Reading and communication skills after universal newborn screening for permanent childhood hearing impairment.

BACKGROUND: Birth in periods with universal newborn screening (UNS) for permanent childhood hearing impairment (PCHI) and early confirmation of PCHI have been associated with superior subsequent language ability in children with PCHI. However their effects on reading and communication skills have not been addressed in a population-based study. METHODS: In a follow-up study of a large birth cohort in southern England, we measured reading by direct assessment and communication skills by parent report in 120 children with bilateral moderate, severe or profound PCHI aged 5.4-11.7 years, of whom 61 had been born in periods with UNS, and in a comparison group of 63 children with normal hearing. RESULTS: Compared with birth during periods without UNS, birth during periods with UNS was associated with better reading scores (inter-group difference 0.39 SDs, 95% CI 0.02 to 0.76, p = 0.042) and communication skills scores (difference 0.51 SDs, 95% CI 0.06 to 0.95, p = 0.026). Compared with later confirmation, confirmation of PCHI by age 9 months was also associated with better reading (difference 0.51 SDs, 95% CI 0.15 to 0.87, p = 0.006) and communication skills (difference 0.56 SDs, 95% CI 0.12 to 1.00, p = 0.013). In the children with PCHI, reading, communication and language ability were highly correlated (r = 0.62-0.84, p<0.001). CONCLUSION: Birth during periods with UNS and early confirmation of PCHI predict better reading and communication abilities at primary school age. These benefits represent functional gains of sufficient magnitude to be important in children with PCHI.

What do babies eat? Evaluation of a food frequency questionnaire to assess the diets of infants aged 6 months.

OBJECTIVE: To evaluate the relative validity of a food frequency questionnaire (FFQ) for assessing nutrient intakes in 6-month-old infants. DESIGN AND SETTING: The FFQ was developed to assess the diets of infants born to women in the Southampton Women's Survey (SWS), a population-based survey of young women and their offspring. The energy and nutrient intakes obtained from an interviewer-administered FFQ were compared with those obtained from a 4-day weighed diary. SUBJECTS AND METHODS: A sub-sample of 50 infants aged 6 months from the SWS had their diets assessed by both methods. The FFQ recorded the frequencies and amounts of milks, baby foods, regular foods and drinks consumed by the infants over the previous seven days. The diaries recorded the weights of all foods and drinks consumed by the infants on four separate days within 15 days following FFQ completion. RESULTS: Spearman rank correlation coefficients for intakes of energy, macronutrients and 18 micronutrients, determined by the two methods, ranged from r = 0.39 to 0.86; adjustment for energy intake tended to increase the correlation coefficients, range r(a) = 0.55 to 0.89. Bland-Altman statistics showed that mean differences between methods were in the range of -12.5% to +12.5% except for vitamin B12 (-18.9%). CONCLUSION: Although there were differences in absolute energy and nutrient intakes between methods, Spearman rank correlation coefficients indicated reasonable agreement in the ranking of intakes. The interviewer-administered FFQ is a useful tool for assessing energy and nutrient intakes of healthy infants aged about 6 months.

The importance of size and growth in infancy: integrated findings from systematic reviews of scientific evidence and lay perspectives.

BACKGROUND: Associations between growth and size during infancy and adult disease have led some to recommend that interventions in infancy might benefit lifelong health. Any such recommendations should be informed by both the scientific evidence for relationships between infancy and later outcomes and the views and opinions of those who care for babies. METHODS: Separate, but interlinked, systematic reviews were conducted of the epidemiological evidence relating infant size or growth to later health and of lay perspectives on infant size and growth. Findings were compared and integrated to consider policy implications. RESULTS: Lay and scientific perspectives both cast infant growth and size as an indicator of other aspects of an infant's life, rather than being of fundamental importance. While the scientific literature is most often concerned with infants at the extreme ends of the population distribution, and towards long-term outcomes, the literature on lay perspectives suggests a focus on defining the 'normal' range, and on current health. CONCLUSIONS: Differences and similarities between scientific and lay perspectives on health can highlight areas of agreement, as well as areas of potential misunderstanding or miscommunication.

