Risk Of Growth Retardation Research Articles

Literature Review : Feeding Comfort With Stunting Problems in Toddlers

The poor practice of complementary feeding (MPASI) is one of the most common problems in developing countries. This can lead to poor absorption of nutrients, especially protein, which is associated with problems related to physical growth disorders such as stunting in children under the age of 5 years. This study used a cross-sectional design intending to clarify the relationship between complementary feeding practices and the risk of stunting in children aged 6 to 12 months from Central Lombok. It was an analytical observational study. A total of 206 children with an average age of 9.3 months were selected as the subjects of this study using cluster sampling. Most of them are women. This study analyzed four parameters of the practice of giving complementary foods, namely the age of the first time complementary foods, types of complementary foods, the frequency of complementary foods, and the frequency of complementary foods. This study found a significant relationship between the frequency of complementary feeding (p=0.047, 95%CI) and the number of complementary foods given (p = 0.020, 95% CI) with the risk of developmental disorders in children. On the other hand, other parameters such as age at initiation of complementary foods and solid food texture were not significantly associated with the risk of growth retardation. One of the factors that directly affect stunting in children under the age of 2 years is intake factors such as breast milk (ASI) and breast milk supplements (MPASI).

Diagnosis of Malnutrition in Children and Adolescents with Identified Developmental Disabilities (IDD) Using Subjective Global Nutrition Assessment (SGNA).

Children with identified developmental disabilities (IDD) experience a higher risk of growth retardation. Anthropometric indicator is one common objective measurement used to determine malnutrition in those children. A comprehensive nutritional assessment tool should be introduced to offer a more robust approach in understanding their nutritional problems. To determine the use of Subjective Global Nutrition Assessment (SGNA) as a nutrition assessment tool for children with IDD in comparison to the anthropometric indicators. This cross-sectional study was conducted in local community settings. IDD included in this study were autism spectrum disorder (ASD), Down syndrome (DS) and cerebral palsy (CP). SGNA and anthropometry measurements including weight, height, mid-upper arm circumference and triceps skinfolds were performed on 93 children with IDD (40 ASD, 26 DS and 27 CP) aged 5-18 years. Cohen's Kappa, sensitivity, specificity and its 95% confidence interval were calculated between SGNA and anthropometric indicators for the agreement in determining malnutrition status of the children. SGNA identified a lower prevalence of malnutrition in children with IDD in comparison to the use of anthropometric indicators. SGNA obtained a moderate-to-fair agreement (above 80% agreement, except height-for-age parameter) and sensitivity (25.71-59.09%) against the use of a single anthropometric indicator in identifying the malnutrition status of the children. The use of SGNA as an adjunct to body mass index-for-age as an anthropometric measurement for diagnosing malnutrition in children and adolescents with IDD is recommended.

Growth and Development of Children with Microcephaly Associated with Congenital Zika Virus Syndrome in Brazil.

The outbreak of Zika virus in Latin America in the period 2015–2016 has caused a sudden increase in the number of severe manifestations and reports of congenital changes in newborns in Brazil. This is the first study that evaluated and compared the growth and cognitive and motor development of children with microcephaly due to Congenital Zika Virus Syndrome (CZS) in relation to typical children. It was an observational, analytical, cross-sectional study with 8 children with CZS and 16 typical children, with a mean age of 20.5 months (±2.1), in a region of northeastern Brazil. Considering the mean, children with CZS presented extremely low performance in the motor domain and in the cognitive development domain, whereas typical children presented average performance in the cognitive and motor development domains. Children with CZS presented a mean growth rate (head circumference and weight) lower than typical children. Therefore, children with CZS are at risk for growth retardation and development compared to typical children.

