Scores For Head Circumference Research Articles

Cooking with liquefied petroleum gas or biomass and fetal growth outcomes: a multi-country randomised controlled trial

Household air pollution might lead to fetal growth restriction during pregnancy. We aimed to investigate whether a liquefied petroleum gas (LPG) intervention to reduce personal exposures to household air pollution during pregnancy would alter fetal growth. The Household Air Pollution Intervention Network (HAPIN) trial was an open-label randomised controlled trial conducted in ten resource-limited settings across Guatemala, India, Peru, and Rwanda. Pregnant women aged 18-34 years (9-19 weeks of gestation) were randomly assigned in a 1:1 ratio to receive an LPG stove, continuous fuel delivery, and behavioural messaging or to continue usual cooking with biomass for 18 months. We conducted ultrasound assessments at baseline, 24-28 weeks of gestation (the first pregnancy visit), and 32-36 weeks of gestation (the second pregnancy visit), to measure fetal size; we monitored 24 h personal exposures to household air pollutants during these visits; and we weighed children at birth. We conducted intention-to-treat analyses to estimate differences in fetal size between the intervention and control group, and exposure-response analyses to identify associations between household air pollutants and fetal size. This trial is registered with ClinicalTrials.gov (NCT02944682). Between May 7, 2018, and Feb 29, 2020, we randomly assigned 3200 pregnant women (1593 to the intervention group and 1607 to the control group). The mean gestational age was 14·5 (SD 3·0) weeks and mean maternal age was 25·6 (4·5) years. We obtained ultrasound assessments in 3147 (98·3%) women at baseline, 3052 (95·4%) women at the first pregnancy visit, and 2962 (92·6%) at the second pregnancy visit, through to Aug 25, 2020. Intervention adherence was high (the median proportion of days with biomass stove use was 0·0%, IQR 0·0-1·6) and pregnant women in the intervention group had lower mean exposures to particulate matter with a diameter less than 2·5 μm (PM2·5; 35·0 [SD 37·2] μg/m3vs 103·3 [97·9] μg/m3) than did women in the control group. We did not find differences in averaged post-randomisation Z scores for head circumference (0·30 vs 0·39; p=0·04), abdominal circumference (0·38 vs 0·39; p=0·99), femur length (0·44 vs 0·45; p=0·73), and estimated fetal weight or birthweight (-0·13 vs -0·12; p=0·70) between the intervention and control groups. Personal exposures to household air pollutants were not associated with fetal size. Although an LPG cooking intervention successfully reduced personal exposure to air pollution during pregnancy, it did not affect fetal size. Our findings do not support the use of unvented liquefied petroleum gas stoves as a strategy to increase fetal growth in settings were biomass fuels are used predominantly for cooking. US National Institutes of Health and Bill & Melinda Gates Foundation. For the Kinyarwanda, Spanish and Tamil translations of the abstract see Supplementary Materials section.

The impact of early caloric intake on growth parameters in extremely preterm neonates

Introduction: Even though adequate caloric intake is essential for the promotion of growth in extremely premature infants, this is rarely achieved. We investigated how total caloric intake in the first week of life and other events during the hospitalization impact head circumference and weight at 36 weeks of corrected age in extremely preterm infants. Patients and methods: The study sample consisted of extremely preterm infants treated at Osijek University Hospital Centre, born between January 2018 and December 2020. Records were collected regarding nutritional data, sex, gestational age, birth weight and head circumference, invasive respiratory support, bacterial infection, necrotizing enterocolitis, postnatal steroids, need for supplemental oxygen at 36 weeks gestation, day of introduction of enteral nutrition, duration of parenteral nutrition, length of stay, hemodynamically significant patent ductus arteriosus, cystic periventricular leukomalacia and retinopathy of prematurity. Results: The study cohort included 30 infants. At 36 weeks gestation for weight, median Z scores were -1.63 (IQR -2.34 to -1.15; 95% CI -2.09 to -1.52), and for head circumference were -1.32 (IQR 2.37 to - 0.81; 95% CI -1.75 to -0.91). Median energy intake on the first day of life was 33.42 kcal/kg, and 80.78 kcal/kg on day 7. Early caloric intake was not correlated with changes in Z scores for head circumference and weight at 36 weeks of gestation. Other factors influenced changes in head circumference and weight Z scores, namely: gestational age, respiratory support during the first week, need for additional O2 at 36 weeks, and retinopathy of prematurity requiring intervention. Conclusion: In our cohort of premature infants at 36 weeks corrected age other factors, not primarily total caloric intake influenced growth parameters.

