Weight Z-score Research Articles

The association between human milk fatty acid composition in mothers with an elevated body mass index and infant growth changes

Few studies have investigated alternations in human milk polyunsaturated fatty acid (PUFA) composition in the context of maternal obesity and its effects on infant growth trajectories. This study explored whether maternal weight status and breastfeeding type influence human milk FA composition and infant anthropometry during the first six months of life. Mother-infant dyads were enrolled from the Prediction of Allergies in Taiwanese Children birth cohort study. Data concerning maternal pre-pregnancy weight, infants' breastfeeding practices, and anthropometric data were obtained regularly. We identified and compared between the composition of 30 FAs in the colostrum and 2-month milk, respectively, in obese/overweight (OB/OW) and normal-weight (NW) mothers. Multiple linear regression analyses were performed to determine the association between PUFA composition at different lactation stages and infant anthropometric parameter changes and to identify the independent variables for body mass index (BMI) z-scores by six months of age. We included 338 mother-infant dyads (OB/OW mothers, 16.9%). OB/OW mothers exhibited lower total n-3 PUFAs (P=0.035), higher ratios of arachidonic acid (C20:4n-6)/eicosapentaenoic acid (C20:5n-3)+docosahexaenoic acid (C22:6n-3), and n-6/n-3 PUFA in colostrum (P=0.037 and 0.011, respectively), and their offspring had higher body weight and BMI z-scores. Nevertheless, no PUFA composition or n-6/n-3 PUFA ratios in colostrum and 2-month milk were associated with anthropometric parameter changes by age 6 months. Infant birth weight z-scores were independently associated with BMI outcomes at age 6 months (adjusted β=0.16, 95% confidence interval (0.05-0.35), P=0.010) CONCLUSION: Neither n-3 nor n-6 PUFA profiles nor n-6/n-3 PUFA ratios at different lactation stages were found to be associated with anthropometric changes by age 6 months, suggesting that human milk PUFA composition may not be an important determinant of early infant growth trajectories.

Demographic, Clinical, and Laboratory Characteristics of Children with Renal Tubular Acidosis

This study included patients followed up for primary renal tubular acidosis (RTA) between 1991 and 2012. Clinical characteristics at presentation, physical examination findings, laboratory test results, and treatments were recorded. The patients’ laboratory results, drug doses, height, and weight were recorded every 3 months for the first year of follow-up. Standard deviation scores (Z-scores) of height and weight for age were determined and the patients’ growth rates were evaluated. Of 50 patients followed up for primary RTA, 31 (62%) had distal RTA and 19 (38%) had proximal RTA. The median age at diagnosis was 3 months (range, 1-174 months) for patients with distal RTA and 10 months (range, 2-33 months) for patients with proximal RTA. The median follow-up times in these two groups were 96 months (range, 6-204 months) and 89 months (range, 6-180 months), respectively. Family history of RTA was more common among patients with distal RTA than those with proximal RTA (p=0.013). Nephrocalcinosis and deafness were detected more frequently in the distal RTA group (p=0.001), while ocular pathologies were more common in the proximal RTA group (p<0.001). In patients with distal RTA, older age at diagnosis was associated with lower weight and height Z-scores (p<0.05). Early diagnosis had a positive effect on the growth of patients with primary RTA.

Fetal growth assessed via ultrasound in relation to maternal HIV infection status and antiretroviral regimens.

To evaluate effects of maternal HIV and antiretroviral treatment (ART) on intrauterine fetal growth. Prospective cohort studies of HIV and ZIKA infection among women living with HIV (WLHIV) and women not living with HIV (WNLHIV) conducted in Brazil and the US from 2016 to 2020. We evaluated fetal growth via repeated ultrasounds and calculated z scores for fetal growth measures using Intergrowth-21st standards among women with singleton pregnancies. Adjusted linear mixed models were fit for each fetal growth z score by HIV status. Among WLHIV, we compared fetal growth z scores by the most common maternal ART regimens, stratified by timing of ART initiation. We included 166 WLHIV and 705 WNLHIV; none had Zika infection. The z scores were similar for WLHIV and WNLHIV for femur length (latest third trimester median = 1.08) and estimated fetal weight (median ≈0.60); adjusted mean differences in fetal weight z scores by HIV status were less than 0.1 throughout gestation. Other fetal growth measurements were lower for WLHIV than WNLHIV early in gestation but increased more rapidly over gestation. Among WLHIV not on ART at conception, adjusted mean z scores were generally similar across regimens initiated during pregnancy but somewhat lower for atazanavir-based regimens for biparietal diameter compared with efavirenz-based or raltegravir-based regimens. Among WLHIV on ART at conception, mean z scores were similar across ART regimens. Within our cohorts, fetal growth was lower in WLHIV than WNLHIV early in gestation but similar by the end of gestation, which is reassuring. Among WLHIV, fetal growth measures were generally similar across ART regimens evaluated.

