Similar Birth Weight Research Articles

Yenidoğan Yoğun Bakım Ünitesindeki Bebeklerin Nekrotize Enterokolit Risk Faktörlerinin Karşılaştırılması

Purpose: Necrotizing enterocolitis is one of the important problems of premature infants. The incidence is about 1-5% in infants followed in neonatal care units and inversely related to gestational age and birth weight. Materials and Methods: In this study, 31 infants with necrotizing enterocolitis and 31 infants with similar gestational age and birth weight as control group hospitalized in Cukurova University Neonatal Care Unit between 1 January 2001-31 January 2004 were evaluated. Results: The incidence of necrotizing enterocolitis in this period was 1.4 (31/2214 admission). Mean gestational age was 30.5  3.2 weeks (25-36), mean birth weight was 1331  384 (730-2150) grams while 71% was younger than 32 gestational weeks and 67.7% was under 1500 grams. The signs of NEC were detected at a mean of 11.2  10. (2-38) days. Twenty-six (83.9%) were being fed at the time of the necrotizing enterocolitis signs appeared. According to the Walsh and Kliegman classification, 19 (61.3%) infants were in stage 1 (17 were 1a, 2 were 1b); 3 (9.6%) infants were in stage 2a, 9 (%29.1) infants were in stage 3 (7 were in 3b). Blood culture was positive in 7 (%22.6) infants with predominance of gram negative microorganisms (5 infants). Eleven (%35.5) infants were exitus, 12 were discharged. Hypoxia, respiratory distress syndrome, intraventricular hemorrhage and umbilical catheterization were significant risk factors in necrotizing enterocolitis . Thrombocytopenia, leucopenia and high C-reactive protein levels were significantly high in necrotizing enterocolitis group. Breast feeding is significantly high in control group. Conclusion: Necrotizing enterocolitis, is a leading cause of morbidity and mortality in neonatal intensive care units. Early breast feeding with small amounts, increasing amount of milk slowly, antenatal steroids, caring hygiene rules can prevent the development of it.

Morbid Obesity Resulting from Inactivation of the Ciliary Protein CEP19 in Humans and Mice

Obesity is a major public health concern, and complementary research strategies have been directed toward the identification of the underlying causative gene mutations that affect the normal pathways and networks that regulate energy balance. Here, we describe an autosomal-recessive morbid-obesity syndrome and identify the disease-causing gene defect. The average body mass index of affected family members was 48.7 (range = 36.7-61.0), and all had features of the metabolic syndrome. Homozygosity mapping localized the disease locus to a region in 3q29; we designated this region the morbid obesity 1 (MO1) locus. Sequence analysis identified a homozygous nonsense mutation in CEP19, the gene encoding the ciliary protein CEP19, in all affected family members. CEP19 is highly conserved in vertebrates and invertebrates, is expressed in multiple tissues, and localizes to the centrosome and primary cilia. Homozygous Cep19-knockout mice were morbidly obese, hyperphagic, glucose intolerant, and insulin resistant. Thus, loss of the ciliary protein CEP19 in humans and mice causes morbid obesity and defines a target for investigating the molecular pathogenesis of this disease and potential treatments for obesity and malnutrition.

Pregnancy Outcomes According to Dialysis Commencing Before or After Conception in Women with ESRD

Pregnancy in ESRD is rare and poses substantial risk for mother and baby. This study describes a large series of pregnancies in women undergoing long-term dialysis treatment and reviews maternal and fetal outcomes. Specifically, women who had conceived before and after starting long-term dialysis are compared. All pregnancies reported to the Australian and New Zealand Dialysis and Transplantation Registry from 2001 to 2011 (n=77), following the introduction of specific parenthood data collection, were analyzed. Between 2001 and 2011, there were 77 pregnancies among 73 women. Of these, 53 pregnancies were in women who conceived after long-term dialysis was established and 24 pregnancies occurred before dialysis began. The overall live birth rate (after exclusion of elective terminations) was 73%. In pregnancies reaching 20 weeks gestation, the live birth rate was 82%. Women who conceived before dialysis commenced had significantly higher live birth rates (91% versus 63%; P=0.03), but infants had similar birthweight and gestational age. This difference in live birth rate was primarily due to higher rates of early pregnancy loss before 20 weeks in women who conceived after dialysis was established. In pregnancies that reached 20 weeks or more, the live birth rate was higher in women with conception before dialysis commenced (91% versus 76%; P=0.28). Overall, the median gestational age was 33.8 weeks (interquartile range, 30.6-37.6 weeks) and median birthweight was 1750 g (interquartile range, 1130-2417 g). More than 40% of pregnancies reached >34 weeks' gestation; prematurity at <28 weeks was 11.4% and 28-day neonatal survival rate was 98%. Women with kidney disease who start long-term dialysis after conception have superior live birth rates compared with those already established on dialysis at the time of conception, although these pregnancies remain high risk.

