Routine third-trimester ultrasound assessment for intrauterine growth restriction

Intrauterine growth restriction significantly impacts perinatal outcomes. Undetected IUGR escalates the risk of adverse outcomes. Serial symphysis-fundal height measurement, a recommended strategy, is insufficient in detecting abnormal fetal growth. Routine third-trimester ultrasounds significantly improve detection rates compared with this approach, but direct high-quality evidence supporting enhanced perinatal outcomes from routine scanning is lacking. In assessing fetal growth, abdominal circumference alone performs comparably to estimated fetal weight. Hadlock formulas demonstrate accurate fetal weight estimation across diverse gestational ages and settings. When choosing growth charts, prescriptive standards (encompassing healthy pregnancies) should be prioritized over descriptive ones. Customized fetal standards may enhance antenatal IUGR detection, but conclusive high-quality evidence is elusive. Emerging observational data suggest that longitudinal fetal growth assessment could predict adverse outcomes better. However, direct randomized trial evidence supporting this remains insufficient.

Growth assessment of children during the COVID-19 pandemic-Can we rely on parental measurements?

Aim

The COVID‐19 pandemic prompted the rapid development of remote medical services. During lockdown periods, children's growth data were obtained from parents’ home assessments. This study aimed to assess the accuracy of home height and weight measurements and analyse their utility in clinical decision‐making.

Methods

A retrospective, single‐centre observational study. Children aged 3–18 years were measured for weight and height at home using guidance provided to parents on proper measurements techniques before subsequent professional re‐evaluation at our endocrine institution clinic. The two sets of measurements were compared and analysed according to various clinical parameters.

Results

Height measurements at home and in the clinic were comparable (diff = 0.1 ± 1.3cm, p = 0.42) amongst the 107 children (mean age 10.2 ± 3.7, 56.1% males) participating in the study, except in overweight and obese children where they were significantly higher in the clinic (diff = 0.86 ± 1.48cm, p = 0.018). Weight and BMI were significantly higher in the clinic (diff = 0.45 ± 0.8kg and diff = 0.3 ± 0.6kg/m², p<0.001 and p<0.001, respectively).

Conclusions

Height measurements of children by their parents were accurate except in obese and overweight children, whereas weight measurements tended to be lower than in the clinic. With proper guidance, parents’ home measurements of height and weight are accurate and suitable for clinical decision‐making.

Comparison of Postnatal Growth Charts of Singleton Preterm and Term Infants Using World Health Organization Standards at 40-160 Weeks Postmenstrual Age: A Chinese Single-Center Retrospective Cohort Study

There remains controversy regarding whether the growth charts constructed from data of term infants, such as those produced by the World Health Organization (WHO) standards, can appropriately evaluate the postnatal growth of preterm infants. This retrospective cohort study, conducted in the First Affiliated Hospital of Shandong First Medical University in Jinan China, aimed to compare the postnatal growth charts of singleton preterm and term infants using WHO standards at 40-160 weeks postmenstrual age (PMA). A total of 5,459 and 15,185 sets of longitudinal measurements [length/height, weight, head circumference (HC), and body mass index (BMI)] from birth to 160 weeks PMA were used to construct growth charts for 559 singleton preterm (mean PMA at birth, 33.84 weeks) and 1,596 singleton term infants (born at 40 weeks PMA), respectively, using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Z-scores (prematurity corrected) were calculated using WHO Anthro software. Compared to WHO standards, all parameters of preterm infants were increased, especially in terms of length/height and weight; the gap between the two almost spanned two adjacent centile curves. Compared to term controls, the length/height, weight, and BMI of preterm infants were higher at 40 weeks PMA, surpassed by term infants at 52-64 weeks PMA, and quite consistent thereafter. The HC of preterm infants at 40-160 weeks PMA was quite consistent with both term controls and the WHO standards. The Z-scores for length/height, weight, and BMI of preterm infants relative to the WHO standards gradually decreased from 1.20, 1.13, and 0.74 at 40-44 weeks PMA to 0.67, 0.42, and 0.03 at 132-160 weeks PMA, respectively; Z-scores for HC of preterm infants rapidly decreased from 0.73 to 0.29 at 40-50 weeks PMA, and then fluctuated in the range of 0.08-0.23 at 50-160 weeks PMA. Preterm infants had higher growth trajectories than the WHO standards and similar but not identical trajectories to term infants during the first 2 years of life. These findings reemphasize the necessity of constructing local growth charts for Chinese singleton preterm infants.