Early growth and development of extremely / very low birth weight infants after discharge

Objective To investigate the early growth and development of extremely low birth weight infants (ELBWI) and very low birth weight infants (VLBWI) through a follow-up study from hospital discharge until 18 months of corrected age. Methods ELBWI and VLBWI who were hospitalized and discharged alive from the Neonatal Intensive Care Unit of Hunan Children's Hospital from January 2013 to June 2014 were recruited. Follow-ups were performed at the corrected age of 40 weeks, as well as at one, three, six, 12 and 18 months of corrected age. Several parameters indicating the growth and development of those infants were monitored and assessed. Extrauterine growth retardation (EUGR) was defined as head circumference (HC) or weight≤10th percentile for gestational age at discharge. T-, rank-sum, or Chi-square (or Fisher's exact) test was performed for statistical analysis. Results (1) A total of 285 ELBWI and VLBWI were recruited. Among them, 145 (50.9%) were alive at last follow-up, 37 (13.0%) died, and 103 (36.1%) were lost. No significant differences in clinical data were observed between the infants who completed the follow-up and those who did not (all P>0.05). (2) Based on HC and weight, the incidences of EUGR in the 145 infants reached the peak at the corrected age of three months [42.8% (62/145) and 40.0% (58/145)], and then declined with increasing age. At 18 months of corrected age, the incidences of EUGR dropped to 31.7% (46/145) and 14.5% (21/145), respectively. (3) There were no significant differences in gender, gestational age, birth weight, length of hospital stay, duration of oxygen therapy, and incidences of complications between the infants with and without EUGR (all P>0.05). (4) The rate of pulmonary surfactant therapy in neonates with EUGR was lower than in those without [27.8% (15/54) vs 53.8% (49/91), χ2=9.340, P 0.05). Neither HC nor weight at the corrected age of 18 months showed significant differences between the two groups (both P>0.05). (5) At 18 months of corrected age, 31.7% (46/145) of the infants had their HC≤10th percentile, and 14.5% (21/145) had their weight≤10th percentile. Infants with HC≤10th percentile were at higher risk of abnormal neurodevelopment than those with HC >10th percentile [67.4% (31/45) vs 40.4% (40/99), χ2=9.154]. Infants with either HC or weight ≤10th percentile had higher risk of abnormal neurodevelopment that those with both HC and weight >10th percentile [65.5% (36/55) vs 38.9% (35/90), χ2=9.641] (both P>0.05). Conclusions ELBWI/VLBWI are at high risk of growth retardation. Incidence of growth restriction declines with age. Key words: Infant, extremely low birth weight; Infant, very low birth weight; Growth and development; Growth disorders; Follow-up studies

Growth Assessment and the Risk of Growth Retardation in Congenital Diaphragmatic Hernia: A Long-Term Follow-Up Study from the Japanese Congenital Diaphragmatic Hernia Study Group.

Little information exists about the physical growth of patients with congenital diaphragmatic hernia (CDH). This study aimed to assess the growth of patients with CDH during long follow-up periods, and to identify growth retardation (GR) risk factors. A multicenter retrospective observational study was conducted in 2013. Of the 228 patients with CDH born between 2006 and 2010, 182 (79.8%) survived to discharge, and 174 cases were included in the study. Body weights and heights were measured at 1.5, 3, and 6 years of age. GR was defined as a Z-score relating to the weight or height of < - 2.0. Cases with GR at 1.5, 3, or 6 years of age comprised the GR group. The clinical variables of the GR and non-GR groups were compared using univariate analysis. Multiple logistic regression analyses were conducted successively on the factors that were significant at p < 0.01 in the univariate analysis and had low correlations with other factors (r < 0.7). The numerical data were divided into two groups based on a cutoff value that was calculated from a receiver operating characteristic curve. The GR group comprised 35 cases (22.7%). The rates of GR at 1.5, 3, and 6 years of age were 19.5 (26/133), 14.4 (16/111), and 13.5% (5/37), respectively. The body weight Z-scores improved in cases with GR between the ages of 1.5 and 3 years (p = 0.036). As the patients aged, the wasting type of GR decreased in frequency (31, 0, and 0% at 1.5, 3, and 6 years of age, respectively) and the stunting type of GR increased in frequency (27, 31, and 100% at 1.5, 3, and 6 years of age, respectively). The univariate analysis showed that birth weight and height, liver-up, large defect size of the diaphragm, use of nitric oxide, patch repair, long hospital stay, home oxygen treatment (HOT), and vasodilator administration at discharge were significant risk factors of GR. The multivariate analysis determined that a birth weight of < 2,698 g (odds ratio [OR] = 5.5, 95% confidence interval [CI] = 2.1-16.8, p < 0.001) and HOT (OR = 5.8, 95%CI = 1.6-23.8, p = 0.007) were significant risk factors for GR. GR was observed in 22.7% of the CDH survivors. Body weight improved between 1.5 and 3 years of age in the GR cases, but some patients developed chronic malnutrition via acute malnutrition. Low birth weight and the need for HOT were GR risk factors. Aggressive management of acute malnutrition may improve the growth of patients with CDH.

