World Health Organization Growth Charts Research Articles

IJCM_39A: To compare the World Health Organization growth charts with Indian Academy of Pediatrics growth charts of under-five children attending urban health center of a Medical College

Background: The nutritional status of the child can be measured by using anthropometry which is the valuable tool and the gold standard method. The magnitude of different measures of nutritional status is affected by choice of reference charts used. Objective: To compare the world Health Organization growth charts with Indian academy of pediatrics growth charts to assess the malnutrition among under 5 children attending Urban health center of a medical College. Methodology: A cross sectional study was conducted among 220 children attended urban health centre of SS. Institute of Medical Sciences for a period of 4 months. Height and weight were measured and plotted on World Health Organization and Indian Academy of Pediatrics charts. Results: In this study underweight was detected among 46.9% of the boys and 43.8% of the girls and stunting was detected among 50.4% of the boys and 43.8% of the girls by using World Health Organization Growth Charts. According to Indian academy of Pediatrics, 32.1% of the boys and 38% of the girls were found to be undernourished and Stunting was detected among 53.9% of the boys and 68.8% of the girls. Conclusion: In this study both the growth charts showed variation in the height and weight measurements.

Identifying biologically implausible values in big longitudinal data: an example applied to child growth data from the Brazilian food and nutrition surveillance system

BackgroundSeveral strategies for identifying biologically implausible values in longitudinal anthropometric data have recently been proposed, but the suitability of these strategies for large population datasets needs to be better understood. This study evaluated the impact of removing population outliers and the additional value of identifying and removing longitudinal outliers on the trajectories of length/height and weight and on the prevalence of child growth indicators in a large longitudinal dataset of child growth data.MethodsLength/height and weight measurements of children aged 0 to 59 months from the Brazilian Food and Nutrition Surveillance System were analyzed. Population outliers were identified using z-scores from the World Health Organization (WHO) growth charts. After identifying and removing population outliers, residuals from linear mixed-effects models were used to flag longitudinal outliers. The following cutoffs for residuals were tested to flag those: -3/+3, -4/+4, -5/+5, -6/+6. The selected child growth indicators included length/height-for-age z-scores and weight-for-age z-scores, classified according to the WHO charts.ResultsThe dataset included 50,154,738 records from 10,775,496 children. Boys and girls had 5.74% and 5.31% of length/height and 5.19% and 4.74% of weight values flagged as population outliers, respectively. After removing those, the percentage of longitudinal outliers varied from 0.02% (<-6/>+6) to 1.47% (<-3/>+3) for length/height and from 0.07 to 1.44% for weight in boys. In girls, the percentage of longitudinal outliers varied from 0.01 to 1.50% for length/height and from 0.08 to 1.45% for weight. The initial removal of population outliers played the most substantial role in the growth trajectories as it was the first step in the cleaning process, while the additional removal of longitudinal outliers had lower influence on those, regardless of the cutoff adopted. The prevalence of the selected indicators were also affected by both population and longitudinal (to a lesser extent) outliers.ConclusionsAlthough both population and longitudinal outliers can detect biologically implausible values in child growth data, removing population outliers seemed more relevant in this large administrative dataset, especially in calculating summary statistics. However, both types of outliers need to be identified and removed for the proper evaluation of trajectories.

Associations of obesity and dengue-associated mortality, acute liver failure and mechanical ventilation in children with dengue shock syndrome.

Dengue-associated complications, including dengue shock syndrome, severe respiratory distress, and pediatric acute liver failure (PALF), are associated with high mortality rates in patients with dengue. There is increasing prevalence of overweight and obesity among children worldwide. Obesity may activate inflammatory mediators, leading to increased capillary permeability and plasma leakage in patients with dengue. Several studies have shown a correlation between obesity and DSS, but did not include dengue fatality or PALF. Therefore, we hypothesized possible associations between obesity and critical dengue-associated clinical outcomes among PICU-admitted children with DSS, including dengue-related mortality, mechanical ventilation (MV) requirements, and dengue-associated PALF. The nutritional status of the participants was assessed using World Health Organization growth charts. A total of 858 participants with complete nutritional data were enrolled in this study. Obesity was significantly associated with risk of severe respiratory failure and MV support (odds ratio = 2.3, 95% CI: 1.31-4.06, P < .01); however, it was not associated with dengue-associated mortality or acute liver failure. Obese pediatric patients with DSS should be closely monitored for severe respiratory distress and the need for high-flow oxygenation support, particularly MV, soon after hospitalization.