Is birth weight related to later glucose and insulin metabolism?--A systematic review.

AIM: To determine the relationship of birth weight to later glucose and insulin metabolism. METHODS: Systematic review of the published literature. Data sources were Medline and Embase. Included studies were papers reporting the relationship of birth weight with a measure of glucose or insulin metabolism after 1 year of age, including the prevalence of Type 2 diabetes mellitus (DM). Three reviewers abstracted information from each paper according to specified criteria. RESULTS: Forty-eight papers fulfilled the criteria for inclusion, mostly of adults in developed countries. Most studies reported an inverse relationship between birth weight and fasting plasma glucose concentrations (15 of 25 papers), fasting plasma insulin concentrations (20 of 26), plasma glucose concentrations 2 h after a glucose load (20 of 25), the prevalence of Type 2 DM (13 of 16), measures of insulin resistance (17 of 22), and measures of insulin secretion (16 of 24). The predominance of these inverse relationships and the demonstration in a minority of studies of other directions of the relationships could not generally be explained by differences between studies in the sex, age, or current size of the subjects. However, the relationship of birth weight with insulin secretion was inconsistent in studies of adults. CONCLUSIONS: The published literature shows that, generally, people who were light at birth have an adverse profile of later glucose and insulin metabolism. This is related to higher insulin resistance, but the relationship to insulin secretion in adults is less clear.

Fetal, infant, and childhood growth and adult blood pressure: a longitudinal study from birth to 22 years of age.

BACKGROUND: People who are small at birth tend to have higher blood pressure in later life. However, it is not clear whether it is fetal growth restriction or the accelerated postnatal growth that often follows it that leads to higher blood pressure. METHODS AND RESULTS: We studied blood pressure in 346 British men and women aged 22 years whose size had been measured at birth and for the first 10 years of life. Their childhood growth was characterized using a conditional method that, free from the effect of regression to the mean, estimated catch-up growth. People who had been small at birth but who gained weight rapidly during early childhood (1 to 5 years) had the highest adult blood pressures. Systolic pressure increased by 1.3 mm Hg (95% CI, 0.3 to 2.3) for every standard deviation score decrease in birth weight and, independently, increased by 1.6 mm Hg (95% CI, 0.6 to 2.7) for every standard deviation score increase in early childhood weight gain. Adjustment for adult body mass index attenuated the effect of early childhood weight gain but not of birth weight. Relationships were smaller for diastolic pressure. Weight gain in the first year of life did not influence adult blood pressure. CONCLUSIONS: Part of the risk of adult hypertension is set in fetal life. Accelerated weight gain in early childhood adds to this risk, which is partly mediated through the prediction of adult fatness. The primary prevention of hypertension may depend on strategies that promote fetal growth and reduce childhood obesity.

Body size at birth and blood pressure among children in developing countries.

BACKGROUND: Studies in developed countries have shown that reduced fetal growth is related to raised blood pressure in childhood and adult life. Little is known about this association in developing countries, where fetal growth retardation is common. METHODS: In 1994-1995, we measured blood pressure in 1570 3-6-year-old children living in China, Guatemala, Chile, Nigeria and Sweden. We related their blood pressure to patterns of fetal growth, as measured by body proportions at birth. The children were all born after 37 weeks gestation and weighed more than 2.5 kg at birth. RESULTS: In each country, blood pressure was positively related to the child's current weight. After adjusting for this and gender, systolic pressure was inversely related to size at birth in all countries except Nigeria. In Chile, China and Guatemala, children who were proportionately small at birth had raised systolic pressure. For example, in Chile, systolic pressure adjusted for current weight increased by 4.9 mmHg (95% CI : 2.1, 7.7) for every kilogram decrease in birthweight, by 1 mmHg (95% CI : 0.4, 1.6) for every centimetre decrease in birth length, and by 1.3 mmHg (95% CI : 0.4, 2.2) for every centimetre decrease in head circumference at birth. In Sweden, systolic pressure was higher in children who were disproportionately small, that is thin, at birth. Systolic pressure increased by 0.3 mmHg (95% CI : 0.0, 0.6) for every unit (kg/m3) decrease in ponderal index at birth. These associations were independent of the duration of gestation. CONCLUSIONS: Raised blood pressure among children in three samples from China, Central and South America is related to proportionate reduction in body size at birth, which results from reduced growth throughout gestation. The relation between fetal growth and blood pressure may be different in African populations. Proportionately reduced fetal growth is the prevalent pattern of fetal growth retardation in developing countries, and is associated with chronic undernutrition among women. Improvement in the nutrition and health of girls and young women may be important in preventing cardiovascular disease in developing countries.