The Socio-Epidemiological Environment and the Health of Infants without Having Been Impacted by Maternal HIV Infection

The results of a cohort study of 177 newborns, from birth until they were 18 months old, are presented. The 87 of those children had lacked impact of maternal HIV infection, and 90 children were not exposed to HIV prenatally. Antisocial factors were observed among the newborns exposed to a prenatal HIV infection which had a negative impact upon them throughout infancy. The social deviance of their family members with a HIV infection was 10.5 times higher than the standard risk of a neonatal abstinence syndrome, 4 times higher than a standard risk of growth retardation during fetal development, and 3.8 times higher than a standard risk of postnatal development disorders. Undiagnosed infants who were exposed to a HIV-infection constitute a medico-social risk group requiring scrupulous and extended medical assistance.

Editorial: Genetics and epigenetics of fetal alcohol spectrum disorders.

Editorial: Genetics and epigenetics of fetal alcohol spectrum disorders.

Growth monitoring and follow-up in preterm infants

Preterm infants are often significantly growth retarded at the time of hospital discharge.They often in the nutritional crisis after hospital discharge, and should be carefully follow up evaluated.Preterm formula and fortified breast milk may improve the growth of preterm infants and is a reasonable option for preterm infants.Preterm formula and fortified breast milk are recommended for preterm infants with weights below the 10th percentile for age at the time of hospital discharge and those birth weights below 1 500 g. After hospital discharge, exclusively human milk-fed preterm infants are at increased risk for suboptimal growth compared to formula-fed infants.Infants with BPD are at increased risk of growth retardation after hospital discharge.Protein and mineral enriched formula may provide short-term growth catch-up. Key words: Infant, premature; Growth; Human milk; Fortified human milk; Preterm formula

Diamond-Blackfan Anemia and Growth Status: The French Registry

To study the frequency and risk factors of growth retardation (GR) in patients with Diamond-Blackfan anemia. A cross-sectional survey including the 95 patients followed by hematologists affiliated with the French Society of Pediatric Hematology and Immunology for whom growth data were available; 43 patients were transfusion dependent, 32 were steroid dependent, and 20 patients were off treatment. GR was defined as height below 2 SD. Growth retardation was observed in 29.5% (28) patients. The proportion of GR increased significantly with age (16% <10, 32% among 10 to 16, 47.6% among 17 to 25, 41.7% among >16 years) and was higher in on-treatment than in off-treatment patients (35% among transfusion-dependent, 37% among steroid-dependent vs 5% among off-treatment). GR was significantly linked to associated malformations (OR, 2.3 [1.1 to 8.0]; P = .02) and intrauterine growth retardation (OR, 6.0 [1.1 to 11.6]; P = .021). GR remained independently associated with age, malformations, and treatment in a logistic regression. Our study showed that the risk of GR increases with age and is associated with treatment dependence. This result addresses the question of the respective part, in the pathogenesis of GR, of the disease severity, illustrated by treatment dependence on the one hand and of the deleterious effects of long-term treatments on the other hand.