MATERNAL KNOWLEDGE REGARDING THE FIRST 1000 DAYS OF LIFE WITH THE INCIDENCE OF STUNTED CHILDREN UNDER THE AGE OF FIVE IN THE WORKING AREA OF SUKOMULYO COMMUNITY HEALTH CENTER

Background: Stunting is a global and national health problem. The World Health Organization (WHO) determines that if the prevalence of stunting is between 30-39%. Based on the reports of Riskesdas in 2010, it was reported that 35.6% of Indonesian children under five were stunted. Stunting is a condition that describes a linear growth disorder characterized by height that is below normal standards for age and sex that is commonly associated with malnutrition and chronic (non-endocrine) infections. The stunting intervention was focused on 1000 Hari Pertama Kehidupan (HPK) period, which is a golden period of a child and if not utilized appropriately, permanent damage could occur. Objective: To determine the correlation between maternal knowledge levels regarding 1000 HPK and the incidence of stunting in children under five. Methods: This study used an observational analytic method with a cross sectional design. Sampling was done with consecutive sampling technique. In this study, will be examined for body length using a stadiometer. After that, the mother will be interviewed to find out the correlation between mother's knowledge regarding 1000 HPK and the incidence of stunting in toddlers. Then the stunting and normal children will be grouped based on the standardized WHO growth chart. Results: Kendall's tau-b statistical test showed a significant relationship (p = 0.000) with positive moderate strength correlation (τ = 0.442). Conclusion: There is a significant relationship and a moderate strength positive correlation between the mother's level of knowledge regarding 1000 HPK and the incidence of stunting Keywords: Maternal knowledge of 1000 HPK, Stunted, Children under five

Comparison of Nutritional Status of Healthy Under-Five Indian Children Using Composite Index of Anthropometric Failure on WHO 2006 versus 2019 Indian Synthetic Growth Charts.

To assess nutritional status of apparently-healthy under-five Indian children using Composite Index of Anthropometric Failure (CIAF) and to compare anthropometric failure prevalence using conventional indices and CIAF on World Health Organization (WHO) vs. synthetic Indian growth charts. This observational study was conducted over 2 y. The inclusion criteria was apparently-healthy children (0-60 mo) and the exclusion criteria were acute/chronic illness and small for gestational age. A total of 1557 children (762 girls) were included in the study. The mean age of the subjects was 21 mo. The Z-scores for height, weight, body mass index (BMI) for age and weight for height in children were lower on WHO vs. synthetic charts (p=0.0001). Significantly higher proportion of children were moderately and severely underweight, stunted and wasted on WHO charts. Synthetic charts identified significantly higher proportion as normal for weight, height, BMI for age, weight for height, overweight (overall), and ahigher prevalence of severe stunting, and severe acute malnutrition (SAM) was notedamong girlscompared to boys. Using CIAF, 54.1% children were normal on WHO charts vs. 78.0% on synthetic (p=0.0001). Larger proportion of girls (8.8%) were stunted+underweight (category-E) vs. boys (4.3%) on synthetic charts (p=0.0003). Significantly higher proportion of children demonstrated failure (single/dual/multiple) on WHO charts except category-Y (higher proportion of underweight on synthetic charts). Maximum difference in CIAF (WHO vs. synthetic) was observed between 0-24 mo age. Of 1215 children normal on synthetic charts, 837 (68.9%) were normal on WHO charts. Of 116 underweight children (category-Y) on synthetic charts, 20 (17.2%) were underweight on WHO charts; remaining had compound failure (wasting+underweight = 49.1%, wasting+stunting+underweight = 14.7%, stunting+underweight = 12.1%) on WHO charts. Among those stunted+underweight (category-E) on synthetic charts, WHO charts classified 1/4th as wasted+stunted+underweight (category-D). Synthetic references are more representative of Indian growth patterns, and seem more appropriate for monitoring growth of Indian children to avoid mislabelling as malnourished.

