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Impact of income maintenance on low birth weight: evidence from the Gary Experiment.

Birth weight is a useful index of infant health. Low birth weight (5.5 pounds or less) is associated with high rates of infant mortality and morbidity. Low birth weight is also associated with low socioeconomic status. The question arises, therefore, whether income transfers can affect the incidence of low birth weight among the poor. The impact of an expanded income support plan on low birth weight was analyzed using data on 404 infants born to participants in the Gary Income Maintenance Experiment. A significant health response was observed for children of women who face high-risk pregnancies.

Adolescent

Increased incidence of lactobezoars in low birth weight infants.

Fifteen low birth weight infants had their conditions complicated by the formation of a lactobezoar. The mean gestational age was 30.3 weeks; mean birth weight was 1,184 g, and the mean age at the time of diagnosis was 11.8 days. Twelve of the infants were receiving an 80 kcal/dL-formula and one infant, a 40 kcal/dL-formula designed for the premature infant. Symptoms included abdominal distension, emesis or increased gastric residual, diarrhea, hematest-positive stools, abdominal mass, and gastric perforation.

Bezoars

Birth weight of Hausa infants in Northern Nigeria.

The birth weight of 1460 Hausa singleton infants was recorded and analysed. The birth weight of Hausa infants (Mean +/- SD) was 3.03 +/- 0.45 kg, being higher in males (3.08 +/- 0.47 kg) than females (2.97 +/- 0.48 kg). The difference was significant (P less than 0.001). The mean birth weight of first born children was significantly lower than the subsequent born, and increasing birth order was associated with higher birth weight irrespective of maternal age. The birth weight was influenced more by the parity as compared to maternal age. The incidence of low birth weight was 15.8 per cent, being lower in males (13.6 per cent) as compared to females (18.1 per cent). Comparison were made with studies from other parts of the country as well as from other countries.

Adolescent

Effect of environmental factors and fetal and maternal genotype on gestation length and birth weight of Holstein calves.

Records of gestation length and birth weight on 1522 live single births (from 1958 to 1976) of Holstein calves were from 81 sires and 552 dams. Average gestation length was 282.3 days, and average birth weight was 42.9 kg. Male calves were carried 1.7 days longer than female calves and weighed 2.9 kg more at birth. Both gestation length and birth weight increased with parity. Calves born in spring and summer were carried shorter times and weighed less than those born in fall and winter. Heritabilities of gestation length and birth weight as progeny traits were .73 and .51 and as maternal traits were .19 and .26. Genetic correlations between gestation length and birth weight were .46 as a progeny trait and .35 as a maternal trait. Genetic correlations between progeny traits and maternal traits were negative. The phenotypic correlation between gestation length and birth weight was .37, and environmental correlation was .30.

Animals

Unconjugated hyperbilirubinemia in very low birth weight infants.

In very low birth weight infants, the occurrence of bilirubin-related brain damage has been repeatedly observed at low serum bilirubin concentrations in close association with altered pathophysiologic status (hypoxia, acidosis, hypothermia, and so on). This increased susceptibility is accompanied by increased severity and duration of unconjugated hyperbilirubinemia as compared with more mature infants. Clinical manifestations of kernicterus in very low birth weight infants are almost always nonspecific. No single biochemical or physiologic measurement is sufficient to predict the risk for development of the bilirubin-related brain damage in this group. Prevention of bilirubin-related brain damage in very low birth weight infants requires not only the maintenance of physiologic and biochemical milieu within normal limits, but also specific therapy to alleviate unconjugated hyperbilirubinemia. Although exchange transfusion has been the mainstay of therapy for unconjugated hyperbilirubinemia, the increased morbidity and mortality associated with exchange transfusion in these immature infants and the need to maintain very low serum bilirubin concentrations suggest that prophylactic phototherapy may be more beneficial for this group.

Bilirubin

Prevention of group-B beta-haemolytic streptococcal septicaemia in low-birth-weight neonates by penicillin administered within two hours of birth.