Neurodevelopment After Neonatal Acute Kidney Injury in Very Preterm-Birth Children

This study aimed to assess head circumference (HC) growth and neurodevelopmental outcomes in very preterm-birth children after neonatal acute kidney injury (AKI). This longitudinal follow-up cohort included 732 very preterm neonates of gestational age<31 weeks admitted to a tertiary center between 2008 and 2020. AKI was categorized as nonoliguric and oliguric AKI based on the urine output criteria during admission. We compared the differences in death, z scores of HC (zHC) at term-equivalent age (TEA) and at corrected ages of 6, 12, and 24 months, and the neurodevelopmental outcomes at corrected age of 24 months after neonatal nonoliguric and oliguric AKI. Among the 154 neonates who developed AKI, 72 had oliguric AKI and 82 had nonoliguric AKI. At TEA, oliguric AKI, but not nonoliguric AKI, was independently associated with lower zHC than non-AKI (mean differences,-0.49; 95% confidence interval [CI],-0.92 to-0.06). Although the 3 groups were comparable in zHC at corrected ages of 6, 12, and 24 months, the oliguric AKI group, but not the nonoliguric AKI group, had a higher rate of microcephaly by corrected age of 24 months. In addition, the oliguric AKI group, but not the nonoliguric AKI group, was more likely to die (61% vs. 9%) and have neurodevelopmental impairment (41% vs. 14%) compare with the non-AKI group. After adjustment, oliguric (adjusted odds ratio [aOR], 8.97; 95% CI, 2.19-36.76), but not nonoliguric, AKI was associated with neurodevelopmental impairment. Neonatal oliguric AKI is associated with neurodevelopmental impairment in very preterm-birth children. Long-term head-size and neurodevelopmental follow-up after neonatal AKI is warranted.

Early-Life Slow Enteral Feeding Progression Pattern Is Associated with Longitudinal Head-Size Growth Faltering and Neurodevelopmental Impairment Outcomes in Extremely Preterm Infants

To determine whether feeding progression patterns in the first eight postnatal weeks, depicted by clustering analysis of daily enteral feeding volume, are associated with longitudinal head-circumference (HC) growth and neurodevelopmental outcomes in extremely preterm (EP) infants. 200 infants who were admitted at gestational ages 23-27 weeks between 2011 and 2018; survived to discharge; and underwent longitudinal HC growth measurements at birth, term-equivalent age (TEA), corrected age (CA) 6-month, 12-month, and 24-month; and neurodevelopmental assessment using the Bayley Scales of Infant Development at CA 24 months were included for analysis. kmlShape analysis identified two distinct enteral feeding progression patterns: fast progression in 131 (66%) infants and slow progression in 69 (34%) infants. Compared to the fast progression group, the slow progression group showed significantly lower daily enteral volumes after day 13, was older in postnatal age reaching full feeding, had a higher rate of Delta z scores of HC (zHC) < -1 (p < 0.001) between birth and TEA, and displayed lower longitudinal zHC from TEA to CA 24 months. The slow progression group also showed higher rates of microcephaly [42% vs. 16%, p < 0.001; adjusted odd ratio (aOR): 3.269, p = 0.001] and neurodevelopmental impairment (NDI) (38% vs. 19%, p = 0.007; aOR: 2.095, p = 0.035) at CA 24 months. For NDI, the model including feeding progression patterns showed a lower Akaike information criterion score and a better goodness of fit than the model that did not include feeding patterns. Characterizing feeding progression pattern may help identify EP infants at high-risk of head-size growth faltering and NDI at early childhood.