OR15-04 Accelerated Longitudinal Weight Gain Among Infants With In Utero COVID-19 Exposure

Abstract Disclosure: M.W. Ockene: None. S.C. Russo: None. H. Lee: None. C. Monthé-Drèze: None. T.L. Stanley: Consulting Fee; Self; RosVivo Therapeutics. Grant Recipient; Self; Pfizer, Inc. I.L. Ma: None. M. Toribio: None. L.L. Shook: None. S.K. Grinspoon: Consulting Fee; Self; Theratechnologies. A.G. Edlow: Consulting Fee; Self; Mirvie, Inc. Grant Recipient; Self; Merck. L.T. Fourman: Consulting Fee; Self; Amryt Pharmaceuticals. Grant Recipient; Self; Amryt Pharmaceuticals. Background: Since its initial outbreak in 2019, coronavirus disease 2019 (COVID-19) has led to unprecedented morbidity and mortality worldwide. Due to a high burden of infection among pregnant women, a novel population of children with in utero exposure to maternal COVID-19 has emerged for which health outcomes are largely unknown. Given the role of the intrauterine environment in shaping chronic disease risk over the life course through effects on fetal programming, there is a pressing need to delineate longitudinal growth patterns among infants born to mothers with COVID-19 during pregnancy. Methods: We conducted a longitudinal cohort study leveraging a prospectively-enrolled perinatal biorepository among 149 infants with in utero exposure to maternal COVID-19 and 127 unexposed controls. Weight, length, and BMI were abstracted from health records at 0, 2 (±0.5), 6 (±1), and 12 (±1) months and standardized using World Health Organization (WHO) growth charts. Linear mixed effect and linear regression models were used to examine differences in anthropometric z-score trajectories over the first year of life between groups. Analyses were adjusted for maternal age, ethnicity, parity, insurance type, and BMI as well as infant sex, birthdate, and breastfeeding. Our pre-specified primary endpoint was change in BMI z-score from birth to 12 months. Results: Infants with in utero COVID-19 exposure versus controls exhibited differential trajectories of weight and BMI, but not length, z-scores over the first year of life (study group x time interaction, P &amp;lt; 0.0001 for weight and BMI z-scores). Infants born to mothers with prenatal COVID-19 had lower BMI z-score at birth (effect size: -0.35, 95% CI, -0.66 to -0.03) and greater increase in BMI z-score from birth to 12 months (effect size: 0.53, 95% CI, 0.06 to 0.99). Change in BMI z-score was greater than the WHO population average of 0 within the exposed (P &amp;lt; 0.0001) but not the unexposed group. Birth weight z-score was found to mediate a significant proportion of the relationship between COVID-19 exposure and postnatal growth (estimate ± standard error, 32 ± 14%, P = 0.02). Conclusions: Infants with in utero exposure to maternal COVID-19 were found to exhibit lower birth weight and accelerated weight gain over the first year of life compared to their unexposed peers. The exaggerated growth trajectory observed in these children may be a catch-up response to a prenatal growth deficit. Lower birth weight and accelerated postnatal weight gain are established risk factors for obesity, abdominal adiposity, and cardiovascular disease later in life. Thus, children born to mothers with prenatal COVID-19 may be at heightened risk of long-term cardiometabolic complications and require close monitoring over the life course. Further studies are now needed to delineate cardiometabolic sequelae of in utero COVID-19 exposure among this emerging global population. Presentation: Friday, June 16, 2023

Serial head circumference measurements should be used to classify congenital microcephaly

BackgroundMeasuring the maximum occipitofrontal circumference only once at birth or within 24 h after birth may lead to misclassifications of microcephaly. This study compared the head circumference (HC) of newborns at birth or within 24 h after birth to their third day of life (DOL3) as well as evaluated maternal- and infant-specific factors associated with increased HC by DOL3.MethodsThis prospective study included 1131 live births between February and May 2019 with a gestational age > 27 weeks. All newborns had their HC measured at birth or within 24 h after birth as well as on DOL3 before discharge. HC measurements were performed by trained personnel using non-elastic tape measures. The World Health Organization (WHO) and Fenton Growth Charts were used as reference ranges for interpretation of full-term and preterm neonates, respectively.ResultsPaired sample t-test analyses found a statistically significant increase in HC measured on the DOL3 compared with HCs of the same newborns at birth or within 24 h of birth. The mean HC increase was 0.17 cm (95% confidence interval [0.13, 0.21], P < 0.001). The mean ± standard deviation HC within 24 h of birth and at DOL3 were 33.58 ± 1.53 cm and 33.75 ± 1.37 cm, respectively. Thirty-two newborns had HCs less than the third percentile (< P3) at birth, 25 of which had HC ≥ P3 at DOL3. After adjusting for mode of and presentation at delivery, newborns whose mothers experienced labor pains (β = 0.31, P < 0.001) and were either symmetrically (β = 0.59, P = 0.002) or asymmetrically small-for-gestational age (SGA; β = 0.37, P = 0.03) had significantly increased HC at DOL3. On average, newborns whose mothers experienced labor pain had 0.31 cm increases in HC at DOL3. Symmetrical SGA newborns also had an average 0.59 cm increase in HC at DOL3. Parity and gestational age were not associated with changes in HC.ConclusionsSerial HC measurements on DOL3 or before newborns’ discharge is crucial to classifying congenital microcephaly.