Between January, 1969, and May, 1974, 11 of 1208 low-birth-weight infants had early onset group-B streptococcal septicaemia. All 11 infants were of less than 35 weeks gestational age and 9 presented with the clinical and radiological signs of idiopathic respiratory distress syndrome. 10 died. Antibotics were given to 3 infants only, but not before the age of 12 h. From June, 1974, infants less than 35 weeks gestational age, and from January, 1977, infants less than 2500 g, received systemic penicillin by 2 h of age after throat, ear, umbilical, rectal, and blood cultures. Penicillin was continued for 10 days if group-B streptococci were isolated but was stopped at 48 h of age if all cultures were negative. Between June, 1974, and November, 1977, there was 1 case of septicaemia and no death from group-B streptococal infection in the 983 low-birth-weight infants born during this period. These data suggest that systemic penicillin from birth prevents low-birth-weight infants from dying of group-B streptococcal infection.

Cross Infection

Plasma concentrations of calcium, chromium, copper, iron, magnesium, and zinc in maternal and cord blood and their relationship to low birth weight.

A study of the relationship between low birth weight and concentrations of six metals in maternal and cord plasma was conducted. Maternal and cord blood were collected at delivery. Cases and controls were matched for maternal age (+/- 3 yr), race, parity, socioeconomic status, and smoking habits and the sex of the neonate. Plasma concentrations of calcium, copper, magnesium, and zinc were determined by flame atomic absorption spectrophotometry; plasma chromium and iron concentrations were determined by flameless atomic absorption techniques. Mean maternal plasma concentrations were significantly lower in the low-birth-weight group than in the controls for iron (p = 0.012) and calcium (p = 0.007). Mean cord plasma concentrations were also significantly lower for calcium (p = 0.037). There were no statistically significant differences between the low- and normal-birth-weight groups for the maternal or cord chromium, copper, magnesium, and zinc concentrations or for the cord iron concentrations. It is probably true that many factors, acting additively or synergistically, can produce low birth weight, and that low birth weight acts only as a marker for a number of biologic insults. The results of this study suggest that nutrient metals may be one of these factors.

Calcium

Quantitative morphology of the placenta. III. The growth of the placenta and its relationship to birth weight.

The relationship of placental components to birth weight was investigated by stereology. 37 placentas from nonpathological pregnancies delivered after a period of 224-303 days of amenorrhea were examined. The umbilical cord was clamped immediately after birth. The ratios of the volume, the surface, the length of the villous vessels and the surface of the villi with birth weight showed a decrease after 277 days of amenorrhea. In contrast to this decrease, the ratio of the volume of the trophoblast with birth weight seems to increase. No difference could be found for the ratios of the placental volume (placental index), the volume of the villous tissue, the volume of the intervillous space and the volume of the nonfunctional tissue with birth weight. These ratios reveal a quantitative morphological base for the clinical experience that postmature fetuses are at a higher risk through deterioration of the placenta.

Birth Weight

Relationship of fetal and placental weight in human beings: fetal/placental weight ratios at various gestational ages and birth weight distributions.

Two thousand consecutive deliveries occurring over an 11-month period were studied for fetal and placental (F/P) weight characteristics. Infant and placental weight pairs were analyzed according to their gestational ages and growth categories (AGA, SGA, LGA). Graphs were constructed to depict normal placental weight gain and F/P ratio changes over a wide range of gestational ages (23 to 43 weeks). Mean placental weights and F/P ratios continued to increase through 42 weeks' gestation in the AGA and LGA groups, though placental weight showed no change in the SGA group after 36 weeks. F/P ratio continued to increase in the SGA group and was indistinguishable from that of the other two groups. Fetal and placental weight were linearly related in the total sample as well as in the individual growth categories. However, when F/P ratio was plotted against placental weight, the infants were segregated into three completely distinct curves, depending upon their growth characteristics. A wide range of placental weight and f/p ratios existed within all three infant birth weight groups. When one-minute Apgar scores were considered, infants with F/P ratios of greater than 10.00 had significantly higher risks of an Apgar score of less than 6.