A comparison of the reproductive performance of ewe lambs and mature ewes

This work compared the reproductive performance of ewe lambs and mature ewes and the growth of their lambs from birth to weaning under conditions in which they had been managed as a single group. Two studies were conducted; the first study, conducted in 2007, included 307 multiparous mature ewes and 297 primiparous ewe lambs and the second study, conducted in 2009, included 399 multiparous mature ewes and 400 primiparous ewe lambs. Physical measures of ewes and lambs were recorded as was their behaviour within 12h of birth in study one. Ewe lambs were lighter (P<0.05) than mature ewes throughout pregnancy and lactation. However, the total live weight gained during pregnancy was similar (P>0.05). Lambs born to ewe lambs were smaller (P<0.05) and lighter (P<0.05) than their birth rank contemporaries born to mature ewes. However, single lambs born to ewe lambs and twin lambs born to mature ewes had similar birth weights and growth to weaning. Lamb survival rates were lowest (P<0.05) for lambs born to ewe lambs although in study two, singleton lambs born to ewe lambs had similar survival rates to both singleton and twin lambs born to mature ewes. This study identified that the limitations to ewe lamb breeding were that they produced smaller, lighter lambs with lower survival rates to weaning and maternal behaviour indicating a lack of experience compared to mature ewes. Therefore future research should be directed at alleviating these constraints.

Evaluation of Treatment Thresholds for Unconjugated Hyperbilirubinemia in Preterm Infants: Effects on Serum Bilirubin and on Hearing Loss?

BackgroundSevere unconjugated hyperbilirubinemia may cause deafness. In the Netherlands, 25% lower total serum bilirubin (TSB) treatment thresholds were recently implemented for preterm infants.ObjectiveTo determine the rate of hearing loss in jaundiced preterms treated at high or at low TSB thresholds.Design/MethodsIn this retrospective study conducted at two neonatal intensive care units in the Netherlands, we included preterms (gestational age <32 weeks) treated for unconjugated hyperbilirubinemia at high or low TSB thresholds. Infants with major congenital malformations, syndromes, chromosomal abnormalities or toxoplasmosis, rubella, cytomegalovirus, herpes, syphilis, and human immunodeficiency infections were excluded. We analyzed clinical characteristics and TSB levels during the first ten postnatal days. After two failed automated Auditory Brainstem Response (ABR) tests we used the results of the diagnostic ABR examination to define normal, unilateral, and bilateral hearing loss (>35 dB).ResultsThere were 479 patients in the high and 144 in the low threshold group. Both groups had similar gestational ages (29.5 weeks) and birth weights (1300 g). Mean and mean peak TSB levels were significantly lower after the implementation of the novel thresholds: 152±43 µmol/L and 212±52 µmol/L versus 131±37 µmol/L and 188±46 µmol/L for the high versus low thresholds, respectively (P<0.001). The incidence of hearing loss was 2.7% (13/479) in the high and 0.7% (1/144) in the low TSB threshold group (NNT = 50, 95% CI, 25–3302).ConclusionsImplementation of lower treatment thresholds resulted in reduced mean and peak TSB levels. The incidence of hearing impairment in preterms with a gestational age <32 weeks treated at low TSB thresholds was substantially lower compared to preterms treated at high TSB thresholds. Further research with larger sample sizes and power is needed to determine if this effect is statistically significant.

