Weight Standard Deviation Score Research Articles

Is a normally functioning gastrointestinal tract necessary for normal growth in late gestation?

It is known that neonates with congenital abnormalities of the intestine tend to be growth-retarded. We wished to explore the hypothesis that normal fetal gut function is needed for normal growth in late gestation. If this is true, then different populations of babies with different congenital gut abnormalities would be expected to have similar impairments of growth and be small at birth. This growth retardation would be more marked in term than in preterm babies and would be independent of other congenital anomalies. To test these hypotheses, we examined 43 babies born with gastroschisis (GS) in Auckland, New Zealand; 69 babies born with GS in Birmingham, England; and 60 babies born with intestinal atresia (IA) in Auckland. For Auckland babies with GS, the mean weight standard deviation score (WSDS) (i.e., birth weight relative to the mean birth weight for gestation) for term babies was lower than that for preterm babies (-0.932+/-0.180 vs -0.064+/-0.237, P=0.014). This was also true for Birmingham babies with GS (-0.991+/-0.193 vs -0.36 +/-0.153, P=0.028). For babies with IA, the mean WSDS for term babies was lower than that for preterm babies (-0.627+/-0.266 vs 0. 057+/-0.211, P=0.034). There was no significant difference between the mean WSDS of babies with and without major congenital abnormalities (-0.402+/-0.201 vs -0.271, P=0.70). Our results demonstrate that term babies born with GS are significantly growth-retarded compared with premature babies born with GS. Term babies born with a proximal IA are also growth-retarded. This strongly suggests that in late gestation, the normal growth is dependent on a normally functioning gastrointestinal tract that allows exposure of the proximal intestinal mucosa to ingested amniotic fluid.

Head growth in cystic fibrosis following early diagnosis by neonatal screening

Growth in length, weight gain, and head circumference were recorded from 3 months to 4 years of age in 25 children with cystic fibrosis diagnosed by neonatal screening. Mean standard deviation (SD) scores at 3 months for length, weight, and head circumference were -0.78, -0.91, and -0.52 respectively. Over the first 2 years length SD scores showed a consistent improvement and stabilised at 0.1 SD below mean from 2 to 4 years. Weight SD scores remained essentially unaltered throughout, approximately 1 SD below the mean. Head circumference, however, after an initial increase from -0.52 at 3 months to -0.25 at 18 months, slowed and fell to 1 SD below the mean at 4 years. The data suggest that head growth continues to lag behind somatic growth in children with cystic fibrosis despite early diagnosis and good nutritional management in early infancy. These data also support functional expression of cystic fibrosis transmembrane conductance regulator in the brain.

3-in-1 weight-monitoring chart

The growth charts used worldwide to measure infant weight do not quantify centile crossing and therefore cannot monitor weight gain. Velocity charts are impractical since they involve two charts and weight velocity has to be calculated for each pair of measurements. A new growth chart is described, designed for 4-week measurement intervals, which combines distance, velocity, and conditional references in one. It consists of conventional weight centiles complemented with extra lines called thrive lines, where the slope defines a cutoff for failure to thrive. Variability in the change in weight standard deviation score (SDS) over time depends only upon the correlation between the two measurements, which in turn depends upon age. A child's weight is plotted and joined to the previous weight 4 weeks earlier, then the slope of the line is compared with the slope of the nearest thrive line. If the child's slope is the smaller, weight gain is below the fifth centile. The chart's main weakness is that measurements need to be 4 weeks apart, which is often unrealistic. The chart is, however, robust to a range of measurement intervals if interpreted correctly. Its sensitivity and specificity under field conditions need to be assessed.