Approaches to preventing burnout: the effects of personal stress management and organizational socialization.

Several approaches to preventing burnout are compared. One hundred and fifty-four nurses in five Hong Kong hospitals completed the Maslach Burnout Inventory (MBI), the Organizational Socialization Inventory (OSI), and three measures of personal stress management. Results indicated that favourable evaluations on the four OSI domains (job training, organizational understanding, coworker support and future prospects) yielded strong negative correlations with the burnout components. Also, the personal stress management measures had strong negative correlations with depersonalization and decreased personal accomplishment, but none were related to emotional exhaustion. Stepwise regression analyses indicated that training was the only (inverse) predictor of emotional exhaustion, whereas interpersonal skills and understanding were strong (inverse) predictors of depersonalization. Additionally, interpersonal skills and coworker support were excellent (inverse) predictors of decreased personal accomplishment. The findings are discussed in terms of their relevance to nursing administration.

Urinary GH and IGF-I excretion in nine year-old children: relation to sex, current size and size at birth.

OBJECTIVES: To study the relationship of 24-hour urinary growth hormone (GH) and IGF-I excretion in childhood to sex and body size. To test the hypothesis that small size at birth followed by postnatal catch-up growth is associated with elevated IGF-I production. DESIGN AND SUBJECTS: Follow-up study of a cohort of 183 healthy children born in Salisbury, UK. MEASUREMENTS: Weight and height, 24-h urinary growth hormone (uGH) and IGF-I (uIGF-I) excretion, and systolic and diastolic blood pressures. RESULTS: At 9 years of age, 24-h uIGF-I excretion, but not uGH excretion, was strongly related to current weight (P < 0.001) and height (P < 0. 001). Urinary GH and IGF-I excretion were positively correlated (r = 0.15, P = 0.05). Boys excreted more uIGF-I per unit uGH than girls (uIGF-I/uGH molar ratio 32.1 compared to 21.0; P for difference = 0. 002). There were no significant relationships of uGH, uIGF-I or uIGF-I/uGH molar ratio with birthweight, birthlength or head circumference at birth, nor with blood pressure at 9 years. 'Catch-up' growth, indicated by an increase in height SD scores between birth and 9 years, was associated with higher IGF-I excretion (P = 0.01) and occurred in children with taller parents (P < 0.001). CONCLUSIONS: Boys appear to be more sensitive to GH than girls, generating more uIGF-I in relation to uGH. Urinary IGF-I excretion at 9 years is related to both absolute height and to the degree of catch-up in height from birth. Our results suggest that IGF-I production is strongly influenced by genetic factors, but also by either the degree to which intrauterine growth falls short of genetic growth potential, or the process of postnatal catch-up growth that follows.

The role of size at birth and postnatal catch-up growth in determining systolic blood pressure: a systematic review of the literature.

OBJECTIVE: To conduct a systematic review in order to (i) summarize the relationship between birthweight and blood pressure, following numerous publications in the last 3 years, (ii) assess whether other measures of size at birth are related to blood pressure, and (iii) study the role of postnatal catch-up growth in predicting blood pressure. DATA IDENTIFICATION: All papers published between March 1996 and March 2000 that examined the relationship between birth weight and systolic blood pressure were identified and combined with the papers examined in a previous review. SUBJECTS: More than 444,000 male and female subjects aged 0-84 years of all ages and races. RESULTS: Eighty studies described the relationship of blood pressure with birth weight The majority of the studies in children, adolescents and adults reported that blood pressure fell with increasing birth weight, the size of the effect being approximately 2 mmHg/kg. Head circumference was the only other birth measurement to be most consistently associated with blood pressure, the magnitude of the association being a decrease in blood pressure by approximately 0.5 mmHg/cm. Skeletal and non-skeletal postnatal catch-up growth were positively associated with blood pressure, with the highest blood pressures occurring in individuals of low birth weight but high rates of growth subsequently. CONCLUSIONS: Both birth weight and head circumference at birth are inversely related to systolic blood pressure. The relationship is present in adolescence but attenuated compared to both the pre- and post-adolescence periods. Accelerated postnatal growth is also associated with raised blood pressure.