Outcomes of neonates with congenital duodenal obstruction: A retrospective study

BackgroundCongenital duodenal obstruction (CDO) is a common cause of intestinal obstruction in newborn infants. There is limited information on growth and neurodevelopmental outcomes of infants with CDO. Recent studies have suggested that early commencement of enteral feeds facilitates early attainment of full feeds in surgical and very premature non-surgical infants. We aimed to describe the physical growth and one-year neurodevelopmental outcomes of infants with CDO, and to explore the association between time of commencement of enteral feeds and time to reach full feeds in CDO. MethodsRetrospective study (2002–2019). ResultsA total of 76 infants were included. The median gestational age was 37.2 w (range: 25.7 to 40.8). There were four deaths, not directly related to CDO. The mean Z scores for weight at birth was -0.39 (SD 1.05) vs -1.18 (SD 1.07) at discharge (p<0.0001). The mean Z scores for head circumference at birth was -0.04 (SD 1.21) vs -0.43 (SD 1.23) at discharge (p = 0.021). Adequate catch up growth occurred by one year. The median Development quotient (DQ) on Griffiths Mental Developmental Scales at one year among 41 non-syndromic infants was 100 (IQR: 94 to 107). On multivariable analysis, each day delay in commencing feeds was associated with 6% increase in time to reach full feeds (adjusted and exponentiated beta coefficient: 1.06; 95% CI: 1.02 to 1.09; p = 0.001). ConclusionsInfants with CDO had significant postnatal growth restriction during hospitalisation. Neurodevelopmental outcomes were reassuring. Early commencement of enteral feeds in the postoperative period may facilitate early attainment of full feeds. Level of evidenceLevel IV Prognostic study

Effect of SARS-CoV-2 infection during the second half of pregnancy on fetal growth and hemodynamics: A prospective study.

IntroductionOur objective was to compare the fetal growth velocity and fetal hemodynamics in pregnancies complicated and in those not complicated by severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection.Material and methodsProspective case‐control study of consecutive pregnancies complicated by SARS‐CoV‐2 infection during the second half of pregnancy matched with unaffected women. The z scores of head circumference, abdominal circumference, femur length, and estimated fetal weight were compared between the two groups. Fetal growth was assessed by analyzing the growth velocity of head circumference, abdominal circumference, femur length, and estimated fetal weight between the second‐ and third‐trimester scans. Similarly, changes in the pulsatility index of uterine, umbilical, and middle cerebral arteries, and their ratios were compared between the two study groups.ResultsForty‐nine consecutive pregnancies complicated, and 98 not complicated, by SARS‐CoV‐2 infection were included. General baseline and pregnancy characteristics were similar between pregnant women with and those without SARS‐CoV‐2 infection. There was no difference in head circumference, abdominal circumference, femur length, and estimated fetal weight z scores between pregnancies complicated and those not complicated by SARS‐CoV‐2 infection at both the second‐ and third‐trimester scans. Likewise, there was no difference in the growth velocity of all these body parameters between the two study groups. Finally, there was no difference in the pulsatility index of both maternal and fetal Doppler scans throughout gestation between the two groups.ConclusionsPregnancies complicated by SARS‐CoV‐2 infection are not at higher risk of developing fetal growth restriction through impaired placental function. The findings from this study do not support a policy of increased fetal surveillance in these women.