Growth hormone therapy in Silver Russell Syndrome: 5 years experience of the Australian and New Zealand Growth database (OZGROW)

Data were analysed on 33 children (22 males) with Silver Russell syndrome treated with growth hormone for periods up to 5 years. Baseline data (medians) at commencement of growth hormone (GH) therapy were age 6.7 years, bone age delay 1.7 years, height standard deviation score (SDS)-3.2, weight SDS -3.1, and growth velocity 5.7 cm/ year. All were prepubertal. Median birth weight SDS for gestational age was -3.2. GH was commenced at 14 IU/m2 per week and subsequently adjusted according to response. Growth velocity and growth velocity SDS for chronological age (CA) improved over baseline and gains in height SDS for CA were 1.0, 1.5 and 1.8 SD over 3, 4 and 5 years respectively (P < 0.001). No significant increase in height SDS for bone age was observed. Increased GH doses were required after the 1st year to maintain growth rates. Mean bone age advancement was 3.1 years after 3 years of treatment, and 6.0 years after 5 years treatment. Younger age was a predictor of the growth response over the 1st year. Predictors of response after 3 years were catch up growth, low weight SDS at birth and low height SDS for CA. Age at onset of puberty was normal, but height at onset of puberty was lower than normal means. We have demonstrated significant improvement in growth in Silver Russell syndrome after 3 years of GH therapy, however data on estimated mature height and final height are insufficient to conclude final outcomes. Further follow up is required to assess the long-term benefit.

The effects of recombinant human erythropoietin on growth and nutritional status.

The availability of recombinant human erythropoietin (rhuEPO) has dramatically improved the care of children with chronic renal failure (CRF). Its use provides the opportunity to determine the relative contribution of anemia to the morbidity of CRF. Growth retardation, one of the most significant complications of CRF in children, is the consequence of several inter-related processes, including decreased protein and energy intake, metabolic bone disease, endocrine abnormalities, and anemia. The literature on the use of rhuEPO in children and data from a United States phase III double-blind, placebo-controlled study of rhuEPO in pediatric dialysis patients are reviewed to determine the effect of rhuEPO treatment on the nutritional status and growth of children with CRF. Despite subjective increases in appetite, there were no consistent improvements in dietary intake or anthropometric measures observed during rhuEPO treatment. Children gained weight during rhuEPO treatment; however, this was not generally associated with increased weight standard deviation scores. There was an improvement in growth velocity in some children; however, improvements in height standard deviation scores were infrequently seen. On review of the available literature, correction of anemia with rhuEPO has not been shown to improve the growth of children with CRF.

Gastrostomy and growth in dystrophic epidermolysis bullosa

Chronic malnutrition and growth failure are features of severe dystrophic epidermolysis bullosa (DEB). Conventional dietetic intervention is of limited benefit. Oesophageal dilatation or reconstruction to alleviate stricture is associated with substantial risks. Surgical placement of a feeding gastrostomy is a comparatively straightforward procedure, provided that specialized anaesthetic and surgical techniques are employed. Gastrostomy insertion was undertaken in 18 children with severe DEB and the effects of this intervention were retrospectively evaluated. The majority received button devices (inserted primarily) and gastrostomy feeding supplemented oral intake. One year postoperatively, the average increase in weight standard deviation scores (SDS) of 13 patients was 0.9 SDS (95% confidence interval 0.44, 1.35) and in height 0.42 SDS (95% confidence interval 0.05, 0.79). One patient developed an incisional hernia and four patients experienced minor leakage around the gastrostomy entry site. Two patients never accepted their gastrostomies, which were therefore removed. Two further patients died for reasons unrelated to the procedure. Our observations suggest that gastrostomy feeding can play a valuable role in severe DEB and is associated with minimal morbidity. Such intervention is best undertaken before growth failure is established, and prior to puberty.

