Birth Weight

Objectives: Recent studies have suggested that survival following the Norwood procedure is influenced by anatomy and is worse for patients with hypoplastic left heart syndrome (HLHS), particularly aortic atresia (AA), as compared to other forms of functional single ventricle and systemic outflow tract obstruction. The current study was undertaken to evaluate our recent experience with the Norwood procedure and to evaluate potential predictors of operative and 1-year mortality. Methods: A retrospective study of risk factors for operative and 1-year mortality in 158 patients undergoing the Norwood procedure between January 1, 1998 and June 30, 2001. Results: HLHS was present in 102 patients (70 with AA) and other forms of functional single ventricle with systemic outflow tract obstruction in the remaining 56. Operative survival was 77% (122/158), 78% for patients with HLHS and 75% for patients with other diagnoses. Multivariable analysis identified birth weight (odds ratio (OR) 0.18/kg, 95% confidence limit (CL) 0.08-0.42, P , 0:001), associated cardiac anomalies (OR 4.45, 95% CL 1.50-13.2, P ¼ 0:001), total support time (OR 1.02/min, 95% CL 1.01-1.03, P ¼ 0:004), and extracorporeal membrane oxygenation (ECMO) or ventricular assist device (VAD) support (OR 17.8, 95% CL 4.40-71.0, P , 0:001) as predictors of operative mortality. The anatomic diagnosis (HLHS versus non-HLHS) was not a predictor of mortality, P ¼ 0:6). The Kaplan-Meier survival estimate at 1 year was 66% (95% CL 58-73%) and was not different for patients with HLHS compared to non-HLHS, P ¼ 0:5. For patients who have survived the Norwood procedure, survival to 1 year was 86% (95% CL 78-91%). Presence of an extra-cardiac anomaly or genetic syndrome (OR 2.70, 95% CL 0.98-7.41%, P ¼ 0:05) and presence of an additional cardiac defect (OR 3.99, 95% CL 1.67-9.57, P ¼ 0:002) were predictors of worse survival in the first year of life. Conclusions: The Norwood procedure is currently being applied to a heterogeneous group of patients. Operative and 1-year survival are equivalent for patients with HLHS and those with other cardiac defects. The presence of additional cardiac or extra-cardiac anomalies are predictors of poor outcome. q

The objective of this study was to compare the reproductive traits of heifers and the development characteristics of their calves following artificial insemination (AI) with sexed and non-sexed semen. The analysed characteristics included conception rate, gestation length, calf birth weight, calf vigour, stillbirth rate, and twinning rate. Data of 530 calves produced with sexed and 1,163 calves produced with non-sexed semen were analysed. The General Linear Model (GLM) was applied to assess the influence of semen type, farm, season of insemination, the calf’s sex and the inseminating sire on gestation length and calf birth weight. With the exception of gestation length (P > 0.05), all other traits studied were significantly (P < 0.01) influenced by the type of semen. The conception rate was 55% for conventional and 44% for sexed semen, and the average gestation length was 274.6 and 274.9 days, respectively. The mean calf birth weight was 37.47 kg for non-sexed and 36.75 kg for...

Mental health outcomes for survivors of critical congenital heart disease (CHD) remain under-investigated. We sought to examine psychiatric disorders and psychosocial functioning in adolescents with single ventricle CHD and to explore whether patient-related risk factors predict dysfunction. This cohort study recruited 156 adolescents with single ventricle CHD who underwent the Fontan procedure and 111 healthy referents. Participants underwent comprehensive psychiatric evaluation including a clinician-rated psychiatric interview and parent- and self-report ratings of anxiety, disruptive behavior, including attention-deficit/hyperactivity disorder (ADHD), and depressive symptoms. Risk factors for dysfunction included IQ, medical characteristics, and concurrent brain abnormalities. Adolescents with single ventricle CHD had higher rates of lifetime psychiatric diagnosis compared with referents (CHD: 65%, referent: 22%; P < .001). Specifically, they had higher rates of lifetime anxie...

Summary. During the second pregnancy of 56 Swedish women resulting in a term birth, energy intake and physical activity were measured for 3 days at weeks 17 and 33. The values were related to maternal lean body mass, pregnancy weight gain, maternal fat accretion and infant birth-weight by multiple linear regression analyses. A significant regression coefficient was found for energy intake at week 17 on maternal fat accretion. Energy intake was not significantly correlated with infant birthweight, not even when physical activity and maternal lean body mass were taken into account. Thus in a well-nourished Swedish population, energy intake is positively related to maternal fat accretion but not to the birthweight of term infants.