Neonatal, atopic and infectious disease outcomes among children born to mothers with latent tuberculosis infection

Exposure to microbes may result in maternal immune responses that can affect fetal immune development. Several lines of evidence have shown that mycobacterial antigens can change the onset of atopic disease. We hypothesized that infants born to mothers with a positive tuberculosis (TB) test and a negative chest radiograph, may exhibit differential development of atopic disease during early childhood. The study was designed as a case control study. Birth records for infants born to untreated mothers with a positive TB skin test (TST), as defined by ≥10 mm induration were reviewed (n = 145 cases) and compared to a randomly selected unmatched control cohort of 46 women with a negative TST who delivered during the same time period at Scripps Hospital in San Diego, CA, USA. Childhood outcome parameters reviewed were: (1) the onset of physician diagnosed asthma; (2) lower respiratory tract infection (LRTI) with wheezing, latent tuberculosis infection/wheezing diagnosed on physical examination; (3) nonsurgical hospitalization; (4) atopic disease (eye/skin/nasal-sinus disease); (5) infections: ear, LRTI, sinus. LRTI was defined as an infection of the lower airways, eg, pneumonia. Outcomes at the end of years 1, 2, and 3–5 years combined were analyzed. Fisher exact test, Chi-square analysis or Poisson regression analysis were used as appropriate and a P-value of <0.05 was defined as significant. The cases and controls had similar birth weights, gestational ages, maternal ages: 3.34 versus 3.35 kg; 38.3 versus 39.2 weeks, 27.4 versus 26 years (P = non-significant). The childhood outcome parameters of the new onset of asthma was significantly higher than controls by age 2 years, but not at other ages studied, based on available clinic follow up data (P = 0.02). There was a difference in the risk for lung infection at age 2 and 3–5 years (P < 0.0001). There were no differences in the other outcome parameters studied (P = ns). There were no cases of infants with a positive TST, maternal Bacille Calmette-Guerin vaccination or active maternal TB, based on our study findings. There was a higher occurrence of asthma and lung infections at age 2 years among controls (P = 0.02). Our study defines for the first time a possible influence of maternal latent TB infection on fetal and childhood illness.

Long Duration of Hyperglycemia in the First 96 Hours of Life Is Associated with Severe Intraventricular Hemorrhage in Preterm Infants

To assess the association between severe intraventricular hemorrhage (IVH) and blood glucose variables during the first 96 hours of life in preterm infants. Preterm infants with IVH grade 3-4 (n = 70) were compared with matched infants of similar gestational age and birth weight, but with no IVH (n = 108). Studied variables included the frequency and duration of hyper/hypoglycemic (>6.9/<3.3 mmol/L, respectively) events, the extreme slope of an event evolution, the maximal glucose value observed, and the "hyper/hypoglycemic index" representing a weighted average of the hyper/hypoglycemic amplitude. The IVH group had significantly more hyperglycemic events (2.9 ± 1.7 vs 2.4 ± 1.8 events, P < .05) with longer duration (22.2 ± 14.2 vs 14.1 ± 12.5 hours, P < .001) and a higher hyperglycemic index (1.0 ± 0.9 vs 1.4 ± 1.0, P = .003) compared with the non-IVH controls. Respiratory distress syndrome, hypotension, and thrombocytopenia increased the adjusted OR for IVH. Hypoglycemia was not independently associated with IVH. Conversely, the increase in hyperglycemic duration was most prominently increasing the aOR for severe IVH (OR = 10.33, 95% CI = 10.0-10.6, P = .033). Longer duration of hyperglycemia in the first 96 hours of life was most strongly associated with severe IVH in preterm infants. Consequently, interventional studies to determine the selective effect of continuous control of long-lasting hyperglycemia by appropriate and timed insulin treatment on the incidence of severe IVH are warranted.

680: Maternal outcomes in stroke during pregnancy and puerperium

classified as obese. Comorbid conditions included gestational diabetes (6%) and chronic hypertension (8%). Among the cohort, 12% had SSD. Women with SSD compared to those without were more likely to have prepregnancy obesity (71 vs. 31%, p 0.04) but had a similar delivery gestational age (38 1.2 weeks vs. 39 1, p 0.21), similar birthweight (3330 429 vs. 3141 491, p 0.36) and similar ponderal index (2.8 0.3 vs. 2.84 4, p 0.8). Obese women when compared to normal weight women had neonates with similar birthweight (3416 646 vs. 3251 386gm, p 0.2) but higher ponderal index (2.9 0.3 vs. 2.7 0.3, p 0.02). Neonatal birthweight was predicted by gestational age ( 0.53, p 0.001) and prepregnancy obesity ( 0.28, p 0.02) but not SSD ( .121, p n.s.) After controlling for comorbid conditions, prepregnancy obesity ( 0.32, p 0.02) but not SSD ( .117, p n.s.) was predictive of neonatal ponderal index. CONCLUSION: Obesity is associated with severe sleep disturbance. In this cohort of full term neonates, it is obesity rather than sleep disturbance that appears to affect neonatal adiposity.

