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PubMed1999

Effects of antenatal corticosteroids on blood pressure in very low birth weight infants during the first 24 hours of life.

OBJECTIVE: We tested the hypothesis that prenatal glucocorticoids significantly increase mean arterial blood pressure in very low birth weight preterm infants during the first 24 hours after birth. STUDY DESIGN: Prospectively collected data from 178 inborn infants with birth weights between 500 and 1499 gm were examined. A total of 80 infants were born to mothers treated with corticosteroids (birth weight: 1057 +/- 271 gm, gestational age: 28.0 +/- 2.6 weeks), and 98 infants were untreated controls (birth weight: 1030 +/- 280 gm, gestational age: 28.0 +/- 2.8 weeks). The study setting was a university-based tertiary care center for newborn intensive care. RESULTS: Mean blood pressures on admission and at 3, 6, 12, 18, and 24 hours were significantly higher in steroid-treated infants. Steroid-treated infants received significantly less volume expansion (3.8 +/- 8.5 ml/kg versus 14.4 +/- 20.7 ml/kg; p < 0.001) than controls. Vasopressor support was also reduced in the steroid group (2.5% versus 11.5%; p < 0.05). CONCLUSION: Antenatal steroids are associated with both a higher mean systemic blood pressure and a decreased use of vasopressors and plasma expanders in very low birth weight infants during the first 24 hours after birth. This effect is not limited to infants of < 1000 gm; it is also significant in infants with a birth weight between 1000 and 1499 gm, and is already detectable in the first hours of life. We speculate that this finding may contribute to the mechanism of steroid protection against conditions such as intraventricular hemorrhage.

Adrenal Cortex Hormones↗
PubMed2002

Perinatal mortality in term and preterm twin and singleton births.

Although, in general, twins have higher perinatal mortality rates than singletons, preterm twins have lower perinatal mortality rates than singletons of the same birth weight or gestational age. This study investigated the hypotheses that this paradoxical twin advantage: 1) is due to gestational age distribution differences between the singleton and twin populations, and 2) is due to increased likelihood of birth having occurred in a tertiary perinatal center. A pre-existing, time-limited data set of all births in the province of Ontario in odd years between 1979 and 1985 was chosen for this study because of the large sample size (n = 618,579). Multivariable logistic regression of the relationship between perinatal mortality and twin status was controlled for mother's age, hospital level and gestational age. Findings confirm the lower mortality of preterm twins. After controlling for level of hospital of birth this difference remained, suggesting that level of hospital of birth was not a major factor responsible for the twin advantage. Analyses in which gestational age was standardized indicate that, for those whose gestational age was less than 2 SD below the mean for their particular group (twin or singleton), twins were actually at higher risk than singletons. These results support hypothesis 1 and do not strongly support hypothesis 2. The results also support earlier authors' suggestions that the definition of term birth should be different for twins and singletons

Gestational Age↗
PubMed1990

Blood pressure increases, birth weight-dependent stability boundary, and intraventricular hemorrhage.

The blood pressure (BP) and transcutaneous PO2 (TcPO2) changes associated with intensive care procedures were evaluated to determine whether responses differ between babies with and without periventricular-intraventricular hemorrhage (PV-IVH). Fifty-three inborn babies less than or equal to 1500 g were studied using a microcomputer-based monitoring system. With almost any procedure including a seemingly benign one such as a diaper change, peak systolic BP increased and TcPO2 decreased. However, responses to interventions did not differ between babies with PV-IVH and those without PV-IVH. Neither did these responses differ between those with birth weight less than or equal to 1000 g and greater than 1000 g. When each baby's record was scanned for the highest peak systolic BP before diagnosis of PV-IVH or within 48 hours in those with no PV-IVH and their BP points plotted against birth weight, a stable region was evident wherein PV-IVH occurred at a lower incidence (13%). When peak systolic BP was beyond this stable region, the incidence of PV-IVH was significantly higher, 70% (P less than .0001). The stability boundary for the maximum systolic BP is birth weight-dependent; the limit for the highest tolerable peak systolic BP is lower for the low-birth-weight infant. In over 70% of instances the highest peak systolic BP was associated with motor activities either induced by nursery procedures or spontaneous. We speculate that decreasing the frequency of intensive care interventions may decrease episodic BP increases to levels beyond the birth weight-dependent stability boundary where PV-IVH is likely to occur.