Our aim was to identify which ultrasound parameters can be most accurately measured and best predict ovine fetal weight in late gestation. Singleton pregnancies were established using embryo transfer in 32 adolescent ewes, which were subsequently overnourished to produce fetuses of variable size (1720-6260 g). Ultrasound measurements at 126-133 days gestation were compared with fetal weight/biometry at late-gestation necropsy (n 5 19) or term delivery (n 5 13). Abdominal circumference (AC) and renal volume (RV) correlated best with physical measurements (r 5 0.78-0.83) and necropsy/birth weight (r 5 0.79-0.84). Combination of AC 1 RV produced an estimated fetal weight equation [Log EFW 5 2.115 1 0.003 AC 1 0.12 RV -0.005 RV 2 ] with highest adjusted R 2 (0.72) and lowest mean absolute/percentage prediction error (396-550 g/11.1%-13.2%).

Socioeconomic inequalities in the health of adults have been largely attributed to lifestyle inequalities. The cognitive development (CD) and emotional health (EH) of the child provides a basis for many of the health-related behaviours which are observed in adulthood. There has been relatively little attention paid to the way CD and EH are transmitted in the foetal and childhood periods, even though these provide a foundation for subsequent socioeconomic inequalities in adult health. The Mater-University of Queensland Study of Pregnancy (MUSP) is a large, prospective, pre-birth cohort study which enrolled 8556 pregnant women at their first clinic visit over the period 1981-1983. These mothers (and their children) have been followed up at intervals until 14 years after the birth. The socioeconomic status of the child was measured using maternal age, family income, and marital status and the grandfathers' occupational status. Measures of child CD and child EH were obtained at 5 and 14 years of age. Child smoking at 14 years of age was also determined. Family income was related to all measures of child CD and EH and smoking, independently of all other indicators of the socioeconomic status of the child. In addition, the grandfathers' occupational status was independently related to child CD (at 5 and 14 years of age). Children from socioeconomically disadvantaged families (previous generations' socioeconomic status as well as current socioeconomic status) begin their lives with a poorer platform of health and a reduced capacity to benefit from the economic and social advances experienced by the rest of society.

Cryopreservation of oocytes by vitrification is a promising new technique for assisted human reproduction. Any new technical development must be accompanied with data concerning obstetric and perinatal outcome. This study analysed the obstetric and perinatal outcomes in 165 pregnancies and 200 infants conceived following oocyte vitrification cycles in three assisted reproduction centres. The results indicate that the mean birth weight and the incidence of congenital anomalies are comparable to that of spontaneous conceptions in fertile women or infertile women undergoing in-vitro fertilization treatment. These preliminary findings may provide reassuring evidence that pregnancies and infants conceived following oocyte vitrification are not associated with increased risk of adverse obstetric and perinatal outcomes.

Objective To observe the maternal and perinatal outcome in pituitary tumor (macro-and micro-adenoma) during pregnancy. Methods A retrospective analysis of a total of 19 cases of pituitary tumor group 1 (10 macroadenoma), and group 2 (9 microadenoma), during pregnancy over last 3 years in our unit were evaluated for pregnancy outcome, comparing maternal and perinatal outcome in the two groups using statistical analysis (Chi square test and Fischer exact t test). Results The mean age was 27.1 years in group 1 (macroadenoma), 29.2 years in group, parity was 0.2 and 0.55, respectively, in the two groups. Mean pituitary size 14.85 cm 3 in group 1 and 0.22 cm 3 in group 2. While there was no signiWcant diVerence in infertility, menstrual disorder in the two groups, galactorrhea, headache, seizures and blurring of vision were more common in macroadenoma group. More patients required medications (cabergoline/ bromocriptine) in group 1 with signiWcantly more women had worsening of their symptoms (raised intracranial tension, seizures) in group 1 than in group 2. Mean gestation and birthweight were better in group 2 (37.6 vs. 36.1 weeks and 2,849 vs. 2,401 g). While vaginal delivery could be achieved in 88.8% women in microadenoma group (group 2), 80% women required cesarean delivery in macroadenoma group (group 1), a highly signiWcant diVerence (P value 0.005), there were no perinatal death in any group. Conclusion Pituitary tumor during pregnancy if properly treated is associated with excellent maternal and perinatal outcome but macroadenoma is associated with lower gestation, birth weight and increased cesarean delivery rate.