Study of growth parameters in children and adolescents with type 1 diabetes mellitus

Objectives: Data on anthropometry in children with type 1 diabetes mellitus (T1D) are sparse in India. The study aimed to assess the growth parameters and the effect of age at diagnosis, duration of diabetes, hemoglobin A1C (HbA1c), and insulin regimens on the growth of children with T1D. Material and Methods: The study included subjects with T1D between the ages of 1 and 18 years, with a duration of diabetes for at least one year. Height for age Z-scores (HAZ), weight for age Z-scores (WAZ), and body mass index for age Z-scores (BAZ) were calculated using standard Indian Academy of Pediatrics 2015 growth charts for Indian children.The study design was an observational cross-sectional study. Results: The number of subjects was 57 (F: M 30:27). The median age (interquartile range) was 13.8 (9–17.1) years, the age at diagnosis was 8 (4–11.5) years, and the mean duration of T1D was 5 (3–7) years. The mean HbA1c was 10.33 ± 1.88%. The growth parameters as assessed by HAZ −0.83 (−1.98–−0.16), WAZ −0.98 (−1.72–−0.11), and BAZ −0.55 (−1.41–0.1) were low in comparison to the population medians. The age at diagnosis, duration of diabetes, and the type of insulin regimen did not significantly impact HAZ and WAZ. Children with HbA1c <8.5% had better HAZ −0.21 (−0.94–0.35) versus −1.07 (−2.07–−0.25), (P = 0.069), and WAZ −0.33 (−0.73–0.23) versus –1.07 (−1.77–−0.29), (P = 0.041) compared to those with HbA1c >8.5%. Conclusion: Children with T1D were shorter and leaner than age- and sex-matched controls. Age at diagnosis, duration of diabetes, and insulin regimens did not significantly impact growth, whereas children with lower HbA1c had better HAZ and WAZ.

Early weight measures and long-term neuropsychological outcome of critically ill neonates and infants: a secondary analysis of the PEPaNIC trial

Neonates and infants surviving critical illness show impaired growth during critical illness and are at risk for later neuropsychological impairments. Early identification of individuals most at risk is needed to provide tailored long-term follow-up and care. The research question is whether early growth during hospitalization is associated with growth and neuropsychological outcomes in neonates and infants after pediatric intensive care unit admission (PICU). This is a secondary analysis of the PEPaNIC trial. Weight measurements upon PICU admission, at PICU discharge, at hospital discharge, at 2- and 4-year follow-up, and of different subgroups were compared using (paired) t-tests. Multiple linear regression analyses were performed to investigate the association between early growth in weight measures and neuropsychological outcomes at 4-year follow-up. One hundred twenty-one infants were included, and median age upon admission was 21 days. Growth in weight per week was less than the age-appropriate norm, resulting in a decrease in weight-for-age Z-score during hospitalization. Weight is normalized at 2- and 4-year follow-up. Weight gain in kilograms per week and change in weight Z-score were not associated with neurodevelopmental outcome measures at 4-year follow-up. Lower weight-for-age Z-score at PICU admission and at hospital discharge was associated only with lower weight and height Z-scores at 4-year follow-up.Conclusion: Growth in weight during hospital stay of young survivors of critical illness is impaired. Worse early growth in weight is associated with lower weight and height but not with neuropsychological outcomes at 4-year follow-up.What is Known:• Critically ill neonates and infants show impaired early growth during admission and are at risk for later neuropsychological impairments.• Unraveling the association between early growth and later neuropsychological impairments is crucial since the first year of life is critical for brain development.What is New:• Critically ill neonates and infants had age appropriate weight measures at 4-year follow-up.• Poor growth in weight during hospital stay was not associated with poorer cognitive, emotional, or behavioral functioning four years after critical illness.