Decrease in Incidence of Bronchopulmonary Dysplasia with Erythropoietin Administration in Preterm Infants: A Retrospective Study

Background: Despite advances in clinical care, the incidence of bronchopulmonary dysplasia (BPD) remains high in premature infants. Erythropoietin (EPO) is used for the treatment of anemia of prematurity (AOP) to decrease blood transfusion needs. EPO has been shown to mobilize circulating endothelial progenitor cells and to enhance lung repair in animal models. Objective: To determine whether EPO treatment for AOP was associated with a reduced incidence of BPD in premature infants. Methods: This retrospective study was performed on all live-born neonates with birth weights from 500 to 1,500 g and gestational age (GA) from 22 to 32 weeks admitted from 1994 to 2002. Infants who received EPO and those who did not receive EPO were compared for incidence of BPD and other morbidities. Results: Of 478 patients, 297 received EPO before 36 weeks’ postmenstrual age (group 1) and 181 did not receive EPO (group 2). Group 1 was of similar birth weight but lower GA than group 2. The incidence of BPD was lower in group 1 than group 2 (26 vs. 36%, p = 0.03); after adjusting for significant risk factors, the adjusted odds ratio for BPD was 0.50 (95% CI 0.32, 0.79), p = 0.0028. The BPD rate was much lower when EPO was initiated before 4 weeks of age (16%) as compared to later initiation (44%). Conclusions: This study shows an association between EPO treatment and reduced incidence of BPD in preterm infants, particularly when EPO treatment was initiated within the first 4 weeks of life.

Exercise capacity, daily activity, and severity of fatigue in term born young adults after neonatal respiratory failure

Little is known about long-term effects of neonatal intensive care on exercise capacity, physical activity, and fatigue in term borns. We determined these outcomes in 57 young adults, treated for neonatal respiratory failure; 27 of them had congenital diaphragmatic hernia with lung hypoplasia (group 1) and 30 had normal lung development (group 2). Patients in group 2 were age-matched, with similar gestational age and birth weight, and similar neonatal intensive care treatment as patients in group 1. All patients were born before the era of extracorporeal membrane oxygenation, nitric oxide administration, and high frequency ventilation. Exercise capacity was measured by cycle ergometry, daily physical activity with an accelerometry-based activity monitor, and fatigue by the fatigue severity scale. Median (range) VO2peak in mL/kg/min was 35.4 (19.6-55.0) in group 1 and 37.6 (15.7-52.7) in group 2. There was a between-group P-value of 0.65 for exercise capacity. Daily activity and fatigue were also similar in both groups. So, residual lung hypoplasia did not play an important role in this cohort. There were no significant associations between exercise capacity and perinatal characteristics. Future studies need to elucidate whether exercise capacity is impaired in patients with more severe lung hypoplasia who nowadays survive.

Timing of Voice Breaking in Males Associated with Growth and Weight Gain Across the Life Course

Background:In contrast to the many studies in females, there are few data in males on the relationships between childhood growth and weight gain and the timing of pubertal maturation and its relevance to adult body mass index (BMI) and body composition.Methods:A total of 2008 males in the 1946 British Birth Cohort Study had assessment of pubertal status including voice-breaking status (no change, starting, or complete) at age 14 yr. These responses were related to growth measurements at birth (weight only) and at 2, 4, 6, 7, 11, 14, 20, 26, 36, 43, 53, and 60–64 yr. Body composition was assessed by dual-energy x-ray absorptiometry at 60–64 yr.Results:Males with more advanced voice-breaking status at age 14 yr had similar birth weights compared with other males; they showed faster weight gain from 0–2 yr and had higher mean weight and BMI at age 2 yr. Subsequently, they continued to accelerate in weight and BMI, and also in height, and maximum differences in body size were seen at age 14 yr. Adult height did not differ between groups, but males with advanced voice breaking had higher adult BMI and greater whole-body lean mass and greater android fat mass at 60–64 yr.Conclusion:Similar to females with earlier menarche, the trajectory to earlier sexual maturation in males is manifested by faster early postnatal growth and weight gain and leads to higher adult BMI. Timing of pubertal maturation has potential relevance to adult disease risks in males. We also describe conditional height difference in sd score as a proxy marker of pubertal timing in males.