The purpose of the study was to assess the association of obstetric complications with risk for mental disorders resulting in hospitalization before the age of 15. Records from all births in Denmark from 1973 through 1993 were linked to records of all psychiatric hospitalizations. Diagnoses were grouped into seven broad categories. A reference population of 10% of births in Denmark from 1973 to 1990 was used for comparison. Obstetric complications were associated with the range of mental disorders occurring in childhood. The strongest predictors were a variable indicating the interaction of birth weight with speed of growth and the 5-minute Apgar score. There was no diagnostic group that stood out as different with respect to obstetric complications. These results are consistent with the hypothesis of the continuum of reproductive casualty.

early childhood problems to sensory integration defi cits, however, some researchers have linked these early problems to aspects of sensory processing and motor performance in children with motor coordination problems and in children with autism. In addition to disruptions in sensory processing, occupational therapists working with children with SPD consistently identify aspects of delayed or atypical early childhood developmental language and motor milestones or developmental problems as characteristic of these children (Cermak, 1985; Cermak and Larkin, 2002). Frequently children with SPD with motor coordination delays may also be referred to as having a Developmental Coordination Disorder (DCD). The prevalence and etiology of DCD has been examined by a number of researchers and is reported to be between 6% and 22% (American Psychiatric Association, 2000), a rate that is consistent with reported rates of 5-13% in SPD (Ahn et al., 2004). Children with DCD are believed to have "minimal brain damage" as identifi ed through the presence of neurological soft signs (Walton et al., 1962; Gubbay et al., 1965; Henderson and Hall, 1982). Perinatal abnormalities and complications have been identifi ed in children with coordination problems and implicated as possible etiological factors with this group. Particular problems have been noted in areas such as jaundice, lower birth weight, and high rates of pre-and postmaturity (Johnston et al., 1987). More recently, Hoare and Kerley (1991) identifi ed a high incidence of pregnancy complications,

We randomly assigned 40 Union Council clusters in rural Rawalpindi, Pakistan, in equal numbers to intervention or control. Married women (aged 16–45 years) in their third trimester of pregnancy with perinatal depression were eligible to participate. In the intervention group, primary ...

Objectives. The objectives of this study were 1) to assess whether there is an independent association between the level of prenatal cocaine exposure and infants' developmental test scores after control of potential confounding variables; and 2) if such an association exists, to determine which biological and social variables, individually and in interaction with each other, may modify it. Methods. In a prospective, longitudinal study of 203 urban term infants, 3 cocaine exposure groups were defined by maternal report and infant meconium assay: unexposed, heavier cocaine exposure (>75th percentile self-reported days of use or meconium benzoylecognine concentration), or lighter cocaine exposure (all others). Examiners, masked to exposure history, tested infants at 6, 12, and 24 months of age with the Bayley Scales of Infant Development. Results. The final mixed linear regression model included as fixed covariates level of prenatal exposure to cocaine, alcohol, and cigarettes; prenatal marijuana exposure; gestational age and birth weight z score for gestational age; and gender. Age at test, caregiver at time of each test (biological mother, kinship caregiver, unrelated foster caregiver), and any previous child-focused early intervention were included as time-dependent covariates. There were no significant adverse main effects of level of cocaine exposure on Mental Development Index (MDI), Psychomotor Development Index (PDI), or Infant Behavior Record. Child-focused early intervention interacted with level of cocaine exposure such that heavily exposed children who received such intervention showed higher adjusted mean MDI scores than all other groups. Although the sample was born at or near term, there was also a significant interaction of cocaine exposure and gestational age on MDI scores, with those in the heavier exposure group born at slightly lower gestational age having higher mean MDI scores compared with other children born at that gestational age. There was also a significant interaction on MDI between child's age and caregiver. At 6 months, the adjusted MDI of children living with a kinship caregiver was 15.5 points lower than that of children living with their biological mother, but this effect was diminished and was no longer significant at 24 months (difference in means: 4.3 points). The adjusted mean MDI of children in unrelated foster care at 6 months was 8.2 points lower than children of biological mothers, whereas it was 7.3 points higher at 24 months. Early intervention attenuated the age-related decline in PDI scores for all groups. Birth weight <10th percentile was associated with lower PDI scores for children with heavier cocaine exposure and with lower MDI scores for all groups. Conclusions. Heavier prenatal cocaine exposure is not an independent risk factor for depressed scores on the Bayley Scales of Infant Development up to 24 months of age when term infants are compared with lighter exposed or unexposed infants of the same demographic background. Cocaine-exposed infants with birth weight below the 10th percentile for gestational age and gender and those placed with kinship caregivers are at increased risk for less optimal developmental outcomes. Pediatric clinicians should refer cocaine-exposed children to the child-focused developmental interventions available for all children at developmental risk.