Nutritional Status of Children with Biliary Atresia and the Role of Portoenterostomy to Improve Nutrition

Background:

Nutritional depletion and growth stunting are present in patients with biliary atresia; “normal” nutrient and vitamin supplementation fail to correct these deficiencies. Children with this condition form the largest group for possible liver transplantation in the future; hence, stress should be laid on close attention to their nutrition.

Methods:

Twenty-five patients with biliary atresia as cases and 25 age-matched children as controls were enrolled in the study from November 2010 to June 2012. Preoperatively, patients underwent standard investigations and anthropometric measurement (weight, height, and head circumference) assessment. Nutritional status (assessed with standard growth chart) was compared with control population, and children were divided into poor nutritional status and good nutritional status. Kasai's portoenterostomy was performed in all patients, and comparison was done between preoperative nutritional status with postoperative status of children and also between hepatic iminodiacetic acid (HIDA) scan-positive (patent bilioenteric pathway) children with HIDA scan-negative children. Postoperatively, after 12 weeks, the same anthropometric measurements were taken again, growth velocity (GV) was assessed, and children were divided into poor, average, and good GV.

Results:

Nutritional status of children with biliary atresia was significantly poor than that of control group. Postoperatively, children had better nutritional status than preoperative nutritional status, especially in HIDA scan-positive children. GV was also significantly better in those children in whom postoperative HIDA scan was positive.

Conclusion:

Children with biliary atresia have poor nutritional status in comparison to normal population and require multifaceted approach to achieve adequate nutrition. Establishment of a patent bilioenteric pathway in these children improves their nutritional status and GV.

Development of birth weight for gestational age charts and comparison with currently used charts: defining growth in the Polish population

OBJECTIVES

This study aimed to obtain the reference curves of birth weight for gestational age percentiles for the Polish population and to compare them to published charts in terms of detected proportions of small for gestational age (SGA) and large for gestational age (LGA).

METHODS

The reference curves of birth weight from 24 to 42 weeks of gestation were computed based on 39,092 singleton deliveries. The nomograms included the 3rd to the 97th percentiles and standard deviations. The percentiles were calculated for female and male newborns. The theoretical and true proportions of percentiles for the studied population were estimated based on six growth charts (Fenton, Intergrowth Project, global reference chart, Yudkin, Dubiel, and the World Health Organization chart).

RESULTS

The 50th percentile male and female newborns at 40 weeks weighed 3645.8 and 3486.7 g, respectively. The difference was 159.1 g. The ranges between the 3rd and 97th percentile at 40 weeks were 1481.5 g for males and 1423.5 for females. A total of 9.8% SGA and 10.27% LGA were defined, higher than that identified using the Fenton chart and even higher than that identified using the Intergrowth Project.

CONCLUSION

Population growth charts identify more newborns with abnormal growth (both LGA and SGA). The similarity between charts in LGA above the 95th percentile is observed. The discrepancies in SGA are significantly greater, specifically in preterm births than in term births. Similar coverage is found in term pregnancies, regardless of birth weight for gestational age or intrauterine charts. The feasibility of a Polish population growth chart needs to be validated for predicting adverse perinatal outcomes.

A retrospective study on the effects of exclusive donor human milk feeding in a short period after birth on morbidity and growth of preterm infants during hospitalization

The risks and benefits of feeding preterm formula (PF) versus donor human milk (DHM) in preterm infants are uncertain, and studies evaluating the efficacy of DHM to the morbidities and growth of preterm infants in the neonatal intensive care unit are confused by the need for milk fortification. We aimed to determine and compare the outcome of short-term morbidities in neonatal intensive care unit and growth between premature infants fed exclusively DHM only until a volume of 130 mL/kg/d of enteral feeding was achieved and infants fed with a PF mix after birth. The data of 132 infants with low birth weight of <1500 g and gestational age of less than 32 weeks were considered. Ninety infants were analyzed, of which 86 were discharged alive. The DHM group (n = 36) was made up of infants who were fed exclusively with DHM, whereas the PF group (n = 54) consisted of infants who were fed with a combination of PF and either DHM or human milk, until a volume of 130 mL/kg/d of enteral feeding was achieved. Once feeding in the DHM group progressed to volumes greater than 130 mL/kg/d, infants were fed fortified DHM and PF alternately. One infant (2.8%) in the DHM group had late-onset sepsis or necrotizing enterocolitis compared with 21 (38.9%) in the PF group (adjusted odds ratio 0.05, 95% confidence interval 0.01-0.41); 13 (36.1%) infants in the DHM group had bronchopulmonary dysplasia compared with 38 (70.4%) in the PF group (odds ratio 0.18, 95% confidence interval 0.05-0.41). Although the DHM group demonstrated a comparatively lower rate of weight gain, head circumference increment, and height increment from birth to the age at which an enteral feeding volume of 130 mL/kg/d was achieved, there were no significant differences in these values at 36 weeks' postmenstrual age between both groups.

