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BACKGROUND/OBJECTIVES: We analysed at what age parents start complementary food in very low birth weight infants, determined risk factors for early introduction of complementary food (post-term age) and analysed whether the age at introduction of complementary food influences height or weight at 2 years of age. SUBJECTS/METHODS: Parents of premature infants born in 2009-2011 answered questionnaires regarding introduction of complementary food in the first year of life (N =2262) and were followed up at a post-term age of 2 years (N =981). Length and weight were compared with full-term infants from the KiGGs study. Logistic and linear regression analyses were conducted to study predictors for early introduction of complementary food and the influence of age at introduction of complementary food on later height and weight. RESULTS: Average age at introduction of complementary food was 3.5 months post-term age. The lower the gestational age at birth, the earlier (post-term age) vegetables and meat were introduced. Age at introduction of complementary food was influenced by intrauterine growth restriction, gestational age at birth, maternal education and a developmental delay perceived by the parents. Length and weight at a post-term age of 2 years was not negatively influenced by early introduction of complementary food. CONCLUSIONS: VLBW infants are introduced to complementary food on average before a post-term age of 4 months. There was no negative effect of early introduction of complementary food on height and weight at 2 years of age. European Journal of Clinical Nutrition (2015) 69, 662-667; doi: 10.1038/ejcn.2015.54; published online 15 April 2015, INTRODUCTION The survival of very low birth weight infants (VLBW, birth weight < 1500 g) has been increasing over the last decades. Monitoring of body growth and development are important [...]

BACKGROUND/OBJECTIVES: Low birth weight (LBW) and rapid postnatal weight gain are associated with future high body adiposity; however, the cumulative effect of LBW and postnatal weight gain remains unclear. The aim of this study was to investigate the influence of body proportionality of LBW infants and postnatal weight gain on body mass index (BMI) and waist circumference (WC) of 8-year-old children. SUBJECTS/METHODS: A nested cross-sectional study was conducted in a cohort of children followed from birth to 6 months and reassessed at 8 years of age. The sample consisted of 167 children born at full term (67 with LBW and 100 with appropriate birth weight). Stunted LBW was defined as length < -2 z-score and wasted LBW as length ≥ -2 z-score and Ponderal Index < 2.5. Rapid growth was defined as weight gain greater than 0.67 s.d. score from birth to 6 months. Multivariate linear regression analysis was used to investigate the net effect of LBW and postnatal weight gain on BMI and WC, controlled for sex, total breastfeeding, socioeconomic status and maternal nutrition. RESULTS: The stunted and wasted LBW contributed significantly to the reduction of BMI and WC, and together explained 10% of the variation of these measurements. Rapid weight gain in the first 6 months of life, shorter total breastfeeding duration, higher socioeconomic status and maternal BMI significantly explained the increase in child BMI and WC. CONCLUSIONS: It was concluded that LBW led to lower body measurements, whereas rapid postnatal weight gain determined higher BMI and WC among school age children. European Journal of Clinical Nutrition (2014) 68, 876-881; doi: 10.1038/ejcn.2014.68; published online 30 April 2014, INTRODUCTION The increasing prevalence of overweight children has encouraged researchers to elucidate the mechanisms by which factors can lead to early changes in body measurements of children. Birth weight, as [...]

Epidemiological studies demonstrated a relationship between low birth weight mainly caused by intrauterine growth restriction (IUGR) and adult metabolic disorders. The concept of metabolic programming centers on the idea that nutritional and hormonal status during the key period of development determines the long-term control of energy balance by programming future feeding behavior and energy expenditure. The present study examined the consequence of early or late 'catch-up growth' after IUGR on feeding behavior and metabolic cues of male offspring of rat dams exposed to protein restriction during gestation and/or lactation. Our results suggest that early catch-up growth may be favorable for fasting metabolic parameters at weaning, as no differences were observed on plasma leptin, triglyceride, glucose, and insulin levels compared with controls. In contrast, if pups remained malnourished until weaning, low insulin concentration was detected and was accompanied by hyperphagia associated with a large increase in hypothalamic NPY and AgRP mRNA expression. At adult age, on a regular chow diet, only the meal structure was modified by fetal programming. The two IUGR groups demonstrated a reduced meal duration that enhanced the speed of food ingestion and consequently increased the rest period associated to the satiety state without changes in the hypothalamic expression of appetite neuropeptides. Our findings demonstrate that in IUGR, regardless of postnatal growth magnitude, metabolic programming occurred in utero and was responsible for both feeding behavior alteration and postprandial higher insulin level in adults. Additionally, catch-up growth immediately after early malnutrition could be a key point for the programming of postprandial hyperleptinemia. perinatal nutrition; appetite neuropeptides; hypothalamus; feeding behavior

