Birthweight Standards Research Articles

Sustained decline in birth weight and increased rate of preterm infants born small for gestational age in Japan.

Birth weights have continued to decline in Japan in recent years. However, secular trend changes such as the birth weight relative to the week of gestation remain to be explored. This study aimed to determine the trends over time in mean birth weight and small for gestational age (SGA) rate for each gestational week. We used a large dataset of 27,015,792 births obtained from birth certificates between 1997 and 2021. Births from 22 to 41 weeks of gestation were evaluated in six groups (22-24, 25-27, 28-31, 32-33, 34-36, and 37-41 weeks of gestational age). For each group, secular trend changes in the z-scores calculated from standard birth weight values were assessed. Time trends in the proportion of SGA and mean birth weight z-scores were evaluated using the Cochran-Armitage trend test and linear regression analysis. Binomial logistic regression was performed to ascertain the effects of gestational age, sex, primiparity, number of births, and maternal age on the likelihood of SGA. The mean birth weight of preterm infants continued to decrease, and the z-score for mean birth weight decreased linearly, falling to -0.7 at 25-27 weeks of gestation from 1997-2001 (first period) to 2017-2021 (final period). Maternal age continued to increase from the first period to the last period for all weeks of gestation. There was a linear increase in the SGA rate in preterm infants born at <34 weeks. Odds ratios for the likelihood of SGA were 1.3 times higher for maternal age ≥40 years than that for 25-29 years (95% CI: 1.29-1.33, p < 0.001). In Japan, there has been a continuous decline in birth weight and an increase in the rate of preterm SGA infants.

Italian neonatal birthweight charts derived from INeS not separated by birth order

BackgroundIdentifying high-risk neonates with abnormal fetal growth is crucial for health risk prediction and early intervention. Small for gestational age (SGA) and large for gestational age (LGA) classifications highlight neonates having a higher risk for postnatal diseases. Accurate diagnosis depends on precise anthropometric measurements and appropriate reference data. In 2010, specific neonatal charts for Italian singletons (INeS charts) were published, tracing separately for first- and later-born neonates due to a 3% birth weight difference. We present INeS charts for birth weight non-separated by first- and later-born babies useful when information on parity is unavailable or unreliable, or for better comparisons with other neonatal charts that are not separated by birth-order.MethodsINeS charts were traced using a parametric function. Starting with the parameters estimates published in a different paper, INeS charts not separated by birth order were traced for the gestational age range of 23 to 42 weeks. In a second step the charts were parametrized as Cole and Green Lambda Mu and Sigma (LMS) model, allowing computation of standard deviation scores.ResultsThe centiles of non-separated INeS charts follow between first- and later-born charts. Distances varied due to changing first-born proportions with gestational age, Max differences of about 100g with later born and 70g with first-born were observed at term. S and L functions have a similar shape for boys and girls. S function shows a pick at about 29 weeks, L function has positive values in all the range of gestational age with a pick at 39 weeks.ConclusionsThe study presents non-separated Birth Weight INeS charts, bridging the gap when parity information is unavailable. Differences with separated charts were generally small, making them reliable for neonatal health assessment. Insights from L and S parameters contribute to standardized birth weight and adjust it by sex and Gestational Age, useful for defining SGA or LGA neonates. The paper enhances neonatal care tools, showcasing INeS chart flexibility in different clinical scenarios and supporting neonatology research.

The impact of reference growth standards on small- and large-for-gestational age outcomes among pregnancies conceived by fresh and frozen embryo transfers

ObjectiveTo describe differences in the frequency of small-for-gestational-age(SGA) and large-for-gestational-age(LGA) driven by different birthweight curves in assisted-reproductive-technology(ART)-conceived pregnancies. DesignRetrospective cohort study SettingSingle academic medical center PatientsSingleton livebirths between 36+0-42+6 from fresh or frozen embryo transfer(ET) InterventionsNone Main Outcome MeasuresSGA (<10th percentile) and LGA (>90th percentile) classified by Fenton, INTERGROWTH-21, World Health Organization, Duryea, and Oken curves. ResultsMedian birthweight and gestational age at birth among fresh ET-pregnancies was 3289 (IQR 2977-3600)grams and 39.4 (IQR 38.6-40.3)weeks, respectively, and among frozen ET-pregnancies was 3399 (IQR 3065-3685)grams and 39.4 (IQR 38.7-40.1)weeks, respectively. The frequency of SGA neonates using each birthweight standard ranged from 5.8%-13.4% for fresh ET (p<0.001) and 3.5%-8.7% for frozen ET (p<0.001). LGA frequency ranged from 5.3%-14.3% for fresh ET (p<0.001) and 6.6%-21.2% for frozen ET (p<0.001). ConclusionsThe frequency of SGA and LGA neonates among ART-conceived gestations is partially driven by the birthweight standard. Selecting an appropriate standard that best reflects the patient population is critical to quantifying the risk of ART-conceived pregnancies.