Nutritional Status in Children Receiving Chronic Peritoneal Dialysis

Chronic peritoneal dialysis (CPD), widely used in uremic children, may have contrasting effects on the nutritional status of patients. Metabolic and nutritional abnormalities due to the combined effects of uremia per se, glucose absorption from the dialysate and catabolic factors, such as protein and amino acid losses into dialysate, poor appetite, and recurrent episodes of peritonitis are the most important. Although CPD allows for fewer dietary restrictions and supplies an extra amount of calories by glucose absorbed with the peritoneal fluid, when protein and energy intakes are assessed the protein intake was almost sufficient or more than that prescribed, whereas the energy intake was low. In CPD children the standard deviation score for weight, height, triceps skinfold thickness, and midarm circumference has been reported as more severely impaired in children less than ten years old. Anthropometric parameters did not worsen during CPD treatment. Plasma proteins and albumin are reported as being low in CPD children. The dietary intake and protein losses have been considered to be the most important determinants of the albumin level in CPD patients. The reported average dialysate losses of free amino acids (AA) during CPD in children vary from 0.02 to 0.03 g/kg/day in different studies. The patterns of plasma AA in CPD is represented by reduced levels of branched chain AA and of other essential amino acids and increased concentrations of some nonessential AA. Several factors may influence plasma AA profile: uremia per se, hormonal alterations, protein and AA losses, and dietary intake. A more specific uremic AA pattern is found in muscle, the largest pool of free AA in the body. Studies on muscle AA in adults on CPD are conflicting: some authors have reported several muscle AA alterations, but others have shown an almost normal pattern. Low valine and leucine muscle levels have been reported in children on CPD.

Disproportionate head growth retardation in cystic fibrosis.

Monthly increments of length, weight gain, and head circumference were recorded from birth to 4 years of age in 52 children with cystic fibrosis. At birth the children showed stunting. Standard deviation (SD) scores at birth for height, weight, and head circumference were -1.24, -0.72, and -1.82 respectively. Over the first four years, length and weight SD scores showed a consistent improvement. However, there was very limited improvement in head circumference, which stabilised 1 SD below the mean from 1.5 years to 4 years. Our data suggest that head growth lags behind gain in height and weight in children with cystic fibrosis despite good nutritional management in early infancy. The data may also support the expression of cystic fibrosis transmembrane conductance regulator in choroid plexus and ependyma.

75 FAILURE OF HEAD GROWTH SPARING IN CYSTIC FIBROSIS

There is little data on head growth in CF, over the first two years, when brain growth is rapid and nutritional deficiency may affect brain cell growth and DNA content. We report the results of a longitudinal study in CF children from birth to 4 years of age. Head circumference (OFC), linear height and weight were measured monthly in 52 CF children by a single auxologist using standard anthropometric techniques. Standard deviation (SD) scores were calculated for height, weight and head circumference measurements. Mean length and OFC SD scores were significantly low at birth (−1.3 and −1.8 respectively, p<0.001). The length SD score showed a significant improvement from birth to 4 years(−1.3 to −0.07 p<0.001). The OFC SD score remained significantly low throughout (−1.1, p=0.001 at 4 years). Weight SD score also improved from a mean of −0.77 at birth to −0.42 at 4 years. Catch up head growth has been found in malnourished children after nutritional rehabilitation and also in children treated for isolated growth hormone deficiency. CFTR expression has been reported in brain although its significance is unclear. It is possible that CSF secretion is influenced by presence of CFTR and this is deficient in CF. Further studies using NMR scans to calculate ventricular volume may throw light on this matter. Intelligence in CF is normally distributed, but regular psychometric testing may be required to reveal deficiencies. In conclusion despite good nutritional management head growth lags behind gain in height and weight in CF children.

Prediction of perinatal morbidity at term in small fetuses: comparison of fetal growth and Doppler ultrasound

To compare fetal growth assessed by ultrasound (change in standard deviation score of abdominal circumference and estimated fetal weight) during the third trimester with predelivery ultrasound measurements of fetal size and Doppler measurements from the umbilical and fetal arteries in order to predict suboptimal perinatal outcome in small babies at term. Prospective observational study. Day assessment unit in a university hospital. One hundred and four consecutive women with a clinical suspicion of a small fetus during the third trimester confirmed by ultrasound (abdominal circumference below the 10th centile) and ultimately delivered at term. Acidaemia at birth, fetal distress requiring emergency caesarean section in labour, admission to the neonatal intensive care unit. Ninety-four babies (90%) weighed less than the 10th centile and the incidence of suboptimal perinatal outcome was 27%. The largest areas under the receiver operating characteristic curves for suboptimal perinatal outcome were obtained with the change in standard deviation score of abdominal circumference and estimated fetal weight, and the ratios of aortic/middle cerebral and renal/middle cerebral pulsatility index. Although low, the odds ratios of the change in estimated fetal weight standard deviation score and the Doppler ratios were significantly different from zero. Ultrasound assessment of fetal growth and predelivery fetal Doppler pulsatility index ratios were superior to predelivery estimates of fetal size and umbilical artery pulsatility index in predicting suboptimal perinatal outcome in small fetuses delivering at term, although the clinical value of such a prediction may be limited.