447. Infant Microcephaly During the Zika Virus Epidemic in Dominican Republic, 2016–2017

BackgroundZika Virus infection (ZIKV) during pregnancy has been linked with fetal microcephaly. The purpose of this study was to describe the microcephaly cases that occurred during the ZIKV epidemic in Dominican Republic (DR) in 2016–2017.MethodsWe analyzed surveillance data from DR National System of Epidemiologic Surveillance. The Intergrowth 21st Newborn size application tool was used to determine percentiles and z scores for head circumference (HC) by gestational age. We used linear and log-binomial regression for multivariate analyses of HC Z-score and severe microcephaly (HC of 0 percentile vs. >0 percentile), respectively.ResultsEighty-five infants were born with microcephaly due to ZIKV from June 2016 to March 2017. ZIKV IgM was positive in all 85 infants. Infants were 55% male and half were from the metropolitan area. Most (89%) received inpatient care and 13% had respiratory distress. One infant had a meningocele and one died soon after birth. Nearly half (47%) of mothers were known to have ZIKV and 45 (53%) mothers recalled having ZIKV symptoms during their pregnancy. Among these 45 women, the most common symptoms were rash (67%), fever (42%), and arthritis/arthralgia (24%). In two cases, ZIKV was reported in the father. Mean gestational age at birth was 37.8 weeks (±1.95 weeks), and 13% were born ≤36 weeks. The mean HC was 28.1 cm (SD ±2.1 cm). Severe microcephaly was detected in 67 (84%) cases, and 41% had an HC on the zero percentile for gestational age. Having insurance was associated with higher mean HC (P = 0.01) while preterm birth was associated with lower mean HC (P = 0.004). None of the variables were found to be significant predictors of HC z-score or severe microcephaly.ConclusionThere was substantial infant morbidity during the 2016–2017 epidemic. Most infants were born to asymptomatic women or women not reported to the Ministry during acute illness. More cases of microcephaly have been reported beyond the observation period which highlights the need for continued surveillance.Disclosures All authors: No reported disclosures.

Clinical And Etiological Profile of Children Aged 1 Month To 60 Months Admitted with Microcephaly in Bal Chikitsalaya, Maharana Bhupal Goverment Hospital, RNT Medical College , Udaipur (Rajasthan)

Objective: To study the clinical and etiological profile with the change in brain by neuroimaging (MRI brain) in children with microcephaly aged 1 month to 60 months. Materials and Methods: Study Design – Hospital based prospective study. Children attending Bal Chikitsalaya, Maharana Bhupal Goverment Hospital, RNT Medical College, Udaipur (Rajasthan) were evaluated as per protocol. Z scores of head circumference were calculated using WHO charts and clinical and etiological profile with the change in brain by neuroimaging (MRI brain) of those with microcephaly. Results: 103 children with microcephaly were enrolled in the study. 58 (56.31%) were male and 45 (43.68%) were female. Male to female ratio was 1.29:1. Mean age of children with microcephaly was 19.71±14.79 months. Most children with microcephaly presented with developmental delay 93(90.29%), abnormal tone 75(72.82%), convulsion 29(28.15%), regression of mile stone 13(12.62%), tremor 11(10.68%), visual abnormalities 12(11.65%), hearing abnormalities 10(9.71%) and dysmorphic facies 9(8.74%). The patients were classified according to the final diagnosis into 3 groups; group I: primary microcephaly – 12(11.65%) cases, group II: secondary microcephaly – 88(85.44%) cases and group III: undiagnosed – 3(2.91%). The most frequent MRI findings were cerebral atrophy in 50(48.54%) cases followed by changes suggestive of hypoxic ischemic encephalopathy (HIE) 19(18.94%) cases. Conclusion: Among the microcephaly children admitted in hospital, severe acute malnutrition was the commonest cause followed by cerebral palsy. Cerebral atrophy was most frequent finding on neuroimaging (MRI) followed by changes suggestive of hypoxic ischemic encephalopathy.

Anthropometric assessment of a Middle Eastern group of autistic children.

Growth abnormalities are uniquely associated with autism spectrum disorders (ASD); however, the extent to which growth abnormalities are present has hardly been investigated. The current study aims to compare the differences in anthropometric parameters in a group of autistic Egyptian children and the healthy normal population. We recruited 100 children with ASD from the Outpatient Clinic for "Autistic Children" at the Medical Research Hospital of Excellence, National Research Centre in Cairo, Egypt. They were diagnosed by DSM-IV criteria of the American Psychiatric Association, Autism Diagnostic Interview-Revised, and Childhood Autism Rating Scale. Of these children at age of 3-10 years, 71 were males and 29 females. Eight anthropometric parameters were assessed in view of data of the healthy Egyptians of pertinent sex and age. Weight and body mass index increased because of a significant increase in subcutaneous fat thickness. This tendency with a probable decrease in muscle mass was more evident in male or in older children, likely resulting from sedentary life style and food selectivity. The Z head circumference score and its variance significantly increased especially in males or older children, suggesting the relative overgrowth of the brain in a substantial percentage of Egyptian children with autism. We concluded that increased fat composition in Egyptian autistic children with decreased muscle mass necessitates tailoring a specially designed food supplementation program to ameliorate the severity of autism symptoms.