The Efficacy of Egg White Powder on Anthropometric Indices in Malnourished Children

Background: White egg powder provides essential amino acids compounds. This study aims to investigate the theory that a regular consumption of white egg powder would improve weight gain and appetite in children with malnutrition. Methods: The present experimental study was conducted among children aged 3-6 years with mild to severe malnutrition referred to Ghadir Mother and Child Hospital affiliated with Shiraz University of Medical Sciences from April to October 2017. The malnourished children received egg white protein (1 g/kg of their current body weight) for 3 weeks. Weight loss as a primary outcome and weight-for-height Z-score (WHZ), height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and BMI-for-age Z-score (BAZ) were measured as secondary outcomes, assessed at baseline and after six weeks of study. Results: Of the 23 children included, 20 finished the study. Weight increased in all children although it was not significant (P = 0.101). A lower appetite was seen at the end of the intervention, but it was not significant (P = 0.575). Malnutrition based on WHZ and BAZ decreased compared to the baseline measurement, while the changes were not significant. Regarding other markers, no statistically significant changes were found compared to the baseline measurement. Conclusion: The addition of white egg powder to complementary nutrition could not improve weight gain and appetite in malnourished children. Further research with a larger study population and longer intervention time is needed to demonstrate the clear effect of egg white on improving malnutrition in children.

Weight growth velocity and growth outcomes in very-low-birth-weight infants developing major morbidities

BackgroundExtrauterine growth restriction (EUGR) is common in very-low-birth-weight-infants and may be associated with poor neurodevelopment. The growth velocity of preterm infants is increasing over decades, but the relationship between growth velocity, EUGR, and morbidities of preterm infants remains unknown. MethodsA total of 263 infants born between 2012 and 2020, with birthweight <1500 g and gestational age of 24–33 weeks, were included. Birthweight and weight on day of evaluation point (corrected gestational age 36 weeks or discharged, whenever comes first) were converted to age-specific and gender-specific Z-scores and analyzed by multivariable modeling. The average growth velocity was calculated by the exponential model. ResultsAverage growth velocity from birth to the evaluation point was 11.8 ± 0.3 g/kg/day. The maximum growth velocity from birth to week 8 postnatal occurred at week 4 postnatal (16.4 ± 0.9 g/kg/day). Infants with smaller birth weight, higher gestational age, and indication of intestinal surgery or those who need more days to achieve full enteral feeding were more favorable to have a weight lower than the 10th centile at the evaluation point. By contrast, most comorbidities of prematurity did not affect either lower age-specific weight Z-scores on the evaluation point or larger change in weight Z-score between birth and evaluation point. ConclusionEUGR was associated with gestational age and birth weight. Infants with moderate-to-severe bronchopulmonary dysplasia, high-grade intraventricular hemorrhage, or retinopathy of prematurity tend to have slower growth velocity at 3–5 weeks postnatal, but these did not contribute to EUGR.

Abstract 17043: Role of Child Opportunity Index on Neonatal Mortality and 1-Year Mortality in Infant Congenital Heart Disease: A Contemporary Population-Based Report