Birth Weight↗
PubMed2004

Indicators of fetal growth do not independently predict blood pressure in 8-year-old Australians: a prospective cohort study.

Inverse associations between size at birth and blood pressure (BP) in later life are commonly statistically significant only after adjustment for current size, consistent with change in size as the determinant. Few studies have been prospective or have included a range of potential confounders. Using regression models, including maternal and demographic variables, we examined associations between size at birth and BP in Australian children followed from week 16 of gestation to the age of 8 years. BP measurements were available from 1417 children born after 37 weeks gestation without congenital abnormalities. In models adjusted only for sex, the birthweight (BW), birth length, ponderal index, head circumference, chest circumference, abdominal girth, mid-arm circumference, triceps skinfold, placental weight, or BW/placental weight ratio did not significantly predict SBP in 8-year-olds. With adjustment for current size, associations were inverse but not statistically significant (regression coefficients: BW, -1.11; 95% confidence limits [CL], -2.22, 0.01; birth length, -0.25; 95% CL, -0.52, 0.24) and remained nonsignificant after adjustment for confounders. Current weight, height, or body mass index significantly predicted SBP and DBP (P<0.001) with differences of 8/4 mm Hg between upper and lower quartiles; effects were similar in infants with lower and higher BW. These findings are consistent with postnatal change in size as the major determinant of BP in 8-year-olds and are important in the context of the worldwide "epidemic" of obesity in childhood as a likely precursor of increasing rates of hypertension in adults.

Australia↗
PubMed1995

An adjustable fetal weight standard.

The monitoring of fetal weight is an important aspect of antenatal care. To construct an individually adjustable standard, we developed a model to link the predicted birth weight to a fetal weight curve which outlines how this weight is to be reached in an uncomplicated pregnancy. A formula was derived which describes the median fetal weight at each gestation as a proportion of the optimal term weight, and also defines the 90th and 10th centile curves as normal limits. We analyzed a birth weight database of 38,114 singleton, routine ultrasound-dated pregnancies resulting in term deliveries. By stepwise multiple regression analysis, we derived coefficients for the factors that act as variables on term birth weight in our population. Apart from gestational age and sex, the maternal height, weight at first visit, ethnic group, parity and smoking all have significant and independent effects on birth weight. The variation due to ethnic group appears to be physiological in this population. Smoking is associated with a reduction in birth weight, which is independent of maternal physique and related to the number of cigarettes per day as reported at the first visit. We have developed a software program which calculates, on the basis of pregnancy variables entered at the first visit, an adjusted normal range for fetal size. This can be printed out as a chart and used for antenatal surveillance of growth.

Birth Weight↗
PubMed2001

Demographic and therapeutic determinants of pain reactivity in very low birth weight neonates at 32 Weeks' postconceptional Age.