Head Circumference is Relatively Larger Than Size: A Novel Screening Tool for Infants With Sagittal Craniosynostosis

Background: The efficacy of minimally invasive techniques for addressing isolated sagittal craniosynostosis decreases with age; thus, timely referral is critical. We sought to identify a screening tool using data from well-child visits. We hypothesized that many infants with sagittal craniosynostosis, but no macrocephaly based on growth chart plotting, in fact have a relative macrocephaly. Methods: All infants with CT and surgically/pathologically confirmed isolated sagittal craniosynostosis were identified. Growth chart data was collected (head circumference (HC), weight, crown-to-toe-length, and World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) percentiles and deviation ( z-scores)). Relative macrocephaly was defined as head circumference &gt;2SD from size (weight and/or length). Results: Initial pilot screen indicated that WHO growth chart data has utility as a screening tool. Subsequent retrospective case-control study with area under the curve (AUC) analysis revealed that HC:length ratio ≥0.71 is indicative of isolated sagittal craniosynostosis as young as 1 week of age, while HC:length ratio ≥0.67 represents the maximization of sensitivity (0.89) and specificity (1.00) as early as 2 weeks old. Prospective internal validation with logistic regression demonstrated that at ages 1 to 2 months greater discriminatory value HC:length ratio was observed. Conclusions: When length is added to head circumference as a screening tool we may identify an abnormal growth pattern beginning as early as 1 week. This represents an opportunity to design an automated alert easily programed into the electronic medical records and may prompt pediatricians to refer patients to craniofacial surgeons early.

Longitudinal assessment of growth and neurodevelopment of children with in utero severe acute respiratory syndrome coronavirus 2 exposure: A prospective cohort study

Introduction Research related to the impact of maternal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on fetuses and neonates remains limited. The majority of previous studies have focused on immediate outcomes. We conducted this prospective cohort study to evaluate the effect of in utero SARS-CoV-2 exposure on the growth and neurodevelopment of infants, considering the scarcity of long-term follow-up studies in the literature. Primary Objective The primary objective of the study was to compare neurodevelopment and growth up to the age of 1 year among coronavirus disease COVID-positive and COVID-negative neonates born to COVID-positive mothers. Secondary Objectives The secondary objectives of the study were to assess the status of exclusive breastfeeding in infants at the age of 6 months and to assess the risks of vertical and horizontal transmission of COVID-19 infection. Methods We included live neonates with gestational age &gt;28 weeks born to pregnant women who tested positive for COVID-19 by reverse transcription polymerase chain reaction and delivered at the institute in this prospective observational cohort study. Details related to delivery and neonatal profile, including the neonatal COVID status were collected. Neonates were followed up at 6 months and 1 year for physical growth profile and neurodevelopmental profile using World Health Organization growth charts and the Baroda Development screening test (BDST). Results A total of 6 SARS-CoV-2-positive and 82 SARS-CoV-2-negative neonates were followed until the age of 1 year. There was no statistically significant difference between the SARS-CoV-2-positive and SARS-CoV-2-negative cohorts concerning gestational age (P-value 0.300), birth weight (P-value 0.988), and neonatal intensive care unit admission (P-value 0.288). Approximately 65.9 and 45.4% of infants were still exclusively breastfeeding at the ages of 6 months and 1 year, respectively. No difference was observed in wasting (P-value 0.393) and stunting at the ages of 6 months (P-value 0.656) and 1 year between the two cohorts. Furthermore, no significant difference was observed in neurodevelopmental status at 6 months (P value for BDST score 0.236; P value for developmental quotient (DQ) 0.446) and 1 year (P value for BDST score 0.635; P value for DQ 0.666) between the two groups. Conclusion Our study generated evidence that in utero exposure to SARS-CoV-2 infection does not seem to affect the growth and neurodevelopment of neonates born to SARS-CoV-2-positive mothers; however, further studies including nonexposed controls, are warranted to support our findings. Furthermore, the benefits of rooming-in and breastfeeding on the neurodevelopment and physical growth of infants far outweigh the minimal risk of horizontal transmission.

