Endothelial function is impaired in fit young adults of low birth weight.

OBJECTIVE: Non-insulin-dependent diabetes, hypertension and ischaemic heart disease, with insulin resistance, are associated with low birth weight (the 'Small Baby Syndrome'). Common to these adult clinical conditions is endothelial dysfunction. We tested the hypothesis that endothelial dysfunction could precede their development in those of low birth weight. METHODS: Endothelial function was measured by ultrasonic 'wall-tracking' of flow-related brachial artery dilatation in fit 19-20 year old subjects randomly selected (blind to the investigators throughout the study) from low (< 2.5 kg) and normal (3.0-3.8 kg) birth weight subjects in the 1975-7 cohort of the Cardiff Births Survey and with no known cause for endothelial dysfunction. RESULTS: Flow-related dilatation was impaired in low birth weight relative to normal birth weight subjects (median 0.04 mm [1.5%] [n = 22] cf. 0.11 mm [4.1%] [n = 17], p < 0.05; 0.04 mm [1.5%] [n = 15] cf. 0.12 mm [4.4%] [n = 12], p < 0.05 after exclusion of inadvertently included ever-smokers). CONCLUSION: The findings suggest that endothelial dysfunction is a consequence of foetal malnutrition, consistent with contributing to the clinical features of the 'Small Baby Syndrome' in later adult life.

Nucleotide supplementation and the growth of term small for gestational age infants.

A double blind randomised controlled trial in small for gestational age (SGA) infants, whose intestinal mucosa was shown to be functionally impaired as a result of intrauterine undernutrition, was carried out to investigate the hypothesis that nucleotide supplementation of a milk formula could improve catchup growth. Anthropometric data were collected on 74 infants, 39 randomly allocated to the nucleotide supplemented group (group N) and 35 to a standard formula group (group S). From study entry to 2 months of age, infants in group N had significantly higher mean rates of weight gain (106.3 compared with 94.7 g/kg baseline weight/week) and length gain (21.8 v 19.7 mm/m baseline length/week). Over the whole six months for which the trial formula was provided group N had significantly higher mean rates of gain of weight (80.1 compared with 71.8 g/kg baseline weight/week), length (16.2 compared with 15.0 mm/m baseline length/week), and head circumference (11.8 compared with 10.8 mm/m baseline head circumference/week). Catchup growth in SGA infants is therefore improved by nucleotide supplementation of infant formula.

Faecal chymotrypsin in small for gestational age infants: effects of nucleotides and breast feeding.

The effect of diet on pancreatic exocrine function, measured by faecal chymotrypsin activity (FCA), was studied longitudinally in three groups of small for gestational age (SGA) infants in the first six months of life. The three groups comprised breastfed infants (group B), those randomly allocated to receive a standard infant formula (group S), or the same formula supplemented with nucleotides (group N). The three groups did not differ in their birthweight or gestational age. Nucleotide supplementation of infant formula improves catchup growth in SGA infants but whether this is due to effects on the gastrointestinal mucosa or the exocrine pancreas is not known. There were no differences in FCA at study entry but by one month group B had significantly lower values than the other groups, and this was maintained at 2, 4, and 6 months. Groups N and S did not differ significantly at any time point. Nucleotide supplementation of infant formula does not influence pancreatic exocrine function and its effect on growth is unlikely, therefore, to be mediated through the pancreas. This study shows that breast feeding is associated with lower FCA which may be related to the lower protein content of human milk. Reliable interpretation of FCA in young infants requires information about their diet.

Growth of "small-for-dates" babies.

The majority of "small-for-dates" (SFD) babies show signs of intrauterine undernutrition. The postnatal period is therefore an opportunity to recover any growth deficit. Growth patterns of SFD babies as a group describe upward centile crossing ("catch-up") over the first 6 months, but there is considerable diversity in growth patterns of individual babies. Some continue in approximately the same centile channel as that in which they were born; others show "catch-up". The rate of early growth is influenced by the severity of intrauterine undernutrition, but perhaps surprisingly the mode of feeding and variations in protein and calorie intake after birth have little or not effect. Whether the size attained by prenatally undernourished SFD babies represents the complete recovery of their growth deficit, or whether more rapid "catch-up" growth is even desirable for later physical size and neuropsychological development, remains to be seen.