BACKGROUND: Management of pain in very low birth weight infants is limited by a lack of empiric knowledge about the multiple determinants of biobehavioral reactivity in infants receiving neonatal intensive care. OBJECTIVE: To examine relationship of early neonatal factors and previous medication exposure to subsequent biobehavioral reactivity to acute pain of blood collection. DESIGN: Prospective cohort study. Methods. One hundred thirty-six very low birth weight (</=1500 g) infants who underwent heel lance for blood collection at 32 weeks' postconceptional age formed the study sample, after excluding those with significant cerebral lesions (periventricular leukomalacia or cerebral parenchymal infarction [grade 4 intraventricular hemorrhage]) on cranial ultrasound. Pain reactions were assessed using the Neonatal Facial Coding System, infant state, and spectral analysis of change in heart rate variability from baseline to reaction to invasive stimulation. Factor analysis was used to provide an empirical basis for deriving summary pain scores, one factor was primarily behavioral and the other primarily autonomic. RESULTS: A normal reaction to procedural pain is characterized by facial grimacing and heightened cardiac sympathetic activity. The most significant factors associated with altered behavioral and autonomic pain reactivity at 32 weeks' postconceptional age were a greater number of previous invasive procedures since birth and gestational age (GA) at birth, both of which were related to a dampened response. After controlling for these variables, exogenous steroid exposure made an independent contribution to both the behavioral and autonomic pain scores, also in the direction of dampening the response. Conversely, previous exposure to morphine was associated with "normalized" (ie, increased) rather than diminished responses. In addition, higher mean heart rate at baseline was associated with lower GA at birth and longer time on mechanical ventilation. CONCLUSION: Early pain exposure at very low GA may alter the autonomic substrate, resulting in infants who are in a perpetual state of stress. The results of this study suggest that the judicious use of analgesia may ameliorate these effects on later pain reactivity. However, although early morphine exposure may "normalize" subsequent pain reaction, this study did not examine its effects on neurodevelopment.

Blood Specimen Collection↗
PubMed2002

Sixty-one day twin to twin birth interval in a low technology setting.

Multiple pregnancy, whether spontaneous or from artificial reproductive techniques, is regarded as high risk. Limiting the twin-twin birth interval to within 30 minutes has been widely practised. However, conservative management of the retained live, immature second twin may be worthwhile. We report a case lasting sixty-one days in a low technology setting.

Anti-Bacterial Agents↗
PubMed1996

Celiac disease and pregnancy outcome.

OBJECTIVES: This study investigated the effect of gluten-free diet on pregnancy outcome and lactation in 125 women affected with celiac disease. METHODS: The study has been designed as a case-control study and a before-after study. RESULTS: In the case-control study, comparison of 94 untreated with 31 treated celiac women indicated that the relative risk of abortion was 8.90 times higher (95% confidence limits: 1.19/66.3), the relative risk of low birth weight baby was 5.84 times higher (90% confidence limits: 1.07/31.9), and duration of breast feeding was 2.54 times shorter (p < 0.001) in untreated mothers. Abortion, low birth weight of baby, and duration of breast feeding did not significantly relate to the severity of celiac disease among untreated women. In the before-after study, 12 pregnant celiac women in either treated or untreated condition were compared. Results indicated that the gluten-free diet reduced the relative risk of abortion by 9.18 times (95% confidence limits: 1.05/79.9), reduced the number of low birth weight babies from 29.4% down to zero (p < 0.05), and increased duration of breast feeding 2.38 times (p < 0.10). Both case-control and before-after studies indicated that threatened abortion and premature delivery did not significantly relate to treatment of celiac disease. CONCLUSIONS: The high incidence of abortion, of low birth weight babies, and of short breast-feeding periods is effectively corrected by gluten-free diet in women with celiac disease.

Abortion, Spontaneous↗
PubMed2007

Caregiver health literacy and the use of child health services.

OBJECTIVES: Eighty million US adults have low health literacy, a risk factor for increased health care use among adults. The purpose of this work was to assess the association between caregiver health literacy and the use and cost of child health services. METHODS: We conducted a cross-sectional study of caregiver-child dyads from a sample of children aged 12 months to 12 years presenting to the pediatric emergency department of an urban, public hospital. Caregiver health literacy was measured by the Short Test of Functional Health Literacy in their preferred language (English or Spanish). Child health care use was measured by a 12-month retrospective review of the public hospital system's electronic database and of state Medicaid billing records for 4 types of visits: preventive care, urgent care, emergency care, and hospital care. Cost of child health care use was provided by Medicaid billing records. Multivariate analysis included caregiver education, age, and language proficiency, as well as child age, special health care needs, ethnicity, and health-insurance coverage. RESULTS: A total of 290 dyads were enrolled in the study. Twenty-two percent of caregivers had low (inadequate or marginal) health literacy. Caregivers with low health literacy were more likely to have less than a high school education, to have limited English proficiency, and to have been born outside the United States. There were no differences in health care use or cost between children of caregivers with low health literacy and children of caregivers with adequate health literacy. Three caregiver characteristics were associated with increased use of child health care services: born outside the United States, age at child's birth <24 years, and limited English proficiency. CONCLUSIONS: One in 5 caregivers of young children has low health literacy. Caregiver health literacy, however, was not associated with disparities in the use of child health services in this inner-city, ethnic minority population.

