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Background Low- and middle-income countries bear a disproportionate burden of preterm birth (PTB) and low infant birth weight (LBW) complications where affective and anxiety disorders are more common in the antepartum period than in industrialized countries. Objective To evaluate the extent to which early pregnancy antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) are associated with infant birth weight and gestational age at delivery among a cohort of pregnant women in Peru. Methods Our prospective cohort study consisted of 4408 pregnant women. Antepartum depression, generalized anxiety, and PTSD were assessed in early pregnancy using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist – Civilian Version, respectively. Pregnancy outcome data were obtained from medical records. Multivariable linear and logistic regression procedures were used to estimate adjusted measures of association (β coefficients and odds ratios) and 95% confidence intervals (CI). Results After adjusting for confounders, women with antepartum generalized anxiety (32.6% prevalence) had higher odds of LBW (adjusted odds ratio (OR)=1.47; 95%CI: 1.10–1.95) and were more likely to deliver small for gestational age (OR = 1.39; 95%CI: 1.01–1.92) infants compared to those without anxiety. Compared to those without PTSD, women with PTSD (34.5%) had higher odds of delivering preterm (OR = 1.28; 95%CI: 1.00–1.65) yet PTSD was not associated with LBW nor gestational age at delivery. Women with antepartum depression (26.2%) were at no increased risk of delivering a preterm, low-birth-weight or small-for-gestational-age infant. Limitations Our ability to make casual inferences from this observational study is limited; however, these findings are consistent with prior studies. Conclusion Generalized anxiety disorder during pregnancy appeared to increase odds of delivering a low-birth-weight or small-for-gestational-age infant, while PTSD was associated with increased odds of delivering preterm. Our findings, and those of others, suggest antenatal care should be tailored to screen for and provide additional mental health services to patients.

Objective: Children born small for gestational age (SGA) are at risk of future obesity and associated comorbidities. Therefore the identification of risk factors and novel biomarkers which are associated with this risk are needed for early detection and to improve preventive strategies. Spexin (SPX), a novel neuropeptide that is involved in the regulation of obesity and fat metabolism, is a candidate biomarker for predicting obesity and related comorbidities at an early age. The aim of this study was to investigate serum levels of SPX in term infants born small, appropriate, and large for gestational age (LGA) and its association with newborn anthropometric measurements. Methods: One hundred and twenty term newborn babies classified as SGA, appropriate for gestational age (AGA), or LGA and their mothers were included. SPX, leptin and visfatin were measured in cord blood and maternal serum by enzyme-linked immunosorbent assay. Results: Fifty-six (46.7%) neonates were girls and 64 (53.3%) were boys. The mean birth weight was 3170.70±663 g, birth length was 48.9±2.79 cm, and head circumference was 34.5±1.67 cm. Birth weights, lengths, and head circumferences of the neonates in the SGA, AGA, and LGA groups were significantly different. Cord blood SPX and leptin levels in the SGA groups were significantly lower than those of both the LGA and AGA groups. Cord blood visfatin levels were significantly lower in the AGA group than the LGA and SGA groups. Maternal SPX levels of SGA babies were significantly lower than those of the mothers in both the LGA and AGA groups, but no significant difference was observed between the SGA and LGA groups. Maternal visfatin levels of the AGA babies were significantly higher than the maternal levels of SGA and LGA groups. There was no difference in terms of maternal leptin levels. Cord blood SPX and leptin levels were positively correlated with birth weight, length and head circumference. Birth weight increased significantly in line with maternal pregestational body mass index. Conclusion: The lowest SPX levels were found in the SGA babies and cord SPX level was significantly correlated with newborn length, weight, and head circumference. © 2022 by Turkish Society for Pediatric Endocrinology and Diabetes The Journal of Clinical Research in Pediatric Endocrinology published by Galenos Publishing House.

Clinical Standards Committee: The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) is a scientific organization that encourages sound clinical practice, and high-quality teaching and research related to diagnostic imaging in women's healthcare. The ISUOG Clinical Standards Committee (CSC) has a remit to develop Practice Guidelines and Consensus Statements as educational recommendations that provide healthcare practitioners with a consensus-based approach, from experts, for diagnostic imaging. They are intended to reflect what is considered by ISUOG to be the best practice at the time at which they are issued. Although ISUOG has made every effort to ensure that Guidelines are accurate when issued, neither the Society nor any of its employees or members accepts any liability for the consequences of any inaccurate or misleading data, opinions or statements issued by the CSC. The ISUOG CSC documents are not intended to establish a legal standard of care, because interpretation of the evidence that underpins the Guidelines may be influenced by individual circumstances, local protocol and available resources. Approved Guidelines can be distributed freely with the permission of ISUOG (info@isuog.org).

ObjectiveTo evaluate the rate of developmental coordination disorder (DCD) and its correlation to cognition and self-experienced health-related quality of life (HRQoL) in children born very preterm.DesignProspective follow-up study.SettingRegional population of children born very preterm in Turku University Hospital, Finland, in 2001–2006.PatientsA total of 170 children born very preterm were followed up until 11 years of age.Main outcome measuresMotor and cognitive outcomes were evaluated using the Movement Assessment Battery for Children - Second Edition (Movement ABC-2) and the Wechsler Intelligence Scale for Children - Fourth Edition, respectively, and HRQoL using the 17-Dimensional Illustrated Questionnaire (17D). The Touwen neurological examination was performed to exclude other neurological conditions affecting the motor outcome.ResultsEighteen children born very preterm (17 boys) (11.3%) had DCD, defined as Movement ABC-2 total test score ≤5th percentile. A positive correlation between motor and cognitive outcome (r=0.22, p=0.006) was found. Children born very preterm with DCD had lower cognitive scores than those without DCD (Full-Scale IQ mean 76.8 vs 91.6, p=0.001). Moreover, children born very preterm with DCD reported lower HRQoL than children born very preterm without motor impairment (17D mean 0.93 vs 0.96, p=0.03). However, HRQoL was higher in this group of children born very preterm compared with population-based normative test results (pConclusionsDCD was still common at 11 years of age in children born very preterm in 2000s. DCD associated with adverse cognitive development and lower self-experienced HRQoL. However, this group of children born very preterm reported better HRQoL in comparison with Finnish norms.