Relief from IL-1

The cytokine interleukin-1 (IL-1) is primarily to blame for a severe type of juvenile arthritis, according to Pascual and colleagues on page 1479. Blocking IL-1 activity in children with systemic onset juvenile idiopathic arthritis (SoJIA) completely resolved disease symptoms in a majority of children who had failed to respond to conventional treatments. SoJIA is a systemic inflammatory disease of unknown etiology that can cause long-term arthritis in children. The pathogenesis of the disease is unclear, although increases in the inflammatory cytokine IL-6 have been reported in the blood of these patients. Currently the most effective therapy for SoJIA is long-term treatment with steroids, which carries with it the risk of growth retardation, osteoporosis, and obesity. Pascual and colleagues now reveal a central role for IL-1—a cytokine that plays a major role in many inflammatory and autoimmune diseases—in the pathology of SoJIA. They show that serum from SoJIA patients provokes healthy cells to increase expression of IL-1, but no other cytokines. In addition, stimulated peripheral blood cells from children with SoJIA produced more IL-1, but not IL-6 or TNF, compared with cells from healthy children. These results prompted Pascual and colleagues to treat these patients with an IL-1 receptor antagonist (Anakinra). The results were remarkable—symptoms were completely resolved or significantly improved in all children with active arthritis, with only one later case of reversion. The mechanism behind the increased IL-1 production in SoJIA is unknown. As SoJIA is not an inherited disease, the defect is likely to be different from familial IL-1–triggered inflammatory diseases in which a mutated NALP3 can no longer control the activation of caspase-1, which cleaves the IL-1β precursor into the active cytokine. The authors are now looking for the serum component that turns on IL-1.

Update of growth effects of inhaled and intranasal corticosteroids.

A small effect (approximately 1 cm) of inhaled and intranasal corticosteroids on the 1 year growth of children with asthma and allergic rhinitis, respectively, has been reported in studies published during the past 10 years. Literature published during the past year confirmed the effect, but provided additional and novel information on the effects of longer-term (over 1 year) treatment, particularly with inhaled corticosteroids. This information is timely, because the longer-term effect size and duration were previously unknown, and the findings have major implications for the content of the safety discussion between caregivers and the parents of children with asthma or allergic rhinitis. The results of these studies provide very reassuring information about the longer-term safety of the use of inhaled corticosteroids in children with asthma. Limited evidence has also supported the notion that intranasal corticosteroids have no longer-term effects on growth. The possibility of an idiosyncratic (versus global) effect received conflicting support in recent literature. The risk of growth retardation can be lessened and managed by the employment of several simple strategies: (i) monitor growth; (ii) use minimal effective dose; and (iii) optimize steroid-sparing strategies. Communication with patients/parents about this possible side-effect, as well as the adverse consequences of the non-use of inhaled and intranasal corticosteroids, is essential to minimize any possible negative impact on adherence. Children whose disease severity warrants inhaled or intranasal corticosteroid therapy should not be denied their benefits on the basis of this safety consideration.

Growth effects of asthma and asthma therapy.

A small effect (1 cm) of inhaled corticosteroids (ICS) on the 1-year growth of asthmatic children was observed in studies published during the 1990s. A high volume of literature published during the past year confirmed mild growth suppression at one year, but provided information on the effects of longer-term treatment. These developments are important, since the effect was previously unknown and the findings have major implications for asthma caregivers and the communication that they have with asthmatic children and their parents. The possibility that this is an idiosyncratic effect received conflicting support. These studies collectively provide support for ICS use and ease the minds of caregivers, parents, and children. The risk of growth retardation can be lessened and managed by the employment of several simple strategies: (1) monitor growth; (2) use the minimal effective dose; (3) optimize steroid-sparing strategies (smoke and allergen environmental controls, vaccinate for influenza, diagnose and treat rhinitis, sinusitis, and gastroesophageal reflux disease, use add-on therapy with a second controller rather than doubling the ICS dose if control is inadequate); and (4) use spacing devices (for pressurized metered-dose inhalers) and mouth rinsing. Open and accurate communication with patients and parents about this possible effect is essential to minimize nonadherence. Ultimately, no child whose disease severity warrants ICS therapy should be denied the tremendous benefits that this therapy can provide because of relatively minor concerns about growth effects.

