR) are associated with structural and functional kidney changes, increasing long-term risk for chronic kidney disease and hypertension. However, recent studies in preterm children are conflicting, indicating structural changes but normal kidney function. This study therefore assessed kidney structure and function in a cohort of adolescents born very preterm with and without verified FGR.MethodsAdolescents born very preterm with FGR and two groups with appropriate birthweight (AGA) were included; one matched for gestational week at birth and one born at term. Cortical and medullary kidney volumes and T1 and T2* mapping values were assessed by magnetic resonance imaging. Biochemical markers of kidney function and renin–angiotensin–aldosterone system (RAAS) activation were analyzed.ResultsSixty-four adolescents were included (13–16 years; 48% girls). Very preterm birth with FGR showed smaller total (66 vs. 75 ml/m2; p = 0.01) and medullary volume (19 vs. 24 ml/m2; p < 0.0001) compared to term AGA. Corticomedullary volume ratio decreased from preterm FGR (2.4) to preterm AGA (2.2) to term AGA (1.9; p = 0.004). There were no differences in T1 or T2* values (all p ≥ 0.34) or in biochemical markers (all p ≥ 0.12) between groups.ConclusionsFGR with abnormal fetal blood flow followed by very preterm birth is associated with smaller total kidney and medullary kidney volumes, but not with markers of kidney dysfunction or RAAS activation in adolescence. Decreased total kidney and medullary volumes may still precede a long-term decrease in kidney function, and potentially be used as a prognostic marker.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Higher blood pressure in adolescent boys after very preterm birth and fetal growth restriction

BackgroundAlthough preterm birth predisposes for cardiovascular disease, recent studies in children indicate normal blood pressure and arterial stiffness. This prospective cohort study therefore assessed blood pressure and arterial stiffness in adolescents born very preterm due to verified fetal growth restriction (FGR).MethodsAdolescents (14 (13–17) years; 52% girls) born very preterm with FGR (preterm FGR; n = 24) and two control groups born with appropriate birth weight (AGA), one in similar gestation (preterm AGA; n = 27) and one at term (term AGA; n = 28) were included. 24-hour ambulatory blood pressure and aortic pulse wave velocity (PWV) and distensibility by magnetic resonance imaging were acquired.ResultsThere were no group differences in prevalence of hypertension or in arterial stiffness (all p ≥ 0.1). In boys, diastolic and mean arterial blood pressures increased from term AGA to preterm AGA to preterm FGR with higher daytime and 24-hour mean arterial blood pressures in the preterm FGR as compared to the term AGA group. In girls, no group differences were observed (all p ≥ 0.1).ConclusionsVery preterm birth due to FGR is associated with higher, yet normal blood pressure in adolescent boys, suggesting an existing but limited impact of very preterm birth on cardiovascular risk in adolescence, enhanced by male sex and FGR.ImpactVery preterm birth due to fetal growth restriction was associated with higher, yet normal blood pressure in adolescent boys.In adolescence, very preterm birth due to fetal growth restriction was not associated with increased thoracic aortic stiffness.In adolescence, very preterm birth in itself showed an existing but limited effect on blood pressure and thoracic aortic stiffness.Male sex and fetal growth restriction enhanced the effect of preterm birth on blood pressure in adolescence.Male sex and fetal growth restriction should be considered as additional risk factors to that of preterm birth in cardiovascular risk stratification.

Comparison of respiratory morbidity in late preterm infants and intrauterine growth retarded infants at school-age

Objective: We aimed to determine respiratory morbidity of late preterm infants versus infants with intrauterine growth retardation (IUGR) at school-age. Patients and Methods: Late preterm appropriate for gestational age (AGA) infants (34-36, 6/7 weeks) (Group 1), IUGR infants (Group 2), extremely preterm AGA (Group 3) and term AGA infants (Group 4) born between 2004 and 2008 were included in this casecontrol study and assessed for respiratory morbidity at school-age. We evaluated the impact of late preterm compared with IUGR and term gestation on respiratory morbidity by using validated American Thoracic Society – Division of Lung Diseases (ATS-DLD-78-C) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Questionnaires on wheezing, infectious respiratory morbidity, and physician-diagnosed asthma panels were constituted and groups were compared. Results: A total of 160 patients were enrolled in the study and 97 (60.6%) of them were boys. Respiratory morbidities at schoolage were found to be significantly higher in both late preterm and IUGR groups when compared to term controls. Each weekly increase in gestational age reduced the risk for wheezing episodes (OR perGW:0.82,95%CI:0.71-0.97, p:0.02). Regarding infectious respiratory morbidities, there was a significant increase when the number of people living at home increased (OR perperson:1.79,95%CI:1.12-2.87, p:0.01), and a decrease in female gender (OR:0.41,95%CI:0.17-0.99, p:0.04) and in the week of gestation (OR perGW:0.84,95%CI:0.71-1.00, p:0.04). Atopic dermatitis (OR:5.26,95%CI:1.57-17.69, p&amp;lt;0.01) and maternal asthma (OR:5.38,95%CI:1.17-24.60, p:0.03) history were found to be risk factors for asthma. Conclusion: Being IUGR may be an important risk factor for respiratory morbidity at school-age. Further studies are needed on this subject.