Background: Pre-eclampsia (PE) carries an increased risk for maternal and/or fetal mortality or serious morbidity. PE is associated with ischemia and increased oxidative stress in the placenta, which may lead to modification of plasma albumin to ischemia-modified albumin (IMA). The aim of this study was to investigate IMA and hematological parameters in mothers and in premature infants in normal and in pre-eclamptic pregnancies. Methods: Twenty-five pregnant women with PE and their premature newborns were categorized as the PE group, and 25 normotensive pregnant women and their premature newborns as the control group. Preterm infants are classified as small for gestational age (SGA) or non-SGA according to the Fenton preterm growth chart. Serum IMA, complete blood count (CBC), liver function tests (LFT), renal function tests (RFT), albumin, and C-reactive protein were measured in the mothers immediately before birth, and in the cord blood and serum of the newborns at 6 and 24 h after birth. Clinical and demographic data were recorded for both groups. Results: While IMA, LFT and RFT were significantly increased in the PE group compared with the control group, albumin and CBC were significantly lower in the PE group. A total of 40% of PE newborns were SGA, 30% of whom had severe SGA (birthweight

ObjectiveThe purpose of this study was to evaluate the cardiac functions and age-related changes of these functions in full-term small for gestational age infants during the first 3 months of life.MethodsCardiac functions of 20 term small for gestational age and 20 term appropriate for gestational age infants were studied using conventional and tissue Doppler echocardiography on postnatal day 5 and at 1 and 3 months.ResultsVentricular diameters, ventricular wall thicknesses, and left ventricular mass significantly increased with age in both groups. All these parameters were significantly lower in small for gestational age infants. No differences were detected by conventional echocardiography between the groups in systolic and diastolic functions. Systolic velocity, early diastolic and atrial contraction velocities, and the ratio between early diastolic and atrial contraction velocities determined by tissue Doppler echocardiography increased with age. Systolic velocity was lower in the small for gestational age babies for all myocardial regions on the 5th day. Peak early diastolic velocity was decreased in the small for gestational age babies at the first and second evaluations for all myocardial regions. The ratio between early diastolic and atrial contraction velocities was significantly lower in the small for gestational age babies for the interventricular septum and right ventricle. Significant positive correlations were detected between the Ponderal index and systolic and early diastolic velocities.ConclusionThe present findings suggest that systolic and diastolic function indices including tissue Doppler measures are significantly affected in small for gestational age babies during the first 3 months of life.

PURPOSE The objective of this study was to investigate and compare corneal thicknesses of prematurely born and full-term early school-aged children, who were grouped into birth weight categories according to gestational age. METHODS This cross-sectional study included 136 school-aged white children. They were grouped as premature (born before 37 weeks of gestation) and full term (born at or after 37 weeks of gestation). These 2 groups were further divided into birth weight groups according to gestational age as small, appropriate, and large for gestational age. Central corneal thickness (CCT) was measured by ultrasound pachymetry. The intraocular pressures of both groups were measured by a Goldmann applanation tonometer. RESULTS The study included right eyes of 136 children. There were 53 girls and 83 boys whose mean age was 6.5 ± 0.9 years (range: 5-8 yrs). Mean pachymetry of the small for gestational age group (526.8 ± 37.9 μm) in prematurely born children was significantly lower than that of appropriate for gestational age (554.6 ± 34.2 μm) (P = 0.039, mean difference 27.8, 95% confidence interval, 1.1-54.5). When prematurely born and full-term children are compared, the mean pachymetric values of the term children (574.5 ± 37.8 μm) were found to be significantly higher than those of the prematurely born children (545.4 ± 35.6 μm) (P ≤ 0.001). CONCLUSIONS Birth parameters affect CCT in early school-aged children. Prematurely born, small for gestational age children have lesser CCT. This should be kept in mind at their follow-ups.

ABALI, SAYGIN/0000-0001-6552-2801; Gurbuz, Fatih/0000-0003-2160-9838; Hatun, Sukru/0000-0003-1633-9570; Abaci, Ayhan/0000-0002-1812-0321; Turan, Serap/0000-0002-5172-5402; Buyukinan, Muammer/0000-0002-2937-823X; yuksel, bilgin/0000-0003-4378-3255; Ozgen, Ilker Tolga/0000-0001-6592-9652; binay, cigdem/0000-0002-7749-8818; ozkan, Behzat/0000-0002-9153-8409; Demir, Korcan/0000-0002-8334-2422; Eren, Erdal/0000-0002-1684-1053 WOS: 000373099300016 PubMed: 26788866 To evaluate the anthropometric features of girls with Turner syndrome (TS) at birth and presentation and the effect of karyotype on these parameters. Data were collected from 842 patients with TS from 35 different centers, who were followed-up between 1984 and 2014 and whose diagnosis age ranged from birth to 18 years. Of the 842 patients, 122 girls who received growth hormone, estrogen or oxandrolone were excluded, and 720 girls were included in the study. In this cohort, the frequency of small for gestational age (SGA) birth was 33%. The frequency of SGA birth was 4.2% (2/48) in preterm and 36% (174/483) in term neonates (P

Objective To gain insight into health and related costs associated with very preterm births, one needs accurate information about the prevalence of the disabling conditions, including neonatal hearing loss (NHL). Study design We assessed the prevalence of NHL by week of gestation and categories of birth weight in very preterm neonates. Results of the 2-stage Automated Auditory Brainstem Response nationwide Newborn Hearing Screening Program in Dutch Neonatal Intensive Care Units and diagnostic examinations were centrally registered between October 1998 and December 2012 and included in this study. NHL was defined as impaired when the neonate conventional Auditory Brainstem Response level exceeded 35 dB near Hearing Level at diagnostic examination. Birth weight was stratified into