How to carry out growth assessment in infants and children under two years old

Rationale and key points Measuring and monitoring growth in infants and young children under two years old is an important part of their clinical assessment in hospital and the community. This article outlines the procedure for measuring growth in infants and children under two years old, and discusses the main factors to consider when undertaking this assessment. » The procedures and some of the data used to monitor the growth of infants and children under two years old differs from those used in older children. » Obtaining growth information for an infant or child involves measuring and recording their length, weight and head circumference. The process of obtaining this information is not necessarily straightforward and errors may occur while measuring and plotting or interpreting data. » Correct use of growth measuring equipment and growth charts is essential to obtain accurate results. Nurses should be able to plot weight, length and head circumference data for infants and children under two years old, and to correctly interpret this data to identify malnutrition and faltering growth. Reflective activity 'How to' articles can help you update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect on and write a short account of: 1. How you think this article will change your practice when you assess growth in infants and children under two years old. 2. What practical experience you require to consolidate your learning, having read this article. 3. Any learning needs that you have identified that would increase your clinical effectiveness and professional development.

Small Size at Birth or Abnormal Intrauterine Growth Trajectory: Which Matters More for Child Growth?

Small size at birth is linked with lifelong adverse health implications. However, small size is only a proxy for the pathological process of interest, intrauterine growth restriction. We examined the extent to which information on intrauterine growth patterns improved prediction of childhood anthropometry, above and beyond birth weight alone. We obtained fetal weights estimated via serial ultrasound for 478 children in the Scandinavian Successive Small-for-Gestational-Age Births Study (1986-1988). Size at birth was classified using birth weight-for-gestational-age z scores and conditional fetal growth z scores (reflecting growth between 25 weeks' gestation and birth) using internal references. Conditional z scores were also expressed as residuals of birth weight z scores. Growth measures were linked with age-5-years anthropometric characteristics using linear regression. In univariable analyses, conditional fetal growth z scores were positively associated with z scores for child height, body mass index, total skinfold thickness, and head circumference (β = 0.24 (95% confidence interval (CI): 0.18, 0.31), β = 0.16 (95% CI: 0.09, 0.23), β = 0.08 (95% CI: 0.01, 0.16), and β = 0.37 (95% CI: 0.22, 0.52), respectively). However, conditional z scores were highly correlated with birth weight z scores (r = 0.9), and residuals explained minimal additional variation in anthropometric factors (null coefficients; adjusted R(2) increases < 0.01). Information on the intrauterine trajectory through which birth weight was attained provided little additional insight into child growth beyond that obtained from absolute size at birth.

Fetal, neonatal, infant, and child international growth standards: an unprecedented opportunity for an integrated approach to assess growth and development

The recent publication of fetal growth and gestational age-specific growth standards by the International Fetal and Newborn Growth Consortium for the 21st Century Project and the previous publication by the WHO of infant and young child growth standards based on the WHO Multicentre Growth Reference Study enable evaluations of growth from ∼9 wk gestation to 5 y. The most important features of these projects are the prescriptive approach used for subject selection and the rigorous testing of the assertion that growth is very similar among geographically and ethnically diverse nonisolated populations when health, nutrition, and other care needs are met and the environment imposes minimal constraints on growth. Both studies documented that with adequate controls, the principal source of variability in growth during gestation and early childhood resides among individuals. Study sites contributed much less to observed variability. The agreement between anthropometric measurements common to both studies also is noteworthy. Jointly, these studies provide for the first time, to my knowledge, a conceptually consistent basis for worldwide and localized assessments and comparisons of growth performance in early life. This is an important contribution to improving the health care of children across key periods of growth and development, especially given the appropriate interest in pursuing "optimal" health in the "first 1000 d," i.e., the period covering fertilization/implantation, gestation, and postnatal life to 2 y of age.