Umbilical Cord Plasma Lysophospholipids and Triacylglycerols Associated with Birthweight Percentiles.

Dysregulated transplacental lipid transfer and fetal-placental lipid metabolism affect birthweight, as does maternal hyperglycemia. As the mechanisms are unclear, we aimed to identify the lipids in umbilical cord plasma that were most associated with birthweight. Seventy-five Chinese women with singleton pregnancies recruited into the GUSTO mother-offspring cohort were selected from across the glycemic range based on a mid-gestation 75 g oral glucose tolerance test, excluding pre-existing diabetes. Cord plasma samples collected at term delivery were analyzed using targeted liquid-chromatography tandem mass-spectrometry to determine the concentrations of 404 lipid species across 17 lipid classes. The birthweights were standardized for sex and gestational age by local references, and regression analyses were adjusted for the maternal age, BMI, parity, mode of delivery, insulin treatment, and fasting/2 h glucose, with a false discovery-corrected p < 0.05 considered significant. Ten lysophosphatidylcholines (LPCs) and two lysophosphatidylethanolamines were positively associated with the birthweight percentiles, while twenty-four triacylglycerols were negatively associated with the birthweight percentiles. The topmost associated lipid was LPC 20:2 [21.28 (95%CI 12.70, 29.87) percentile increase in the standardized birthweight with each SD-unit increase in log10-transformed concentration]. Within these same regression models, maternal glycemia did not significantly associate with the birthweight percentiles. Specific fetal circulating lysophospholipids and triacylglycerols associate with birthweight independently of maternal glycemia, but a causal relationship remains to be established.

Factors Associated with Fetal Growth in Pregnancies Complicated by Type 2 Diabetes Mellitus

Background and Hypothesis:The prevalence of type 2 diabetes (T2DM) is increasing, and it is associated with an increased risk for adverse perinatal outcomes. Fetal overgrowth is associated with an increased risk for obesity and diabetes in offspring of individuals with type 2 diabetes, and we sought to identify factors associated with excess fetal growth in pregnant individuals with T2DM.&#x0D; Experimental Design or Project Methods:This was a retrospective cohort study of 350 pregnant individuals with T2DM who delivered at IU Health Hospitals or Eskenazi Hospital from January 1, 2019-December 31,2021. We excluded pregnancies complicated by twin gestation or stillbirth. Maternal demographic data and perinatal outcomes were abstracted from the electronic medical record. Birth weights were classified as small for gestational age (SGA; &lt;10th percentile), appropriate for gestational age (AGA; 10-90th percentile), and large for gestational age (LGA; &gt;90th percentile) using a US birth weight standard. Maternal characteristics and pregnancy outcomes were compared across the 3 categories using ANOVA and chi squared statistic. Multinomial logistic regression was used to identify factors associated with birth weight category.&#x0D; Results:LGA birth weight occurred in 95 (27%) and SGA birth occurred in 32 (9%) of pregnancies. After adjusting for covariates, HbA1c after 20 weeks’ gestation was significantly associated with risk for SGA birth weight (aOR 0.4, 95% CI 0.19-0.94) and LGA birth weight (aOR 1.47, 95% CI 1.10-1.96). Individuals requiring treatment with both insulin and oral agents at the first prenatal visit were at increased risk for LGA birth weight (aOR 4.49, 95% CI 1.43-14.10).&#x0D; Conclusion and Potential Impact:Our findings highlight the important relationship between glycemic control in the second half of pregnancy and fetal growth. Additional research is needed to optimize glycemic control in pregnant individuals with T2DM.

The Relationship Between Personal Factors, Smoke Exposure at Home, and Respiratory Problems in Early Childhood in Nakhon Si Thammarat Province, Thailand.