Objective To gain insight into health and related costs associated with very preterm births, one needs accurate information about the prevalence of the disabling conditions, including neonatal hearing loss (NHL). Study design We assessed the prevalence of NHL by week of gestation and categories of birth weight in very preterm neonates. Results of the 2-stage Automated Auditory Brainstem Response nationwide Newborn Hearing Screening Program in Dutch Neonatal Intensive Care Units and diagnostic examinations were centrally registered between October 1998 and December 2012 and included in this study. NHL was defined as impaired when the neonate conventional Auditory Brainstem Response level exceeded 35 dB near Hearing Level at diagnostic examination. Birth weight was stratified into

Objective. To assess the effect of demographic and neonatal risk factors and outcome at the last available assessment on the probability of full responders, postal responders (those who only responded to the mailed questionnaire), or nonresponders in a follow-up study of 19-year-old adolescents who were born as preterm infants. Design. The 19-year follow-up program was part of a large ongoing collaborative study in the Netherlands on the long-term effect of prematurity and dysmaturity on various medical, psychological, and social parameters. In the original cohort, 1338 infants (94%) with a gestational age of Results. The odds ratios (ORs) for male versus female for the probabilities of nonresponse and postal response were statistically significant: 2.7 (95% CI: 1.9–3.9) and 1.6 (95% CI: 1.0–2.5), respectively. The same holds for the ORs for non-Dutch versus Dutch and low versus high maternal education for nonresponse: 2.0 (95% CI: 1.3–3.2) and 3.7 (95% CI: 2.0–6.7), respectively. Special education and severe handicap showed a statistically significant influence on nonresponse (OR: 1.6; 95% CI: 1.1–2.4 and OR: 2.6; 95% CI: 1.3–5.2) and postal response (OR: 2.0; 95% CI: 1.2–3.3 and OR: 4.4; 95% CI: 2.0–9.9), respectively. At the age of 19 years, primary school and special education were found significantly more frequent in the postal responders than in the full-response group (20% and 21% vs 6% and 12%). The full responders, on the other hand, were higher educated than were the postal responders. Conclusions. In this follow-up study at the age of 19 years, boys, non-Dutch adolescents, and low maternal education were overrepresented in the nonresponse and postal-response groups. Nonresponse decreased the proportion of infants with adverse outcome in assessed children. To be able to present reliable results for the total group of survivors in long-term follow-up studies, the nonresponse bias needs to be quantified. Therefore, it is evident that more research using statistical methods such as imputation of missing data is needed.

Bij kinderen die te vroeg geboren worden of met een te laag geboortegewicht voor de zwangerschapsduur (‘small for gestational age’ (SGA)) is intensieve zorg en nazorg gewenst. Knelpunten hierbij zijn de vaak gedeelde zorg door kinderartsen, huisartsen, jeugdgezondheidszorg (jgz) en andere professionals voor de zeer te vroeg geboren kinderen (< 32 zwangerschapsweken), en het signaleren van mogelijke later ontstane gezondheidsproblemen bij de matig vroeg geboren kinderen (na 32-37 zwangerschapsweken). De multidisciplinair ontwikkelde en evidencebased jgz- richtlijn ‘Te vroeg en/of small for gestational age (SGA) geboren kinderen’ is relevant voor alle professionals betrokken bij de zorg voor deze groep kinderen. De belangrijkste aanbevelingen zijn: (a) tijdig en volledig overdragen van gegevens na ontslag uit ziekenhuis, (b) gestructureerde gegevensuitwisseling bij gedeelde nazorg, (c) aanwijzen van een casemanager per kind, (d) corrigeren van de testleeftijd voor de mate van vroeggeboorte bij ontwikkelingsonderzoek, en (e) mogelijkheid van gebruik van speciale curves en normen voor vroeggeboren kinderen bij het beoordelen van de groei en ontwikkeling.

Bij kinderen die te vroeg geboren worden of met een te laag geboortegewicht voor de zwangerschapsduur (‘small for gestational age’ (SGA)) is intensieve zorg en nazorg gewenst. Knelpunten hierbij zijn de vaak gedeelde zorg door kinderartsen, huisartsen, jeugdgezondheidszorg (jgz) en andere professionals voor de zeer te vroeg geboren kinderen (< 32 zwangerschapsweken), en het signaleren van mogelijke later ontstane gezondheidsproblemen bij de matig vroeg geboren kinderen (na 32-37 zwangerschapsweken). De multidisciplinair ontwikkelde en evidencebased jgz- richtlijn ‘Te vroeg en/of small for gestational age (SGA) geboren kinderen’ is relevant voor alle professionals betrokken bij de zorg voor deze groep kinderen. De belangrijkste aanbevelingen zijn: (a) tijdig en volledig overdragen van gegevens na ontslag uit ziekenhuis, (b) gestructureerde gegevensuitwisseling bij gedeelde nazorg, (c) aanwijzen van een casemanager per kind, (d) corrigeren van de testleeftijd voor de mate van vroeggeboorte bij ontwikkelingsonderzoek, en (e) mogelijkheid van gebruik van speciale curves en normen voor vroeggeboren kinderen bij het beoordelen van de groei en ontwikkeling.

This review describes adverse outcomes in pregnancy after brief, intermittent, or permanent residence at high altitudes. Review of literature shows that congenital malformations rates are higher at high altitudes. Additionally, rates of stillbirths, small size for gestational age, and preeclampsia are increased in populations living at high altitudes and are associated with high maternal hemoglobin levels (>14.5 g/dl). In conclusion, a pregnant woman exposed briefly, intermittently, or permanently to high altitudes results in increased risk of adverse outcomes when compared to pregnancies observed at sea level. Esta revisión describe los procesos asociados con mantener un embarazo en mujeres nacidas al nivel del mar que cursan su embarazo en la altura; en aquellas que viajan intermitentemente, o las que nacen y residen en la altura. La literatura examinada demuestra que la frecuencia de malformaciones congénitas es elevada en la altura; que las tasas de mortalidad fetal tardía, nacidos pequeños para su edad gestacional, y preeclampsia se encuentran incrementadas en la altura, asociadas a valores altos de hemoglobina materna (>14,5 g/dL). En conclusión, el embarazo en una mujer expuesta de forma aguda, intermitente o permanente a las grandes alturas, genera mayores riesgos en comparación con un embarazo desarrollado a nivel del mar.