THE THRIVE INDEX: A METHOD OF IDENTIFYING AND QUANTIFYING ABNORMAL WEIGHT GAIN IN EARLY CHILDHOOD

Weight gain is a sensitive indicator of health in infancy but there is no recognised point when a fall away becomes abnormal. We collected weights from an annual cohort of 3418 children, aged 18-30 months(m) and, by correlational methods, produced a measure of centile shift, the “Thrive Index”(TI). This is the deficit between a child's actual weight standard deviation score (SDS) and that predicted by their early weight, adjusted for regression to the mean. Only 5% children had a TI value of less than -1.26 SDS in the first 18m and this value can thus be used as a lower threshold of normality in the population. We report the early findings of a screening programme using this method. 50 chil dren with subnormal TI values have been identified at a median age of 9.6m (2.6-20.4m), and followed up for a median of 9.2m (2.1-17.0m). At medical assessment at a median age of 13.4m, 13/50 had already recovered, but 24/50 now had a TI <-1.75, compared to 17/50 at the time of screen (p = 0.04 Chi2). Major organic disease was found in 2 and neglect in 6. Evidence of undernutrition was found in 29 children and advice offered. In the remainder no clear cause was uncovered, At early follow up 19/50 were now recovered and only 15/50 had a TI <-l.75 (p = 0.06 Chi2 trend). Bottle feeding, deprivation and undernutrition were significant predictors of non-recovery. Our findings suggest that the Thrive Index may be useful both to identify a vulnerable group of children and to provide a quantifiable measure of their progress, at an age when other measures of longitudinal growth are impractical.

Renal transplantation in the first year of life: the treatment of choice for infants with end-stage renal disease.

The treatment of choice for end-stage renal failure within the first year of life is controversial. Between September 1970 and February 1991, we performed 28 kidney transplants (27 primary, 1 retransplant, 23 living donor, 5 cadaver) in infants less than 1 yr of age (mean, 7 +/- 2 months; range, 6 wk to 12 months). The 1-yr patient survival rate for living donor recipients was 100% versus 20% for cadaver recipients (P = 0.0001). The 1-yr graft survival rate for living donor recipients was 96% versus 20% for cadaver recipients (P = 0.001). The 1-yr patient survival rate for cyclosporin A (CSA) recipients (N = 12) was 100% versus 75% for non-CSA recipients (P = 0.03). The 1-yr graft survival rate for CSA recipients was 92% versus 75% for non-CSA recipients (P = 0.08). There was no difference in the number of rejection episodes or serum creatinine levels in CSA versus non-CSA recipients. Compared with pretransplant values, the mean posttransplant standard deviation scores (SDS) for height (N = 18), weight (N = 22), and head circumference (N = 8) improved: height SDS from -1.9 to -1.5 (not significant); weight SDS from -2.5 to 0.6 (P less than 0.0005); head circumference SDS from -2.0 to -0.7 (P = 0.01). Because no other renal replacement therapy can match these results, we conclude that renal transplantation is the treatment of choice for infants with end-stage renal failure.

A method of predicting adult height and obesity in long-term survivors of childhood acute lymphoblastic leukemia.

Short stature and obesity have been reported among long-term survivors of childhood acute lymphocytic leukemia (ALL). We examined factors that contribute to these adverse sequelae. Serial height and weight measurements were analyzed for 91 long-term survivors who were treated for ALL between 1967 and 1975 at a single institution. These patients were all younger than 12 years at diagnosis, were in continuous complete remission, had reached final height, and had height and weight measurements within 1 year of age 18 years. They had received craniospinal (n = 33) or cranial irradiation (n = 58) to total doses of 24 Gy as CNS prophylaxis. Standard deviation scores (SDS) were used to reflect the deviation of height and weight measurements from population means, and the body mass index (BMI; weight divided by height squared) was used in assessing obesity at age 18 years. Short stature (less than fifth percentile) was seen in 41 patients (45%), and obesity (BMI greater than or equal to 24 kg/m2) in 35 (38%). Regression formulae were developed that explain 65% and 62% of the variability in patient height and BMI, respectively. Risk factors were identified for abnormally short stature, which was defined to be a decrease of 1.5 SDS in height from diagnosis to age 18 years. These factors include younger age and above-average height for age at diagnosis (height SDS greater than 0), craniospinal irradiation, and greater decrease in height SDS during antileukemic therapy. Risk factors for obesity at age 18 years include weight SDS greater than 0 and greater than height SDS at 1 year after the end of chemotherapy.