The risk of developing many adult-onset diseases, including hypertension, type 2 diabetes, and renal disease, is increased in low-birth-weight individuals. A potential underlying mechanism contributing to the onset of these diseases is the formation of a low nephron endowment during development. Evidence from the human, as well as many experimental animal models, has shown a strong association between low birth weight and a reduced nephron endowment. However, other animal models, particularly those in which the mother is exposed to elevated glucocorticoids for a short period, have shown a 20-40% reduction in nephron endowment without discernible changes in the birth weight of offspring. Such findings emphasize that a low birth weight is one, but certainly not the only, predictor of nephron endowment and suggests reduced nephron endowment and risk of developing adult-onset disease, even among normal-birth-weight individuals. Recognition of the dissociation between birth weight and nephron endowment is important for future studies aimed at elucidating the role of a reduced nephron endowment in the developmental programming of adult disease. glucocorticoid exposure; kidney development; hypertension

BACKGROUND: Maternal exposure to wood fuel smoke may lead to impaired fetal growth due to hypoxia and or oxidative stress from smoke constituents such as carbon monoxide and particulate matter. OBJECTIVES: We studied the risk of low birth weight (LBW) and reduced mean birth weight in relation to reported use of wood for cooking during the prenatal period, compared with natural gas (NG). METHODS: We studied a historical cohort of women who had a singleton live birth in the years 2000-2002, from a semirural area of Pakistan. Infant&apos;s birth weight was obtained from records, and prenatal records had data for maternal body mass index and parity. Cooking habits, daytime sleep habits, and type of fuel used during the pregnancies in 2000-2002 were ascertained by a survey done in 2004-2005. We performed multiple linear and logistic regression modeling using propensity scores to adjust for confounding variables. RESULTS: Unadjusted mean ([+ or -] SD) birth weight was 2.78 [+ or -] 0.45 kg in wood users, and 2.84 [+ or -] 0.43 kg (p < 0.06) in NG users. Infants born to wood users averaged 82 g lighter than infants born to NG users when weight was adjusted for confounders (p < 0.07). The rate of LBW (< 2,500 g) was 22.7% among wood users compared with 15.0% in NG users (p < 0.01), for an adjusted relative risk of 1.64 (95% confidence interval, 1.10-2.34). The population attributable risk for LBW explained by wood use was estimated to be 24%. CONCLUSION: Cooking with wood fuel during pregnancy, a potentially modifiable exposure, was associated with LBW and marginally lower mean birth weight compared with using NG. KEY WORDS: birth weight, cooking habits, historical cohort, natural gas, pregnancy, propensity scores. Environ Health Perspect 116:543-549 (2008). doi:10.1289/ehp.10782 available via http://dx.doi.org/ [Online 15 January 2008], Low birth weight (LBW) is associated with high mortality and morbidity in infants (Ismail et al. 2003; Khan et al. 2005; Moss et al. 2002; Tripathy et al. 2002). LBW [...]

BACKGROUND. Children born extremely premature ( METHODS. We performed a follow-up study of 5319 children born between January 1990 and June 1992. We got the information on birth weight and gestational age from birth registration forms; when the children were between 9 and 11 years of age, we gathered information about their school performance (reading, spelling, and arithmetic) from questionnaires completed by the parents and the children&apos;s primary school teachers. RESULTS. The association between birth weight and reading, as well as spelling and arithmetic disabilities, showed a graded relationship, with children who weighed CONCLUSIONS. Gestational age and birth weight were associated with school performance in the 10-year-old child and the association extended into the reference range of both birth weight and gestational age. Key Words prematurity, low birth weight, learning disabilities Abbreviations IQ--intelligence quotient OR--odds ratio CI--confidence interval AOR--adjusted odds ratio, THE SURVIVAL RATES of extremely premature ( Most of our colleagues have focused primarily on children born with a very low birth weight ( A recent follow-up study with questionnaire [...]