The purpose of this study was to examine the relationship between personal factors, smoke exposure at home, and respiratory problems in early childhood in Nakhon Si Thammarat Province, Thailand. This study was retrospective. There was a total of 414 samples in the study. The instruments included the questionnaire about the personal data of early childhood and their caregivers, the smoke exposure assessment form, and the early childhood respiratory problem assessment form. The relationship between personal factors, smoke exposure at home, and respiratory problems in early childhood was analyzed by the Chi-squared test and binary logistic regression. The results revealed that smoke exposure at home in early childhood was moderate (52.2%). There 68.8% had respiratory problems. The relationship between birth weight, and smoke exposure at home in early childhood was found to be significantly related to respiratory problems (X2 =5.014 p< 0.05 and X2 = 85.711 p< 0.001, respectively). It was found that children with a birth weight ≤2500g had respiratory problems at 2.55 times of the samples with birth weight >2500g (AOR = 2.55, 95% CI: 1.10-5.96), and moderate-high smoke exposure had respiratory problems at 8.86 times of the samples with low smoke exposure (AOR = 8.86, 95% CI: 5.39-14.60). Nutritional status and breastfeeding were not significantly related to respiratory problems in early childhood p > 0.05. The birth weight and smoke exposure at home factors were found to be related to their respiratory problems in early childhood. Thus, it is necessary to reduce stimuli, especially smoking at home. Moreover, the standard birth weight of their early childhood will reduce the rate of respiratory problems.

Role of antenatal anxiety in the relationship between maternal exposure to nitrogen dioxide and small for gestational age: A birth cohort study

BackgroundBoth Nitrogen dioxide (NO2) exposure and antenatal anxiety have individually been associated with small for gestational age (SGA). Little is known, however, about whether there is effect modification of antenatal anxiety on NO2-related SGA. MethodsThe prospective birth cohort study included 1823 mother-newborn pairs in Guangzhou, China, from January 2017 to April 2020. Exposure to NO2 during the pre-conceptional and prenatal periods was estimated using an inverse distance weighted method. Antenatal anxiety was assessed by Trait Anxiety Inventory. SGA was determined by the Chinese gestational age- and sex-specific birthweight standards. Cox proportional hazards regression models was used to estimate hazard ratios (HRs) and 95 % confidence intervals (CIs) for SGA as per 10 μg/m3 increase in NO2. Modifying effects of trait anxiety on NO2-related SGA were identified by stratified analyses, and three-dimensional response surface plots and two-dimensional heat maps. ResultsEach 10 μg/m3 increase in NO2 exposure during the third trimester was significantly associated with SGA risk among overall participants (HR = 1.221, 95 % CI: 1.014–1.471) and primipara (HR = 1.271, 95 % CI: 1.023–1.579). We found significant effect modification of anxiety level for NO2-related SGA in the third trimester (Pinteraction < 0.05). Pregnant women with higher levels of trait anxiety were more likely to deliver SGA newborns, particularly for those with high trait anxiety (HR = 1.781, 95 % CI: 1.007–2.945). Primiparous women were more susceptible. ConclusionsThis study provides evidence that antenatal trait anxiety may modify the effects of maternal NO2 exposure on SGA risk. The third trimester could be a critical window of susceptibility.

Birth Weight in Consecutive Pregnancies and Maternal Cardiovascular Disease Mortality Among Spontaneous and Iatrogenic Term Births: A Population-Based Cohort Study.

Knowledge on the association between offspring birth weight and long-term risk of maternal cardiovascular disease (CVD) mortality is often based on firstborn infants without consideration of women's consecutive births. We studied long-term CVD mortality according to offspring birth weight patterns among women with spontaneous and iatrogenic term deliveries in Norway (1967-2020). We constructed birth weight quartiles (Qs) by combining standardized birth weight with gestational age in quartiles (Q1, Q2/Q3, and Q4) for the women's first 2 births. Mortality was estimated using Cox regression and expressed as hazard ratios (HRs) with 95% confidence intervals (CIs). Changes in offspring birth weight quartiles were associated with long-term maternal CVD mortality. Compared with women who had 2 term infants in Q2/Q3, women with a first offspring in Q2/Q3 and a second in Q1 had higher mortality risk (HR=1.33, 95% CI: 1.18, 1.50), while risk was lower if the second offspring was in Q4 (HR=0.78, 95% CI: 0.67, 0.91). The risk increase associated with having a first infant in Q1 was eliminated if the second offspring was in Q4 (HR=0.99, 95% CI: 0.75, 1.31). These patterns were similar for women with iatrogenic and spontaneous deliveries. Inclusion of information from subsequent births revealed heterogeneity in maternal CVD mortality which was not captured when using only information based on the first offspring.

