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In order to assess the extent to which children in the United Kingdom (UK) will follow the UK-WHO head circumference standard, we used head circumference data from the Southampton Women’s Survey (SWS; n=3159) and the Avon Longitudinal Study of Parents and Children (ALSPAC; n=15,208) in children age 0-36 months, converted into z-scores using both the UK-WHO or UK1990 references. Rapid head growth was defined as crossing upwards through 2 major centile bands (1.33 SD). The UK-WHO standard identified many more infants with heads above the 98th centile compared to the UK1990 reference (UK-WHO 6% to 16% of infants at various ages, UK1990 1% to 4%). Rapid head growth in the first 6 to 9 months was also much more common using the UK-WHO standard (UK-WHO: 14.6% to 15.3%; UK1990: 4.8% to 5.1%). Practitioners should be aware of these findings to avoid unnecessary referrals.

Background Postnatal head growth failure is well recognised in very preterm infants (VPI), the largest deficit occurs at 3–4 weeks followed by some catch-up growth until 36weeks corrected gestational age (36wCGA). Head circumference (HC) is correlated with brain volume and later neurodevelopmental outcome. Early nutritional deficits commonly occur in parenteral nutrition (PN) dependent VPI. We hypothesised that a Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen would improve early head growth. Aim To compare the change in HC (ΔHC) and standard deviation score (ΔSDS) achieved at day 28 in VPI randomised to receive SCAMP nutrition (12% glucose, 3.8g/kg/day protein/lipid) or a control standardised, concentrated PN regimen (10% glucose, 2.8g/kg/day protein/lipid). Methods The double-blind study (ISRCTN: 76597892) received ethical approval. Control PN was started within 6 hours of birth. Following parental consent, VPI ( Results 150/196 eligible infants were randomised at mean age 73.5 hours. Mean (SD) birthweight (g) and gestation (weeks) was: 900(158) versus 884(183) and 26.8(1.3) versus 26.6(1.4) in SCAMP (n = 74) and control (n = 76) groups respectively. SCAMP achieved higher mean actual protein/energy intakes (calculated weekly) with largest difference occurring in week 2: 25.5g/kg versus 20.9g/kg and; 762kcal/kg versus 664kcal/kg. Differences in ΔHC are already apparent at day 7 (p Conclusion Early postnatal head growth failure in VPI can be prevented by optimising PN.

Background The Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen is a method of hyperalimentation shown to improve early head growth in very preterm infants. Early hyperalimentation is associated with marked hyperglycaemia. Increasing early protein intake reduces the risk of insulin-treated hyperglycaemia. We hypothesised that increasing carbohydrate and protein intake simultaneously using the SCAMP regimen would not result in more insulin-treated hyperglycaemia. Methods Control parenteral nutrition (PN) was started within 6 h birth and infants ( Results Infants were randomised (d 2 –5) to SCAMP (n = 74) and control (n = 76) groups. In 14-day-survivors (Table 1), SCAMP (n = 68) achieved higher mean actual protein/carbohydrate intakes than control (n = 72) from day 3–4. This was not associated with a difference in MBG or insulin use. Conclusion The SCAMP regimen did not result in the major disturbances in blood glucose control previously described with hyperalimentation. We propose this is partly explained by differences in early protein intake.

Background The Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen is a method of hyperalimentation shown to improve early head growth in very preterm infants. 1 Early hyperalimentation has been associated with potassium/phosphate deficits. 2 The SCAMP regimen uses standardised supplementary electrolyte infusions to immediately correct deficits. We hypothesised that the SCAMP regimen (30% more protein/energy) would require more potassium/phosphate supplementation (Ksupp/Psupp) than a control regimen with the same electrolyte content. Methods Control parenteral nutrition (PN) was started within 6 h birth and infants ( Results Infants were randomised (d2–5) to SCAMP (n = 74) and control (n = 76) groups. Maximum differences in protein/energy intakes were achieved day 5–8. These were associated with increased Ksupp/Psupp requirements in SCAMP infants (Table 1). Despite higher mean potassium/phosphate intakes in SCAMP infants (d5–8), mean (sd) plasma levels (mmol/l) were lower (ns): potassium: 4.38 (0.81) versus 4.53 (0.81); phosphate: 1.55 (0.21) versus 1.62 (0.29). Conclusion Hyperalimentation using the SCAMP regimen resulted in increased potassium/phosphate requirements. This has implications for standardised PN bag composition. References Morgan C, McGowan P, Herwitker S, et al . Pediatrics 2014;133:e620–8 Moltu SJ, Strommen K, Blakstad EW, et al . Clin Nutr 2013;37;207–12