Epidemiological studies suggest that infants of low birth weight show poor neonatal growth and increased susceptibility to adult diseases such as diabetes and lung disease. Uncoupling protein 2 and 3 (UCP2 and UCP3) have been implicated in the development of such diseases; pigs provide an ideal model to examine the influence of birth weight due to the natural variance in piglet weight within a litter. This study examined whether birth weight influences the expression of UCP2 and UCP3 in adipose tissue, skeletal muscle, and lung. Piglets from 11 litters were ranked according to birth weight and three from each litter assigned to small (SFD), normal (NFD), or large for dates (LFD) groups. Blood samples and morphometric measurements were taken over the first 14 days of life, and tissue samples were taken on day 7 or 14. Plasma hormone and metabolite concentrations and the expression of UCP2 and UCP3 mRNA in adipose tissue, skeletal muscle, and lung were measured. UCP2 and UCP3 expression in adipose tissue was lower in the SFD compared with the LFD group on day 7. UCP3 expression in skeletal muscle was higher than that of adipose tissue. Lung UCP2 and skeletal muscle UCP3 mRNA expression were unaffected by size at birth. Regression analysis indicated that UCP3 expression was differentially associated with IGF-1, leptin, and insulin. In conclusion, low birth weight is associated with tissue-specific effects on UCP expression. It remains to be established whether these subsequently contribute to pathological conditions such as diabetes. mitochondria; postnatal growth; metabolism

Objectives. To determine whether blood pressure (BP) differed between very low birth weight (VLBW; birth weight [less than or equal to] 1500 g) subjects and normal birth weight (NBW; birth weight >2499 g) subjects in late adolescence, and to determine whether growth restriction in utero was related to BP in VLBW survivors at this age. Methods. This was a cohort study of 210 preterm survivors with birth weights Results. VLBW subjects had higher sphygmomanometer systolic and diastolic BPs than NBW subjects (mm Hg; mean difference [95% confidence interval]; systolic, 8.6 [3.4, 13.9]; diastolic, 4.3 [1.0, 7.6]). VLBW subjects also had significantly higher mean systolic ambulatory BPs (mm Hg; mean difference [95% confidence interval]) for the 24-hour period (4.7 [1.4, 8.0]), and for both the awake (5.0 [1.6, 8.5]) and asleep (3.6 [0.04, 7.1]) periods. There were no significant differences between the birth weight groups for any ambulatory diastolic BPs. Within the VLBW subjects, there was no significant relationship between birth weight standard deviation score and any measure of BP. Conclusions. BP was significantly higher in late adolescence in VLBW survivors than in NBW subjects. Growth restriction in utero was not significantly related to BP in VLBW survivors. Pediatrics 2003;111:252-257; very low birth weight, ambulatory blood pressure, hypertension, growth restriction in utero., ABBREVIATIONS. BP, blood pressure; VLBW, very low birth weight; NBW, normal birth weight; ABP, ambulatory blood pressure; SD, standard deviation; CI, confidence interval; IQR, interquartile range. Higher blood pressure (BP) [...]

Objective. Children with neurologic impairments have shown diminished pain response compared with control subjects; however, it remains unclear what mechanisms underlie this response or when it develops. If this were also true with premature infants who undergo neonatal intensive care, then infants with parenchymal brain injury (PBI) would be at increased risk of underrecognition and undertreatment of procedural pain. The purpose of this study was to determine whether infants with PBI display altered responses to acute procedural pain at 32 weeks&apos; postconceptional age (PCA), compared with control subjects. Methods. We compared responses to blood collection by heel lance at 32 weeks&apos; PCA in 12 very low birth weight infants (mean [range] birth weight: 876 g [630-1240 g]; gestational age: 26.3 weeks (24-28 weeks) who had sustained PBI in the neonatal period, with 12 control subjects matched for gestational age at birth and gender (838 g [625-990 g]; 26.3 weeks [24-28 weeks]) who had normal neonatal brain imaging. PBI was defined as cerebral parenchymal infarction (grade 4 intraventricular hemorrhage) or cystic periventricular leukomalacia on serial cranial ultrasound scans conducted in the neonatal period. Biobehavioral responses to pain were measured using facial activity (Neonatal Facial Coding System) and measures of heart rate (HR) variability (low-frequency [LF] power [0.04-0.15], high-frequency [HF] power [0.15-0.8 Hz], and LF/HF ratio) as a measure of cardiac autonomic modulation. Neurodevelopmental follow-up was undertaken at 18 months. Results. The infants with PBI had significantly higher illness severity scores at day 1 compared with day 3 (Score of Neonatal Acute Physiology II: 32.1 vs 19.8) but similar previous pain experiences (109 vs 115) and total morphine exposure (0.29 vs 0.30 mg/kg). Both groups of children mounted similar responses to heel lance at 32 weeks&apos; PCA with no difference in facial response or HR variability. Mean HR and facial action scores increased from baseline to the lance, whereas LF, HF, and the LF/HF ratio decreased significantly. No group differences were found. The only statistically significant difference between groups was that infants with PBI had more tongue protrusion at lance. Neurodevelopmental follow-up showed 8 of 11 toddlers with PBI had cerebral palsy compared with 0% of control toddlers. Psychomotor Developmental Index score on the Bayley Scales of Infant Development II was significantly lower in the PBI group. Five of 11 toddlers with PBI had Mental Developmental Index score Conclusion. Contrary to expectations, we did not find any evidence of an altered pain response pattern in infants with proven brain injury in the neonatal period. Although most infants with PBI developed cerebral palsy, these findings suggest that cerebral injury predominantly to the central white matter leaves brainstem responses intact in the neonatal period. Furthermore, it seems that the injured brain of the preterm infant has not yet expressed the identifiable differences in pain display and the functional impairment observed at later ages. Pediatrics 2002;110:570-576; preterm infants, pain reactivity, parenchymal brain injury., ABBREVIATIONS. SNI, significant neurologic impairment; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; NICU, neonatal intensive care unit; PCA, postconceptional age; PBI, parenchymal brain injury; SNAP, Score of Neonatal Acute Physiology; NFCS, [...]