Establishment method and significance of birthweight curve and reference in single center

Objective: To establish neonatal birthweight percentile curves based on single-center cohort database using different methods, compare them with the current national birthweight curves and discuss the appropriateness and significance of single-center birthweight standard. Methods: Based on a prospective first-trimester screening cohort at Nanjing Drum Tower Hospital from January 2017 to February 2022, the generalized additive models for location, scale and shape (GAMLSS) and semi-customized method were applied to generate local birthweight percentile curves (hereinafter referred to as the local GAMLSS curves, semi-customized curves) for 3 894 cases who were at low risk of small for gestation age (SGA) and large for gestation age (LGA). Infants were categorized as SGA (birth weight<10th centile) by both semi-customized and local GAMLSS curves, semi-customized curves only, or not SGA (met neither criteria). The incidence of adverse perinatal outcome between different groups was compared. The same method was used to compare the semi-customized curves with the Chinese national birthweight curves (established by GAMLSS method as well, hereinafter referred to as the national GAMLSS curves). Results: (1) Among the 7 044 live births, 404 (5.74%, 404/7 044), 774 (10.99%, 774/7 044) and 868 (12.32%, 868/7 044) cases were diagnosed as SGA according to the national GAMLSS curves, the local GAMLSS curves and the semi-customized curves respectively. The birth weight of the 10th percentile of the semi-customized curves was higher than that of the local GAMLSS curves and the national GAMLSS curves at all gestational age. (2) When comparing semi-customized curves and the local GAMLSS curves, the incidence of admission to neonatal intensive care unit (NICU) for more than 24 hours of infants identified as SGA by semi-customized curves only (94 cases) and both semi-customized and local GAMLSS curves (774 cases) was 10.64% (10/94) and 5.68% (44/774) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks of infants identified as SGA by the semi-customized curves only and both semi-customized and local GAMLSS curves was 12.77% (12/94) and 9.43% (73/774), 9.57% (9/94) and 2.71% (21/774), 24.47% (23/94) and 7.24% (56/774) respectively, which were significantly higher than those of the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. (3) When comparing semi-customized curves and the national GAMLSS curves, the incidence of admission to NICU for more than 24 hours of infants identified as SGA by semi-customized curves only (464 cases) and both semi-customized and national GAMLSS curves (404 cases) was 5.60% (26/464) and 6.93% (28/404) respectively, both significantly higher than that in non SGA group [6 176 cases, 1.34% (83/6 176); all P<0.001]. The incidence of emergency cesarean section or forceps delivery for non-reassuring fetal status (NRFS) in infants identified as SGA by semi-customized curves only and both semi-customized and national GAMLSS curves was 4.96% (23/464) and 12.38% (50/404), both significantly higher than that in the non SGA group [2.57% (159/6 176); all P<0.001]. The incidence of preeclampsia, pregnancy<34 weeks, and pregnancy<37 weeks in the semi-customized curves only group and both semi-customized and national GAMLSS curves group was 8.84% (41/464) and 10.89% (44/404), 4.31% (20/464) and 2.48% (10/404), 10.56% (49/464) and 7.43% (30/404) respectively, all significantly higher than those in the non SGA group [4.37% (270/6 176), 0.83% (51/6 176), 4.23% (261/6 176); all P<0.001]. Conclusion: Compared with the national GAMLSS birthweight curves and the local GAMLSS curves, the birth weight curves established by semi-customized method based on our single center database is in line with our center' SGA screening, which is helpful to identify and strengthen the management of high-risk infants.