Background The Standardised, Concentrated with Added Macronutrients Parenteral (SCAMP) nutrition regimen is a method of hyperalimentation shown to improve early head growth in very preterm infants.1 Early hyperalimentation is associated with marked hyperglycaemia.2 Increasing early protein intake reduces the risk of insulin-treated hyperglycaemia.3 We hypothesised that increasing both carbohydrate and protein intake simultaneously using the SCAMP regimen would not result in more insulin-treated hyperglycaemia. Methods Control parenteral nutrition (PN) was started within 6 h birth and infants ( Results Infants were randomised (d2–5) to SCAMP (n = 74) and control (n = 76) groups. SCAMP achieved higher mean actual protein/carbohydrate intakes from day 3–4. This was not associated with a difference in MBG or insulin use (Table 1). Conclusion The SCAMP regimen did not result in the major disturbances in blood glucose control previously described with hyperalimentation. We propose this is partly explained by differences in early protein intake. References Morgan C, McGowan P, Herwitker S, et al. Pediatrics 2014;133:e620–8 Tan M, Cooke RWI. Arch Dis Child Fetal Neonatal Ed 2008;93:F337–41 Mahaveer A, Grime C, Morgan C. Nutr Clin Pract 2012;27:399–405

Background Manual measurement of head circumference (HC) is used to quantify head growth in preterm infants. Laser shape digitizers offer semi-automatic HC measuring and additional information on head volume (HV). Reliability and accuracy in obtaining HC and HV in neonates has not been investigated yet. Aims 1. To determine intraobserver and interobserver variability of HC and HV measurements in neonates with a 3D digital capture system. 2. To compare the method with manual HC measurements. Methods Standard weekly HC measurements on a neonatal unit were conducted manually and digitally with STARScanner laser shape digitizer (Vorum Research Corp., Vancouver, BC) over 12 months. Method comparison was performed using Passing-Bablok-Regression (PBR), Cusum test and Bland-Altman (BA) analyses. Multiple scan examinations by different trained observers were performed to obtain intraobserver/interobserver data. Results 1. Intraobserver coefficient of variation was low for HC (0.1–0.9%) and HV (0.54–1.1%) . BA (mean percentage of difference M d ; 95% CI) of interobserver data showed interchangeability for HC ( M d –0.005; CI-0.39–0.39) and HV ( M d 1.51; CI –1.17–4.1). 2. 2. Method comparison data was acquired from 446 measurements in 258 infants (HC 318 ± 19.5mm). Overall agreement was good (M d –0.82; CI –4.89–3.24) , PBR showed no significant systematic or proportional differences (a = 1.03, CI 0.99–1.06; b = –7.06 CI –17.7–3.01) . There was no significant deviation from linearity (p = 0.62). Conclusions Infant head shape capturing with the examined device is reliable, accurate and save. It offers additional information on HV. Possible benefits of HV in quantifying head growth in preterm infants need to be further investigated.

Background Head circumference (HC) is measured in newborns to evaluate head growth. It is not known, whether HC is always an appropriate measure of head volume (HV). Digital capture of the neonatal head offers information on HC and HV. Aims To determine overall correlation of HC and HV and with regard to postmenstrual age (PMA) and with regard to the actual body weight (BW). Methods Head measurements with STARscanner laser shape digitizer (Vorum research Corp., Vancouver, BC) were performed in preterm infants prior to discharge over a 12 month period. Data on HC and HV were calculated with STARscanner Laser Data Acquisiton System (Orthomerica, Orlando, FL) and analyzed in different subgroups. Results Included were 243 neonates at time of discharge (mean HC 32.8 ± 1.9 cm, mean HV 356.7 ± 64.3 ml). a) There was an overall correlation between HC and HV (r = 0.90, R² = 0.81, p 0.001). Correlation between HC and HV was: b) in infants with a PMA (r = 0.71, R² = 0.52, p = 0.001) vs. PMA > 37 weeks (r=0.92, R² = 0.85, p 0.001) and c) in BW (r = 0.69, R² = 0.49, p = 0.04) vs. BW >2500g (r = 0.88, R² = 0.77, p 0.001). Conclusions Neonates with comparable HC can show very different HV, especially in infants with low PMA or BW. Thus additional measurement of HV enables to detect variable patterns of head growth and shape. Underlying causes and the meaning for neurological outcome need to be determined.

EDITOR, - Harvey Marcovitch's review of failure to thrive was flawed in its failure to define the term satisfactorily.1 In the wider sense failure to thrive can be defined as the failure of a child to fulfil his or her potential in terms of physical, social, and emotional growth and development. In the somatic sense, the term failure to thrive is usually applied to infants and preschool children to denote a failure to gain weight at an appropriate rate. In other words, the child is thin; typically, head growth is preserved relative to linear growth, and linear growth is preserved relative to body weight. By contrast, short stature simply means height below the third centile and makes no assumption about the normality or otherwise of the child. …