This review analyzes the importance of hemoglobin levels in pregnant women and its implications in pregnancy. It discuss the use of biomass fuel for cooking and the impact on birthweight, maternal hemoglobin levels and the risk of late fetal death, pre-term delivery, and small for gestational age. Furthermore, the need to correct the cutoff points of hemoglobin level to define anemia at high altitudes is addressed. Current evidence suggests that corrections should not be made and iron supplements should be given to pregnant mothers with moderate or severe anemia. It is discussed whether iron supplementation should change its target population from pregnant women to infants aged 6 to 36 months. Esta revisión analiza la importancia del valor de la hemoglobina en la gestante, y su implicancia sobre el embarazo. Discute el uso de combustible de biomasa y la repercusión en el peso del recién nacido, los valores de hemoglobina materna y el riesgo de muerte fetal tardía, parto pretérmino y nacer pequeño para la edad gestacional. Asimismo, se aborda la necesidad de corregir el punto de corte de los valores de hemoglobina para definir anemia en la altura. La evidencia actual sugiere no corregirla, así también, la suplementación de hierro a las gestantes debería ser dirigida a los casos de anemia moderada o severa. Se discute si se debería reorientar la suplementación de hierro a niños de 6 a menos de 36 meses de edad.

The aim of the present study was to describe socioeconomic inequalities in low birth weight (LBW), premature birth (PM) and small size for gestational age at birth (SGA) between 2000 and 2005 in Barcelona, Spain, jointly evaluating the effect of mother's country of origin, and neighborhood of residence socioeconomic level measured using unemployment and educational level. We performed a cross-sectional study of births to mothers aged 12-49 years who were residents in the city of Barcelona in 2000-2005, analyzing adverse pregnancy outcomes (n=61,676). Weighted multilevel logistic regression models were fitted with individual data on level 1 and neighborhood data on level 2, to obtain adjusted odds ratios (aOR) with 95% confidence intervals and residual variance. Individually, pregnancy outcomes are more favorable in births to older mothers and to mothers from Maghrib and Central and South America than from developed countries (including Spain) or from other developing countries. After adjusting for individual variables, poor pregnancy outcomes were associated with poor neighborhoods (more unemployment was associated to LBW: aOR =1.56; PM aOR = 1.51; SGA aOR =1.66). The same trend was observed for associations with illiteracy rate. The present study shows that there are socioeconomic inequalities in adverse pregnancy outcomes in the city of Barcelona. One of the main challenges in perinatal health continues to be the reduction of adverse pregnancy outcomes in the city. © 2011 The New York Academy of Medicine.

Objective: To identify associations of maternal hemoglobin (Hb) with perinatal outcomes at low and moderate altitudes in Peru. Methods: Study of records with sequential information using perinatal database system. The study included 295 651 pregnant women with their products. Using multiple logistic regression analysis, we estimated the probability of stillbirths, preterm and small for gestational age (SGA) births associated with maternal Hb levels at low (01999 m) and moderate altitudes (20002999 m). Results: Maternal Hb decreased as pregnancy progressed from first to third trimester at both altitudes. Hb was higher at moderate than at low altitude (p

Objective: Many obstetric interventions are performed to improve long-term neonatal outcome. However, long-term neonatal outcome is usually not a primary outcome because it is time-consuming and expensive. The aim of this project was to identify different perinatal risk indicators and to develop prediction models for neurologic morbidity at 2 and 5 years of age. Study design: Data from a Dutch cohort study of preterm and small-for-gestational-age infants was used. Neonates who were born in The Netherlands in 1983 with a gestational age of

The GH receptor (GHR) plays a key role in the the function of the GH/IGF-I axis and is the major effector of human growth. A common polymorphic variant consisting of genomic exon 3 deletion or retention (d3-GHR and full-length GHR, respectively), described in 2000, has been linked with increased receptor activity due to enhanced signal transduction. Subsequent pharmacogenetic studies have addressed a possible role of GHR polymorphism on the response to recombinant human GH treatment first in short children and then in adults, many of them suggesting that growth response to GH may be influenced, at least in some aspects, by this polymorphism. Similar studies, performed in patients with acromegaly, assumed an influence of the d3- GHR variant in the relationship between GH and IGF-I levels. More recently, some studies have investigated the relation between GHR genotype and treatment with the GHR antagonist pegvisomant, suggesting a better clinical response to therapy related to d3-GHR genotype. This review provides a summary of the main pharmacogenetic studies performed on this current and still open topic.

Objective: Many obstetric interventions are performed to improve long-term neonatal outcome. However, long-term neonatal outcome is usually not a primary outcome because it is time-consuming and expensive. The aim of this project was to identify different perinatal risk indicators and to develop prediction models for neurologic morbidity at 2 and 5 years of age. Study design: Data from a Dutch cohort study of preterm and small-for-gestational-age infants was used. Neonates who were born in The Netherlands in 1983 with a gestational age of

Small for gestational age (SGA) infants are defined as babies having a birth weight below the 10th percentile for gestational age. A great number of studies have shown that children with SGA have an increased risk of impaired neurodevelopment. Electroencephalography (EEG) is an excellent method for measuring brain maturation in newborns. In this study, the effect of SGA on the maturation of cerebrocortical electrographic activity was investigated by the EEG and also analyzed with power spectral analysis. Serial EEGs were performed in 40 term SGAs, and 20 term appropriate for gestational age (AGA) infants in 1st week, 1st and 3rd month. Power spectral analysis was performed quantitatively in five channels (Fp1-C3, C3-O1, Fp2-C4, C4-O2, and Cz-C4 channels). Amplitude levels of the SGA group were significantly lower than the AGA group in all records. Delta frequency was the major frequency component in the groups. Delta frequency activities in the midline vertex region were decreased in the AGA group with increasing postconceptual age while the activities of the SGA group were increased. Contrarily, beta frequency activities in the midline vertex region were increased in the AGA group with increasing postconceptual age while these activities of the SGA group were decreased. Theta frequency activities in the fronto-central regions were lower in the SGA group. In terms of the vertex, k-complex, and sleep spindle, there was no difference between the two groups. We conclude that cerebrocortical electrophysiological maturation has been delayed in term SGA infants during the first three months of postnatal life. © 2009 Elsevier B.V.