Objective. Volume guarantee (synchronized intermittent mandatory ventilation [SIMV]+VG) is a novel mode of SIMV for automatic adjustment of the peak inspiratory pressure to ensure a minimum set mechanical tidal volume ([V.sub.T mech]), The objective of this study was to compare the effects of SIMV+VG with conventional SIMV on ventilation and gas exchange in a group of very low birth weight infants recovering from acute respiratory failure. Methods. Nine infants were initially studied during 2 consecutive 60-minute ventilatory modalities of conventional SIMV (ventilator settings by clinical team) and SIMV+VG 4.5 ([V.sub.T mech] set at 4.5 mL/kg) in random order. Eight additional infants were studied during the same ventilatory modalities plus 1 additional epoch consisting of SIMV+VG 3.0 ([V.sub.T mech] set at 3.0 mL/kg). Results. Peak inspiratory pressure was significantly lower during SIMV+VG 3.0. Mean airway pressure, [V.sub.T mech], number of large [V.sub.T mech] (>7 mL/kg), and mechanical minute ventilation ([V&apos;.sub.E]) were reduced during SIMV+VG 4.5 compared with SIMV and were further reduced during SIMV+VG 3.0. Spontaneous [V&apos;.sub.E] increased during SIMV+VG 4.5 and was even higher during SIMV+VG 3.0. The resulting total [ V&apos;.sub.E] was higher during both SIMV+VG modes compared with SIMV. Arterial oxygen saturation by pulse oximetry, transcutaneous carbon dioxide tension, and fraction of inspired oxygen did not differ significantly, although transcutaneous carbon dioxide tension increased slightly during SIMV+VG 3.0. Conclusions. The short-term use of SIMV+VG resulted in automatic weaning of the mechanical support and enhancement of the spontaneous respiratory effort while maintaining gas exchange relatively unchanged in comparison to conventional SIMV. Pediatrics 2002;110: 529-533; mechanical ventilation, patient triggered ventilation, weaning., ABBREVIATIONS. VLBW, very low birth weight; SIMV, synchronized intermittent mandatory ventilation; PIP, peak inspiratory pressure; VG, volume guarantee ventilation; [V.sub.T mech], mechanical tidal volume; PEEP, positive end-expiratory pressure; FI[O.sub.2], fraction [...]

Byline: Andreas Schulze (1), Kabir Abubakar (2), Gerald Gill (3), Clifton R. Way (4), John C. Sinclair (5) Keywords: Bronchopulmonary dysplasia Infant Newborn Metabolic rate Oxygen transport Abstract: Objective: We determined pulmonary oxygen consumption (VO.sub.2lung) in low-birthweight infants with acute lung disease to help explain the greater whole-body oxygen consumption (VO.sub.2wb) in these infants with than in those without lung disease. Methods and materials: Eleven infants (birth weight 1,076+-364 g gestational age 28+-3 weeks) undergoing mechanical ventilation for respiratory distress syndrome were studied in their first week of life. We measured VO.sub.2wb by indirect calorimetry and simultaneously determined systemic oxygen uptake (VO.sub.2Fick) as the product of cardiac output (echocardiography) and the arterial--mixed venous oxygen content difference (cooximetry) assuming that VO.sub.2wb-VO.sub.2Fick accounts for VO.sub.2lung. Right atrial blood samples were used to determine mixed venous oxygenation, and infants were excluded if samples returned saturations greater than 89%. Results: VO.sub.2lung was 1.92+-1.74 ml kg.sup.--1 min.sup.--1, representing 25% of their VO.sub.2wb (7.58+-1.48 ml kg.sup.--1 min.sup.--1). VO.sub.2lung was not correlated with clinical measures of acute disease severity. However, infants with the most severe changes on follow-up radiography (Edwards score 5 as assessed by radiologist blinded for VO.sub.2 data) all had a VO.sub.2lung level greater than 2.0 ml kg.sup.--1 min.sup.--1. Conclusion: VO.sub.2lung can account for the elevated metabolic rate in low-birthweight infants with lung injury. We speculate that this reflects in part inflammatory pulmonary processes and may herald chronic lung disease. Author Affiliation: (1) Division of Neonatology, Department of Obstetrics and Gynecology, Ludwig Maximilian University, Munich, Germany (2) Georgetown University Hospital, Division of Neonatology, 3800 Reservoir Rd NW, Washington, DC 20007, USA (3) Department of Radiology, Faculty of Health Sciences, McMaster University, 1200 Main St. West, Hamilton, Ontario L8N 3Z5, Canada (4) Division of Cardiology, Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1200 Main St. West, Hamilton, Ontario L8N 3Z5, Canada (5) Division of Neonatology, Department of Pediatrics, Faculty of Health Sciences, McMaster University, 1200 Main St. West, Hamilton, Ontario L8N 3Z5, Canada Article History: Received Date: 29/11/2000 Accepted Date: 13/07/2001 Article note: Final revision received: 10 July 2001 Electronic Publication