Introduction: Although mortality has declined among infants with congenital heart disease (CHD), racial/ethnic and sociodemographic disparities persist. The child opportunity index (COI) is a census-based metric of neighborhood conditions based on education, health/environment, and social/economic domains. We sought to determine the impact of COI on neonatal and 1-year mortality of infants with CHD. Hypothesis: We hypothesized that neighborhood sociodemographic factors as measured by COI would have a greater impact on longer-term outcomes. Methods: This is a retrospective population-based cohort in California (2011-2017) of infants with CHD who underwent a cardiac intervention in the first year of life. COI was categorized into high, moderate, and low. Each COI domain was evaluated. The primary outcomes included 1-year mortality, neonatal mortality prior to 30 days of life, and days alive out of hospital in the first year of life (DAOOH). Uni- and multivariable logistic and linear regression were used. Results: The sample included 9,729 infants with an overall 1-year mortality rate of 8.2% and neonatal mortality rate of 3.5%. After adjusting for race/ethnicity, maternal age, sex, CHD severity (RACHS-1 category), birth weight z-score, and gestational age at birth, the odds of 1-year mortality were significantly higher among infants from low compared to high COI (1.37, 95%CI: 1.13, 1.67). In contrast, the adjusted odds of neonatal mortality were not different in low compared to high COI (1.20, 95%CI:0.89,1.61). Low and moderate COI groups had significantly lower DAOOH compared to high COI (low: -10.30, 95%CI: -15.2, -5.4; moderate: -7.43, 95%CI: -12.96, -1.89). Results were similar for each COI domain ( Figure 1). Conclusion: Neighborhood factors reflecting the home environment influence outcomes beyond the neonatal period. Future studies are needed to determine whether targeting domains of the COI will mitigate ongoing risks of poor CHD outcomes.

Clinical factors associated with need for neurosurgical care in young children with imaging for macrocephaly: a case control study

BackgroundMacrocephaly is present in 2.3% of children with important neurosurgical conditions in the differential diagnosis. The objective of this study was to identify clinical associations with actionable imaging findings among children with head imaging for macrocephaly.MethodsWe conducted a case-control study of head imaging studies ordered for macrocephaly among children 24 months and younger in a multistate children’s health system. Four neurosurgeons reviewed the images, determining cases to be a ‘concern’ if neurosurgical follow-up or intervention was indicated. Electronic health records were reviewed to collect patient-level data and to determine if surgery was performed. Controls were matched 3:1 to cases of ‘concern’ in a multivariate model using conditional logistic regression.ResultsIn the study sample (n = 1293), 46 (4%) were concern cases, with 15 (1%) requiring surgery. Significant clinical factors associated with neurosurgical concern were bulging fontanel [aOR 7.47, (95% CI: 2.28–24.44), P < 0.001], prematurity [aOR 21.26, (95% CI: 3.76–120.21), P < 0.001], any delay [aOR 2.67, (95% CI: 1.13–6.27), P = 0.03], and head-weight Z-score difference (W_diff, defined as the difference between the Z-scores of head circumference and weight) [aOR 1.70, (95% CI: 1.22–2.37), P = 0.002].ConclusionsHead imaging for macrocephaly identified few patients with findings of concern and fewer requiring surgery. A greater head-weight Z-score difference appears to represent a novel risk factor for neurosurgical follow-up or intervention.

Developing a nutrition screening tool for children with cystic fibrosis ages 0 to 2 years: Children with cystic fibrosis nutrition screening tool

BackgroundFor children with cystic fibrosis (CF), achieving and maintaining optimal growth by the age of 2 years is critical for future health outcomes. A standardized nutrition screening is needed to identify growth problems, enable timely interventions, and improve nutritional outcomes for children (0 to 2 years) with CF. The purpose of this study was to develop a nutrition screening tool for children (0 to 2 years) with CF to identify nutrition risk at every clinical encounter. MethodsA retrospective cross-sectional study was used to develop a nutrition screening tool to determine if nutrition interventions needed to change (at-risk) or continue (not at-risk). Retrospective data for pertinent nutrition factors were collected for 99 children attending an accredited CF clinic. The nutrition factors were compared to a dietitian assessment. A stepwise discriminant analysis determined weight-for-age (WFA) and weight-for-length (WFL) z-scores were significant. Then anthropometric data and corresponding dietitian assessment results were collected for children with CF attending two other accredited CF clinics (n = 29, n = 30). Discriminant analysis was used to determine sensitivity and specificity of the nutrition factors and to create a nutrition screening tool equation. ResultsThe nutrition screening model that included WFA z-score, LFA z-score, WFL z-score, and weight change velocity adequacy determined nutrition risk the best. The sensitivity was 89.7 %, specificity 83.2 %, NPV 93.3 %, and PPV 75.4 % for this model. ConclusionThe nutrition screening tool equation developed in this study standardizes the process to identify children (0 to 2 years) with CF at nutrition risk. Further validation is needed.