Clinical Profile of Hypoglycaemia in Neonates at Risk in a Tertiary Care Teaching Institute in Southern India: A Longitudinal Study

Introduction: Hypoglycaemia is common in babies at risk. Without early detection, timely diagnosis and treatment, hypoglycaemia can cause disastrous consequences on neurological and developmental outcomes. Therefore, continuous monitoring of blood glucose levels in babies at risk should be done to reduce its impact. Aim: To describe the clinical profile and sequential blood sugar levels in the first four postnatal days in at-risk neonates and to identify the risk group of neonates with recurrent hypoglycaemia. Materials and Methods: This was a longitudinal study done in the Neonatal Intensive Care Unit (NICU) and Special Newborn Care Unit (SNCU) of a tertiary care teaching institute; Sri Avittam Thirunal Hospital (SATH), Government Medical College, Thiruvananthapuram, Kerala, India, from October 2017 to October 2018. Neonates admitted with risk factors for hypoglycaemia according to ‘National Neonatology Forum’ clinical guidelines with low capillary blood sugar (&lt;40 mg/dL) within the first two to four hours of life were included in the study. These neonates were followed-up clinically till fourth postnatal day with glucose monitoring. Statistical analysis was done using Statistical Package for the Social Sciences (SPSS) software version 22. Categorical variables were expressed as proportions and compared using the Chi-square test. A p-value &lt;0.05 was considered statistically significant. Results: A total of 368 ‘at risk’neonates had hypoglycaemia at admission (2 to 4 hours) and of these 200 (54.3%) developed recurrent hypoglycaemia. Out of the neonates with recurrent hypoglycaemia, 150 (75%) were preterm and 50 (25%) were term. The preterm Small for Gestational Age (SGA) had a higher chance of developing recurrent hypoglycaemia than preterm Appropriate for Gestational Age (AGA) and Large for Gestational Age (LGA) (p-value=0.0256). Although, 102 (40.2%) preterm had asymptomatic hypoglycaemia, 90 (78.9%) term neonates showed symptoms of hypoglycaemia. The major clinical manifestation was jitteriness in those with a single episode 31 (18.45%) and lethargy/poor activity in those with more than one episode 66 (33%). The blood glucose levels less than 25 mg/dL at admission was significantly associated with the occurrence of a repeat episode of hypoglycaemia (p-value=0.028). Conclusion: Blood glucose monitoring in neonates with risk factors is mandatory as 54.3% of neonates developed recurrent hypoglycaemia. Of these, preterm SGA had a high chance of developing recurrent hypoglycaemia. The variable presentations in neonatal hypoglycaemia indicates the need for detailed and thorough clinical examination with glucose monitoring in these at-risk neonates. Initial blood glucose level less than 25 mg/dL was significantly associated with recurrent hypoglycaemia.

The effect of perinatal and obstetric history characteristics on neonatal mortality and morbidity of preterm SGA and AGA babies with a birth weight of 1000-2000 grams.

The effect of perinatal and obstetric history characteristics on neonatal mortality and morbidity of preterm SGA and AGA babies with a birth weight of 1000-2000 grams.

Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

Prematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

Postnatal Maturation of Amplitude Integrated Electroencephalogram in Preterm SGA and Preterm AGA Neonates: A Prospective Observational Study