Byline: C. Buhrer (1), I. Grimmer (1), B. Metze (1), M. Obladen (1) Keywords: Key words Newborn infants; Prematurity; CRIB score; Risk factors; Mortality; Impairment; Outcome Abstract: Objective: To assess the ability of the Clinical Risk Index for Babies (CRIB) to predict long-term neurodevelopmental impairment in very low birth weight (VLBW) infants.APDesign: Single-center cohort study.APSetting: Tertiary neonatal care hospital and follow-up clinic.APPatients: Four hundred fifty-five VLBW infants consecutively admitted from 1992 to 1997 inclusive.APMeasurements and results: Calculations of CRIB scores from birth weight, gestational age, the presence of congenital malformations, worst base excess, maximum and minimum appropriate fraction of inspired oxygen (FIO.sub.2) during the first 12 h of life was possible in 430 infants. Three hundred eighty-six infants survived until discharge (89 %) and 352 (91 %) were examined at 1 year corrected age using the Griffiths scales of mental development. Major neurodevelopmental impairment (general quotient < 2 standard deviations below average) was observed in 76 infants (22 %). CRIB scores and the individual CRIB components differed significantly between infants with and those without neurodevelopmental impairment. By logistic regression analysis, CRIB scores and minimum FIO.sub.2 were independent predictors of death, while CRIB and maximum FIO.sub.2 were independently associated with neurodevelopmental impairment. For combined poor outcome (death or impairment), CRIB, minimum and maximum FIO.sub.2 were independent predictors. In predicting major neurodevelopmental impairment, the area under the receiver operating characteristic curve for CRIB (0.703 +- 0.035) did not differ significantly from that of birth weight (0.697 +- 0.035) or any other CRIB component.APConclusion: While high CRIB scores are associated with major neurodevelopmental impairment, the CRIB score is of limited value for stratification in randomized trials or for adjustments in comparing performance between hospitals with neurodevelopmental impairment as the main outcome measure. Author Affiliation: (1) Department of Neonatology, Charite-Virchow Hospital, Humboldt University, D-13344 Berlin, Germany e-mail: christoph.buehrer@charite.de Tel.: + 49-30-45 06 64 13 Fax: + 49-30-45 06 69 22, DE Article note: Received: 19 September 1999/Final revision received: 19 July 1999/Accepted: 20 December 1999