Caregivers↗
PubMed1991

Unexplained fluctuations in the risk for schizophrenia by month and year of birth.

Variation in their year and month of birth was studied in the 13,661 schizophrenics born between 1914 and 1960 known to the Scottish Psychiatric Case Register. Year-to-year fluctuations in the number of schizophrenics per 10,000 live births were outside chance limits. So were month-to-month fluctuations between January 1932 and December 1960, and this was largely due to fluctuations in the numbers of schizophrenics born in February, March, April and May. Time-lagged correlations with mean monthly temperatures suggest that in these same four months the incidence of schizophrenia is influenced by temperature six months previously - the lower the temperature in the autumn the higher the incidence of schizophrenic births the following spring. If these findings can be confirmed in other data sets, they would suggest that some influence which varies consistently with season and temperature is contributing to the aetiology of schizophrenia and may exert its effects as early as the third or fourth month of foetal development.

Cohort Studies↗
PubMed1983

A model for studying the pathogenesis and incidence of low-birth-weight infants.

A model is proposed for analyzing the many extextrinsic and intrinsic factors that might affect the incidence of low-birth-weight (LBW) infants (less than 2,501 g) adversely in populations of variable socioeconomic status (SES). The model provides for categorizing all mothers either into one of four broad categories of rinsic factors or into a normal group, free of all extrinsic factors. Application of the model in a prospective study of 972 infants showed that the incidence of LBW infants was low in normal pregnancies and significantly higher in the categories of extrinsic factors, that SES had a limited role in the birth of LBW infants, and that intrinsic factors had an almost negligible adverse effect if properly controlled.

Adolescent↗
PubMed1993

Vietnamese infant and childhood mortality in relation to the Vietnam War.

OBJECTIVES: There is obvious potential for war to adversely affect infant and childhood mortality through direct trauma and disruption of the societal infrastructure. This study examined trends in Vietnam through the period of the war. METHODS: The 1988 Vietnam Demographic and Health Survey collected data on reproductive history and family planning from 4172 women aged 15 through 49 years in 12 selected provinces of Vietnam. The 13,137 births and 737 deaths to children younger than age 6 reported by the respondents were analyzed. RESULTS: For the country as a whole, infant and childhood mortality dropped by 30% to 80% from the prewar period to the wartime period and was stable thereafter. In provinces in which the war was most intense, mortality did not decline from the prewar period to the wartime period but declined after the war, consistent with an adverse effect during the wartime period. CONCLUSIONS: The data are limited by assignment of birth location on the basis of mother's current residence and by inadequate information on areas of war activity. Nonetheless, the data do not indicate a widespread, sizable adverse effect of the war on national infant and childhood mortality in Vietnam but suggest detrimental effects in selected provinces.

Adult↗
PubMedDate not supplied

Nationwide singleton birth weight percentiles by gestational age in Taiwan, 1998-2002.