Background: As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods: Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC - Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem) between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG) is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results: Twenty four percent of children older than 3 years were inappropriately referred (NCR). Of the correctly referred children 74-88% were short corrected for parental height, 40-61% had a height SDS

The goal of the Dialysis Outcomes in Colombia (DOC) study was to compare the survival of patients on hemodialysis (HD) vs peritoneal dialysis (PD) in a network of renal units in Colombia. The DOC study examined a historical cohort of incident patients starting dialysis therapy between 1 January 2001 and 1 December 2003 and followed until 1 December 2005, measuring demographic, socioeconomic, and clinical variables. Only patients older than 18 years were included. As-treated and intention-to-treat statistical analyses were performed using the Kaplan-Meier method and Cox proportional hazard model. There were 1094 eligible patients in total and 923 were actually enrolled: 47.3% started HD therapy and 52.7% started PD therapy. Of the patients studied, 751 (81.3%) remained in their initial therapy until the end of the follow-up period, death, or censorship. Age, sex, weight, height, body mass index, creatinine, calcium, and Subjective Global Assessment (SGA) variables did not show statistically significant differences between the two treatment groups. Diabetes, socioeconomic level, educational level, phosphorus, Charlson Co-morbidity Index, and cardiovascular history did show a difference, and were less favorable for patients on PD. Residual renal function was greater for PD patients. Also, there were differences in the median survival time between groups: 27.2 months for PD vs 23.1 months for HD (P less than 0.001) by the intention-to-treat approach; and 24.5 months for PD vs 16.7 months for HD (P less than 0.001) by the as-treated approach. When performing univariate Cox analyses using the intention-to-treat approach, associations were with age ?65 years (hazard ratio (HR)=2.21; confidence interval (CI) 95% (1.77-2.755); P less than 0.001); history of cardiovascular disease (HR=1.96; CI 95% (1.58-2.90); P less than 0.001); diabetes (HR=2.34; CI 95% (1.88-2.90); P less than 0.001); and SGA (mild or moderate-severe malnutrition) (HR=1.47; CI 95% (1.17-1.79); P=0.001); but no association was found with gender (HR=1.03, CI 95% 0.83-1.27; P=0.786). Similar results were found with the as-treated approach, with additional associations found with Charlson Index (0-2) (HR=0.29; Cl 95% (0.22-0.38); P less than 0.001); Charlson Index (3-4) (HR=0.61; Cl 95% (0.48-0.79); P less than 0.001); and SGA (mild-severe malnutrition) (HR=1.43; Cl 95% (1.15-1.77); P less than 0.001). Similarly, the multivariate Cox model was run with the variables that had shown association in previous analyses, and it was found that the variables explaining the survival of patients with end-stage renal disease in our study were age, SGA, Charlson Comorbidity Index 5 and above, diabetes, healthcare regimes I and II, and socioeconomic level 2. The results of Cox proportional risk model in both the as-treated and intention-to-treat analyses showed that there were no statistically significant differences in survival of PD and HD patients: intention-to-treat HD/PD (HR 1.127; CI 95%: 0.855-1.484) and as-treated HD/PD (HR 1.231; CI 95%: 0.976-1.553). In this historical cohort of incident patients, there was a trend, although not statistically significant, for a higher (12.7%) adjusted mortality risk associated with HD when compared to PD, even though the PD patients were poorer, were more likely to be diabetic, and had higher co-morbidity scores than the HD patients. The variables that most influenced survival were age, diabetes, comorbidity, healthcare regime, socioeconomic level, nutrition, and education. © 2008 International Society of Nephrology.

Background As abnormal growth might be the first manifestation of undetected diseases, it is important to have accurate referral criteria and a proper diagnostic work-up. In the present paper we evaluate the diagnostic work-up in secondary health care according to existing consensus guidelines and study the frequency of underlying medical disorders. Methods Data on growth and additional diagnostic procedures were collected from medical records of new patients referred for short stature to the outpatient clinics of the general paediatric departments of two hospitals (Erasmus MC – Sophia Children's Hospital, Rotterdam and Spaarne Hospital, Haarlem) between January 1998 and December 2002. As the Dutch Consensus Guideline (DCG) is the only guideline addressing referral criteria as well as diagnostic work-up, the analyses were based on its seven auxological referral criteria to determine the characteristics of children who are incorrectly referred and the adequacy of workup of those who are referred. Results Twenty four percent of children older than 3 years were inappropriately referred (NCR). Of the correctly referred children 74–88% were short corrected for parental height, 40–61% had a height SDS Conclusion Existing guidelines for workup of children with suspected growth failure are poorly implemented. Although poorly implemented the DCG detects at least 5% pathologic causes of growth failure in children referred for short stature. New guidelines for referral are required with a better sensitivity and specificity, wherein distance to target height should get more attention. The general diagnostic work up for short stature should include testing for celiac disease in all children and for Turner syndrome in girls.