Changes in body proportions over the first year of life: comparisons between 'light-for-dates' and 'appropriate-for-dates' term infants.

The ponderal index (PI) has been used to compare changes in body proportions over the first year of life in light-for-dates (LFD) and appropriate-for-dates (AFD) term infants. At birth the mean PI of the LFD infants was significantly lower than that of the AFD infants, but at 1 year there was no significant difference between the two groups. These findings indicate that LFD infants increase their weight relatively more than their length over the first year of postnatal life, to become similarly proportioned to AFD infants.

Nutrition and early growth of preterm infants.

Recent studies have renewed the controversy over what should constitute the best milk for preterm infants. While pooled human breast milk continues to be widely recommended it seems for reasons poorly understood not to allow adequate early post-natal growth. In view of possible programming of later growth and neuropsychological development by early nutritional experiences there is a need to further research the question of what should constitute optimum nutrition for preterm infants. We suggest that modifying or finding natural modifications in human milk rather than further altering cow's milk might provide some of the answers. Particular attention also needs to be given to long-term neurological, anthropometric and psychological assessment to relate functional outcome to early nutritional experiences.

Growth of Hong Kong infants during the first two years of life.

Physical growth in weight, length and head circumference during infancy and early childhood (the first two years) of Hong Kong children born in the 1960's and 1970's have been compared with a widely used international reference standard (National Center for Health Statistics). During the first 3-6 months the mean growth curves closely follow the reference mean. Over the following 6-12 months however, there is a distinct downward deviation. From about 18 months onwards the growth trajectories once again closely parallel the reference. This 'faltering' of physical growth, which shows some similarities with that described by young children in poor parts of the world has been attributed by some to less than adequate nutrition during the weaning period. Yet over the past 20 years or so Hong Kong has very much become part of the developed world. This apparent paradox leads us to speculate that genetic influences might play an important role in the faltering of growth.

Mothers' awareness of risk-reducing measures for the sudden infant death syndrome.

A questionnaire was given to 37 mothers of infants under 12 months admitted to a hospital paediatric ward in August 1992 to assess their awareness of current risk-reducing recommendations for the sudden infant death syndrome (SIDS) and the role of health professionals in providing this information. Three mothers had not heard of SIDS; all were Bangladeshi. Twenty-seven mentioned lateral or supine lying, 18 overheating and 15 smoking. Only one mother actually volunteered that, as a risk-reducing measure, medical advice should be promptly sought if the baby became unwell. About one half of the mothers could name three of the four 'official' risk-reducing recommendations. In only seven mothers could there be recalled any information being given by health workers (hospital and community midwives, health visitor, general practitioner, etc.). For the best possible benefit to be derived from current risk-reducing campaigns we need to improve our understanding of how parents obtain relevant information and what role health professionals should have in this.

Early postnatal weight gain: comparisons between Asian and Caucasian infants.

Little is known about the early weight gain of British born Asian babies. This study sets out to compare weight gain of 34 healthy Asian term babies with 34 white Caucasian babies over the first two months of life. The Asian infants were lighter at birth but their rate of weight gain did not differ significantly from their white Caucasian counterparts. These findings offer indirect support for the hypothesis that the smaller size at birth of Asian babies is not due to intrauterine growth retardation. Had this occurred a greater weight gain indicating 'catch-up growth would have been expected.

Size at birth of Asian and white Caucasian babies born in Leicester: implications for obstetric and paediatric practices.