There are limited nationwide population-based data about birth weight percentiles by gestational age in Taiwan. The purpose of this study was to develop updated intrauterine growth charts that are population based and contain the information of birth weight percentiles by gestational age for singleton newborns in Taiwan. We abstracted and analyzed the birth registration database from the Ministry of the Interior in Taiwan during the period of 1998-2002 that consisted of over one million singleton births. Percentiles of birth weight for each increment of gestational week from 21 to 44 weeks were estimated using smoothed means and standard deviations. The analyses revealed that birth weight rose with advancing gestational age, with greater slopes during the third trimester and then leveled off beyond 40 weeks of gestational age. The male to female ratio ranged from 1.088 to 1.096. The mean birth weights during the period of 1998-2002 were higher than those previously reported for the period of 1945-1967; while the birth weight distribution and percentile during the period of 1998-2002 were similar to those reported for the period of 1979-1989. The 10th, 50th, and 90th percentiles of birth weigh at 40th gestational age among the male newborns were 2914, 3374, and 3890 g respectively; and for the female newborns 2816, 3250, and 3747 g. At the gestational age of 37 weeks, the 10th, 50th, and 90th percentiles of birth weigh among the male newborns were 2499, 2941, and 3433 g respectively; and for the female newborns 2391, 2832, and 3334 g. From 1998 to 2002, there was a gradual increase in the prevalence of low birth weight and preterm birth together with the percentage of infants born to foreign-born mothers. This study provides the first nationwide singleton intrauterine growth charts in Taiwan that are population-based and gender-specific. The normative data are particularly useful for the investigation of predictors and outcomes of altered fetal growth.

Birth Weight↗
PubMed1995

Admission to a neonatal intensive care unit as a predictor of long-term health: a 12-year follow-up.

Long-term physical, emotional, and social health of neonatal intensive care unit (NICU) graduates was assessed. Twelve-year follow-up interviews were conducted with 253 (86.3%) mothers from a cohort interviewed after their child's birth. One hundred and sixteen children had been admitted to the NICU and 137 to the normal neonatal nursery (NNN) at a tertiary care hospital (1978 to 1980). NICU boys have more chronic physical health problems and have been hospitalized more often than NNN boys. A larger proportion of NICU boys have a physical impairment. NICU girls have lower social competence, social support, and self-esteem than NNN girls, and the impact of NICU admission on these outcomes was significantly greater for girls than boys. Long-term follow-ups should not be limited to very low birth weight infants. NICU admission could be a simple flag for primary care providers to identify children at risk for problems in adolescence, especially psychosocial problems among girls. Physical and emotional health should continue to be monitored into adolescence for all NICU graduates.

Adolescent↗
PubMed2004

[Very preterm infant (< 32 weeks) vs very low birth weight newborns (1500 grammes): comparison of two cohorts].

UNLABELLED: Studies concerning very preterm newborns are either defined by birth weight (<1500 g) or gestational age (<32 weeks). The aim of our study was to underline limits of cohort definitions by birth weight. METHODS: Data come from the Nord Pas de Calais EPIPAGE cohort. Every birth occurring in 1997 before 32 weeks or with a birth weight less than 1500 g and transferred in a neonatal unit was included. Two cohorts were defined, one by gestational age (<32 weeks), the other by birth weight (<1500 g). Two subgroups could be defined from these to cohorts: group A (<32 weeks and > or =1500 g), from cohort (<32 weeks), group B (> or =32 weeks and <1500 g) from cohort (<1500 g). RESULTS: Five hundred nine newborns were included. Perinatal characteristics of both cohorts seemed comparable. The analysis by subgroups A and B revealed an excess of pulmonary and neurological morbidity in very preterm infant compared to very low birth weight newborn. This was linked to an excess of growth restricted newborns in this cohort with more advanced gestational ages. CONCLUSION: Cohorts of very preterm newborns should rather be defined by gestational age. If not possible, results in very low birth weight cohorts should also be given by gestational age and rate of growth restriction should be described.

Child Development↗
PubMed2001

Thyroid function in healthy and sick very-low-birth-weight infants--thyrotropin and free thyroxine levels until the sixth week of age.

Hypothyroxinemia in preterm infants without congenital hypothyroidism is associated with developmental delay. Longitudinal information on thyroid function in very-low-birth-weight (VLBW, <1,500 g birth weight) infants is limited: we present data on thyroid function in sick and healthy VLBW infants until 6 weeks of age. Free T(4) and TSH levels routinely obtained on days 14-21 and days 35-49 in 92 consecutive VLBW infants were correlated retrospectively with neonatal morbidity. Free T(4) levels were positively correlated with gestational age; an independent effect of neonatal disease on thyroid function was not detectable.