Objective: Low birth weight remains a major cause of morbidity and mortality in early infancy and childhood. It is associated with an increased risk of health problems later in life, particularly coronary heart disease and stroke. A meeting was convened to identify the key health issues facing a child born small for gestational age (SGA) and to propose management strategies. Participants: There were 42 participants chosen for their expertise in obstetrics, peri- and neonatal medicine, pediatrics, pediatric and adult endocrinology, epidemiology, and pharmacology. Evidence: Written materials were exchanged, reviewed, revised, and then made available to all. This formed the basis for discussions at the meeting. Where published data were not available or adequate, discussion was based on expert clinical opinions. Consensus Process: Each set of questions was considered by all and then discussed in plenary sessions with consensus and unresolved issues identified. The consensus statement was prepared in plenary sessions and then edited by the group chairs and shared with all participants. Conclusions: The diagnosis of SGA should be based on accurate anthropometry at birth including weight, length, and head circumference. We recommend early surveillance in a growth clinic for those without catch-up. Early neurodevelopment evaluation and interventions are warranted in at-risk children. Endocrine and metabolic disturbances in the SGA child are recognized but infrequent. For the 10% who lack catch-up, GH treatment can increase linear growth. Early intervention with GH for those with severe growth retardation (height sd score

OBJETIVO: Fornecer informações para pediatras e neonatologistas quanto à expectativa real da evolução destas crianças e, assim, auxiliar no planejamento de sua atuação. FONTES DOS DADOS: Pesquisa bibliográfica nas bases de dados da Cochrane Library, MEDLINE e Lilacs. SÍNTESE DOS DADOS: Para avaliação do crescimento e desenvolvimento nos primeiros 2-3 anos, deve-se corrigir a idade cronológica em função do grau de prematuridade. Prematuros pequenos para a idade gestacional e os com displasia broncopulmonar despertam maior preocupação quanto a seu prognóstico. Especial atenção deve ser dada à adequação da nutrição do prematuro de extremo baixo peso nos primeiros anos; estes prematuros geralmente evoluem com falha no catch-up, elevada morbidade e necessidade de reinternação nos primeiros 2 anos de vida. São crianças menores e mais leves no início da infância, mas podem apresentar catch-up tardio, entre 8-14 anos. Crianças nascidas de extremo baixo peso são de alto risco para anormalidades neurológicas e atraso no desenvolvimento nos primeiros anos de vida. Na idade escolar, são freqüentes os problemas educacionais, comportamentais e psicológicos. Adolescentes e adultos nascidos de extremo baixo peso ainda persistem com alguma diferença em seu desempenho, mas sua integração social não é prejudicada. CONCLUSÕES: O crescimento e desenvolvimento de todos os prematuros de extremo baixo peso devem ser cuidadosamente monitorizados após a alta hospitalar, para garantir que estas crianças e suas famílias recebam adequado suporte e intervenção, a fim de otimizar seu prognóstico. OBJETIVE: To provide information for pediatricians and neonatologists to create realistic outcome expectations and thus help plan their actions. DATA SOURCES: Searches were made of the Cochrane Library, MEDLINE, and Lilacs databases. SUMMARY OF FINDINGS: The assessment of growth and development over the first 2-3 years must adjust chronological age with respect of the degree of prematurity. There is special concern regarding the prognoses of small for gestational age preterm infants, and for those with bronchopulmonary dysplasia. Attention must be directed towards improving the nutrition of extremely low birth weight infants during their first years of life; these infants have high prevalence levels of failure to catch-up on growth, diseases and rehospitalizations during their first 2 years. They are frequently underweight and shorter than expected during early childhood, but delayed catch-up growth may occur between 8 and 14 years. Extremely low birth weight infants are at increased risk of neurological abnormalities and developmental delays during their first years of life. Educational, psychological, and behavioral problems are frequent during school years. Teenage and adult outcomes show that although some performance differences persist, social integration is not impaired. CONCLUSIONS: The growth and neurodevelopment of all ELBW infants must be carefully monitored after discharge, to ensure that children and their families receive adequate support and intervention to optimize prognoses.

Aim: To assess whether attrition rate influences outcome in the follow-up of very preterm infants. Study design: In a national follow-up study of infants born alive in 1983 in the Netherlands with a gestational age less than 32 weeks and/or a birth weight less than 1500 g, outcome was assessed separately for adolescents who responded early or late to a follow-up invitation at age 14 years. Neonatal data and outcome results of earlier assessments from early and late responders were compared to those of non-responders by univariate and nominal (polytomous logistic) regression analysis. Subjects: There were 723 (76%) early responders, 130 (14%) late responders and 109 (11%) non-responders. Results: We found significantly more non-Dutch origin and more disabilities and school problems at age 10 years in late- and especially in non-responders. At age 14 years, the health utility index was significantly lower in late responders compared to early responders. School outcome did not show difference in relation to the response groups. Conclusion: The results suggest that the incidence of adverse outcome in very preterm infants is underestimated when follow-up is incomplete and hence response rate is not a negligible problem in the assessment of late outcome. Therefore, follow-up studies should include a drop-out analysis to enable comparison to other studies.

Aim: To assess whether attrition rate influences outcome in the follow-up of very preterm infants. Study design: In a national follow-up study of infants born alive in 1983 in the Netherlands with a gestational age less than 32 weeks and/or a birth weight less than 1500 g, outcome was assessed separately for adolescents who responded early or late to a follow-up invitation at age 14 years. Neonatal data and outcome results of earlier assessments from early and late responders were compared to those of non-responders by univariate and nominal (polytomous logistic) regression analysis. Subjects: There were 723 (76%) early responders, 130 (14%) late responders and 109 (11%) non-responders. Results: We found significantly more non-Dutch origin and more disabilities and school problems at age 10 years in late- and especially in non-responders. At age 14 years, the health utility index was significantly lower in late responders compared to early responders. School outcome did not show difference in relation to the response groups. Conclusion: The results suggest that the incidence of adverse outcome in very preterm infants is underestimated when follow-up is incomplete and hence response rate is not a negligible problem in the assessment of late outcome. Therefore, follow-up studies should include a drop-out analysis to enable comparison to other studies.