This investigation extends our knowledge of the size of British born Asian babies compared with those of white Caucasian origin. Seventy Leicester born term Asian babies at birth were lighter, shorter, leaner and had smaller heads than their white Caucasian counterparts. The Asian mothers were shorter and lighter at the start of pregnancy but their weight/height2 index was the same. With the appreciation that the Asian population in Britain is far from homogenous in regard to religion, diet and country of origin, it is concluded that the smaller size at birth of Asian babies is unlikely to be due to undernutrition of their mothers in pregnancy. Genetic factors, as indicated by the shorter stature of the mothers are more likely to be responsible. These findings have implications for obstetric and paediatric practices.

The ratio of mid-arm circumference to occipital frontal circumference in Chinese babies: a marker of late gestation growth retardation.

The ratio of mid-arm circumference to occipital frontal circumference (MAC/OFC), an index of late gestation growth retardation, was determined in 175 healthy newborn term Chinese babies. The ratio of 0.31 (S.D., 0.02) was significantly higher than in recent data published for Asian, White and Black neonates: whether this is due to differences in measuring techniques or better intra-uterine nutrition remains to be seen. As an initial test of its potential usefulness this ratio was determined in 12 term Chinese babies who showed clinical signs of undernutrition. All but one had a ratio 2S.D. or more below the mean. The MAC/OFC ratio, with its ease of measurement, simplicity and cheapness, is a useful addition to existing methods for assessing late gestation nutritional status.

Case study. Erythropoietin for anaemia in a preterm Jehovah's Witness baby.

An infant born at 24 weeks gestation to Jehovah's Witness parents was made a Ward of Court and treated against their wishes with blood products. Erythropoietin was used without obvious benefit, but the child did well. The parents did not reject the child and maintained a good relationship with medical and nursing staff. We present this case in the light of current discussions on child welfare and recent reform of the law relating to child protection and highlight the many difficult dilemmas faced by the medical team.

Early post-natal growth of large-for-dates babies of non-diabetic mothers is influenced by maternal glucose metabolism.

Growth of weight, length, head circumference and skinfold thickness (subscapular and triceps) from birth to 6 months in 53 large-for-dates (LFD) Chinese babies weighing greater than 4.0 kg at term and born to non-diabetic mothers was investigated and correlated with biochemical indices of maternal glucose tolerance at birth: glycosylated haemoglobin (HbA1), serum corrected fructosamine and the area under the oral glucose (50 g) tolerance (OGTT) curve. Growth in all physical dimensions, especially weight, showed a downward shift towards a reference mean. These changes in relative size were caused by slower growth velocities. None of the mothers had abnormally high concentrations of HbA1 or fructosamine nor an abnormal OGTT. However, weight velocities did show small but significant correlations with fructosamine (r = -0.42), and OGTT area units (r = 0.39) but not with HbA1. For some macrosomic babies born to apparently normal mothers, birth is seen to interrupt a process operating in prenatal life that accelerates growth. Covert abnormalities of maternal glucose homeostasis could explain this. Abnormal glucose tolerance during pregnancy might therefore be viewed as a continuum extending from (i) its maximum expression, the frankly diabetic state, through (ii) gestational diabetes to (iii) the mother who has no biochemically evident abnormality of glucose homeostasis but who has sufficient alteration to modify fetal growth. Post-natal growth of LFD babies is additional information which, when taken along with other markers of maternal glucose tolerance, might help to identify the mother at later perinatal risk.

Traditional Chinese infant supplementary medical foods given by mothers in Hong Kong.

Chinese mothers living in Hong Kong are used to giving their babies special medicinal food to strengthen the infant's internal defences and to restore the body's harmonious state. However since the majority of registered doctors are trained in the Western pharmacological tradition it is difficult for them to comprehend the concepts and idioms of this practice. This paper set out to investigate the frequency and varieties of medicinal foods given to 166 Chinese infants during the first 30 months after birth. One hundred and forty seven babies were given medicinal foods at some stage. The frequency of their administration varied from weekly to once or twice per month. The most popular medicinal food was "Job's tears" and the most widely administered compound herb preparations were milk preparation solution, flower teas and various cool teas. The potential pharmacological effects of these medicinal foods were searched from a Chinese medicines computerized database and found to be principally anti-inflammatory, bacteriostatic, diuretic and appetite stimulant. This study contributed a better appreciation of the popularity of infant supplementary medicinal foods in Hong Kong and the rationale for their use.