Background: Brain-derived neurotrophic factor (BDNF) plays important roles in the central regulation of food intake and body weight control. However, little is known about the role of BDNF in childhood obesity. Objective: To investigate the relationship between plasma levels of BDNF and anthropometric factors, metabolic derangements due to obesity, adipocytokine levels and birth weight in obese Japanese children. Subjects and methods: Sixty-six obese Japanese children aged from 5 to 15 years old were enrolled. The age-matched control group consisted of 32 non-obese healthy children. The plasma levels of BDNF and adipocytokines (leptin and adiponectin) were assayed using ELISA techniques. Results: The mean BMI Z-scores were −0.67, +2.15 and +3.39 for the non-obese control children, obese (BMI ≥ 90th percentile, <99th percentile) and morbidly obese (BMI ≥ 99th percentile), respectively. The plasma levels of BDNF were significantly decreased in the morbidly obese children compared with the levels in the obese and non-obese control children (507 ± 33 pg/ml vs. 626 ± 46 pg/ml, 621 ± 35 pg/ml, p < 0.05). Univariate linear regression analysis showed that the plasma level of BDNF was positively correlated with birth weight (r = 0.264, p < 0.05) and inversely * e64 S. Araki et al. correlated with the BMI Z-score (r = −0.314, p < 0.05). Multivariate forward stepwise linear regression analysis revealed that the birth weight and BMI Z-score are independent predictors of the plasma BDNF level. Conclusion: The plasma level of BDNF, which is decreased in morbidly obese children, is associated with birth weight and the BMI Z-score. Our results suggest that BDNF may play important roles in the development and pathophysiology of childhood obesity.

The California Cerebral Palsy Project (CACP) is a population-based study of 192 children with moderate or severe congenital cerebral palsy who were born between 1983 and 1985 in four San Francisco Bay area counties and who were alive and residing in California at age 3 years. Initial ascertainment of cases was based on records of two agencies known to enrol virtually all CACP-eligible children. Final case status was established by standardised clinical examination in 67% of cases and extensive record review in 33%. The 192 cases gave a prevalence at age 3 of 1.23/1000 survivors. Twins were 10% of the cases with a prevalence of 6.7/1000. Overall, 53% of the cases had birthweight greater than or equal to 2500 g and 28% had birthweight less than 1500 g. There was no association between birthweight and severity of functional impairment and no consistent association between birthweight and the presence of associated disabilities. The CACP prevalence is lower than that reported in other s...

Interchangeability between fast Fourier transform (FFT) and autoregressive (AR) analysis was assessed on series of 256 R-R intervals recorded in 56 seated subjects and in 15 men performing an orthostatic test. Low-(LF) and high-frequency (HF) components were calculated and expressed both in absolute (square milliseconds) and normalized units (NU). During orthostatic stress, the same upward trend for LF square milliseconds and LF/HF ratio and downward trend for HF square milliseconds and HF NU were observed with FFT and AR analysis. However, the values for HF square milliseconds were significantly greater with FFT, as compared with AR analysis in standing position ( P b .05). Moreover, Bland & Altman method highlighted a large discrepancy between the results of FFT and AR analysis for all heart rate variability indices in the 3 conditions. Therefore, parametric and nonparametric spectral analyses could not be considered as interchangeable at rest in healthy subjects even if they give same qualitative results. D

Poor birth outcomes are associated with illicit drug use during pregnancy. While prenatal cigarette exposure has similar effects, cessation of illicit drug use during pregnancy is often prioritized over cessation of smoking. The study goal was to examine the impact of pregnancy tobacco use, relative to use of illicit drugs, on birth outcomes. Women were recruited at entry to prenatal care, with background and substance use information collected during pregnancy. Urine drug screens were performed during pregnancy, and the final sample (n = 265) was restricted to infants who also had biologic drug testing at delivery. Participants were classified by pregnancy drug use: no drugs/no cigarettes, no drugs/ cigarette use, illicit drugs/no cigarettes, and illicit drugs/ cigarette use. Groups differed significantly on infant birthweight, but not gestational age at delivery after control for confounders including background and medical factors. Among women who smoked, the adjusted mean birthweight gain was 163 g for those not using hard illicit drugs, while marijuana use had no effect on birth weight beyond the effect of smoking cigarettes. Women who used hard illicit drugs and did not smoke had an adjusted mean birthweight gain of 317 g over smokers. Finally, women who refrained from hard illicit drugs and smoking had a birthweight gain of 352 g. Among substance using pregnant women, smoking cessation may have a greater impact on birthweight than eliminating illicit drug use. Intervention efforts should stress that smoking cessation is at least as important to improving pregnancy outcomes as abstaining from illicit drug use.