The Danish newborn standard and the International Fetal and Newborn Growth Consortium for the 21st Century newborn standard: a nationwide register-based cohort study

It is a matter of debate whether 1 universal standard, such as the International Fetal and Newborn Growth Consortium for the 21st Century standard, can be applied to all populations. The primary objective was to establish a Danish newborn standard based on the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard to compare the percentiles of these 2 standards. A secondary objective was to compare the prevalence and risk of fetal and neonatal deaths related to small for gestational age defined by the 2 standards when used in the Danish reference population. This was a register-based nationwide cohort study. The Danish reference population included 375,318 singletons born at 33 to 42 weeks of gestation in Denmark between January 1, 2008, and December 31, 2015. The Danish standard cohort included 37,811 newborns who fulfilled the criteria of the International Fetal and Newborn Growth Consortium for the 21st Century standard. Birthweight percentiles were estimated using smoothed quantiles for each gestational week. The outcomes included birthweight percentiles, small for gestational age (defined as a birthweight of 3rd percentile), and adverse outcomes (defined as either fetal or neonatal death). At all gestational ages, the Danish standard median birthweights at term were higher than the International Fetal and Newborn Growth Consortium for the 21st Century standard median birthweights: 295g for females and 320 g for males. Therefore, the estimates of the prevalence rate of small for gestational age within the entire population were different: 3.9% (n=14,698) using the Danish standard vs 0.7% (n=2640) using the International Fetal and Newborn Growth Consortium for the 21st Century standard. Accordingly, the relative risk of fetal and neonatal deaths among small-for-gestational-age fetuses differed by SGA status defined by the different standards (4.4 [Danish standard] vs 9.6 [International Fetal and Newborn Growth Consortium for the 21st Century standard]). Our finding did not support the hypothesis that 1 universal standard birthweight curve can be applied to all populations.

Fitness of INTERGROWTH-21st birth weight standards for Chinese-ethnicity babies

ObjectiveTo determine the fitness of the INTERGROWTH-21st birth weight standards (INTERGROWTH21) for ethnic Chinese babies compared with a local reference (FOK2003).DesignPopulation-based analysis of territory-wide birth data.SettingAll public hospitals in Hong...

Intra-amniotic inflammation and birth weight in pregnancies with preterm labor with intact membranes: A retrospective cohort study.

To assess the association between newborn birth weight and the presence of intra-amniotic infection, presence of sterile intra-amniotic inflammation, and absence of intra-amniotic inflammation in pregnancies with preterm labor with intact membranes. A total of 69 pregnancies with preterm labor with intact membranes between gestational ages 22 + 0 and 34 + 6 weeks who delivered within seven days of admission were included in this retrospective cohort study. Transabdominal amniocentesis to determine the presence of microorganisms and/or their nucleic acids in amniotic fluid (through culturing and molecular biology methods) and intra-amniotic inflammation (according to amniotic fluid interleukin-6 concentrations) were performed as part of standard clinical management. The participants were further divided into three subgroups: intra-amniotic infection (presence of microorganisms and/or nucleic acids along with intra-amniotic inflammation), sterile intra-amniotic inflammation (intra-amniotic inflammation alone), and without intra-amniotic inflammation. Birth weights of newborns were expressed as percentiles derived from the INTERGROWTH-21st standards for (i) estimated fetal weight and (ii) newborn birth weight. No difference in birth weights, expressed as percentiles derived from the standard for estimated fetal weight, was found among the women with intra-amniotic infection, with sterile intra-amniotic inflammation, and without intra-amniotic inflammation (with infection, median 29; with sterile inflammation, median 54; without inflammation, median 53; p = 0.06). Differences among the subgroups were identified in the birth weight rates, expressed as percentiles derived from the standard for estimated fetal weight, which were less than the 10th percentile (with infection: 20%, with inflammation: 13%, without inflammation: 0%; p = 0.04) and 25th percentile (with infection: 47%, with inflammation: 31%, without inflammation: 9%; p = 0.01). No differences among the subgroups were observed when percentiles of birth weight were derived from the birth weight standard. The presence of intra-amniotic inflammatory complications in pregnancies with preterm labor with intact membranes prior to the gestational age of 35 weeks was associated with a higher rate of newborns with birth weight less than the 10th and 25th percentile, when percentiles of birth weight were derived from the standard for estimated fetal weight.