Organochlorine pesticide residues in breast milk and maternal psychopathologies and infant growth from suburban area of Ankara, Turkey

We aimed to determine the levels of organochlorine pesticides (OCPs) in the breast milk; to assess the effect of detectable OCPs on maternal–infant characteristics and; to evaluate the relation between OCPs and the maternal psychopathologies [Brief Symptom Inventory (BSI), Postpartum Bonding Questionnaire (PBQ), Mother-to-Infant Bonding Scale (MIBS) and Edinburgh Postnatal Depression Scale (EPDS)] and infant growth. DDT, beta-hexachlorocyclohexane (HCH), aldrin and heptachlor were detected in 89.3, 70.7, 58.7 and 34.7 % of the samples, respectively. Mothers with low monthly family income had detectable DDTs less frequently. The frequencies of detectable heptachlor epoxide were significantly higher in mothers with gestational nausea. Anaemic mothers had more frequently detectable alpha-HCH. Z scores of head circumference were inversely correlated with beta-HCH and DDT levels. The heptachlor epoxide levels were positively correlated with PBQ, MIBS and indexes of BSI. No relation was detected between EPDS and OCPs. Further studies are needed for changes in maternal psychopathologies.

Clinical profile of children with developmental delay and microcephaly

Aim:To study the profile of children with developmental delay and microcephaly.Materials and Methods:Children attending child development clinic with developmental delay were evaluated as per protocol. Z scores of head circumference were calculated using WHO charts. Clinical, radiological and etiological profile of those with microcephaly and those without was compared.Results:Of the 414 children with developmental delay 231 had microcephaly (z score ≤ -3). Mean age of children with microcephaly was 35.1 ± 27.9 months (range 4-184), males (72.7%). Comorbidities were epilepsy (42.9%), visual abnormality (26.4%), hearing abnormality (16.9%). Mean DQ was 29.75 + 17.8 in those with microcephaly was significantly lower compared to the rest (P = 0.002). Secondary microcephaly was associated with cerebral palsy in 69.7%. Other causes were congenital infections (4), inborn error of metabolism (3), post-meningoencephalitis (5), malformations (12), and syndromic (13). Neuroimaging was done in 118 (51.1%) cases of which 104 (88.1%) were abnormal. On comparison children with microcephaly had more epilepsy, lower developmental quotient, vision abnormalities findings as compared to normocephalic children with developmental delay (P > 0.05).Conclusion:Microcephaly was associated with lower, DQ, higher comorbidities in children with developmental delay. Spastic CP is commonly associated with microcephaly.

G169 Preventing Early Postnatal Head Growth Failure in Very Preterm Infants: The Randomised Controlled SCAMP Nutrition Study

BackgroundPostnatal head growth failure is well recognised in very preterm infants (VPI), the largest deficit occurs at 3–4 weeks followed by some catch-up growth until 36weeks corrected gestational age (36wCGA)....