Bayesian simultaneous equation models for the analysis of energy intake and partitioning in growing pigs

SUMMARYThe objective of the current study was to develop Bayesian simultaneous equation models for modelling energy intake and partitioning in growing pigs. A key feature of the Bayesian approach is that parameters are assigned prior distributions, which may reflect the current state of nature. In the models, rates of metabolizable energy (ME) intake, protein deposition (PD) and lipid deposition (LD) were treated as dependent variables accounting for residuals being correlated. Two complementary equation systems were used to model ME intake (MEI), PD and LD. Informative priors were developed, reflecting current knowledge about metabolic scaling and partial efficiencies of PD and LD rates, whereas flat non-informative priors were used for the reminder of the parameters. The experimental data analysed originate from a balance and respiration trial with 17 cross-bred pigs of three genders (barrows, boars and gilts) selected on the basis of similar birth weight. The pigs were fed four diets based on barley, wheat and soybean meal supplemented with crystalline amino acids to meet or exceed Danish nutrient requirement standards. Nutrient balances and gas exchanges were measured atc. 25, 75, 120 and 150 kg body weight (BW) using metabolic cages and open circuit respiration chambers. A total of 56 measurements were performed. The sensitivity analysis showed that only the maintenance component was sensitive to the prior specification, and hence the maintenance estimate of 0·91 MJ ME/kg0·60per day (0·95 credible interval (CrI): 0·78–1·09) should be interpreted with caution. It was shown that boars’ ability to deposit protein was superior to that of barrows and gilts, as these had an estimated maximum PD (PDmax) of 250 g/day (0·95 CrI: 237–263), whereas the barrows and gilts had a PDmaxof 210 g/day (0·95 CrI: 198–220). Furthermore, boars reached PDmaxat 109 kg BW (0·95 CrI: 93·6–130), whereas barrows and gilts maximized PD at 81·7 kg BW (0·95 CrI: 75·6–89·5). At 25 kg BW, the boars partitioned on average 5–6% more of the ME above maintenance into PD than barrows and gilts, and this was progressively increased to 10–11% more than barrows and gilts at 150 kg BW. The Bayesian modelling framework can be used to further refine the analysis of data from metabolic studies in growing pigs.

Thalamic changes in a preterm sample with periventricular leukomalacia: correlation with white-matter integrity and cognitive outcome at school age

Thalamic abnormalities have been well documented in preterms with periventricular leukomalacia (PVL), although their contribution to long-term cognitive dysfunctions has not been thoroughly investigated. Significant differences between groups were observed for global thalamic volume. Neuropsychological assessments showed that preterms with PVL scored within the normal range, although significantly below controls in the full intelligence quotient and the specific cognitive domains of processing speed and working memory. Correlations of several thalamic regions with Working Memory Index and FIQ were found in the PVL group. Moreover, thalamic atrophy correlated with white-matter (WM) damage indexes (fractional anisotropy and radial diffusivity) assessed by diffusion tensor imaging. The findings suggest that thalamic damage is a common correlate of WM microstructural alterations and might be involved in the cognitive deficits seen in premature infants with PVL at school age. We analyzed the impact of PVL-associated thalamic injury on cognitive status at school age and its correlation with WM integrity as measured by magnetic resonance imaging techniques. Thalamic volume and shape of 21 preterm children with PVL were compared with those of 11 preterm children of similar gestational age and birth weight with no evidence of focal WM abnormality.

Long-term neurodevelopmental outcomes in children born with gastroschisis: the tiebreaker

Purpose We evaluated 2-year neurodevelopmental outcomes in children with gastroschisis. Methods We reviewed the records of children with gastroschisis treated between August 2001 and July 2008. Children discharged from the neonatal intensive care unit were referred to the state-sponsored Developmental Tracking Infant Progress Statewide (TIPS) program. We reviewed TIPS assessments performed before age 2 years. School districts evaluated children referred by TIPS and determined their eligibility for early intervention services. Poor outcomes were defined as scores of “failure” or “moderate/high risk” on the screening assessment or enrollment in early intervention services by 2 years. Children with gastroschisis were compared with case-matched nonsurgical, nonsyndromic children of similar gestational age and birth weight. Results One hundred five children were born with gastroschisis, and 46 were followed up with TIPS. There was no statistically significant difference in performance on screening assessments or in the rate of enrollment in early intervention services between the gastroschisis children and controls. Conclusions Children born with gastroschisis have similar 2-year neurodevelopmental outcomes as nonsurgical, nonsyndromic neonatal intensive care unit children of similar gestational age and birth weight. Both groups of children have a higher rate of enrollment in early intervention than their healthy peers. These data suggest that neurodevelopmental outcomes in gastroschisis children are delayed secondary to prematurity rather than the presence of the surgical disease.