THE IMPACT OF REFERENCE GROWTH STANDARDS ON SMALL- AND LARGE-FOR-GESTATIONAL-AGE OUTCOMES AMONG PREGNANCIES CONCEIVED BY FRESH AND FROZEN EMBRYO TRANSFER

Pregnancies cvonceived by assisted reproductive technology (ART) are associated with increased risks of small-for (SGA) and large-for-gestational-age (LGA) neonates. While reference birthweight standards are essential for identifying these neonates, who are at increased risk of hypoglycemia, sepsis, and respiratory distress, prevalence of SGA and LGA varies widely and remains imprecisely characterized due to variation in populations studied and reference standards used.

Portuguese versus Fenton Curve: Which one better explains maternal and neonatal outcomes in Portuguese women with gestational diabetes?

Background and aimsGrowth charts are commonly used to identify foetal growth alterations, playing an important role as extreme growth centiles correlate with worse foetal and neonatal outcomes. This study aim was to compare birthweight classification (small for gestational age (SGA), adequate for gestational age and large for gestational age (LGA)) from women with gestational diabetes mellitus (GDM) by applying the population-based growth chart (Fenton Curve) and the standard chart customised for our country (Portuguese Curve). Moreover, we compared obstetric and neonatal outcomes according to birthweight classification between these curves. MethodsA multicentre observational study with prospectively collected data from 19,470 pregnant women diagnosed with GDM (30 Portuguese institutions) was conducted. ResultsThe proportion of SGA neonates was higher with Fenton Chart than with Portuguese standard chart (12.7% vs 10.9%) and the prevalence of LGA was higher using the Portuguese Chart (4.1%vs 10.9%).Statistically significant differences in the classifications given by the two curves and for maternal/neonatal outcomes were found.The Area Under the Curve and Akaike Information Criterion pointed out to a better correlation between weight classification of the Portuguese Curves and the majority of expected maternal and neonatal outcomes: gestational hypertension, preeclampsia, hydramnios, vaginal dystocic labour, hyperbilirubinemia, respiratory distress syndrome, trauma from delivery, admission in neonatal intensive care unit, prematurity and neonatal morbidity. ConclusionOur study highlights the importance of having a standard birthweight curve specifically designed for each population. Neonates’ weight classification carries prognostic implication and misclassification could lead to potential mistreatment or overtreatment.

Birth weight reference for Japanese twins and risk factors for infant mortality: A population-based study.

There is no standard birth weight curve for twins in Japan other than a prototype curve based on 1988–1991. Twins have a high perinatal mortality rate than singletons; therefore, we developed a new standard curve for twin birth weight using data from the 1995–2016 Vital Statistics and compared it with previous reports. We used 469,064 cases for analysis, excluding stillbirths and cases with missing values, and created a standard curve using LMS (statistical methods to vary the distribution by using skewness, median, and coefficient of variation) method. In comparison with previous reports, the mean birth weight decreased by 100–200 g. The groups with the lowest neonatal death rates (NDRs) and infant death rates (IDRs) were those with a birth weight of 1,500–2,499 g (NDR: 0.3%, IDR: 0.6%) and those born at 34–36 weeks (NDR: 0.2%, IDR: 0.4%). Compared to these, the IDR was significantly higher in the 2,500–3,999 g group and the 37–39 weeks group (incidence rate ratio (IRR): 1.1 in the 2,500–3,999 g group, IRR: 1.3 in the 37w0d–39w6d group). In particular, the risks of neonatal mortality and infant mortality were higher in infants born at a birth weight above 3,500 g. Infants born at a birth weight above 3,500 g may include recipients of twin-to-twin transfusion syndrome. The most common causes of infant mortality are accidental death and sudden infant death syndrome (SIDS). We considered the possibility that infants treated as healthy newborns and whose mothers were discharged from the hospital without adequate twin care guidance may be more likely to experience unintentional accidents and SIDS at home. The present study suggested that creating a new twin birth weight standard curve and guidance on managing twins at home for full-term and normal birth weight infants may lead to a reduction in infant deaths.

Validation of DIGIROP models and decision support tool for prediction of treatment for retinopathy of prematurity on a contemporary Swedish cohort

Background/AimsRetinopathy of prematurity (ROP) is currently diagnosed through repeated eye examinations to find the low percentage of infants that fulfil treatment criteria to reduce vision loss. A prediction model for...