Breast Milk Lead and Cadmium Levels in Suburban Areas of Nanjing, China

To evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk in the second postpartum month, to investigate the relationship between Pb/Cd levels in breast milk and some sociodemographic parameters, and to explore whether these levels affect the infants' physical status or the mothers' psychological status (postpartum depression). A cross-sectional study was conducted between November 2009 and December 2010. Altogether 170 healthy mothers were enrolled from Nanjing Maternity and Child Health Care Hospital. The inclusion criteria were: voluntary to participate in this study, healthy, with no chronic disease, breastfeeding in the second postpartum month, living in a suburban but not non-industrial area of Nanjing, and not occupationally exposed to toxic metals. All the mothers completed a questionnaire and were evaluated based on the Edinburgh Postpartum Depression Scale (EPDS) to identify the risk of postpartum depression. Pb and Cd levels in breast milk were determined by inductively coupled plasma mass spectroscopy. The infants of these mothers were examined for their z scores of weight for age, length for age, head circumference for age, and body mass index for age. The median breast milk levels of Pb and Cd were 40.6 μg/L and 0.67 μg/L, respectively. In 164 (96.5%) of the 170 samples, Pb levels were higher than the limit reported by the World Health Organization (> 5 μg/L). Breast milk Cd level was > 1 μg/L in 54 (31.8%) mothers. The mothers with a history of anemia had a higher breast milk Pb level than those without a history of anemia (41.1 μg/L vs. 37.9 μg/L, P = 0.050). The median breast milk Cd level in those who were active and passive smokers during pregnancy was significantly higher than that in non-smokers (0.88 μg/L vs. 0.00 μg/L, P = 0.025). The breast milk Cd level in the mothers not taking iron and vitamin supplements for 2 months postpartum was higher than in those taking the supplements (iron supplement: 0.74 μg/L vs. 0.00 μg/L, P = 0.025; vitamin supplement: 0.78 μg/L vs. 0.00 μg/L, P = 0.005). Breast milk Cd level at the second postpartum month was negatively correlated with the z scores of head circumference (r = - 0.248, P = 0.042) and weight for age at birth (r =- 0.241, P = 0.024) in girls. No correlation was found between the breast milk Pb/Cd levels and the EPDS scores. Considering the high levels of Pb and Cd in breast milk in this study, breast milk monitoring programs are necessary.

Breast milk lead and cadmium levels from suburban areas of Ankara

The objectives of this study were (1) to evaluate levels of lead (Pb) and cadmium (Cd) in the breast milk at 2 months postpartum, (2) to investigate the relationship between Pb and Cd levels in breast milk and some sociodemographic parameters and (3) to detect whether these levels have any influence on the infant's physical status or on postpartum depression in the mothers. Pb and Cd levels in breast milk were determined by Inductively Coupled Plasma Mass Spectroscopy (ICP-MS). The median breast milk concentrations of Pb and Cd were 20.59 and 0.67 μg/l, respectively. In 125 (87%) of 144 samples, Pb levels were higher than the limit in breast milk reported by the World Health Organization (WHO) (> 5 μg/l). Breast milk Cd levels were > 1 μg/l in 52 (36%) mothers. The mothers with a history of anemia at any time had higher breast milk Pb levels than those without a history of anemia (21.1 versus 17.9 μg/l; p = 0.0052). The median breast milk Cd levels in active and passive smokers during pregnancy were significantly higher than in non-smokers (0.89, 0.00 μg/l, respectively; p = 0.023). The breast milk Cd levels of the mothers who did not use iron and vitamin supplements for 2 months postpartum were found to be higher than in those who did use the supplements (iron: 0.73, 0.00 μg/l, p = 0.023; vitamin: 0.78, 0.00 μg/l, p = 0.004, respectively). Breast milk Cd levels at the 2nd month were correlated negatively with the z scores of head circumference and the weight for age at birth (r = − 0.257, p = 0.041 and r = − 0.251, p = 0.026, respectively) in girls. We found no correlation between the breast milk Pb and Cd levels and the Edinburgh Postpartum Depression Scale scores. Breast milk monitoring programs should be conducted that have tested considerable numbers of women over time in view of the high levels of Pb in breast milk in this study.

Growth of very low birth-weight Indian infants during hospital stay

To evaluate the growth pattern of Very Low Birth Weight (VLBW) infants (birthweight <1500 g) during hospital stay and to compare the growth of Small for gestational age (SGA) and Appropriate for gestational age (AGA) infants. Prospective observational study. SETTING. Level III Neonatal Intensive Care Unit (NICU) in Northern India. A cohort of 97 VLBW infants, admitted to NICU at Sir Ganga Ram Hospital, from 1 January, 2007 to 31 July, 2008. INTERVENTION/MEASUREMENT: Weight, length and head circumference (HC) were serially measured from birth till discharge and respective Z scores were calculated as per data from Fentons references. Growth was also assessed by superimposing these trends on Ehrenkranzs postnatal growth charts. The mean Z scores for weight, length and HC at birth were -1.17, -1.09 and -0.54, respectively. These decreased to -2.16, -2.24 and -1.35, respectively by discharge. Both SGA and AGA infants exhibited a decrease of approximately 1 Z score in all parameters. On postnatal charts, growth of infants remained at or above respective reference lines, except in those below 1000 g at birth. Average daily weight gain after regaining birth weight was 15.18 ± 1.7 g/kg/d, whereas the increase in HC and length were 0.48 ± 0.2 cm/week and 0.60 ± 0.4 cm/week, respectively. These increments when compared to the intrauterine growth rates, indicated discrepant growth trends. VLBW infants suffered significant growth lag during NICU stay and exhibited disproportionately slow growth of HC and length.