Very small infants with low serum thyroxine levels may be at increased risk for intraventricular hemorrhage and death. Transient hypothyroxinemia (TH) of prematurity appears related to poor nervous system development. Researchers measured the thyroid hormone in 342 infants with birth weights below 3.5 pounds. TH was diagnosed in 85% of infants tested, and they were at greater risk of bleeding in the ventricles of the brain or dying while hospitalized. It is not yet clear if the low thyroxine level causes the neonatal complications., Transient hypothyroxinemia (TH) of prematurity has been correlated with poor neurodevelopmental outcome. However, the relationship between thyroid function and neonatal mortality and brain injury has not been described. Objective. To investigate the relationship between thyroid function and neonatal outcome. Methods. Review of infants weighing [is less than] 1500 grams admitted to a single level III newborn intensive care unit (n = 342). Serum total [T.sub.4] values of initial newborn screening of infants dying before hospital discharge were compared with those of surviving infants. Total [T.sub.4] values from infants with and without intraventricular hemorrhage (IVH) and periventricular leukomalacia (PVL) also were compared. Results. [T.sub.4] values strongly correlated with gestational age Q = .56). Overall, 289 (85%) of 342 infants had TH. None of the infants had true congenital hypothyroidism. [T.sub.4] values of infants with cystic PVL (n = 15) were not statistically different from those for infants who did not develop cystic PVL. Infants with IVH (n = 58) had a lower [T.sub.4] value than did infants who did not develop IVH (5.4 [+ or -] 3.4 [micro]g/dL vs 7.8 .sup. 3.6 [micro]g/dL). Infants who died before hospital discharge (n = 24) had a lower [T.sub.4] value than did infants discharged to home (3.4 [+ or -] 2.2 vs 7.9 [+ or -] 3.7 [micro]g/dL). After controlling for potential confounding variables, [T.sub.4] value remained associated with an increased odds of IVH (odds ratio: 1.2; 95% confidence interval: 1.05 to 1.4) and mortality (odds ratio: 2.3; 95% confidence interval 1.6 to 3.4). Conclusions. In our population of very low birth weight infants, TH has an incidence of 85%. Very low [T.sub.4] values on initial newborn screening are associated with increased odds of death and IVH. Additional investigation is needed to determine whether low serum thyroxine level contributes to IVH and neonatal death or whether it is simply an associated factor. Pediatrics 1998;101:903-907; thyroxine, mortality, intraventricular hemorrhage, prematurity., ABBREVIATIONS. TH, transient hypothyroxinemia; [T.sub.4], total serum thyroxine; TSH, thyroid-stimulating hormone; IVH, intraventricular hemorrhage; PVL, periventricular leukomalacia; VLBW, very low birth weight; BPD, bronchopulmonary dysplasia; IUGR, intrauterine growth restriction; PDA, [...]

Kidney function appears to go through three phases in very low birth weight babies. Researchers evaluated urine output and kidney function in 32 infants weighing 1,000 gm or less at birth. The infants followed a similar pattern: for about the first day after birth, urine output was low. This was followed by a marked increase in urine output and sodium loss. The first two phases were not correlated with intravenous fluid intake or with transfer from an overhead heating bed to an incubator, which could have affected water loss through the skin. Finally, the infant established a urinary excretion pattern responsive to fluid intake. This same pattern was seen in a study where infants were kept in a humid environment. These data suggest that the pattern may be a normal adaptation to life outside the womb. Intravenous fluids and ion balance must be monitored carefully and tailored individually., Objective. We had shown previously that preterm infants undergo three phases of fluid and electrolyte homeostasis; prediuretic, diuretic, and postdiuretic. The objectives of the present study were: (1) to determine whether infants even more immature and infants cared for under thermal environmental conditions different from those previously studied also undergo these three phases; and (2) to relate these phases to changes in renal function. Methods. Consecutive, timed urine collections were made during the first 5 days of life in 32 infants with birth weights of 1000 g or less. Infants were cared for in radiant warmers for 24 hours and then transferred to nonhumidified incubators. Diuresis was defined as urine flow rate (V7) of 3 mL or more/kg per hour and weight loss of 0.8 g or more/kg per hour. The physiologic relationships among water and sodium balance, insensible water loss, arterial blood pressure, and renal function were made during the three phases. Results. Twenty-eight (87%) of the 32 infants underwent the three homeostatic phases. The median ages of onset and cessation of diuresis were 25 and 96 hours, respectively. There was no correlation between onset of diuresis and change of thermal environment. During the prediuretic phase, V averaged 1.6 mL/kg per hour, and 17 of 28 infants had at least one collection period in which V was less than 1 mL/kg per hour; urinary sodium excretion was 0.1 mEq/kg per hour; the glomerular filtration rate (GFR) was 0.22 mL/kg per hour, fractional excretion of sodium (FENa) was 6.2%; and urine osmolality was dilute (221 mOsm/kg). During the diuretic phase, V and sodium excretion more than tripled; GFR and FENa doubled; and there was no change in urine osmolality. During postdiuresis, V and Na excretion decreased to values intermediate between the prediuretic and diuretic phases, and FENa fell to prediuretic levels, but there was no change in GFR or urine osmolality. There was poor correlation between blood pressure and GFR. Insensible water loss was high and variable during all phases, exceeding 190 mL/kg per day in the smallest infants. Conclusions. Extremely low birth weight infants manifest three phases of fluid and electrolyte homeostasis, as do more mature infants, independent of thermal environment. Diuresis and natriuresis are the result of abrupt increases in GFR and FENa. We speculate that this may be the result of expansion of the neonatal extracellular space as fetal lung fluid is reabsorbed. Pediatrics 1995,96:484-489; neonatal renal function, postnatal diuresis, postnatal adaptation, fetal-to-neonatal transition, insensible water loss., ABBREVIATIONS. RDS, respiratory distress syndrome; GFR, glomerular filtration rate; FENa, fractional excretion of sodium; ELBW, extremely low birth weight; IWL, insensible water loss; O/I, urine output to fluid intake ratio. [...]