A simple method to improve the energy value of bank human milk.

Drip milk can be collected in large amounts, hence its potential value for human milk banks. This advantage is however offset by its low energy value. For those milk banks which depend mostly on drip milk, the energy value of its donor milk can be improved to a more acceptable level, and total volumes of donations increased, by encouraging mothers to combine collections of both drip and expressed milk.

Urinary D-glucaric acid excretion in idiopathic neonatal jaundice.

OBJECTIVE: To determine the extent to which immaturity of hepatic microsomal enzyme activity might contribute to physiological jaundice. METHODS: Urinary excretion of D-glucaric acid, expressed in mumol glucaric acid/ mmol creatinine, was measured in 122 Chinese full-term healthy newborn babies during the first five days of life. Among the 122 babies, 22 were born by normal spontaneous delivery at the British Military Hospital and 100 were born by caesarean section at the Prince of Wales Hospital. RESULTS: In all babies the excretion of D-glucaric acid was highest on the first day of life and gradually decreased over the following 5 days. Five babies born by spontaneous delivery and six babies born by caesarean section developed jaundice during the study period. The excretion of D-glucaric acid in the jaundiced babies was significantly higher on the first two days than in the non-jaundiced babies. CONCLUSIONS: D-glucaric acid excretion was increased in jaundiced newborn babies in the first few days of life. This finding does not indicate less liver microsomal enzyme activity in the jaundiced babies compared to those non-jaundiced. On the contrary, it suggests that in idiopathic neonatal jaundice compensatory mechanism might operate from a very early stage to excrete a higher bilirubin load that might be present through haemolysis.

Sudden infant death syndrome: links with infant care practices.

OBJECTIVES: To investigate infant care practices in a small ethnic minority population within Britain that might suggest possible factors contributing to the low incidence of the sudden infant death syndrome in Asian populations. DESIGN: Ethnographic interviewing, a qualitative comparative method drawn from social anthropology. SETTING: Central Cardiff. SUBJECTS: Non-random sample of 60 mothers of Bangladeshi or Welsh ethnic origin and working or middle class occupational status, who had infants under one year old. None of the families interviewed had experienced a sudden infant death. RESULTS: Broad cultural contrasts emerged as a series of themes from the interview data: living patterns, family networks, sleeping patterns, and concepts of time and dependence. CONCLUSION: Bangladeshi infants were cared for in a consistently rich sensory environment; Welsh infants, in contrast, were more likely to experience alternating periods of high and low sensory input. Long periods of lone quiet sleep may be one factor that contributes to a higher rate of sudden deaths in white than in Asian infants.

Relation between birth weight at term and systolic blood pressure in adolescence.

OBJECTIVE: To examine whether birth weight is related to systolic blood pressure during adolescence. DESIGN: Retrospective (comparative) cohort study. The observers who traced and studied the subjects were unaware of their case-control status. SUBJECTS: 330 subjects were born in Cardiff in 1975-7. Cases who were low birth weight at term (< 2500 g) were matched with controls of normal birth weight (3000-3800 g) at term. MAIN OUTCOME MEASURES: Systolic blood pressure measured by random zero sphygmomanometry in the subject's right arm with the subject supine, corrected for size and age. RESULTS: The mean age at examination was 15.7 years. The mean systolic blood pressure of the cases was 105.8 mm Hg and of the controls 107.5 mm Hg. The corrected difference (95% confidence interval) in systolic blood pressure between the cases and controls was 1 mm Hg (-3 to +1 mm Hg; two tailed probability 0.33). CONCLUSION: Systolic blood pressure in adolescents of low birth weight is not significantly different from that of adolescents of normal birth weights.