Growth in utero and blood pressure levels in the next generation.

OBJECTIVE: To determine whether blood pressure levels in adult life are related to the mother's fetal growth and size at birth. DESIGN: A follow-up study of men and women whose mothers' or fathers' size at birth was recorded in Preston, Lancashire, UK. SUBJECTS: Two hundred and twenty-eight men and women born in Preston, Lancashire, UK, and still living in Lancashire. MAIN OUTCOME MEASURES: Blood pressure at 18-40 years of age. RESULTS: Systolic and diastolic pressures fell with increasing mother's birthweight and head circumference. Systolic pressure fell by 2.4 mmHg (95% confidence interval (CI) 0.1-4.7) for each pound increase in mother's birthweight and by 4.0 mmHg (95% CI 0.2-7.8) for each one inch increase in head circumference. These associations were little changed by adjusting for length of gestation or for the subject's age, sex, body mass index or alcohol consumption. They were independent of the mother's blood pressure. As expected, mothers' birthweights were strongly related to their children's birthweights (P= 0.009), but the association between mother's birthweight and offspring's blood pressure was largely independent of this. Father's size at birth was not related to the offspring's blood pressure. CONCLUSIONS: If the growth of a female fetus is constrained by lack of nutrients, there are persisting changes in her physiology and metabolism which lead to reduced fetal growth and raised blood pressure in the next generation. Public health policies to improve fetal growth in one generation may therefore benefit succeeding generations as well.

Birthweight and social deprivation: influences on serum lipids and fibrinogen.

UNLABELLED: Epidemiological studies have shown that adults with low birthweight have a higher risk of cardiovascular disease and some others have shown that they have a less favourable serum lipid and lipoprotein profile. If cholesterol metabolism were programmed in utero, we would expect to see an influence of birthweight on blood lipids in children. In 422 children aged 11-15 y in Middlesborough, Cleveland, UK, we investigated the association between birthweight and serum lipids and plasma fibrinogen. We also investigated the influence of childhood social deprivation, measured using the Townsend deprivation index, on these measures. CONCLUSIONS: We found a significant inverse association between birthweight and serum triglyceride level, but not with other serum lipid levels. From a regression model we estimate that triglyceride rose by 1.1 mmol l(-1) kg(-1) fall in birthweight after adjustment for sex, current age and weight. Findings were similar in boys and girls separately. This could contribute to the observed inverse association between birthweight and cardiovascular mortality. Social deprivation was associated with higher fibrinogen, but not lipid levels. Our data highlight the importance of considering influences throughout the life course on adult disease.

Evaluation of the Dinamap 8100 and Omron M1 blood pressure monitors for use in children.

The aim of this study was to evaluate the Dinamap 8100 and the Omron M1 (the test devices) against standard criteria for use in children in a fieldwork setting. Device calibration and validation were carried out in accordance with the British Hypertension Society protocol for special groups such as children. A total of 102 children, recruited from infant and junior schools in Southampton, had six sequential measurements made of their blood pressure-four measurements with a mercury sphygmomanometer and two with one of two test devices, 55 children with the Dinamap 8100 and 47 with the Omron M1. Systolic and diastolic readings with the Dinamap 8100 were on average 11 mmHg higher (95% confidence interval [CI] +9, +12 mmHg) and 3 mmHg lower (95% CI -5, -1 mmHg), respectively, than measurements with the mercury sphygmomanometer, overestimating systolic pressures and underestimating diastolic pressures across the whole range observed. The Omron M1 gave readings lower by 1 mmHg on average for systolic pressures and 2 mmHg for diastolic pressures compared with the sphygmomanometer (95% CIs -4, +1 mmHg and -5, +1 mmHg respectively), specifically overestimating higher pressures and underestimating lower pressures. According to the criteria of the British Hypertension Society, neither the Dinamap 8100 nor the Omron M1 can be recommended for use in children in clinical situations in which accuracy of the absolute measurement is required. In epidemiological surveys, in which differences in blood pressure between groups of people are more important than absolute levels, it may be more appropriate to use these devices. Of the two, its more consistent performance supports the Dinamap 8100 as the instrument of choice in such studies of children.