0099 Circadian Rest-Activity Rhythm Development is associated with Weight Gain in Early Infancy

Abstract Introduction In early childhood, irregular sleep schedules that may promote circadian rhythm misalignment predict greater weight gain. However, circadian rest-activity (CRA) rhythmicity in infancy in relation to growth is understudied. The aim of the present study was to investigate the association between newborn circadian rest-activity rhythmicity and change in weight-for-age from birth to three months. Methods Data were captured as a secondary data analysis from the Snuggle Bug / Acurrucadito Study (see Support). English or Spanish speaking mothers (n=41, age M±SD=33.1±4.6y, 31.7% Hispanic/Latina) and their full-term (≥37wk) infants of normal weight (2.5-4kg; 58.5% female; 25.6% WIC enrolled) were recruited from Phoenix, Arizona. CRA rhythmicity was measured at eight weeks with ankle-worn Micro Motionloggers (Ambulatory Monitoring Inc.) for five 24hr periods at one-minute epochs. CRA metrics assessed included 24hr autocorrelation, mesor, magnitude, acrophase, goodness-of-fit R2, interdaily stability, intradaily variability, and relative amplitude. Birthweight was mother-reported and 3mon infant weight was measured with a Seca scale. Weight-for-age Z-scores (WAZ) by infant sex were computed based upon World Health Organization growth charts and the change difference between timepoints was the primary outcome. Regression models adjusting for birth WAZ examined the relationships between CRA metrics at eight weeks with change in WAZ from birth to 3mo. Results At eight weeks, mean±SD CRA metrics were as follows: 24hr autocorrelation of 0.25±0.03, mesor of 115.6±14.7, amplitude of 68.1±18.3, goodness-of-fit R2 of 0.42±0.10, acrophase of 14:12±1:42, interdaily stability of 0.57±0.12, intradaily variability of 0.93±0.19, and relative amplitude of 0.61±0.11. Mean birth WAZ and change in WAZ from birth to 3mon were 0.39±0.73 and -0.57±0.77, respectively. After adjusting for birth WAZ, in separate models, greater mesor (R2 Change=0.10, β=-0.32, p=0.03), amplitude (R2 Change=0.11, β=-0.34, p=0.03), and goodness-of-fit R2 (R2 Change=0.10, β=-0.32, p=0.04) were significantly associated with less change in WAZ from birth to 3mon. Conclusion Among relatively healthy, full-term infants born of normal weight, greater 24hr circadian rest-activity rhythmicity achieved by 8 weeks was associated with slower rate of weight gain across the newborn stage. Promoting behaviors and environmental cues from parents that strengthen early circadian rhythmicity in their infants may promote healthy weight trajectories. Support (if any) NIH/NHLBI R01HL147931

Cardiometabolic risk factors among children who are affected by overweight, obesity and severe obesity.

The increasing severity of obesity is expected to lead to more serious health effects. However, there is limited information on the prevalence and clinical characteristics of cardiometabolic risk factors in severely children affected by obesity in Malaysia. This baseline study aimed to investigate the prevalence of these factors and their association with obesity status among young children. In this study, a cross-sectional design was employed using the baseline data obtained from the My Body Is Fit and Fabulous at school (MyBFF@school) intervention program involving obese school children. Obesity status was defined using the body mass index (BMI) z-score from the World Health Organization (WHO) growth chart. Cardiometabolic risk factors presented in this study included fasting plasma glucose (FPG), triglycerides (TGs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), blood pressure, acanthosis nigricans, insulin resistance (IR), and MetS. MetS was defined using the International Diabetes Federation (IDF) 2007 criteria. Descriptive data were presented accordingly. The association between cardiometabolic risk factors, such as obesity status, and acanthosis nigricans with MetS was measured using multivariate logistic regression, which was adjusted for gender, ethnicity, and strata. Out of 924 children, 38.4% (n = 355) were overweight, 43.6% (n = 403) were obese, and 18% (n = 166) were severely obese. The overall mean age was 9.9 ± 0.8 years. The prevalence of hypertension, high FPG, hypertriglyceridemia, low HDL-C, and the presence of acanthosis nigricans among severely children affected by obesity was 1.8%, 5.4%, 10.2%, 42.8%, and 83.7%, respectively. The prevalence of children affected by obesity who were at risk of MetS in <10-year-old and MetS >10-year-old was observed to be similar at 4.8%. Severely children affected by obesity had higher odds of high FPG [odds ratio (OR) = 3.27; 95% confdence interval (CI) 1.12, 9.55], hypertriglyceridemia (OR = 3.50; 95%CI 1.61, 7.64), low HDL-C (OR = 2.65; 95%CI 1.77, 3.98), acanthosis nigricans (OR = 13.49; 95%CI 8.26, 22.04), IR (OR = 14.35; 95%CI 8.84, 23.30), and MetS (OR = 14.03; 95%CI 3.97, 49.54) compared to overweight and children affected by obesity. The BMI z-score, waist circumference (WC), and percentage body fat showed a significant correlation with triglycerides, HDL-C, the TG: HDL-C ratio, and the homeostatic model assessment for IR (HOMA-IR) index. Severely children affected by obesity exhibit a higher prevalence of and are more likely to develop cardiometabolic risk factors compared to overweight and children affected by obesity. This group of children should be monitored closely and screened periodically for obesity-related health problems to institute early and comprehensive intervention.