Empowered mothers and co-resident grandmothers: Two fundamental roles of women impacting child health outcomes in Punjab, Pakistan.

We show that i) empowered mothers and ii) coresident grandmothers each benefit children's nutritional health measured by height-for-age z-scores (HAZ) and weight-for-age z-scores (WAZ) for age groups 5 years and less. First, using cross-sectional data from the Pakistan Demographic and Health Survey (PDHS) for the year 2017-18, we estimate the impact of empowered mothers on child health outcomes using an instrumental variable approach to correct for endogeneity. Empowerment is measured by two indices: as a sum of the questions that gauge both attitudinal and behavioral dimensions of female agency and also and using multiple correspondence analysis (MCA) for these same questions. Second, we use a fuzzy regression discontinuity design (FRDD) to measure the causal impact of coresident grandmothers on the health outcomes of the children using multiple rounds of the Multiple Indicator Cluster Survey (MICS) from the years 2008, 2011, 2014 and 2018. The difference between the actual ages of the grandmother from the Potential Retirement Eligibility Criteria (PREC) has been used to correct for potential endogeneity. The results show that on average, the weight for age z-scores (WFA) for children under five increases by 0.28 SD with a one-index point increase in mother's empowerment. Similarly, on average, WFA increases by 0.098 SD when grandmothers are present in a household. Finally, we explore heterogeneity in the average effects stated above based upon the gender of the child as well as the wealth and geographic location of the household. The benefits of mothers' empowerment are largely driven by improvements in girls' nutrition as well as children living in rural areas while the presence of grandmothers primarily improves the nutrition of boys, children in rural areas, and children belonging to poor families.

A Quality Improvement Initiative to Reduce Necrotizing Enterocolitis in Very Preterm Infants.

To reduce the incidence of necrotizing enterocolitis (NEC) among very preterm infants in the Calgary Health Region to ≤2% within 2 years. A multidisciplinary team developed key drivers for NEC. Targeted interventions included strategies to increase mothers' own milk (MOM), improve compliance with feeding regimens, standardize management of feeding intolerance, prevent intestinal microbial aberrations, and feed conservatively during blood transfusion and the treatment of patent ductus arteriosus. The outcome measure was NEC (≥ stage 2). Changes in NEC rates were examined among racial and ethnic groups. Process measures included MOM feeding at discharge, the difference between actual and expected time to reach full feeds, lowest hemoglobin, and the duration of empirical antibiotics. Growth, the rate of blood transfusion, and the duration of parenteral nutrition were balancing measures. The preintervention, intervention, and sustainment periods were January 2013 to June 2016, July 2016 to December 2018, and December 2018 to December 2021, respectively. We included 2787 infants born at ≤326/7 weeks' gestation (1105 preintervention, 763 during intervention, and 919 in sustainment). NEC decreased from 5.6% to 1.9%. Process measures indicated increased MOM feeding at discharge, improved compliance with feeding regimens, increased lowest hemoglobin levels, and shorter durations of empirical antibiotics. Balancing measures revealed improved weight Z-scores, shorter durations on parenteral nutrition, and increased rates of blood transfusion. Quality improvement initiatives to increase MOM, improve compliance with feeding regimens, feed conservatively during blood transfusion and treatment of patent ductus arteriosus, and prevent intestinal microbial aberrations were associated with reduced NEC.

Anthropometric Differences in Community- Versus Clinic-Recruited Infants Participating in a Trial of Azithromycin for Prevention of Childhood Mortality in Burkina Faso.