Head circumference and development in young children after renal transplantation

Growth impairment, microcephaly and developmental delay in young children with chronic renal failure improve after successful renal transplantation. There have been few reports on head circumference (HC) and development after transplantation. Standard deviation scores (SDS) of height and HC and developmental quotient (DQ) after successful renal transplantation were evaluated in 12 recipients under 5 years of age. At the time of transplantation their mean age was 2.5 years and mean bodyweight was 9.0 kg. Mean height SDS was -3.0 at transplantation and increased to -2.3 at 1 year after transplant (P = 0.002). Mean HC-SDS increased from -1.4 to -0.9 at 1 year after transplant (P = 0.02). As for each category of DQ examined 1 year after transplant, mean scores of gross motor function, basic practice, personal relations, speech and recognition increased from 69 to 90 (P = 0.007), from 77 to 102 (P = 0.02), from 87 to 103 (P = 0.04), from 71 to 90 (P = 0.0006), and from 88 to 101 (P = 0.03), respectively. In young children, physical growth, HC growth and DQ scores increased 1 year after transplantation. Dialysis and transplantation program should be planned in young children with end-stage renal failure in anticipation of growth and development of each patient.

Assessment of head size adjusted for height: An anthropometric tool for clinical use based on Argentinian data

Relative macrocephaly describes a large head in relation to stature, and this indicator could be helpful in depicting syndromes with large heads and short stature, providing the existence of some relationship between both measurements in normal children. The aims of this study were (1) to evaluate the existence of a relationship between head circumference (HC), height and weight, (2) to build an instrument for evaluating it and validate its clinical utility. Relationship between HC, height and weight was explored in a national sample of 3571 healthy, well nourished boys and girls aged 0-5.99 years. Age-adjusted correlation coefficients calculated were: HC and height, 0.30; HC and weight, 0.37; and height and weight, 0.60. A growth standard of HC to height ratio was constructed using the LMS method with both sexes pooled, and selected centiles and SD scores of HC to height ratio for each age were estimated. Z-scores of HC for age, and HC to height ratio were calculated for 13 children with hypochondroplasia, and 90 with achondroplasia, both conditions associated with macrocephaly. Only four children with hypochondroplasia had HC for age above 2.00 SD, whereas all of them showed SD scores above 2.00 when the HC to height ratio was evaluated. Results suggest that the prepared standard may be of clinical utility. A new standard is proposed, capable of pinpointing children with relative macrocephaly.

Growth after neonatal arterial switch operation for D-transposition of the great arteries.

The objective of this study was to evaluate growth in infants with d-transposition of the great arteries (d-TGA) who underwent switch operation (anatomical correction) in the early neonatal period. Growth data (at birth and 1, 3, 6, 12, and 24 months of age) were retrieved in 23 infants with d-TGA who survived the operation without major complications. Measures were transformed into z scores and compared with normative data for age. Following surgery, infants showed low z scores for weight, height, and head circumference. Weight and height showed a trend to reach normal ranges between 6 and 12 months of age, and the z scores were positive at 24 months. z scores for head circumference were still negative at 24 months of age. No dietary interventions were implemented during this period, and the infants were fed their own mothers' milk or, before discharge, high-calorie, preterm formula. Following anatomical correction for d-TGA in the early neonatal period, infant growth shows a characteristic pattern, with parameters normalized by 12 months of age in most cases. Head growth shows a different pattern, although gross motor development seems unaffected.