Abstract 2: Effectiveness and safety of early growth hormone treatment in children born small for gestational age: Long-term data from NordiNet® International Outcome Study (IOS) and ANSWER program

Background: Growth hormone (GH) is indicated for the treatment of short stature in children born small for gestational age (SGA) who fail to show catch-up growth. In pilot studies, early initiation of GH has been associated with favorable growth responses in short SGA children. However, few studies have examined the short- and long-term effects of initiating GH in children born SGA who are <4 years (yr) of age, compared with those starting later. This analysis therefore investigated the effect of age at GH initiation on long-term effectiveness and safety in children born SGA.Methods: The NordiNet IOS (NCT00960128) and ANSWER (NCT01009905) programs are complementary, noninterventional, multicenter studies that evaluated the long-term effectiveness and safety of Norditropin (somatropin; Novo Nordisk A/S, Denmark) as prescribed in real-life clinical practice. In this analysis, children born SGA who were prepubertal at GH initiation were grouped according to age at GH start: <4 yr, 4-6 yr, and ≥6 yr. Patient characteristics at birth and at GH start, auxological measurements, and adverse events were evaluated in each group.Results: Overall, 3351 SGA patients were included in the effectiveness set (age at GH start: <4 yr [n=389, 54.8% male]; 4-6 yr [n=1048, 57.6% male]; and ≥6 yr [n=1914, 56.6% male]). The proportion of patients born pre-term (<37-week gestation) was 38.6% in the <4 yr group, 36.1% in the 4-6 yr group, and 28.2% in the ≥6 yr group. Mean (SD) birth length standard deviation score (SDS) and birth weight SDS were: −2.9 (1.6) and −2.3 (1.2) in the <4 yr group, −2.8 (1.3) and −2.2 (1.1) in the 4-6 yr group, and −2.5 (1.4) and −2.0 (1.2) in the ≥6 yr group. Mean (SD) age at GH start was 3.1 (0.7), 4.9 (0.6), and 9.3 (2.2) years in the <4 yr, 4-6 yr, and ≥6 yr groups, respectively. Mean (SD) GH duration and daily GH dose in the study were: 3.5 (3.1) yr and 0.044 (0.016) mg/kg in the <4 yr group, 4.1 (3.1) yr and0.039 (0.012) mg/kg in the 4-6 yr group, and 3.5 (2.5) yr and 0.042 (0.012) mg/kg in the ≥6 yr group. Mean (SD) height SDS (HSDS) at GH start was −3.3 (1.2) in the <4 yr group, −3.1 (0.9) in the 4-6 yr group, and −2.8 (0.8) in the ≥6 yr group. After 4 and 8 yr of GH, mean (SD) ÄHSDS from baseline was 1.7 (0.7) and 2.5 (0.6) in the <4 yr group, 1.6 (0.7) and 2.2 (0.8) in the 4-6 yr group and 1.3 (0.7), and 1.7 (0.6) in the ≥6 yr group. Among patients who reached near-adult height in the study, mean (SD) HSDS was −1.9 (0.6) in the <4 yr group (n=3), −1.9 (0.8) in the 4-6 yr group (n=10), and −1.8 (1.0) in the ≥6 yr group (n=220). In the safety set (n=5643), the most commonly reported non-serious adverse reactions (AR) were headache (n=20) and arthralgia (n=5). The most common serious ARs were headache (n=3) and epiphysiolysis (n=4). ARs and serious ARs were distributed equally among groups.Conclusions: This analysis of real-world data confirms the effectiveness and safety of GH in children born SGA, irrespective of patient age at treatment initiation.

Predictive performance of newborn small for gestational age by a United States intrauterine vs birthweight-derived standard for short-term neonatal morbidity and mortality