Accelerated Longitudinal Weight Gain Among Infants With In Utero COVID-19 Exposure.

Since the initial outbreak of coronavirus disease 2019 (COVID-19), a novel population of children with in utero exposure to maternal infection has emerged whose health outcomes are largely unknown. To compare longitudinal growth trajectories among infants with vs without in utero COVID-19 exposure. We conducted a longitudinal cohort study leveraging a prospectively enrolled perinatal biorepository among 149 infants with in utero COVID-19 exposure and 127 unexposed controls. Weight, length, and body mass index (BMI) were abstracted from health records at 0, 2, 6, and 12 months and standardized using World Health Organization growth charts. Analyses were adjusted for maternal age, ethnicity, parity, insurance, and BMI as well as infant sex, birthdate, and breastfeeding. Infants with in utero COVID-19 exposure vs controls exhibited differential trajectories of weight and BMI, but not length, z-score over the first year of life (study group × time interaction, P < .0001 for weight and BMI). Infants born to mothers with prenatal COVID-19 had lower BMI z-score at birth (effect size: -0.35, 95% CI -0.66 to -0.03) and greater gain in BMI z-score from birth to 12 months (effect size: 0.53, 95% CI 0.06 to 0.99). Birth weight z-score mediated a significant proportion of the relationship between COVID-19 exposure and postnatal growth (estimate ± SE, 32 ± 14%, P = .02). Infants with in utero COVID-19 exposure exhibited lower birth weight and accelerated weight gain in the first year of life, which may be harbingers of downstream cardiometabolic pathology. Further studies are needed to delineate cardiometabolic sequelae among this emerging global population.

Height and weight development of low-birth-weight infants at 9 months

BackgroundLow birth weight (LBW) is defined as a birth weight <2500 g at birth, regardless of the term of pregnancy. The objective of this study was to evaluate the height and weight development of LBW infants from 0 to 9 months of corrected age (CA) in Senegal. MethodThis was a prospective, descriptive, and analytical cohort follow-up of up to 9 months of CA including all live newborns of LBW hospitalized and followed up from 1 August 2019 to 31 May 2020. World Health Organization growth charts were used to assess height and weight growth. ResultsDuring the study, 136 LBW newborns were included. The mean gestational age was 32 weeks of amenorrhea. At discharge, 46 children (33.82%) were exclusively breastfed. At birth, the mean weight was 1487 g (3rd–10th percentile) and the mean height was 41.52 cm (10th–25th percentile). At 9 months of CA, the mean weight was 8119 g (median) and the mean height was 74 cm (median). The children had achieved satisfactory growth in weight (84%) and height (89%). At 9 months of CA, 27% of the children were behind in one of the four areas of psychomotor development. ConclusionAt the end of 9 months of CA, height and weight were normal.

MULT: New height references and their efficiency in multi-ethnic populations.