Outcomes of pregnancies complicated by hyperemesis gravidarum

To evaluate maternal and fetal outcomes among women with hyperemesis gravidarum (HG). In a university hospital and a research and training hospital, a retrospective cohort study was conducted among women with singleton deliveries between 2003 and 2011. Maternal outcomes evaluated included gestational diabetes, pregnancy-induced hypertension, cesarean delivery. Neonatal outcomes also determined were 5-min Apgar score of less than 7, low birth weight, small for gestational age (SGA), preterm delivery, fetal sex, and stillbirth. There were no statistical differences in the mean of age, parity, the number of artificial pregnancy, and smoking between two groups. Infants from HG pregnancies manifested similar birth weight (3,121.5 ± 595.4 vs. 3,164 ± 664.5 g) and gestational age (38.1 ± 2.3 vs. 38.1 ± 2.6 weeks), relative to infants from the control group (p = 0.67 and 0.91, respectively). In addition, no statistical significant differences were found in the rates of SGA birth, preterm birth, gestational diabetes, pregnancy-induced hypertension, and adverse fetal outcome between two groups (p > 0.05). Cesarean delivery rates were similar in two groups (31.9% in hyperemesis group vs. 27% in control group, p = 0.49). Comparing the gender of the newborn baby and Apgar scores less than 7 at 5 min, there were no statistically significant differences between two groups (p = 0.16 and 0.42, respectively). Hyperemesis gravidarum is not associated with adverse pregnancy outcomes.

Comparing Humidified High Flow Nasal Cannula (HHFNC) Versus Nasal Continuous Positive Airway Pressure (NCPAP) as Respiratory Supports after Extubation in Preterm Infants

Background & Aim: After Vapotherm HHFNC was discontinued, the other type of HHFNC (RT329 Infant Oxygen Delivery System) was introduced but there are few studies using this system. The aim of this study is to evaluate the effectiveness and safety of HHFNC as a mode of respiratory support after extubation for preterm infants compared with nCPAP. Methods: This was a retrospective study of preterm infants supplied by HHFNC or nCPAP after extubation at Korea University Ansan Hospital. For short term effects, the change of heart rate, respiration rate and FiO2 needed for respiratory stabilization were monitored. The rates of re-intubation/weaning within 72 hours after extubation were measured. The complication (localized nasal necrosis, localized nasal infection and air leak syndrome) after use were recorded. Results: HHFNC group (n=23) and nCPAP group (n=23) had similar gestational age and birth weight. There were no significant differences of short term effects in both groups. The rate of re-intubation was 26% (6/23) in HHFNC group and 17% (4/23) in nCPAP group (P=0.78). The rate of weaning from the device was 39% (9/23) in HHFNC group and 48% (11/23) in nCPAP group (P=0.52). There were no statistically significant differences of complications in both groups. Conclusions: Comparing HHFNC with nCPAP, there were the similar rates of re-intubation/weaning and no differences in adverse outcomes. HHFNC may be an effective and safe as a mode of respiratory support after extubation in preterm infants. However, well-designed random trial control studies are needed for clinical application.

Are Twins Growth Restricted?

It is now well established that IUGR is associated with an increased risk of a range of adult onset diseases, including cardiovascular disease, obesity, and type 2 diabetes. Infants from twin pregnancies are generally born smaller than singletons; therefore, it has been suggested that twins represent a naturally occurring model of IUGR. Although twin gestations contribute significantly to the population burden of preterm birth and small size at birth, whether twins have the same long-term health consequences as IUGR singletons remains unclear. The purpose of this review is to consider what is currently known about the clinical implications of twinning, the differences that exist between the growth and developmental profiles of singleton and twin fetuses, and to use this as a basis for exploring the question of whether fetuses conceived as twins are analogous to IUGR singletons of similar birthweight and gestation. This question is increasingly important in both the clinical and research settings, because the incidence of twinning is increasing and the long-term implications of reduced size at birth are mostly investigated in species which bear multiple offspring.