Apgar Score

The effect of maternal smoking on birth weight and the subsequent health of the child.

The effect of maternal smoking during pregnancy on birth weight was studied in 12,068 births, the mothers in 1819 of which were regarded as smokers. The children of the smokers were compared with those of controls of similar age, parity, marital status and place of residence. Maternal smoking reduced birth weight in a dose-related manner. Birth weight was least affected among young, primiparous mothers who smoked only slightly, a difference which was, however, entirely caused by those mothers who stopped smoking for the last 3 mth of pregnancy, and this subgroup showed similar figures for postneonatal mortality and morbidity up to the age of 5 to those of their controls. Postneonatal mortality was higher in the total group of the smokers than among their controls, the primiparous or young mothers not differing in this respect from the others. Morbidity up to the age of 5 was significantly higher (p less than 0.001) among the children of the smokers, the children of the primiparas and young mothers being affected in a similar way to the others. The low birth weight infants of the smokers had a higher mean birth weight and lower perinatal mortality than the low birth weight infants of the controls, but morbidity up to age of 5 and postneonatal mortality were higher among the smokers in respect of both low birth weight infants and others.

Adult

Birth weight of children with Down's syndrome.

The difference in birth weight between children with Down's syndrome and their siblings was estimated to be in the interval from .18 to .37 kg with 90 percent confidence, the Down's syndrome infants having the smaller mean birth weights. When we adjusted their birth weight, using a multiple linear regression analysis, to take into account several factors known to affect it, the difference in birth weight was only slightly less than the unadjusted difference. The data support the hypothesis that an extra chromosome No. 21 results in a smaller than expected birth weight.

Birth Order

Factors associated with low birth weight of infants delivered at term.

The singleton births in the 1958 British Perinatal Mortality Survey (Butler and Bonhan, 1963; Butler and Alberman, 1969) were used to study the aetiology of low birth weight of infants delivered at term. After exclusion of macerated stillbirths and infants with lethal congenital defects, 468 infants of 259 days or more gestation and a birth weight which was less than 2500 g were identified. The mothers and their pregnancies were compared with those of the population of 16 994 singleton births. Delivery at term of a low birth weight infant was significantly associated with maternal prepregnant weight, maternal height, maternal smoking, primiparity, maternal employment, low social class, a previous infant of low birth weight, threatened abortion and severe toxaemia. No significant associations were found with illegitimacy, area of residence, previous spontaneous abortion, essential hypertension, mild toxaemia, chronic or acute infections or other conditions. There were significant negative associations with a history of previous large infants and with maternal blood group AB.

Adult

Maternal smoking and birth weight.

To determine whether it is the smoker or smoking per se that explains the observed reduction in birth weight of infants of mothers who smoked during pregnancy, data collected on 1016 pairs of successive births which occurred between 1946 and 1963 in Washington County, Maryland, were studied. The mean birth weight difference between first and second members of pairs of consecutive live births of the same mother was examined in relation to her smoking habits during both pregnancies. A multiple regression technique was used to simultaneously adjust for the effects of maternal smoking habits during pregnancy, infant sex, maternal age, and birth order on birth weight difference. There were no significant differences in mean birth weight difference among pairs in which the mother smoked throughout both pregnancies, pairs in which the mother was a nonsmoker during both pregnancies, and pairs in which the mother smoked during the second pregnancy of the pair, but not the first. When birth weights of only first members of the pair were studied, the mean birth weight of infants of women who were nonsmokers throughout both pregnancies was higher than that of infants of women who smoked during both pregnancies. Infants of first members of pairs in which the mothers smoked only during the second pregnancy tended to have birth weights which were lower than that of infants of nonsmokers and higher than that of infants of smokers. These findings neither confirm nor deny the hypothesis that the smoker rather than the smoking per se causes a reduction in birth weight.

Adult

Prematurity and perinatal mortality in the Rhesus (Macaca mulatta): relationship to birth weight and gestational age.