To develop new height references (MULT) based on longitudinal data of multi-ethnic populations and to compare them to the height references from the Dutch Growth Study, from the Centers for Disease Control and Prevention (CDC) and from the World Health Organization (WHO). The MUL height references were developed through the LMS method and the Generalized Additive Models for Location Scale and Shape. They were constructed based on 2611 subjects (15 292 measurements) from the advantaged quintile of the Young Lives (Younger Cohort), Millennium Cohort Study, Adolescent Nutritional Assessment Longitudinal Study, and Epidemiological Health Investigation of Teenagers in Porto studies. The M, S curves were described to compare the growth trajectory of the MULT, DUTCH, CDC and WHO height references. For the population comparative analysis, we used the total sample of the studies (91 063 observations, 17 641 subjects). The Lin's concordance correlation coefficient (CCC) and Cohen's kappa coefficient (K) were used to verify the agreement between MULT, WHO and CDC height references. The MULT height references showed taller boys for the periods of 61-174 months and 196-240 months and taller girls for 61-147 and 181-240 months, when compared to CDC and WHO height references. There was an almost perfect agreement between WHO and MULT height references (CCC >0.99) for the subjects aged 2 to 5 years. MULT height references presented a taller population and a high agreement with WHO growth charts, especially for children under 5 years, indicating that it could be useful to assess nutritional status of multi-ethnic populations.

The Etiological Spectrum of Short Stature among Children Attending Endocrine Clinic at Tertiary Care Hospital

Background: One of the most frequent reasons for referral to pediatric endocrinology units is short stature. Children's short height has a complicated etiology that includes genetics, race, gender, nutrition, and several endocrine hormones. Objective: To determine the etiological spectrum of short stature among children presenting to endocrinology outpatient clinics in a tertiary care hospital. Methods: This descriptive cross-sectional study was performed in the outpatient clinic of the Endocrinology Department at the National Institute of Child Health Hospital from September to December 2022. Short stature was defined as height for age &lt;-2 standard deviations for the corresponding age and gender according to World Health Organization growth charts. 263 children were enrolled in the study. Detailed history and panel investigation for short stature were mediated for each child. Results: A total of 263 patients were enrolled in the study having a median age of 8 (IQR=6-9) years and the majority were females (53.2%). The median SD of height and current weight was -3.48 (IQR= -4.3 - -2.83) and -2.8 (IQR= -3.59 - -2.17) respectively. The most frequently seen classification of short stature was the normal variant (68.1%) followed by endocrine disorders (19.8%), dysmorphic syndrome (9.9%), and chronic disease (2.3%). The most common cause of short stature was familial short stature (47.9%) followed by growth hormone deficiency (18.3%), constitutional short stature (9.1%), Turner syndrome (9.1%), both familial and constitutional SS (8%), idiopathic short stature (3%), celiac disease (2.3%), Cushing syndrome (n=2, 0.8%), panhypopituitarism (0.8%) and Seckel syndrome (0.8%). Conclusion: This study analyzed that the majority of short stature are normal variants. However, findings of endocrine disorders, dysmorphic disorders, and chronic disease suggest timely screening and detection of short stature to avoid serious consequences of silent underlying diseases.

A validation of newly developed weight estimating tape for Korean pediatric patients.

Pediatric drug dosages are based on body weight, so accurate measurement thereof is essential. However, this is not possible in emergencies. When using weight-estimating tapes, World Health Organization (WHO) growth charts serve as reference weights; however, local growth charts might be more accurate. This study developed a tape based on 2017 Korean National Growth Charts, which are more suitable for the Korean population than WHO growth charts, and evaluated its performance in a Korean pediatric population. This prospective cross-sectional study analyzed 792 pediatric patients who had visited the emergency department from June 2021 to December 2021. Weights were estimated using the Broselow tape (BT), Pediatric Advanced Weight Prediction in the Emergency Room XL (PAWPER XL), and Body Habitus-based Pediatric Emergency Tape (BHPET). The performance and measurement agreement of the tapes were analyzed. Among the tapes, the BHPET had the smallest mean absolute percentage error (MAPE), of 10.23%, and a root mean square percentage error (RMSPE) of 14.14%. Also, the percentage of weight estimations within 10% of the actual weight (PW10) was 59.6%, indicating better accuracy than the BT and PAWPER XL in all age groups. The intraclass correlation coefficients of the BT, PAWPER XL, and BHPET were 0.931, 0.977, and 0.985, respectively (p < 0.001). The performance and accuracy of the BHPET was similar or slightly superior to that of the other tapes. The body weight estimated using the BHPET for a local pediatric population was sufficiently correlated with the actual body weight.