Clinic-based recruitment for preventative interventions for child health may select for healthier populations compared with community-based outreach. Nutritional status during infancy as measured by anthropometry is predictive of mortality, growth faltering later in life, and poor cognitive development outcomes. We evaluated baseline differences in infant nutritional status among children recruited directly in their community versus clinic recruitment among infants participating in a trial of azithromycin compared with placebo for prevention of mortality in three districts of Burkina Faso. Infants between 5 and 12 weeks of age were recruited in their community of residence via vaccine outreach teams or in primary health-care clinics during vaccine clinics. Weight, height, and mid upper arm circumference were measured. We used linear and logistic regression models to compare anthropometric outcomes among community and clinic recruited infants, adjusting for age at enrollment, gender, and season. Among 32,877 infants enrolled in the trial, 21,273 (64.7%) were recruited via community outreach. Mean weight-for-age z-score (WAZ) was -0.60 ± 1.2 (SD), weight-for-length z-score (WLZ) was -0.16 ± 1.5, and length-for-age z-score was-0.53 ± 1.3. Infants enrolled in the community had lower WAZ (mean difference, -0.12; 95% CI, -0.20 to -0.04) and WLZ (mean difference, -0.21; 95% CI, -0.32 to -0.09). Community-recruited infants were more often underweight (WAZ < -2; odds ratio [OR], 1.25; 95% CI, 1.09-1.43) and wasted (WLZ < -2; OR, 1.54; 95% CI, 1.31-1.79). There was no evidence of a difference in height-based measures. Community and clinic recruitment likely reach different populations of children.

Association Between Birth Weight Z-Score and Blood Pressure in Young Adults

Association Between Birth Weight Z-Score and Blood Pressure in Young Adults

Association Between Birth Weight Z-Score and Blood Pressure in 9- to 10-Year-Old Icelandic Children

Association Between Birth Weight Z-Score and Blood Pressure in 9- to 10-Year-Old Icelandic Children

Childhood interstitial lung disease in Turkey: first data from the national registry.

The childhood interstitial lung diseases (chILD) Turkey registry (chILD-TR) was established in November 2021 to increase awareness of disease, and in collaboration with the centers to improve the diagnostic and treatment standards. Here, the first results of the chILD registry system were presented.In this prospective cohort study, data were collected using a data-entry software system. The demographic characteristics, clinical, laboratory, radiologic findings, diagnoses, and treatment characteristics of the patients were evaluated. Clinical characteristics were compared between two main chILD groups ((A) diffuse parenchymal lung diseases (DPLD) disorders manifesting primarily in infancy [group1] and (B) DPLD disorders occurring at all ages [group 2]).There were 416 patients registered from 19 centers. Forty-six patients were excluded due to missing information. The median age of diagnosis of the patients was 6.05 (1.3-11.6) years. Across the study population (n = 370), 81 (21.8%) were in group 1, and 289 (78.1%) were in group 2. The median weight z-score was significantly lower in group 1 (- 2.0 [- 3.36 to - 0.81]) than in group 2 (- 0.80 [- 1.7 to 0.20]) (p < 0.001). When we compared the groups according to chest CT findings, ground-glass opacities were significantly more common in group 1, and nodular opacities, bronchiectasis, mosaic perfusion, and mediastinal lymphadenopathy were significantly more common in group 2. Out of the overall study population, 67.8% were undergoing some form of treatment. The use of oral steroids was significantly higher in group 2 than in group 1 (40.6% vs. 23.3%, respectively; p = 0.040). Conclusion: This study showed that national registry allowed to obtain information about the frequency, types, and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. What is Known: • Childhood interstitial lung diseases comprise many diverse entities which are challenging to diagnose and manage. What is New: • This study showed that national registry allowed to obtain information about the frequency, types and treatment methods of chILD in Turkey and helped to see the difficulties in the diagnosis and management of these patients. Also, our findings reveal that nutrition should be considered in all patients with chILD, especially in A-DPLD disorders manifesting primarily in infancy.

Nutritional status of young children born with low birthweight in a low resource setting: an observational study

ObjectiveEvery year, an estimated 20 million babies are born with low birthweight and this number is increasing globally. Survivors are at risk of lifelong morbidities like undernutrition. We assessed the growth and nutritional status for children born with low birthweight at Mulago Hospital, Uganda.MethodsWe conducted a cross sectional study to describe the nutritional status of children aged between 22 and 38 months and born weighing ≤ 2000 g. Anthropometric measurements; weight for height, height for age and weight for age z-scores were generated based on the World Health Organization standards to define wasting, stunting and underweight respectively. Data was collected using a structured questionnaire and analysis was done using STATA version 14.ResultsOf the 251 children, 129 (51.4%) were male, mean age was 29.7 months SD 4.5) and maternal mean age was 29.9 (SD 5.3). A total of 101(40.2%) had normal nutritional status. The prevalence of wasting, underweight and stunting were: 8 (3.2%), 36 (14.4%) and 106 (42.2%) respectively.ConclusionSix of ten children born with low birthweight were at risk of undernutrition in early childhood: underweight and stunting were higher than the national prevalence. Targeted interventions are needed for children with very low birth weight.