Weight charts and patterns of weight gain for pregnant women in Argentina are scarce. The aims of the study were: 1) to design a new reference weight gain chart to asses the nutritional status of pregnant women using the body mass index (BMI); 2) to estimate weight gain patterns, and 3) to compare it with a proposed reference chart. In 326 pregnant women before 16th week gestation at enrollment during 2001-2002 at the Sarda&#39; Maternity Hospital (Buenos Aires), weight, height, mid arm circumference and skinfold were measured and body mass index was calculated. Mean, standard deviation, coefficient of variation and polynomial percentiles 3rd through 97th were generated for each gestational age between 12th to 42nd weeks. Maximum variability was 18.4% after 28th week, mean preconcepcional BMI was 24.2 +/- 4.5 kg/m2 and 96% of newborns were at term with a mean Ponderal Index of 2.7 +/- 0.2 g/cm3. Trimesters weight increments were 0.600 kg +/- 0.473, 6.476 kg +/- 3.739 and 5.388kg +/-...

The authors examined the relation between fish consumption during pregnancy and fetal growth among 44,824 women from the Danish National Birth Cohort (1996)(1997)(1998)(1999)(2000)(2001)(2002). They evaluated the associations between consumption of total fish, fatty fish, and lean fish in midpregnancy and birth weight, birth length, and head circumference among singleton full-term infants. Fish consumption was ascertained by food frequency questionnaire. The birth of infants classified below the 10th percentile for gestational age and gender was significantly increased among women who consumed more than 60 g of fish per day, as compared with women who consumed 5 g or less per day. Adjusted odds ratios were 1.24 (95% confidence interval (CI): 1.03, 1.49) for birth weight and 1.21 (95% CI: 1.01, 1.43) for head circumference. The adjusted odds ratio was borderline significant for birth length (odds ratio ¼ 1.20, 95% CI: 1.00, 1.45). These increases in risk were followed by small decreases in average values for these growth measures. Furthermore, the inverse association for total fish consumption could be explained by consumption of fatty fish, while no association was found for lean fish. These results indicate that consumption of fatty fish, a known route of exposure to persistent organic pollutants, could be associated with reduced fetal growth.

Objective: To examine the utility of the Bayley Infant Neurodevelopmental Screener (BINS) for the neurodevelopmental follow up of high-risk preterms. Methods: The study group consisted of 122 preterm infants of the gestational ages between 26 and 37 weeks. Medical factors such as; mean birth weight, gestational age, gender, birth place and type, number of multiple pregnancy, days of hospitalization and oxygen therapy, use of antenatal steroids, and occurence of sepsis for each patient were evaluated. The neurodevelopmental examination and BINS administration was made at each visit to the patients whose ages were adjusted for prematurity. Results: At the corrected age of 7-10 months patients at 26-29 GA had significantly lower total means of BINS scores when compared to those of the other two groups at 30-32 and 33-37 GA (P!0.01 and P!0.001). At the corrected age of 3-4 months, the total means of the BINS scores of the patients at 30-32 GA were lower than that of the patients at 33-37 GA (P!0.009). at 7-10 months the scores of the items defining the expressive and cognitive functions of the patients at 26-29 GA were lower than those of the patients at 30-32 GA (P!0.05) and 33-37 GA (P!0.05). At 16-20 months the mean scores of the items of expressive functions were significantly lower in patients of the 26-29 GA compared to those of the patients of 33-37 GA (P!0.03). Conclusion: As data accumulates, BINS will turn out to be a quick way of determining infants at risk of developmental delay in many aspects of neurologically high risk conditions. q