Aging↗
PubMed2006

Effects of the IGF-I/IGFBP-3 complex on GH and ghrelin nocturnal concentrations in low birth weight children.

OBJECTIVE: There is limited information regarding the effects of IGF-I and/or IGFBP-3 on circulating ghrelin concentrations. To determine the effects of IGF-I on GH and ghrelin concentrations, we examined the GH and ghrelin nocturnal profiles before and after the administration of the IGF-I/-IGFBP-3 complex (Iplex) to low birth weight children. DESIGN: The children were studied on two separate occasions, the first under basal conditions, and the second time after the sc administration of 1 mg/kg of Iplex at 2100 h. Blood samples for determination of GH and ghrelin were obtained every 20 min between 2300 h and 0700 h, while the children were sleeping. In each patient, we calculated the mean GH and ghrelin area under the curve (GH AUC and GHR AUC), both under basal conditions and after the administration of the IGF-I/IGFBP-3 complex. SETTING: The study was performed at a University Research Centre located at a General Hospital in Santiago, Chile. PATIENTS: Twenty prepubertal children (11 boys and 9 girls), born after a full-term pregnancy with a birth weight below 2.8 kg were studied at a mean +/- SEM age of 7.3 +/- 0.5 years (range 4-11 years). Their mean height was -1.8 +/- 0.3 standard deviation score (SDS) and their mean BMI was 0.1 +/- 0.2 SDS at the time of the study. MAIN OUTCOME AND RESULTS: Mean nocturnal GH AUC exhibited a significant decrease (2903 +/- 185 vs 1860 +/- 122 ng/ml min, P < 0.01), whereas mean GHR AUC showed a significant increase after administration of the IGF-I/IGFBP-3 complex (68 +/- 16 vs 288 +/- 36 ng/ml min, P < 0.01). CONCLUSIONS: These findings indicate that the IGF-I/IGFBP-3 complex appears to have opposite effects on circulating GH and ghrelin concentrations in low birth weight children, suggesting that, in addition to its known negative feed-back effect on GH, IGF-I and/or IGFBP-3 may have a positive feed-back effect on ghrelin.

Area Under Curve↗
PubMed1991

Increase in the concentration of immunoreactive endothelin in human pregnancy.

Maternal plasma concentrations of immunoreactive endothelin (ir-ET) during pregnancy, labour and after birth were measured by radioimmunoassay. Concentrations of ir-ET in the umbilical artery, umbilical vein, amniotic fluid and neonatal urine were also examined. The mean (+/- S.E.M.) plasma ir-ET concentration in early pregnancy (4-7 weeks) was 13.7 +/- 0.5 pmol/l, which was significantly higher than that in non-pregnant women (5.9 +/- 0.3 pmol/l). During pregnancy, plasma ir-ET concentrations gradually decreased to a minimum of 11.5 +/- 0.4 pmol/l in weeks 20-23, and then increased again towards term (12.5 +/- 0.4 pmol/l after 36 weeks of pregnancy). In women undergoing vaginal delivery, the mean plasma ir-ET concentration (17.1 +/- 0.7 pmol/l) increased significantly, compared with that in late pregnancy. After delivery, the plasma ir-ET concentration decreased abruptly to 4.0 +/- 0.2 pmol/l on the first day. Plasma ir-ET concentrations in umbilical vessels were significantly higher than those in maternal plasma. In addition, concentrations in the umbilical artery were significantly higher than those in the umbilical vein in cases of vaginal delivery. Concentrations of ir-ET in amniotic fluid were much higher than those in maternal or fetal plasma. ir-ET concentrations in neonatal urine on day 1 after birth were below the detection limit (less than 0.1 pmol/l) by radioimmunoassay in 70% of the cases examined but on day 5 after birth ir-ET was present at measurable concentrations in all cases. It is suggested that endothelin may act as a circulating hormone during pregnancy and labour in both maternal and fetal circulations.

Amniotic Fluid↗