Introduction: Maturation of the brain is affected by various biological and environmental factors encountered by the infant during the intensive care period in Neonatal Intensive Care Unit (NICU) due to the medical treatments, procedures, and the noisy environment that disrupts the normal brain development process. Severe neurological sequelae of preterm infants are common because of the immature central nervous system. Cerebral Function Monitor (CFM) or Amplitude integrated Electroencephalogram (a-EEG) is a device for monitoring the background neurological activity. Aim: To assess postnatal maturation of a-EEG in clinically stable and neurologically normal preterm Small for Gestational Age (SGA) and preterm Appropriate for Gestational Age (AGA) neonates from 30 weeks 0/7 days to 34 weeks 6/7 days of gestation admitted in a tertiary care NICU at J. K. Lon Mother and Child Hospital, attached to Government Medical College, Kota. Materials and Methods: This prospective observational study was conducted over a one year duration, from January 2020 to December 2020 on 60 preterm neonates that were admitted in NICU of a tertiary care hospital. The serial a-EEG recording was done on haemodynamically stable, included preterm neonates after taking consent, on 3rd, 7th, and 14th postnatal day of life during the course of admission. The postnatal maturation of amplitude integrated EEG of Preterm Small for Gestational Age (PSGA) neonates was compared with their Preterm Appropriate for Gestational Age (PAGA) neonates based on a validated a-EEG scoring. The analysis was done by using Statistical Package for Social Sciences (SPSS) version 21.0. Student t-test was applied. Results: The total a-EEG scores for 3rd, 7th, and 14th day of SGA group neonates were 7.55±1.45, 7.25±1.02 and 10.22±1.05 and were delayed from the AGA group of neonates with 7.86±1.55, 8.68±1.00 and 10.62±1.01, with mean difference (95% CI), 0.30 (-0.49 to 1.13), 1.43 (0.88 to 1.97) and 0.39 (-0.15 to 0.95) respectively. Only the total a-EEG scores for day 7 were significantly delayed in SGA group. Conclusion: All the maturation a-EEG scores of clinically stable and neurologically normal PSGA neonates was found to be significantly delayed at any point of life on postnatal day 7th of life.

Cord Blood from SGA Preterm Infants Exhibits Increased GLUT4 mRNA Expression.

Insulin and insulin-like growth factor (IGF) signaling plays an important role in prenatal and postnatal growth and glucose metabolism. Both small-for-gestational age (SGA) and preterm infants have abnormal growth and glucose metabolism. However, the underlying mechanism remains unknown. Recently, we showed that term SGA infants have abnormal insulin/IGF signaling in cord blood. In this study, we examined whether preterm infants show similar aberrations in cord blood insulin/IGF signaling. A total of 41 preterm cord blood samples were collected. Blood glucose, insulin, IGF-1, and C-peptide concentrations were measured, and mRNA expression of IGF1R, INSR, IRS1, IRS2, and SLC2A4 (i.e., GLUT4) was analyzed by quantitative reverse-transcription PCR. This study included 34 appropriate-for-gestational age (AGA) and 7 SGA preterm neonates. No hyperinsulinemia or any differences in IGF1R or INSR mRNA expression were detected between the two groups. However, GLUT4 mRNA levels were increased in preterm SGA. Moreover, the expression level in hypoglycemic preterm SGA was significantly higher than that in hypoglycemic preterm AGA. IRS2 mRNA expression did not show a statistically significant difference between preterm SGA and AGA neonates. SGA preterm birth does not induce hyperinsulinemia; however, it modifies insulin/IGF signaling components such as GLUT4 in umbilical cord blood. Our study suggests that prematurity or adaptation to malnutrition alters the insulin/IGF signaling pathway.

Birth Weight Standard Deviation Score is a Significant Determinant of Serum Urotensin-II Levels at Term-Equivalent Age in Preterm Infants

Urotensin II (U-II) is a potent vasoconstrictor peptide, and increased U-II levels are associated with atherosclerosis and hypertension in adults. Low birth weight (LBW) infants have higher risks of such diseases in the future. A small number of nephrons is one of possible mechanism underlying these risks in LBW infants, while vascular elasticity and cardiac function might be another important factor. The objective of this study is to evaluate U-II levels in preterm LBW infants at an early stage of life and determine perinatal factors associated with U-II levels. The study population consisted of 57 preterm LBW infants (26 males and 31 females), including 49 appropriate for gestational age (AGA) and 8 small for gestational age (SGA) infants, born at a gestational age of ≤34 weeks with a mean birth weight of 1,589 g. Serum U-II levels were measured at term-equivalent age to evaluate perinatal factors related to serum U-II levels. Preterm SGA infants had significantly higher serum U-II levels than preterm AGA infants at term-equivalent age (p = 0.019). Serum U-II levels in preterm LBW infants at term-equivalent age were inversely correlated with birth weight standard deviation (SD) score in a simple regression analysis (r = - 0.395, p = 0,002) and the correlation was maintained in the multiple regression analysis. Our results indicate that birth weight SD score might be associated with serum U-II levels in preterm LBW infants at term-equivalent age. Further studies are required to determine whether U-II levels at an early stage of life might influence the risk of atherosclerosis and hypertension. · U-II is a potent vasoconstrictor.. · We evaluated serum U-II levels in preterm infants.. · Fetal growth is negatively related to serum U-II levels..