Comparative study of growth responses and screening of inter-specific OTA production kinetics by A. carbonarius isolated from grapes

The aim of this work was to assess OchratoxinA (OTA) production of different Aspergillus carbonarius isolates, evaluate their growth profile through different growth measurements, and reveal any underlying correlation between them. Ten different isolates of A. carbonarius isolated from Greek vineyards located in different geographical regions were examined in vitro for their OTA production potential after an incubation period of up to 11 days. All fungal isolates grew on a synthetic grape juice medium (SGM) similar to grape composition at optimum conditions of temperature and water activity (25°C and 0.98 a_w). Samples for OTA determination were removed at 3, 5, 7, 9, and 11 days of growth and analyzed by HPLC. Based on OTA measurements the isolates were characterized by diverse OTA production ranging from 50 to 2000 ppb at day 11. The different fungal growth responses (colony diameter, colony area, biomass, biomass dry weight, and colony density) have been measured and correlated with toxin production by means of principal components analysis (PCA), confirming satisfactory correlation and explained over 99% of data variability. Leudeking-Piret model was also used to study OTA production with time, revealing a mixed-growth associated trend and pointing a fail-safe model with slightly better prediction through colony area. This approach contributes to the assessment of correlation between mycotoxin production and different methods of fungal growth determination in relation to time.

The impact of growth curve changes in assessing premature infant growth

OBJECTIVE

To assess the impact of using the recently published WHO growth standard, based on healthy, breastfed infants in multiple countries that excluded prematurely born infants, versus the Infant Health Development Program (IHDP) growth reference constructed from premature infants, on the interpretation of the growth of premature infants after hospital discharge.

STUDY DESIGN

A retrospective cohort was constructed of infants born at gestational age ≤35 weeks who initially presented for care at one of the 32 outpatient sites between 2006 and 2008 (N=2297). Kappa statistics measured overall agreement and agreement in ever classifying infants <5th percentile or ≥ 95th percentile for age between the WHO and IHDP. Logistic regression models identified factors associated with growth curve disagreement in classifying infants at the extremes of growth.

RESULT

The WHO and IHDP growth curves showed moderate agreement for all measurements (κ=0.40-0.52). When the curves disagreed on whether an infant was <5th percentile for weight (8.3% of cohort) or length (13.6% of cohort), the WHO curve classified the infant in this category over 90% of the time. For head circumference, the IHDP curve classified more infants below the 5th percentile. Gestational age <30 weeks was associated with growth curve disagreement for weight and length <5th percentile.

CONCLUSION

Choice of growth curve affects the assessment of growth and the classification of underweight status. Longitudinal studies are needed to determine which assessment identifies the greatest number of premature infants at risk for long-term growth issues.

Calculating postnatal growth velocity in very low birth weight (VLBW) premature infants

OBJECTIVE

Currently, there is no standardized approach to the calculation of growth velocity (GV; g kg (-1) day(-1)) in hospitalized very low birth weight (VLBW) infants. Thus, differing methods are used to estimate GV, resulting in different medical centers and studies reporting growth results that are difficult to compare. The objective of this study was to compare actual GV calculated from infant daily weights during hospitalization in a Neonatal Intensive Care Unit (NICU) with estimated GV using two mathematical models that have been shown earlier to provide good estimated GVs in extremely low birth weight (ELBW) infants: an exponential model (EM) and a 2-Point model (2-PM).

STUDY DESIGN

Daily weights from 81 infants with birth weights (BWs) of 1000 to 1499 g were used to calculate actual GV in daily increments from two starting points: (1) birth and (2) day of life (DOL) of regaining BW. These daily GV values were then averaged over the NICU stay to yield overall NICU GV from the two starting points. We compared these actual GV with estimated GV calculated using the EM and 2-PM methods.

RESULTS

The mean absolute difference between actual and EM estimates of GV showed <1% error for 100% of infants from both starting points. The mean absolute difference between actual and 2-PM estimates showed <1% error for only 38 and 44% of infants from birth and regaining BW, respectively. The EM was unaffected by decreasing BW and increasing length of NICU stay, whereas the accuracy of the 2-PM was diminished significantly (P<0.001) by both factors.

CONCLUSION

In contrast to the 2-PM, the EM provides an extremely accurate estimate of GV in larger VLBW infants, and its accuracy is unaffected by common infant factors. The EM has now been validated for use in all VLBW infants to assess growth and provides a simple-to-use and consistent approach.