The Manroe reference ranges for absolute total neutrophil count (ATN) for birth to 28 days of life may be outdated for very low birth weight (VLBW) infants and may need to be revised. In a study of 200 VLBW infants, white blood cell counts showed neutropenia (abnormally high neutrophil counts). The lowest ATN values prior to 60 hours of life may need to be revised downward, to reflect the increased viability of VLBW infants over those born 10 years ago. Reference ranges for absolute total immature neutrophil count (ATI) and for the proportion of absolute total immature neutrophils to total neutrophils (I:T) may still be appropriate. Further research is needed to determine if the use of neutrophil indices may assist in diagnosing the presence of infection in VLBW infants, since those with low neutrophil counts may be more susceptible to infection., Objective. Healthy very-low-birth-weight neonates (VLBW, [less than or equal to]1500 g) exhibit a high incidence of neutropenia according to Manroe&apos;s reference ranges for neutrophil indices. Since these reference ranges may be inappropriate for VLBW neonates, we determined the reference ranges for circulating peripheral neutrophils in VLBW neonates between birth and 28 days of age. Methods. Serial, timed peripheral white blood cell counts (n = 1788) were prospectively obtained between birth and 28 days from 193 inborn, VLBW neonates delivered between January 1 and December 31, 1990. Data were divided into neutrophil counts obtained prior to (n = 630) and after (n = 1158) 60 hours of age. After excluding counts from neonates with perinatal and/or neonatal complications, values from "normal" neonates were compared to Manroe&apos;s reference ranges. Where indicated new ranges were developed. Results. Although immature neutrophil (ATI) and immature:total neutrophil (I:T) values were within Manroe&apos;s reference ranges (P >.1) throughout the neonatal period, 67% of total neutrophil values (ATN) obtained prior to 60 hours of age were outside (P 70% of ATN values were abnormal in neonates with apnea, neutrophilia occurring in >90% of counts; I:T values, however, were normal between 61 hours and 28 days. Conclusions. Normal preterm VLBW neonates have ATN reference ranges that differ significantly from that for larger, older neonates, demonstrating the effects of development on neutrophil dynamics. The predictability of neonatal infection using these new reference ranges requires additional study. Pediatrics 1994;94:76-82; neutrophils, neonates, very-low-birth-weight, reference ranges, maternal hypertension, apnea.

A stimulating home environment may result in normal cognitive development in children who had a very low birth weight (VLBW). The incidence of delayed cognitive development is higher among VLBW children (birth weight less than 1,500 grams) than among non-VLBW children. Researchers examined the effects of different biological and social factors on the cognitive development of 79 VLBW infants at one and two years old. At the age of one year, a neurological score was the most effective predictor of cognitive development. After the age of two years, the most effective predictors of cognitive development were neurological score and stimulation in the home environment. VLBW children are more likely to be from a lower socioeconomic group. Lower socioeconomic status is also associated with delayed cognitive development in children., Objective. To investigate the effects of biological and social factors on the cognitive development of very low birth weight children, a longitudinal follow-up study was conducted from birth to 3.6 years of age. Methodology. The study group consisted of a cohort of 79 surviving high-risk, very low birth weight infants. Neonatal cerebral ultrasonographic findings and a neurological score were used as indicators of biological risk. A sociodemographic risk score and the Home Observation for Measurement of the Environment inventory were used as indicators of social risk. Cognitive development was assessed at ages 1 and 2 years by the Mental scale of the Bayley Scales of Infant Development and at age 3.6 years by the Kaufman Assessment Battery for Children. esults. The mean mental index at 1 year of age was 96 (SD 19), at 2 years of age 86 (SD 26), and at 3.6 years of age for intelligence 87 (SD 13) and for achievement 86 (SD 14). In a stepwise multiple regression analysis of biological as well as social factors, the neurological score alone was the best predictor for cognitive development at 1 year of age, explaining 46% of the variance. From 2 years of age onward, the best predictors for cognitive development were the neurological score together with the home environment, explaining 46% of the variance for the Mental Developmental Index at age 2, 34% for intelligence, and 56% for achievement at age 3.6. Conclusions. Children at high biological risk were able to catch up on their cognitive delay in a highly stimulating home environment. Children at low as well as high biological risk in a less stimulating home environment showed a decline in cognitive development. For these children, early intervention programs might be important in the prevention of cognitive disabilities. Pediatrics 1993;92:658-665; very low birth weight, cognitive development, neonatal cerebral ultrasonography, neurology, sociodemographic risk, home environment.