[Association of body size at birth with impaired glucose tolerance during their adulthood for men and women aged 41 to 47 years in Beijing of China].

OBJECTIVE: To explore if there was relationship between small body size at birth and type 2 diabetes and impaired glucose tolerance (IGT) during adulthood in China. METHODS: Six hundred and twenty-eight singletons born in the Peking Union Medical College Hospital in Beijing during July 1948 to the end of 1954 were followed-up and their medical records at birth were abstracted. Anthropometry and standard oral glucose tolerance test were carried out for all of them. Plasma insulin level was measured with radioimmunoassay for them. RESULTS: Prevalence of type 2 diabetes and IGT decreased with the increase in their birth weight, Ponderal index (PI) and head circumference at birth (for trend test, chi(2) = 6.7, P = 0.01; chi(2) = 4.8, P = 0.03; and chi(2) = 5.8, P = 0.02; respectively), with the highest of 43.8% in those with thin body size (PI < 24 kg/m(3)) at birth and obesity (BMI < 75 percentile) during adulthood, and the lowest of 8.3% in those with more fat at birth (PI >or= 28 kg/m(3)) and keeping relatively thin (BMI < 25th percentile) during adulthood. BMI of mothers in their early and late pregnancy correlated reversely with blood glucose levels two hours after sugar load for their children in adulthood. In addition, body weight, PI and head circumference at birth correlated reversely with their plasma insulin levels fasting and two hours after sugar load and levels of 32 -- 33 split pro-insulin during their adulthood. After adjustment for current BMI, lifestyle and economic status, body size at birth mentioned above still associated with their glucose tolerance and level of plasma insulin during adulthood. CONCLUSION: There was relationship between small body size at birth and prevalence of type 2 diabetes and IGT during adulthood. Prevalence of type 2 diabetes and IGT depended on the synergic effect of thin body size at birth and obesity during adulthood.

Weight gain in pregnancy, triceps skinfold thickness, and blood pressure in offspring.

OBJECTIVE: To determine whether women who are poorly nourished in early pregnancy, as determined by triceps skinfold thickness, or who have poor pregnancy weight gain have offspring with higher blood pressure (BP). METHODS: We evaluated 296 11-year-old children born to women who had taken part in a study of nutrition in pregnancy. Women had been weighed at 18 and 28 weeks' gestation and had had their triceps skinfold thickness measured at 18 weeks. In our follow-up study, their children were weighed and had their BP recorded. Blood pressure was adjusted for weight, gender, ethnic group, cuff size, and time of measurement. RESULTS: The children's mean (standard deviation [SD]) systolic BP was 106 (12) mmHg and their mean (SD) diastolic BP was 62 (7) mmHg. Maternal triceps skinfold thickness at 18 weeks' gestation and maternal pregnancy weight gain between 18 and 28 weeks' gestation were weakly inversely related to the children's BP. However, among women with triceps skinfold thickness at 18 weeks below the group median (15 mm), reduced pregnancy weight gain was associated with significantly higher BP in the offspring; systolic pressure increased by 11.3 mmHg (95% confidence interval [CI] 2.2, 20.4) and diastolic pressure by 10.1 mmHg (95% CI 3.2, 17.1) for each kilogram-per-week decrease in pregnancy weight gain. CONCLUSION: In women who were poorly nourished in early pregnancy, reduced pregnancy weight gain was associated with higher BP in the 11-year-old offspring. We suggest that fetal adaptations to poor maternal nutrition lead to elevated BP in childhood but adequate maternal weight gain during pregnancy may protect against this.