Amplitude‐integrated EEG differences in premature infants with and without bronchopulmonary dysplasia: a cross‐sectional study

To evaluate differences in amplitude-integrated electroencephalogram (aEEG) recordings of infants with and without bronchopulmonary dysplasia (BPD). This is a cross-sectional study of infants ≤27 weeks at birth who did (n = 17) or did not develop BPD (n = 17). aEEG tracings were recorded at 36(0) -36(6) weeks post-menstrual age for 6 h using the BrainZ BRM3 monitor. A cross-cerebral channel was evaluated using offline software Analyze (BrainZ). Infants with BPD had lower gestational age and higher male predominance (25 ± 1 weeks, 70%) compared with non-BPD infants (26 ± 1 weeks, 30%, all p ≤ 0.03), but similar birth weight (704 ± 195 vs. 796 ± 167 g, p = 0.1). During active sleep, infants with BPD had wider span voltage (p = 0.03), higher lower border voltage (p < 0.03), as well as less periods of quiet sleep per hour (p < 0.01) compared with non-BPD infants. These differences persisted after adjustment for covariates. Infants with BPD have small but significant differences in their aEEG tracings compared with infants without BPD at 36 weeks. Further study of infants with BPD using aEEG appears justified to determine whether aEEG variables correlate with neurodevelopmental outcome.

Gray Matter Volume Decrements in Preterm Children With Periventricular Leukomalacia

Periventricular leukomalacia (PVL) is the prototypic lesion in the encephalopathy of prematurity. Although PVL is identified by targeting cerebral white matter (WM), neuropathological and MRI studies document gray matter (GM) loss in cortical and subcortical structures. This study aimed to investigate the distribution of GM changes in children with a history of premature birth and PVL. Voxel-based morphometry was used to examine regional GM abnormalities in 22 children with a history of preterm birth and PVL. Preterms with PVL were compared with 22 terms and 14 preterms without PVL of similar GA and birth weight. GM and WM global volumetric volumes were found to decrease in comparison with both control groups. Regional GM volume abnormalities were also found: compared with their term peers, preterm children with PVL showed several regions of GM reduction. Moreover, PVL differed from preterms without PVL in the medial temporal lobe bilaterally, thalamus bilaterally, and caudate nuclei bilaterally. In addition, in our preterm sample with PVL, birth weight showed a statistical significant correlation with decreased GM regions. In conclusion, the voxel-based morphometry methodology revealed that PVL per se does involve GM reductions.

A Case-Control Study of Perinatal and Early Life Experiences and Adult Irritable Bowel Syndrome (IBS)

Background: Select perinatal and early life experiences—such as low birthweight, nasogastric tube placement, and maternal separation—have been linked to irritable bowel syndrome (IBS) or IBS-like symptoms in humans and animals. However, confirmatory data regarding these events are lacking. Specific Aims: To determine whether there are specific perinatal and early life experiences associated with adult IBS. Methods: Participants in a previously constructed family case-control study were mailed new questionnaires asking about early life events. Subjects contacted included 506 cases and 462 controls. Continuous variables were compared between IBS-affecteds and controls using the t-test; categorical variables were compared with the Pearson chi-square test. Results: 642 (66%) responded. Median age for cases and controls was 49 years (range: 18.0-70.0) and consisted of 82% females, 98% were Caucasian. The distribution of IBS subtypes among cases was: 23% IBS-D, 9% IBSC, 26% IBS-M, and 42% other. Cases had similar birth weights to controls; low birthweight (≤2500g) was not associated with IBS status. Cases and controls reported similar gestational age at birth (median 40.0 wks), were equally likely to have reported health problems at delivery (8%) and to have received breast milk during infancy and for a similar duration. However, cases were more likely to have experienced infant colic (22% v. 11%, p<0.001). By IBS subtype, 13% of IBS-D (p=0.64, compared to controls), 28% of IBS-C (p=0.01), 25% of IBS-M (p<0.01), and 25% of other IBS (p<0.01) cases reported colic. Conclusions: Infancy health factors—such as birth weight, gestational age, health problems at delivery, and breast milk—were not predictive of adult IBS. However, infantile colic was more common among IBS patients, raising the question as to whether colic may be an early symptom of IBS or an early life event that results in the development of visceral hypersensitivity.