Very low birth weight infants from developing countries may have a higher risk of neurodevelopmental disabilities than those with a normal birth weight. A study examined the incidence of neurodevelopmental disabilities among 106 one-year-old infants with a birth weight of less than 1,250 grams from low-income families in Cape Town, South Africa. Six children had cerebral palsy, and six were developmentally delayed without cerebral palsy. Among the 96 children who were evaluated again at the age of two years old, 22% had major disabilities. An additional child had been diagnosed with cerebral palsy, and nine had signs of mental retardation. Almost all the children with cerebral palsy had been underweight for their gestational age at the time of birth.

Different biological and environmental factors may increase the risk of growth deficiency, or failure to thrive (FTT), in infants with a low birth weight (LBW). Many pediatricians use the term FTT to describe growth deficiency or inconsistency in young children. Among 914 infants with a LBW, 20% met the criteria for FTT and 16% met some of the criteria for FTT by the age of 2 1/2 years. More new cases of FTT were diagnosed at the age of eight months than at any other age. Children with FTT were more likely to develop more slowly or have a less stimulating home environment than those without FTT. At the age of three, children with FTT also had lower IQ scores and were smaller., Objective. To determine the epidemiology, clinical characteristics, and outcomes for low birth weight (LBW) infants with growth deficiency, or failure to thrive (FTT, the term commonly used by pediatric providers to describe growth deficiency or faltering in early childhood). Design. Three-year prospective cohort study with matched case-control study of outcomes. Setting. Eight large university hospital sites throughout the United States. Sample. 914 LBW infants inborn at the sites and meeting study criteria. Results. FTT was a common condition in this cohort, with 180 (19.7%) of 914 LBW infants meeting case criteria by 30 months. New cases of FTT peaked at 8 months gestation-corrected age. In addition to expected differences in growth between infants with and without FTT, infants with FTT had lower developmental indices and less stimulating home environments. At 36 months, FTT infants had lower IQ scores and were much smaller than infants without FTT. Conclusions. Growth deficiency, or FTT, is a common clinical condition for those involved in the follow-up care of LBW infants. Worse cognitive and growth outcomes were observed for those meeting the restrictive case criteria employed in this study. More than 80% of the cases in this LBW cohort did not involve any chronic medical disorders, but several biological and environmental differences were found between those who developed FTT and those who did not. Pediatrics 1993; 91:941-948; failure to thrive, low birth weight, preterm infant, growth outcomes, cognitive outcomes, epidemiology.

The effect of comprehensive prenatal care on birth weight was examined using a prospective randomized design. A total of 428 pregnant women were randomly assigned to comprehensive prenatal care (n = 217) or standard prenatAl care (n = 211). Comprehensive care was provided by a multidisciplinary team of nurse-midwives, social workers, a nutritionist, para-professional home visitors, and a psychologist. Standard prenatal care consisted of medical care provided by obstetric residents. Multiple regression analysis using behavioral, demographic, and medical variables showed a strong relationship between the set of predictors and birth weight. Comprehensive care was related to higher birth weights for primiparous but not multiparous mothers. Separate analyses of variance for primiparas and multiparas similarly showed a favorable effect of comprehensive care on birth weight for primiparous but not multiparous mothers. Pediatrics 1992;89:128-132;

Percutaneous central venous catheterization (PCVC) is the insertion of a tube-like structure called a catheter through the skin into a peripheral vein and on into a central vein, for monitoring blood pressure in the vein or for obtaining blood samples for analysis. This procedure is now being used in infants with very low birth weights, who would otherwise require frequent venipuncture (puncture of a vein) for blood tests. The effects of PCVC on 317 infants who received a total of 478 percutaneous catheters during a three-year period were assessed. Two hundred and forty-one catheters were placed in infants weighing one kilogram (2.2 pounds) or less. The average length of time that an infant was catheterized was 13 days. Almost half of the catheters placed in the central and thoracic veins were removed, because of leakage or clotting in 43 percent of cases, and because of sepsis (infection) or blockage of a vein in 6 percent of cases. Of 23 cases of suspected sepsis, six resulted from the catheter and 12 were associated with another site of infection. Sepsis due to PCVC was associated with increased duration of catheterization, infection with Staphylococcus epidermidis, and infant weight of one kilogram or less. Sepsis due to infection unrelated to the catheter was associated with the presence of another infection site, previous infection, extremely low birth weight, and persistent clinical problems. PCVC decreased the stress associated with repeated venipuncture, reduced the incidence of complications to less than the rate associated with surgically-inserted central venous catheters, and helped in identifying factors that increase the risk of sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)