Size at birth and adrenocortical function in childhood.

OBJECTIVE: The mechanisms underlying the association between reduced size at birth and cardiovascular disease and non-insulin-dependent diabetes mellitus in adult life are not known. One possibility is that the intra-uterine environment has permanent effects on the function or activity of the hypothalamo-pituitary-adrenal axis. We tested this by relating size at birth to the urinary excretion of adrenal androgen and glucocorticoid metabolites in a population sample of 9-year-old children. SUBJECTS AND METHODS: One hundred and ninety children (89 boys and 101 girls) of known present height, weight and size at birth collected a 24-hour urine sample. The urinary breakdown products of dehydroepiandrosterone sulphate and of cortisol and cortisone were measured by gas chromatography and their respective breakdown products summed ('adrenal androgen metabolites' and 'glucocorticoid metabolites'). Excretion was expressed in microgram/day. RESULTS: Urinary adrenal androgen metabolite excretion was higher in children who had been light at birth. A 1-kg decrease in birthweight was associated with a 40% (95% CI 9-79%) increase in metabolite excretion. Excretion was positively associated with current weight and age, but the relation with birth weight was independent of weight, age or sex. Urinary glucocorticoid metabolite excretion was positively associated with current weight, but not independently with age. The urinary excretion of total glucocorticoid metabolites was higher in children who had been light at birth, but the relation was best described as U-shaped, with the highest average urinary glucocorticoid metabolite excretion being found in children who had been either light or heavy at birth. The U-shaped (quadratic) relation persisted after adjustment for sex and current weight (P for quadratic term 0.006). CONCLUSION: These findings suggests that the intra-uterine environment, as measured by fetal size at birth, has long-lasting effects on the function of the hypothalamo-pituitary-adrenal axis.

Fetal and infant influences on non-insulin-dependent diabetes mellitus (NIDDM).

The 'thrifty phenotype' hypothesis states that impaired glucose tolerance (IGT) and non-insulin-dependent diabetes mellitus (NIDDM) are the result of adaptation to undernutrition in the fetal and infant environment. In adapting the fetus and infant have to be nutritionally 'thrifty'. If poor nutrition continues throughout life these adaptations are not detrimental. However, if adult nutrition is better, the ability of the pancreas to maintain homeostasis is exceeded, with resulting diabetes. The hypothesis has been tested by a series of longitudinal studies which relate early growth with IGT and NIDDM in adult life. The studies show that babies who are small at birth or during infancy have increased rates of IGT and NIDDM. These relations are independent of social class and are seen at all levels of current body mass. More detailed anthropometric measurements at birth show that the baby at risk of glucose intolerance is characterized by disproportionate fetal growth, particularly relative thinness. Direct measurements have shown that this is a function of insulin resistance rather than deficiency. Reduced fetal growth is also associated with higher levels of plasma glucose in children. The aetiology of IGT and NIDDM may lie in undernutrition in utero or during infancy. This has major implications for their prevention.

Is blood pressure inversely related to birth weight? The strength of evidence from a systematic review of the literature.

OBJECTIVE: To assess the strength of evidence for an inverse relationship between blood pressure and birth weight. DESIGN: A systematic review of the published literature. SETTING: Published studies describing the relationship between blood pressure and birth weight since 1956. SUBJECTS: More than 66,000 subjects aged 0-71 years. RESULTS: Thirty-four studies described the relationship of blood pressure with birth weight. The majority of the studies of children and adults showed that blood pressure fell with increasing birth weight. Studies of adolescents were inconsistent. In neonates there was a positive relationship between blood pressure and birth weight. The pattern with age was supported by the limited number of studies with repeated measures and was dependent neither on the method of analysis nor on work from a single academic group or country. CONCLUSIONS: Blood pressure is inversely related to birth weight in children and in adults. The positive results in neonates and the inconsistency in adolescence may be related to the unusual growth dynamics during these phases of growth. Further studies should concentrate on the mechanisms which underlie the relationship.