Serum growth hormone binding protein activity in healthy neonates, children and young adults: correlation with age, height and weight.

Serum growth hormone binding protein (GHBP) activity was estimated in healthy neonates (n = 6), children and adolescents (n = 97) and young adults (n = 19). GHBP activity was measured by incubating 125I-hGH (human growth hormone) (approximately 25,000 c.p.m.) with serum (100 microliters) in the presence and in the absence of excess unlabelled hGH, followed by separation of specifically bound 125I-hGHBP complexes from free 125I-hGH by gel filtration on Ultrogel AcA44 minicolumns. The results are expressed as the percentage specific binding relative to an adult reference serum (%RSB), after correction for endogenous hGH of the unknown serum. The between-assay coefficients of variation for two sera of %RSB activity of 51.2 and 115.4% were 6.0 and 7.0% respectively. In neonates, low values of serum GHBP were found (%RSB = 27.1 +/- 5.0 SEM) followed by a major rise during the first 6 years of life to a mean value (%RSB = 68.3 +/- 4.1 SEM) which more than doubled that of neonates. Thereafter, values rose progressively throughout childhood and puberty to reach maximum values in young adults (%RSB = 95.0 +/- 3.1 SEM). A novel observation was that serum GHBP activity correlated significantly with height standard deviation score (SDS) (males: r = 0.77, P less than 0.001; females: r = 0.56, P = 0.01) and weight SDS (P less than 0.001) for both sexes before puberty. During puberty GHBP correlated only with weight SDS in males (r = 0.60, P less than 0.01). In all age groups studied, no correlation could be found between serum GHBP and height velocity.

Zinc Supplementation in Infants With a Nutritional Pattern of Failure to Thrive: A Double-Blind, Controlled Study

The objective of this study was to determine whether zinc deficiency is one of the factors involved in nutritional failure to thrive in infants and toddlers. Participants were selected on the basis of anthropometric criteria, particularly a decline in weight velocity preceding changes in length gains. The investigation was designed as a double-blind, randomized, pair-matched, controlled study of dietary zinc supplementation of 6 months' duration. Anthropometric data were collected at 0, 1, 3, and 6 months. Twenty-five pairs of infants completed the project. When compared with placebo-treated control children, the zinc-supplemented group (combined sexes) and the supplemented boys showed significant improvements in standard deviation scores for weight for all three intervals, the largest differences occurring for the 0- to 3-month interval (P less than or equal to .0001). The zinc-supplemented girls demonstrated a trend toward improvements in changes in standard deviation scores for weight (P = .056). There were no differences in length gains for either boys or girls. This improvement in weight gains after zinc supplementation demonstrates that mild zinc deficiency can be one of the etiologic factors in nutritional failure to thrive during infancy.

Experience with continuous cycling peritoneal dialysis during the first year of life.

The clinical experience in eight infants aged 5.8 +/- 2.3 (SD) months at the initiation of continuous cycling peritoneal dialysis (CCPD) is described. BUN, creatinine, albumin, calcium, phosphorus and alkaline phosphatase measurements were performed serially and no changes were seen throughout the follow-up period. Mean total energy and protein intake were 94 +/- 8% and 79 +/- 9% of the recommended. The initial and final standard deviation scores (SDS) for height were -1.42 +/- 1.32 and -2.47 +/- 1.36 (P less than 0.001), respectively. The SDS for body weight and head circumference were -1.67 +/- 0.71 and -1.67 +/- 1.04, respectively, at the beginning of the study and -1.83 +/- 0.98 and -1.88 +/- 1.52, respectively, at the end of the period of observation. The incidence of peritonitis was one episode every 11.6 patient months; six patients developed nine hernias. The present study demonstrates that CCPD is an acceptable dialytic modality, with minimal morbidity, for the management of infants awaiting renal transplantation.