The Correlation Between Feeding Patterns And The Incidence Of Stunting In Children Aged 0-59 Months

Stunting is one of the severe problems in Indonesia. One of its causes is a lack of nutritional intake during infancy. In addition, maternal parenting, especially in feeding patterns, will affect the children's growth and development. This study aims to determine the correlation between feeding patterns and the incidence of stunting. The research design used correlational analytics. The population was stunted children aged 0-59 months at Kalibuntu Village, Probolinggo Regency. In addition, there were 66 respondents in this study with total sampling. The independent variable was feeding patterns, while the dependent variable was the incidence of stunting. Data collection was carried out using a questionnaire on feeding patterns that respondents' mothers filled out. In addition, the authors measured respondents' height and assessed with a WHO (World Health Organization) growth chart to collect data on the incidence of stunting. Data analysis used the Spearman rank rho test. Almost half of the respondents had inappropriate feeding patterns (42.4%). In addition, most of the stunted children's height was categorized as short (85.3%). 15.2% of stunted children with inappropriate feeding patterns had very short height. In addition, 56.1% of respondents with appropriate feeding patterns were categorized as short. The Spearman rank rho test obtained p=0.000, indicating H0 was rejected and H1 was accepted. In addition, the value of the correlation coefficient was 0.439, showing a moderate correlation between both variables. In conclusion, feeding patterns correlate with the incidence of stunting among children aged 0-59 months in Kalibuntu Village, Probolinggo Regency.

Association between nutritional status and dengue severity in Thai children and adolescents.

Most cases of dengue virus infection are mild, but severe cases can be fatal. Therefore, identification of factors associated with dengue severity is essential to improve patient outcomes and reduce mortality. The objective of this study was to assess associations between nutritional status and dengue severity among Thai children and adolescents. This retrospective cross-sectional study was based on the medical records of 355 patients with dengue treated at the Hospital for Tropical Disease (Bangkok, Thailand) from 2017 to 2019. Subjects were Thai children aged less than 18 years with dengue virus infection confirmed by positive NS1 antigen or IgM. The 1997 and 2009 World Health Organization (WHO) dengue classifications were used to define disease severity and body mass index for age while the WHO growth chart was used to classify nutritional status. The proportions of patients with dengue fever who were underweight, normal weight, and overweight were 8.8%, 61.5%, and 29.7%, respectively. The proportions of patients with dengue haemorrhagic fever (DHF) who were underweight, normal weight, and overweight were 10.2%, 66.1%, and 23.7%, respectively. The proportions of patients with non-severe dengue who were underweight, normal weight, and overweight were 8.6%, 60.9%, and 30.5%, respectively; the same proportions of patients with severe dengue were 10.5%, 67.1%, and 22.4%, respectively. Higher proportions of patients with severe plasma leakage (DHF grade III and IV) were overweight compared with those with mild plasma leakage (DHF grade I and II) (45.5% vs. 18.8%). No difference in nutritional status was observed in patients with different dengue severity.

A Case of Persistent Hypoglycemia with Disorder of Sex Development

A Case of Persistent Hypoglycemia with Disorder of Sex Development

Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart

ObjectiveTo determine how various centile cut points on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts predict perinatal morbidity/mortality, and how this relates to choosing a fetal growth chart for clinical use.MethodsWe linked antenatal ultrasound measurements for fetuses > 28 weeks’ gestation from the British Columbia Women’s hospital ultrasound unit with the provincial perinatal database. We estimated the risk of perinatal morbidity/mortality (decreased cord pH, neonatal seizures, hypoglycemia, and perinatal death) associated with select centiles on each fetal growth chart (the 3rd, 10th, the centile identifying 10% of the population, and the optimal cut-point by Youden’s Index), and determined how well each centile predicted perinatal morbidity/mortality.ResultsAmong 10,366 pregnancies, the 10th centile cut-point had a sensitivity of 11% (95% CI 8, 14), 13% (95% CI 10, 16), and 12% (95% CI 10, 16), to detect fetuses with perinatal morbidity/mortality on the INTERGROWTH, WHO, and Hadlock charts, respectively. All charts performed similarly in predicting perinatal morbidity/mortality (area under the curve [AUC] =0.54 for all three charts). The statistically optimal cut-points were the 39th, 31st, and 32nd centiles on the INTERGROWTH, WHO, and Hadlock charts respectively.ConclusionThe INTERGROWTH, WHO, and Hadlock fetal growth charts performed similarly in predicting perinatal morbidity/mortality, even when evaluating multiple cut points. Deciding which cut-point and chart to use may be guided by other considerations such as impact on workflow and how the chart was derived.