Background: Improved survival due to advances in neonatal care has brought issues such as postnatal growth and development more to the focus of our attention. Most studies report stunting in children born very preterm and/or small for gestational age. In this article we study the growth pattern of these children and aim to identify factors associated with postnatal catch-up growth. Methods: 1338 children born with a gestational age

Objective. To assess the effect of demographic and neonatal risk factors and outcome at the last available assessment on the probability of full responders, postal responders (those who only responded to the mailed questionnaire), or nonresponders in a follow-up study of 19-year-old adolescents who were born as preterm infants. Design. The 19-year follow-up program was part of a large ongoing collaborative study in the Netherlands on the long-term effect of prematurity and dysmaturity on various medical, psychological, and social parameters. In the original cohort, 1338 infants (94%) with a gestational age of

Background: Improved survival due to advances in neonatal care has brought issues such as postnatal growth and development more to the focus of our attention. Most studies report stunting in children born very preterm and/or small for gestational age. In this article we study the growth pattern of these children and aim to identify factors associated with postnatal catch-up growth. Methods: 1338 children born with a gestational age

Adiponectin is an adipocytokine with insulin-sensitizing and antiatherogenic properties. Reduced concentrations of adiponectin precede the onset of type 2 diabetes and the development of atherosclerosis. Our aim was to quantify adiponectin concentrations in small for gestational age (SGA) children. Fifty-one SGA children, 24 obese, and 17 short-normal children with birth weight appropriate for gestational age (short-AGA) were studied. The statures of the SGA children were corrected for their midparental height and subdivided into two groups according to their corrected height: catch-up growth group, children with corrected height of 0 z-score or greater (n = 17); and noncatch-up growth group, subjects with corrected height less than 0 z-score (n = 34). SGA children showed adiponectin levels significantly lower than short- normal children (35.2 +/- 3.5 vs. 80.4 +/- 26.6 micro g/ml; P < 0.0001) and obese children (77.5 +/- 39.4 micro g/ml; P < 0.0001). Catch-up growth children showed adiponectin levels significantly lower than noncatch-up growth subjects (29.4 +/- 10.3 vs. 38.1 +/- 11.5 micro g/ml; P = 0.01). Adiponectin concentrations were inversely related to height z-score, corrected stature, weight, and body mass index and were positively related to birth weight. Our results suggest that adiponectin levels are reduced in SGA children and are even lower in those with postnatal catch-up growth. Whether this finding implies a higher risk of developing type 2 diabetes and atherosclerosis remains to be established.

Objective: To investigate the relationship between parameters of diastolic function, loading conditions and remodeling of the left ventricle in the appropriate-for-gestational age and small-for-gestational age fetus. Methods: Two-dimensional echocardiographic left ventricular images were digitized in 24 appropriate-for-gestational age and 14 small-for-gestational age fetuses. The maximal short axis and long axis were measured. The left ventricular contour was divided into 12 segments. The changes in whole left ventricular cavity area were calculated for ventricular global area change assessment. The coefficient of variation for segmental fractional area change was calculated for the evaluation of left ventricular regional wall motion nonuniformity. Results: Mean left ventricular long axis/short axis ratio in the small-for-gestational age fetus (1.11 ± 0.08) was smaller (P < 0.01) than in the appropriate-for-gestational age fetus (1.75 ± 0.26). Mean fractional area change in the small-for-gestational age fetus was larger (P < 0.01) than in the appropriate-for-gestational age fetus (37.8 ± 17.6% vs. 21.1 ± 9.9%). Mean left ventricular global area change in the small-for-gestational age fetus was smaller (P < 0.05) than in the appropriate-for-gestational age fetus (53.2 ± 7.4% vs. 61.5 ± 10.3%). Mean ventricular isovolumic relaxation time in the appropriate-for-gestational age fetus was shorter (P = 0.03) than in the small-for-gestational age fetus (37 ± 6 ms vs. 57 ± 9 ms). Mean transmitral E-wave/A-wave ratio in the small-for-gestational age fetus was smaller (P < 0.01) than in the appropriate-for-gestational age fetus (0.69 ± 0.08 vs. 0.80 ± 0.08). A negative correlation (P < 0.05) was demonstrated between: (i) fractional area change and global area change in both small-for-gestational age (r = -0.62) and appropriate-for-gestational age fetuses (r = -0.58); (ii) umbilical artery systolic/diastolic ratio and transmitral E-wave/A-wave ratio in both appropriate-for-gestational age (r = -0.58) and small-for-gestational age (r = -0.60) fetuses. A positive correlation existed between fractional area change and isovolumic relaxation time in the small-for-gestational age fetus (r = +0.72; P < 0.01). Conclusions: The changes in ventricular shape, wall motion, spatial non-uniformity and diastolic function in the small-for-gestational age fetus could be considered as adaptive changes, known as ventricular remodeling. It is proposed that the leading cause of ventricular remodeling in the small-for-gestational age fetus is chronic pressure overload due to increased placental vascular resistance. P. Tsyvian is a recipient of a research fellowship from the Dutch Research Council (NWO), Grant (047-003-038).

In een samenwerkingsproject van de Nederlandse kinderartsen werden in 1983 perinatale gegevens bijeengebracht over 1338 kinderen, levend geboren na een zwangerschap van minder dan 32 weken en/of met een geboortegewicht onder 1500 g (‘Project on preterm and small for gestational age infants’, POPS). Hun toestand werd onderzocht na 2 jaar door hun kinderartsen, na 5 jaar door een team van onderzoekers en na 9, 10-11 en 14 jaar door middel van een vragenlijst ingevuld door ouders, leerkrachten en de kinderen zelf. Uit deze 14 jaar naonderzoek bleek dat een gering percentage van deze kinderen (10) een ernstige handicap of beperking had op de schoolleeftijd. Hoewel dus 90 op die leeftijd geen ernstige beperkingen had, ondervond de helft van hen aanzienlijke problemen in het dagelijkse leven. Lichte ontwikkelingsstoornissen en gedrags- en leerstoornissen namen toe naarmate deze kinderen ouder werden. Dergelijke stoornissen kunnen zelfstandig functioneren op volwassen leeftijd ernstig belemmeren. Afwijkingen vastgesteld tijdens gestandaardiseerd neurologisch onderzoek op jonge leeftijd hebben een hoge voorspellende waarde voor deze latere problemen. Vroege signalering van ontwikkelingsstoornissen bij te vroeg geboren kinderen en het vroeg starten van gerichte interventies zouden een belangrijk instrument kunnen zijn om de late gevolgen te beperken.