Catch up growth following abuse.

Poor growth in association with child abuse is well recognised, but the eventual outcome with respect to growth has not been clearly defined. In a study of 95 children who had suffered child abuse standard deviation (SD) scores for height and weight were significantly below the mean at presentation and improved at follow up. Sixty four children who remained at home showed significant increase in height SD scores only (p less than 0.01). Twenty children were either taken into long term fostercare or adopted and showed significant increases in height and weight SD scores (p less than 0.001 and p less than 0.01, respectively). The remaining 11 children, who were fostered for short periods only, showed little change in either index. Catch up growth for height defined as a change in SD scores of one or more occurred in seven (11%) of the children at home compared with 11 (55%) of those taken into long term fostercare (p less than 0.001). Catch up growth for weight occurred in 14 (22%) of those at home and 10 (50%) of those in long term fostercare (p less than 0.01). Children suffering child abuse show greater catch up growth when taken into long term fostercare. Growth patterns should be used to decided where these children are placed.

CATCH UP GROWTH AND CHILD ABUSE

Poor growth in association with child abuse is well recognised but eventual outcome in terms of growth parameters has not been clearly defined. The changes in standard deviation scores (SDS) for height and weight were calculated in 95 children who had suffered child abuse. Catch up growth was defined as an increase in SDS >1.0. Ages at presentation ranged from 6 weeks to 12 years and length of follow up from 9 months to 8 years. The mean SDS for height and weight increased significantly between presentation and most recent clinic visit (p <0.001 and p <0.01 respectively). The 64 children who remained at home (group 1) showed a significant increase in height SDS only (p <0.01). The 20 children taken into long term fostercare or adopted (group 2) showed significant increases in both height and weight SDS (p <0.001 and p <0.01 respectively). The remaining 11 children who were fostered for short periods only (group 3) showed little change in either index. Catch up growth in height occurred in 12% of group 1 compared to 55% group 2 (p <0.001). Catch up growth in weight occurred in 22% group 1 compared to 50% group 2 (p <0.05). Children suffering child abuse show greater catch up growth when taken into long term care.

Lead zirconate—lead titanate piezo-electric ceramics with iron oxide additions: Weston, T.B., Webster, A.H., McNamara, W.M., journal of the American ceramic society vol 52, no 5 (21 May 1969) pp 253–257 (1922)

Research examining the relationship between breastfeeding and infant weight has generated conflicting results. Few studies account for significant covariates and many suffer methodological problems such as retrospective self-report. The current study aimed to investigate relationships between breastfeeding duration, infant weight and eating and positive maternal mealtime behaviours, whilst overcoming many of the limitations of previous research. Eighty-one women on low-risk maternity units gave informed consent and were visited at home at 1-week, 1-, 6- and 12-months postpartum. Infants included 45 males and 36 females (mean birth-weight 3.52 kg [SD 0.39]). Mothers and infants were weighed and measured and feeding information was recorded at each visit. Infant weight was converted to a standard deviation score (SDS), accounting for age and sex. Mothers reported infant eating behaviours at 12-months using the Children's Eating Behaviour Questionnaire and were observed feeding their infants solid food at home at 6- and 12-months. Partial correlations (covariates: maternal age, education, BMI, smoking during pregnancy, household income, infant birth weight SDS and age introduced to solid foods) revealed negative associations between breastfeeding duration and 1- to 6- and 1- to 12-month weight gain, and 6- and 12-month weight. Breastfeeding duration was also associated with a slower rate of infant eating and greater observed maternal vocalisations, appropriateness and sensitivity. Results support a dose-response relationship between breastfeeding and infant weight and suggest that breastfeeding may encourage the development of obesity-protective eating behaviours through learning to attend to internal hunger and satiety signals. Future research should investigate whether relationships between slowness in eating and weight extend to satiety responsiveness after infancy.