Objetivos: O objetivo deste estudo foi avaliar o efeito da corticoterapia pré-natal nos resultados pós-natais de recém-nascidos portadores de enterocolite necrosante. Métodos: Estudo retrospectivo de 173 neonatos com diagnóstico de enterocolite necrosante divididos em dois grupos: os que receberam e os que não receberam corticóide no período pré-natal, comparados quanto a alguns parâmetros perinatais e de evolução clínica. Resultados: A média do peso foi 1.380,2 g para o grupo 1 e 1.279,5 g para o grupo 2 (p > 0,05); a média da idade gestacional foi 32 semanas para o grupo 1 e 33 semanas para o grupo 2 (p > 0,05); a média para o aparecimento dos sintomas foi 16 dias e 12 dias, respectivamente (p > 0,05); 26,1% foram Bell III ao diagnóstico no grupo 1, e 27,9% no grupo 2 (p > 0,05); 39,1% dos neonatos do grupo 1 evoluíram para Bell III e 37,5% do grupo 2 (p > 0,05). A complicação clínica mais freqüente em ambos os grupos foi perfuração intestinal. A média do tempo de internação foi 52 dias no grupo 1 e 46 dias no grupo 2 (p > 0,05). A mortalidade foi de 23,2% para o grupo 1 e 20,2% para o grupo 2 (p > 0,05). Conclusões: Não foi observada associação entre o uso pré-natal de corticóide e melhora na evolução clínica dos recém-nascidos com enterocolite necrosante.

OBJECTIVE: Decreased conjugation is probably more important than hemolysis for causing jaundice in G6PD-deficient neonates. The role of enzyme inducers, like phenobarbital, in G6PD deficiency is unclear. This randomized controlled trial was performed to evaluate ...

To investigate the incidence, efficacy, and safety of elective induction in a community teaching hospital over 1 year. Methods: This is a retrospective case-control study of rate, safety, and efficacy of all term inductions with vertex presentations judged to be elective by chart analysis. Cases were matched one for one for age, parity, and pay status with controls in spontaneous labor. The elective induction women were compared with those in spontaneous labor using 2 Student t test, and Fisher exact test. Potential risk factors for cesarean delivery and neonatal intensive care unit (NICU) admission were then selected and subjected to bivariate analysis. Stepwise logistic regression was applied to control for confounding and to select which risk factors were important for those end points. Results: There were 461 case-control pairs. The elective induction rate was 12.3%. Cesarean delivery was increased by elective induction in bivariate analysis (odds ratio [OR] ‫؍‬ ‫؍‬ ‫؍‬ 1.81, confidence interval [CI] ‫؍‬ ‫؍‬ ‫؍‬ 1.07, 3.08; power ‫؍‬ ‫؍‬ ‫؍‬ .60). The cesarean delivery rate was 8.7% (control 5.0%). In a multiple regression model of potential risk factors for cesarean delivery, nulliparity (

Objective: Both healthy preterm infants and those with bronchopulmonary dysplasia (BPD) have poor lung function during childhood and adolescence, although there is no evidence whether prematurity alone explains the reduction in lung function found in BPD infants. Our study seeks to know if lung function, measured in infancy by means of rapid thoracic compression with raised volume technique, is different between preterm infants with and without BPD. Methods: Lung function was measured in 43 preterm infants with BPD and in 32 preterm infants without BPD at a chronological age range of 2-28 months. Forced vital capacity (FVC), forced expiratory volume at 0.5 sec, and forced expiratory flows at 50, 75, 85%, and 25-75% of FVC were obtained from maximal expiratory volume curves by means of rapid thoracic compression with raised volume technique. Maximal flow at functional residual capacity was measured using rapid thoracic compression at tidal volume. Multiple regression analysis and generalized least squares (GLS) random-effects regression model were used to control for variables such as gender, weeks of gestation, age, birth weight, and tobacco smoke exposure. A sub-analysis was performed in infants born at 28þ weeks of gestation. Results: BPD was associated to significantly lower flows (regression coefficients: À0.51, À0.54, À57, À0.53, and À0.82, respectively for FEF 50 , FEF 75 , FEF 85 , FEF 25-75). This association was driven by males and maintained in the subgroup of infants born at 28þ weeks of gestation. Conclusion: BPD is associated with an additional decrease of lung function during the first 2 years of life in infants born preterm. Pediatr Pulmonol.