Growth of children according to maternal and child HIV, immunological and disease characteristics: a prospective cohort study in Kinshasa, Democratic Republic of Congo.

Most HIV-infection in children occurs in sub-Saharan Africa where antiretroviral therapy is seldom available. This study compares the growth progression and retardation of HIV-infected and uninfected children in the Democratic Republic of Congo (formerly Zaire). It estimates the risk for child growth retardation according to child and maternal immunological factors, severity of maternal and child illness, and maternal socioeconomic and marital status. In a prospective cohort study of 258 children born to HIV seropositive mothers and 256 children of seronegative mothers in Kinshasa, Congo, the growth in length, weight, and weight-for-length of infected children (n = 68), uninfected children born to seropositive mothers (n = 190), and uninfected children born to uninfected mothers (n = 256) was compared. Serological, anthropometric and other clinical measures were collected monthly from 3-12 months and bi-monthly during the second year of life. Polymerase chain reaction for HIV was performed on bloods drawn at 2 days and 3 months post partum. Length-for-age, weight-for-age, and weight-for-length mean z-scores against National Center for Health Statistics (NCHS) reference data were calculated, and Cox proportional hazards models were used to estimate the risk of falling below -2.00 z-scores as a function of child and maternal immunological, clinical and sociodemographic variables. There was no difference in mean length-for-age at birth between HIV-infected (Group 1) children, uninfected children of infected mothers (Group 2) or Control children, but by 3 months old, HIV-infected children were shorter than both Group 2 and Controls. In weight-for-age and weight-for-length, Group 1 infants were lighter and more wasted at birth and onwards. Group 2 newborns were lighter than Controls at birth, but by three months they had caught up to Controls in both length and weight and remained the same as Controls thereafter. The odds of falling below -2.00 z-scores by 20 months for length, weight, and weight-for-length for HIV-infected children compared to uninfected children were 2.10, 2.84, and 2.56 respectively. Both HIV-infection and associated illnesses were factors associated with child stunting, underweight and wasting. The mother's age, socioeconomic status, presence of father, stage of illness and immune status had no detectable effect on the child's growth in the first two years of life. The HIV-infected children in Congo with no access to antiretroviral therapy were stunted, underweight, and wasted compared to same age uninfected children. Both HIV infection and HIV-associated signs and symptoms, not maternal immunological or socioeconomic circumstances, placed children at risk for growth retardation.

Low birthweight, preterm births and intrauterine growth retardation in relation to maternal smoking.

The association between the intensity and duration of cigarette smoking during pregnancy and the frequency of low birthweight, preterm births and intrauterine growth retardation was investigated in a historical cohort. All 5166 livebirths occurring in the city of Pelotas, Brazil, during 1993 were identified and mothers interviewed soon after delivery. Children whose mothers smoked during pregnancy had a birthweight 142 g lower than those of non-smoking mothers. The odds ratio for low birthweight among children of smokers was 1.59 [95% CI 1.30-1.95]. There was no association between smoking and preterm delivery assessed by the Dubowitz score. In relation to intrauterine growth retardation, smoking was associated with an odds ratio of 2.07 [95% CI 1.69-2.53]. There was a direct dose-response association between the number of cigarettes smoked and the risk of growth retardation. Women whose partner smoked were also at higher risk of having a child with growth retardation. All the above results were adjusted for confounding factors. The effect of maternal smoking on low birthweight seems to be attributable to intrauterine growth retardation rather than preterm delivery.

The obstetric perspective of neurofibromatosis

Neurofibromatosis is a complex hereditary disease involving many organs and systems. A possibility of reciprocal adverse effects exists between the disease and pregnancy. A survey of the relevant literature suggests that management of the pregnant patient with neurofibromatosis is an obstetric challenge. After appropriate genetic counseling, patients with minimal or mild neurofibromatosis who wish to conceive should receive high-risk pregnancy care. Special attention should be directed toward maternal hypertension and the aggravating features of neurofibromatosis. The fetus may inherit the disease and also be at risk for growth retardation. Patients with severe neurofibromatosis should be advised not to conceive.