The use of birthweight standards to define small for gestational age may fail to identify neonates affected by poor fetal growth as they include births associated with suboptimal fetal growth. This study aimed to compare intrauterine vs birthweight-derived standards to define newborn small for gestational age to predict neonatal morbidity and mortality. This was a secondary analysis of a multicenter observational study of 118,422 births. Live-born singleton, nonanomalous newborns born at 23 to 41 weeks of gestation were included. Those with missing gestational age estimation or without a first- or second-trimester ultrasound to confirm dating, birthweight, or neonatal outcome data were excluded. Birthweight percentile was computed using an intrauterine standard (Hadlock) and a birthweight-derived standard (Olsen). We compared the test characteristics of small for gestational age (birthweight of <10th percentile) by each standard to predict a composite neonatal morbidity and mortality outcome (death before discharge, neonatal intensive care unit admission >48 hours, respiratory distress syndrome, sepsis, necrotizing enterocolitis, grade 3 or 4 intraventricular hemorrhage, or seizures). Severe composite morbidity was analyzed as a secondary outcome and was defined as death, neonatal intensive care unit admission >7 days, necrotizing enterocolitis, grade 3 or 4 intraventricular hemorrhage, or seizures. The areas under the curve using receiver-operating characteristic methodology and proportions of the primary outcome by small for gestational age status were compared by gestational age category at birth (<34, 34 0/7 to 36 6/7, ≥37 weeks). Of 115,502 mother-newborn dyads in the parent study, 78,203 (67.7%) were included, with most exclusions occurring because of missing or inadequate dating information, multiple gestations, or delivery outside the gestational age range. The primary composite outcome occurred in 9.5% (95% confidence interval, 9.3-9.7), and the severe composite outcome occurred in 5.3% (95% confidence interval, 5.1-5.4). Small for gestational age was diagnosed by intrauterine and birthweight-derived standards in 14.8% and 7.4%, respectively (P<.001). Neonates considered small for gestational age only by the intrauterine standard experienced the primary outcome more than twice as often as those considered non-small for gestational age by both standards (18.4% vs 7.9%; P<.001). For the prediction of the primary outcome, small for gestational age by the intrauterine standard had higher sensitivity (29% vs 15%; P<.001) but lower specificity (87% vs 93%; P<.001) than by the birthweight standard. Both standards had weak performance overall, although the intrauterine standard had a higher area under the curve (0.58 vs 0.53; P<.001). When subanalyzed by gestational age at birth, the difference in areas under the curve was only present among preterm deliveries 34 to 36 competed weeks. Neither standard demonstrated any discrimination for morbidity prediction among term births (area under the curve, 0.50 for both). When the prediction of severe morbidity was compared, the intrauterine still had better overall prediction than the birthweight standard (areas under the curve, 0.65 vs 0.57; P<.001), although this also varied by gestational age at birth. Among nonanomalous neonates, neither intrauterine nor birthweight-derived standards for small for gestational age accurately predicted neonatal morbidity and mortality, with no discriminatory ability at term. Small for gestational age intrauterine standards performed better than birthweight standards.

Performance of Six Birth-Weight and Estimated-Fetal-Weight Standards for Predicting Adverse Perinatal Outcome: A 10-Year Nationwide Population-Based Study

(Abstracted from Ultrasound Obstet Gynecol 2021;58:264–277) One of the risk factors for perinatal mortality and morbidity is abnormal fetal growth. The goal of this study was to study the prediction of adverse perinatal outcomes in preterm and term babies based on 3 birth weight (BW) standards (Australian population-based, Fenton, and INTERGROWTH-21st) and 3 estimated fetal weight (EFW) standards (Hadlock, INTERGROWTH-21st, and World Health Organization [WHO]) to classify small-for-gestational age (SGA) and large-for-gestational age (LGA).

Karakteristik Katarak Kongenital di RSUD Provinsi NTB Periode 2018-2019

Congenital cataracts are the leading cause of blindness in children. Lens opacity in early life has the potential to cause permanent visual impairment if not treated promptly. Cataract surgery performed at the right time can prevent children from amblyopia (lazy eye). This study aims to determine the characteristics of congenital cataracts at the West Nusa Tenggara Provincial General Hospital in the 2018-2019 period. This research uses descriptive method. The data used is secondary data from medical records of congenital cataract patients at the West Nusa Tenggara Provincial General Hospital in the 2018-2019 period. In the 2018-2019 period, 40 children had congenital cataracts. Most of the cataract sufferers were women (52.5%); living outside the city of Mataram (92.5%) with an age distribution of under 12 months (95%) and the rest over 12 months. For infants under 12 months, 53 percent have been diagnosing at the age of 1-2 months. The characteristics of congenital cataracts found were generally bilateral (52.5%), had standard birth weight (52.5%), history of natural birth delivery (67.5%), and had other extraocular congenital abnormalities (72.5%). Most patients with congenital cataracts in the West Nusa Tenggara Provincial General Hospital have been diagnosing at a (pretty/moderately) early age of 1-2 months at the beginning of their lives. So, with appropriate and prompt therapy, hoping that it can reduce the risk of amblyopia.