While the relative influence of birth weight and gestational age in determining perinatal mortality has not been definitively established, it has been assumed that birth weight makes the predominant contribution to perinatal mortality. The joint effects of birth weight and gestational age were examined by analyzing approximately 2,500 births from timed pregnancies in two rhesus (Macaca mulatta) breeding colonies. Perinatal events in the rhesus are described and shown to be similar to the human. The results demonstrate that gestational age is as important as birth weight in determining perinatal mortality. Since the degree of accuracy in the estimation of rhesus gestational age was much greater than is usually attained in human studies, the estimation of gestational age from the last menses may be too crude to determine the importance of this variable in human perinatal mortality.

Animals

Birth weight and gestational age in children with cerebral palsy or seizure disorders.

Birth weight and gestational age of single-born children with cerebral palsy (CP) and those with seizure disorders were compared with norms for 40,000 single-born children in the same prospectively identified population. Low birth-weight and short gestation were important risk factors for CP, but these characteristics were uncommon, and the majority of children with CP were of normal birth weight and term gestational age. Preterm children with CP by age 7 years tended to have been even smaller at birth than was appropriate for their short gestions. Among term infants with later CP, the birth weights of the majority were appropriate for dates, but a subgroup were noticeably small for dates at term. Low birth weight, preterm birth, and smallness for dates at term were not significantly related to the risk of seizure disorders in children free of CP.

Birth Weight

Urine solute excretion in growing low-birth-weight infants.

Fifteen thriving low-birth-weight infants who weighed less than 1,950 gm at birth were randomly selected to study the urine solute excretion on two milk-based proprietary formulas, SMA or Formula 4. The results showed that urine oxmolality rose progressively with increasing caloric concentration and was 78, 111, and 163 mOsm/kg H2O on 67, 80, and 100 kCal/dl SMA, respectively. Formula 4 gave rise to significantly higher urine osmolality (133 mOsm/kg H2O) than SMA, when fed at the same caloric density of 67 kCal/dl. Although the dependence of urine solute excretion on dietary load was confirmed, the rapidly growing low-birth-weight infant appears to incorporate a larger portion of potential urine solute into growing tissues, than is the case in the term infant.

Animals

Birth weight in relation to maternal socio-economic status.

On an attempt to illustrate the influence of maternal socio-economic status on birth weight, this study was carried out on 689 full term new borns. The weight, age, parity, income and occupation of their mothers were compared to the birth weight. A correlation was also performed between birth weight and the presentation of the babies and the ante-natal care offered to their mothers. A positive correlation was only found to be present between birth weight and family income below 10 pounds/month. A similar correlation was noticed between birth weight and the interpregnancy interval up to 30 months. The presentation of the foetus might be of influence on birth weight only in cephalic and breeck presentation. The age of the mother, occupation, weight were negatively correlated with birth weight.

Birth Weight

Effect of diet on plasma aminograms of low birth weight infants.

The composition of nutrient mixtures for the low birth weight infant is a matter of considerable concern, and questions have been raised about the adequacy of the cystine and tyrosine contents of available preparations. Low birth weight infants were fed isonitrogenous isocaloric formulas whose content of tyrosine and cystine varied 3- and 7-fold, respectively, for 3-day periods in a Latin Square design. Two-hour postprandial plasma aminograms indicate a statistically significant difference (P = 0.05) between plasma cystine levels noted in infants fed the formula containing cystine at 6 mg/100 ml and those fed the formula containing cystine at 28 mg/100 ml. No significant differences were noted between other formula groupings. Plasma tyrosine concentrations were rapidly reduced whenever tyrosine intake was less then 50 mg/kg of body weight. Such a dietary approach may be of value in reduction of the elevated plasma tyrosine levels seen in infants with transient tyrosinemia of prematurity. Postprandial concentrations of plasma amino acids for the low birth weight infant are a useful reference standard for evaluation of the response of the low birth weight infant to new therapeutic feeding mixtures, particularly parental or jejunal feedings.

Amino Acids