In een samenwerkingsproject van de Nederlandse kinderartsen werden in 1983 perinatale gegevens bijeengebracht over 1338 kinderen, levend geboren na een zwangerschap van minder dan 32 weken en/of met een geboortegewicht onder 1500 g (‘Project on preterm and small for gestational age infants’, POPS). Hun toestand werd onderzocht na 2 jaar door hun kinderartsen, na 5 jaar door een team van onderzoekers en na 9, 10-11 en 14 jaar door middel van een vragenlijst ingevuld door ouders, leerkrachten en de kinderen zelf. Uit deze 14 jaar naonderzoek bleek dat een gering percentage van deze kinderen (10) een ernstige handicap of beperking had op de schoolleeftijd. Hoewel dus 90 op die leeftijd geen ernstige beperkingen had, ondervond de helft van hen aanzienlijke problemen in het dagelijkse leven. Lichte ontwikkelingsstoornissen en gedrags- en leerstoornissen namen toe naarmate deze kinderen ouder werden. Dergelijke stoornissen kunnen zelfstandig functioneren op volwassen leeftijd ernstig belemmeren. Afwijkingen vastgesteld tijdens gestandaardiseerd neurologisch onderzoek op jonge leeftijd hebben een hoge voorspellende waarde voor deze latere problemen. Vroege signalering van ontwikkelingsstoornissen bij te vroeg geboren kinderen en het vroeg starten van gerichte interventies zouden een belangrijk instrument kunnen zijn om de late gevolgen te beperken.

The levels of lipid peroxidation in sera of asymmetric small-for-gestational-age (SGA) babies at the second hour of fife were investigated. Lipid peroxidation levels, measured as malondialdehyde (MDA), were 3.3 +/- 1.1 and 3.9 +/- 1.2 mmol/L in SGA and appropriate-for-gestational age (AGA) groups, respectively. The difference was not significant (p >0.05). This result may indicate that free radical scavengers are sufficient in SGA babies.

The concentration of serum ferritin reflects the extent of iron stores in premature infants. We aimed to determine serum ferritin levels and iron status in asymmetric small for gestational age (SGA) babies. This study was performed on 21 SGA babies and 19 appropriate for gestational age (AGA) babies. Hemoglobin, iron, iron binding capacity and ferritin levels were inevestigated in the first six hours after the birth. Hemoglobin levels in the SGA and control groups were 20.9 ± 1.3 (19.4-23.4 g/dl) and 19.6 ± 0.8 (18.5-21.5 g/dl), respectively (p = 0.001). Serum ferritin levels in the SGA and AGA groups were 58.36 ± 20.1 ng/ml and 90.46 ± 30.5 ng/ml, respectively. Ferritin levels were found lower in the SGA group (p < 0.001). In the SGA group, decreased serum iron and increased iron binding capacity were found but the difference was not significant (p > 0.05). Decreased ferritin levels may result from either impaired iron transport associated with uteroplacental vascular insufficiency or increased iron utilization during enhanced erythropoiesis in conditions characterized by chronic fetal hypoxia. Our results stress the significance of iron supplementation and careful anemia follow-up in term SGA babies. Because anemia progress early, beginning iron therapy as soon as possible is a necessity in SGA babies as in prematures.

Background. The validity of the results of studies using retrospectively collected information on exposures is often criticized, because cases may report differently from controls even if their true exposure status is the same. This study was performed to quantify the extent to which this effect (differential misclassification) may occur for alcohol and cigarette consumption by pregnancy outcome. Methods. Prospective as well as retrospective information on alcohol and cigarette consumption was collected for 2806 mothers resident in all 12 provinces of the Netherlands, who gave birth between 1978 and 1979. Changes in mean reported consumption and changes from user to non-user based on retrospective and prospective information were compared for cases and controls. This was done by calculating absolute differences (retrospective minus prospective) in reported consumption and by calculating 'misclassification odds ratios'. Further, conventional odds ratios based on retrospective information were compared with those based on prospective information. Outcome measures were stillbirth, small for gestational age (SGA), congenital malformations, preterm birth and low birthweight. Results. The only statistically significant result was found for smoking and SGA. Mothers with an SGA child retrospectively reported a higher number of cigarettes smoked than they had prospectively, more so than mothers of a control child. However, the odds ratios of the relation between SGA and smoking based on prospective and retrospective information, respectively, were virtually the same. Conclusions. Our results suggest that information bias is unlikely to have a large influence on effect estimates in studies using retrospective information on alcohol and cigarette consumption. Chemicals/CAS: alcohol, 64-17-5

Background. The validity of the results of studies using retrospectively collected information on exposures is often criticized, because cases may report differently from controls even if their true exposure status is the same. This study was performed to quantify the extent to which this effect (differential misclassification) may occur for alcohol and cigarette consumption by pregnancy outcome. Methods. Prospective as well as retrospective information on alcohol and cigarette consumption was collected for 2806 mothers resident in all 12 provinces of the Netherlands, who gave birth between 1978 and 1979. Changes in mean reported consumption and changes from user to non-user based on retrospective and prospective information were compared for cases and controls. This was done by calculating absolute differences (retrospective minus prospective) in reported consumption and by calculating 'misclassification odds ratios'. Further, conventional odds ratios based on retrospective information were compared with those based on prospective information. Outcome measures were stillbirth, small for gestational age (SGA), congenital malformations, preterm birth and low birthweight. Results. The only statistically significant result was found for smoking and SGA. Mothers with an SGA child retrospectively reported a higher number of cigarettes smoked than they had prospectively, more so than mothers of a control child. However, the odds ratios of the relation between SGA and smoking based on prospective and retrospective information, respectively, were virtually the same. Conclusions. Our results suggest that information bias is unlikely to have a large influence on effect estimates in studies using retrospective information on alcohol and cigarette consumption. Chemicals/CAS: alcohol, 64-17-5

To assess the impact of both perinatal disorders and developmental problems identified at preschool age on school performance, we followed a virtually complete birth cohort of very premature (