Background: Obesity has been identified as an important risk factor in the development of cardiovascular diseases; however, other factors, combined or not with obesity, can influence cardiovascular risk and should be considered in cardiovascular risk stratification in pediatrics. Objective: To analyze the association between anthropometry measures and cardiovascular risk factors, to investigate the determinants to changes in blood pressure (BP), and to propose a prediction equation to waist circumference (WC) in children and adolescents. Methods: We evaluated 1,950 children and adolescents, aged 7 to 18 years. Visceral fat was assessed by WC and waist-hip relationship, BP and body mass index (BMI). In a randomly selected subsample of these volunteers (n = 578), total cholesterol, glucose and triglycerides levels were evaluated. Results: WC was positively correlated with BMI (r = 0.85; p < 0.001) and BP (SBP r = 0.45 and DBP = 0.37; p < 0.001). Glycaemia and triglycerides showed a weak correlation with WC (r = 0.110; p = 0.008 e r = 0.201; p < 0.001, respectively). Total cholesterol did not correlate with any of the variables. Age, BMI and WC were significant predictors on the regression models for BP (p < 0.001). We propose a WC prediction equation for children and adolescents: boys: y = 17.243 + 0.316 (height in cm); girls: y = 25.197 + 0.256 (height in cm). Conclusion: WC is associated with cardiovascular risk factors and presents itself as a risk factor predictor of hypertension in children and adolescents. The WC prediction equation proposed by us should be tested in future studies. (Arq Bras Cardiol. 2013; [online].ahead print, PP.0-0

The primary aim of this pilot study was to study uterine artery (UtA) blood flow volume in uneventful human pregnancies delivered at term, at mid and late gestation by means of 3D and bi-dimensional ultrasound imaging with angio-Doppler combined with fluid-dynamic modeling. Secondary aims were to correlate flow volume to placental site and to UtA Pulsatility Index (PI).

To modify the technique of multifetal pregnancy reduction and to study the outcome of reduced twins in comparison with nonreduced twins and high-order multiple gestations. Design: Prospective controlled study. Setting: The Egyptian IVF-ET Center, Cairo. Patient(s): Seventy-five patients with high-order multiple pregnancies resulting from assisted reproduction. Controls were 40 nonreduced twin pregnancies and 22 high-order multiple gestations. Intervention(s): Transvaginal ultrasonically guided multifetal pregnancy reduction was performed. The first 30 cases were done using KCl as a cardiotoxic agent. The modified technique was used for the last 45 cases at an earlier gestational age (approximately 7 weeks) by eliminating the use of KCl and by aspirating the embryonic parts. Main Outcome Measure(s): Miscarriage rate, gestational age at delivery, birth weight, and pregnancy complications.

A retrospective analysis was undertaken in a consecutive series of 33 full-term infants (birth weight >2500 g and a minimum of 37 weeks gestational age) with symptomatic intracranial hemorhage (ICH) admitted to a regional neonatal intensive care unit from January 1986 to December 1992. Eleven infants were born in our institution; 17 were male. The estimated local incidence of symptomatic ICH for the inborn population was 4.9/10 000 live births, with a regional incidence of 2.7/10 000 live births. Twenty-four (72.3%) infants presented with seizures, apnea, or respiratory distress. Five (15.1%) children developed ICH associated with extracorporeal membrane oxygenation, ventriculoperitoneal shunting, and cardiac surgery. There were two deaths (6.1%) associated with a grade IV periventricular hemorrhage (PVH) and cardiac surgery. Nine infants (27.3%) showed PVH, while an additional nine children developed multifocal cortical hemorrhages. Eight infants (24.%) showed extraxial ICH, four children (12.1%) sustained lobar hemorrhages, and three children (9.1%) showed ICH associated with prenatal CNS abnormalities. Excluding five children with iatrogenic ICH, coagulopathies occurred in 9 of 28 infants (32.1%) and constituted a major determinant of the development of ICH. Neurosurgical intervention was limited to one infant with massive ICH and one child with hydrocephalus as a late sequela of ICH. Developmental follow-up was complete in 32 children with a mean and median duration of 3.4 years. Full-term infants with ICH associated with risk factors for hypoxic-ischemic injury showed a significantly greater risk of developmental delay compared to infants with uncomplicated ICH.

Objective-Efforts to understand specific effects of prenatal methamphetamine exposure on cognitive processing are hampered by high rates of concomitant alcohol use during pregnancy. We examined whether neurocognitive systems differed among children with differing prenatal teratogenic exposures when they engaged in a verbal memory task.

Objective: This study examines the maternal characteristics and birth outcomes of infants of U.S. resident Asian-Indian-American (AIA) mothers and compares those to infants of U.S. resident Whites and African-American (AA) mothers. Methods: Single live births to U.S. resident mothers with race/ethnicity coded on birth certificate as AIA, non-Hispanic White, or non-Hispanic AA were drawn from NCHS 1995 to 2000 U.S. Linked Live Birth/Infant Death files. Results: Compared to AAs or Whites, AIAs have the lowest percentage of births to teen or unmarried mothers and mothers with high parity for age or with low educational attainment. After taking these factors into account, AIA had the highest risk of LBW, small-for-gestational age and term SGA births but a risk of infant death only slightly higher than Whites and far less than AAs. Conclusions: The birth outcomes of AIAs do not follow the paradigm that more impoverished minority populations should have greater proportions of low birth weight and preterm births and accordingly greater infant mortality rates.