Development of weight and height age z-score after total cavopulmonary connection.

We aimed to analyze somatic growth of patients after total cavopulmonary connection (TCPC) as well as to identify factors influencing postoperative catch-up growth. A total of 309 patients undergoing TCPC at 4 years old or less between 1994 and 2021 were included. Weight-for-age z-score (WAZ) and height-for-age-z-score (HAZ) at TCPC and at postoperative time between 1 to 3 years were calculated. Factors influencing somatic growth were analyzed. Most frequent diagnosis and initial palliation were hypoplastic left heart syndrome (HLHS) (34%) and the Norwood procedure (51%), respectively. Median age and weight at TCPC was 2.0 (IQR: 1.7-2.5) years and 11.3 (10.5-12.7) kg, respectively. Median 519 days after TCPC, significant increase in WAZ (-0.4 to -0.2, p<0.001) was observed, but not in HAZ (-0.6 to -0.6, p=0.38). Older age at TCPC (p<0.001, OR: 2.6) and HLHS (p=0.007, OR: 2.2) were risks for low WAZ after TCPC. Older age at TCPC (p=0.009. OR: 1.9) and previous Norwood procedure (p=0.021, OR: 2.0) were risks for low HAZ after TCPC. Previous bidirectional cavopulmonary shunt (BCPS) was a protective factor for both WAZ (p=0.012, OR: 0.06) and HAZ (p=0.028, OR: 0.30) at TCPC. In patients undergoing TCPC at the age of 4 years or less, a significant catch-up growth was observed in weight-for-age z-score after TCPC, but not in height-for-age-z-score. Previous BCPS resulted to be a protective factor for a better somatic development at TCPC. HLHS undergoing Norwood were considered as risks for somatic development after TCPC.

Maternal capital predicts investment in infant growth and development through lactation.

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Longitudinal growth of children born with gastroschisis or omphalocele

Normal childhood growth is an indicator of good health, but data addressing the growth of children born with abdominal wall defects (AWDs) are limited. The detailed growth phenotypes of children born with gastroschisis or omphalocele are described and compared to peers without AWDs from birth to adolescence. Data from 183 gastroschisis and 144 omphalocele patients born between 1993 and 2017 were gathered from Finnish nationwide registers and electronic health records. Weight (n = 3033), length/height (n = 2034), weight-for-length (0–24 months, n = 909), and body mass index measures (2–15 years, n = 423) were converted into sex- and age-specific Z-scores. Linear mixed models were used for comparisons. Intrauterine growth failure was common in infants with gastroschisis. Birth weight Z-scores in girls and boys were − 1.2 (0.2) and − 1.3 (0.2) and length Z-scores − 0.7 (0.2) and − 1.0 (0.2), respectively (p < 0.001 for all comparisons to infants without AWDs). During early infancy, growth failure increased in infants with gastroschisis, and thereafter, catch-up growth was prominent and faster in girls than in boys. Gastroschisis children gained weight and reached their peers’ weights permanently at 5 to 10 years. By 15 years or older, 30% of gastroschisis patients were overweight. Infants with omphalocele were born with a normal birth size but grew shorter and weighing less than the reference population until the teen-age years.Conclusion: Children with gastroschisis and omphalocele have distinct growth patterns from fetal life onwards. These growth trajectories may also provide some opportunities to modulate adult health.What is Known:• Intrauterine and postnatal growth failure can be seen frequently in gastroschisis and they often show significant catch-up growth later in infancy. It is assumed that part of the children with gastroschisis will become overweight during later childhood.What is New: • The longitudinal growth of girls and boys with gastroschisis or omphalocele is described separately until the teenage years. The risk of gaining excessive weight in puberty was confirmed in girls with gastroschisis.