Objective: To explore hospital costs by pregnant women with a history of early-onset preeclampsia or HELLP syndrome, managed according to customary, but non-standardized prenatal care, by relating maternal and child outcome to maternal health care expenditure. Study design: This was a cohort study, in women of 18 years or older who suffered from early-onset preeclampsia or HELLP syndrome in their previous pregnancy (n = 104). We retrieved data retrospectively from hospital information systems and medical records of patients who had received customary, nonstandardized prenatal care between 1996 and 2012. Our analyses focused on the costs generated between the first antenatal visit at the outpatient clinic and postpartum hospital discharge. Outcome measures were hospital resource use, costs, maternal and child outcome (recurrence of preeclampsia or HELLP syndrome, incidence of eclampsia, gestational age at delivery, intrauterine fetal demise, small-forgestational-age birth and low 5 min Apgar score). We used linear regression analyses to evaluate whether maternal and child outcome and baseline characteristics correlated with hospital costs. Results: Maternal hospital costs per patient averaged s 8047. The main cost drivers were maternal admissions and outpatient visits, together accounting for 80% of total costs. Primary cost drivers were preterm birth and recurrent preeclampsia or HELLP syndrome. Conclusion: Hospital costs in the next pregnancy of formerly preeclamptic women varied widely with over 70% being medically unexplainable. The results of this study support the view that care standardization in these women can be expected to improve costs and efficacy of care without compromising outcome.

Infants are considered large for gestational age (LGA) if their birth weight is greater than the 90th percentile for gestational age and they have an increased risk for adverse perinatal outcomes. Maternal diabetes is one of the factors affecting birthweight. However there are limited data on the perinatal outcomes of infants of gestational diabetic mothers. The aim of the present study was to compare the neonatal outcomes of LGA infants delivered by women with and without gestational diabetes mellitus. This was a retrospective study of LGA infants of ≥36 weeks of gestation born at the Gazi University Medical School Hospital during the period of 2006-2009. Neonatal outcomes included hypoglycemia and polycythemia in the early neonatal period and hospital admissions. The Chi-square and Student&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s t test were used for comparing variables. Seven hundred eligible infant-mother pairs were enrolled in the study. Eighty-seven of them (12.4%) were infants of gestational diabetic mothers and 613 (87.6%) were infants of non-diabetic mothers. The incidence of hypoglycemia at the first hour was higher in infants of diabetic mothers (12.8%) than in infants of non-diabetic mothers (5.3%) (P=0.014). Polycythemia was also more frequently observed in infants of the gestational diabetic mothers (9.3%) than in infants of the non-diabetic mothers (3.0%) (P=0.010). Although overall hospital admission rates were not different between the two groups, infants of diabetic mothers were more likely to be admitted because of resistant hypoglycemia (P=0.045). The results of this study suggested that LGA infants of mothers with gestational diabetes mellitus were at a greater risk for hypoglycemia and polycythemia in the early neonatal period than LGA infants of nondiabetic mothers.

OBJECTIVE. Methamphetamine use among pregnant women is an increasing problem in the United States. Effects of methamphetamine use during pregnancy on fetal growth have not been reported in large, prospective studies. We examined the neonatal growth effects of prenatal methamphetamine exposure in the multicenter, longitudinal Infant Development, Environment and Lifestyle study.

1. To assess the accuracy of the gestation-adjusted projection method in estimating birth weight in Thai pregnant women. 2. To determine the efficiency of the gestation-adjusted projection method for the detection of low actual birth weight, normal birth weight, and large fetus groups. Diagnostic clinical trial. The present study was conducted on 328 uncomplicated pregnancies that were monitored at the Department of Obstetrics and Gynecology, Charoenkrung Pracharuk Hospital during the period of August I to November 30, 2006. The fetal biometry was measured by ultrasound at 34 weeks&#39; gestation or after Fetal weight was calculated according to Hadlock&#39;s formula. The extrapolation technique is based on the gestation-adjusted projection (GAP) method. The accuracy of the method was assessed by analyzing the weight predictions in relation to the actual birth weight (ABW). Main outcome measurements were simple error absolute error absolute percentage error and accuracy within 10% o...