Longitudinal growth of children born with gastroschisis or omphalocele.

Normal childhood growth is an indicator of good health, but data addressing the growth of children born with abdominal wall defects (AWDs) are limited. The detailed growth phenotypes of children born with gastroschisis or omphalocele are described and compared to peers without AWDs from birth to adolescence. Data from 183 gastroschisis and 144 omphalocele patients born between 1993 and 2017 were gathered from Finnish nationwide registers and electronic health records. Weight (n = 3033), length/height (n = 2034), weight-for-length (0-24 months, n = 909), and body mass index measures (2-15 years, n = 423) were converted into sex- and age-specific Z-scores. Linear mixed models were used for comparisons. Intrauterine growth failure was common in infants with gastroschisis. Birth weight Z-scores in girls and boys were - 1.2 (0.2) and - 1.3 (0.2) and length Z-scores - 0.7 (0.2) and - 1.0 (0.2), respectively (p < 0.001 for all comparisons to infants without AWDs). During early infancy, growth failure increased in infants with gastroschisis, and thereafter, catch-up growth was prominent and faster in girls than in boys. Gastroschisis children gained weight and reached their peers' weights permanently at 5 to 10 years. By 15 years or older, 30% of gastroschisis patients were overweight. Infants with omphalocele were born with a normal birth size but grew shorter and weighing less than the reference population until the teen-age years. CONCLUSION: Children with gastroschisis and omphalocele have distinct growth patterns from fetal life onwards. These growth trajectories may also provide some opportunities to modulate adult health. WHAT IS KNOWN: • Intrauterine and postnatal growth failure can be seen frequently in gastroschisis and they often show significant catch-up growth later in infancy. It is assumed that part of the children with gastroschisis will become overweight during later childhood. WHAT IS NEW:  â€¢ The longitudinal growth of girls and boys with gastroschisis or omphalocele is described separately until the teenage years. The risk of gaining excessive weight in puberty was confirmed in girls with gastroschisis.

Screening of hydrocephalus in infants using either WHO or population-based head circumference reference charts.

AIM: The aim was to compare the performances of the World Health Organization (WHO) and population-based (PB) references in the screening for hydrocephalus in infants aged <2 years. METHODS: We collected 341 longitudinal head circumference (HC) measurements of hydrocephalic infants and 120 181 measurements of 15 145 healthy infants from primary care. The measurements were converted into z-scores, and a new screening parameter, change in HC standard deviation score (SDS) over time (ΔHC SDS), was calculated. Comparisons were made using receiver operating characteristics analysis and linear mixed models. RESULTS: The mean HC SDSWHO was 3.5 and the mean HC SDSPB was 2.9 in the hydrocephalic infants, and in healthy children, those numbers were 1.0 SDSWHO and 0 SDSPB , respectively. The best screening accuracy was obtained with the PB reference in combination with the ΔHC SDS parameter (AUC 0.89). The accuracy of the WHO standard could be improved to a similar level by customising the screening cut-offs of HC SDS according to the population and combining screening parameters. CONCLUSIONS: Auxology alone was not sufficient for the screening of hydrocephalus. The WHO standard should be validated in the population, and population-specific cut-offs for normality defined before its introduction.

Procedural Sedation Intubation in a Paramedic-Staffed Helicopter Emergency Medical System in Northern Finland.

OBJECTIVE: Airway management to ensure sufficient gas exchange is of major importance in emergency care. Prehospital endotracheal intubation (ETI) by paramedics is a widely debated method to ensure a patent airway. ETI is performed with procedural sedation in comatose patients because of the regulation. The use of medications increases the rate of successful airway management compared with nonmedication ETI and may also improve outcomes in patients with traumatic brain injury. In the absence of an operative emergency physician and with long distances, paramedic-induced airway management may increase the survival of patients in selected scenarios. A paramedic-staffed helicopter emergency medical system in Northern Finland operates in a rural area without an emergency physician and paralytic medications and treats critically ill patients using basic or advanced life support ground units. The aim of this study was to evaluate the success rates of ETI performed by a small, appropriately trained, and experienced group of 8 nurse paramedics in an out-of-hospital setting. METHODS: The inclusion criterion for the study was an attempted intubation in patients with medical or traumatic indication for airway management by nurse paramedic. RESULTS: Fifty-one patients were treated with ETI. The first-pass success rate was 72.5%, the second-pass success rate was 94.1%, and the overall success rate was 100% within 4 attempts. The median on-scene time was 54 minutes, and there were no signs of aspiration during laryngoscopy or after successful ETI. The primary mortality rate was 11.7%. CONCLUSION: The use of a rigid standard operating procedure for paramedic rapid sequence induction, paralytics, a video laryngoscope, and a gum elastic bougie might positively affect the ETI first-pass success rate. A follow-up study after these future modifications is needed. This small study suggests that intubation might be 1 option for airway management by an experienced nonanesthesiologist in Lapland.

[Finland is a pioneer in childhood growth monitoring--Is is evidence-based?]. / Suomi on lasten kasvunseurannan edelläkävijä--onko hyödyistä näyttöä?

In Finland, growth monitoring is a fundamental part of preventive child health care, aiming at an early detection of childhood illnesses as well as weight gain or loss. However, evidence-based studies on growth monitoring are practically lacking. Updated growth curves must be representative of the monitored population. Screening of Turner syndrome and celiac disease with novel growth monitoring methods could facilitate early diagnosis. Electronic health records provide an alternative to develop an automated growth monitoring program, which was found to be distinctly better than the manually orientated one in primary care. Systematic growth monitoring seems to be beneficial, although true population- based evidence on effectiveness is scarce.

Flawed oral health of a non-smoking adolescent suggests smoking in adulthood.

BACKGROUND: Smokers often have oral health problems. We studied whether poor oral health among non-smoking adolescents is connected to smoking behaviour in adulthood. METHODS: We used an age cohort born in 1979 (n = 2582) taking part in annual oral health check-ups between the ages of 13 and 15. Self-reported non-smokers were used as the study population. As measures we used decayed, missing or filled teeth/surfaces (DMF) and decayed teeth (D) and smoking behaviour at ages 13-15 and the depending measure was smoking behaviour at the age of 29. RESULTS: Those who were non-smokers at ages 13-15 and had tooth decay (D > 0) in an oral check-up during that period had higher risk (OR (Odds Ratio) 1.88, 95% confidence interval 1.2-2.9) of being a smoker by age 29. Tooth decay at age 15 predicted earlier onset of smoking for those, who became smokers later in life. Dental caries (DMF > 0) was not associated with higher risk of becoming a smoking adult, but those with dental caries at age 13 were more likely to start smoking earlier. CONCLUSIONS: Poorer dental health, especially tooth decay in adolescence is a possible indicator of a greater likelihood of transforming from being a non-smoker to a smoker. Dentists should notice this for allocated health promotion.

Pragmatic controlled trial to prevent childhood obesity in maternity and child health care clinics: pregnancy and infant weight outcomes (the VACOPP Study).

BACKGROUND: According to current evidence, the prevention of obesity should start early in life. Even the prenatal environment may expose a child to unhealthy weight gain; maternal gestational diabetes is known to be among the prenatal risk factors conducive to obesity. Here we report the effects of antenatal dietary and physical activity counselling on pregnancy and infant weight gain outcomes. METHODS: The study was a non-randomised controlled pragmatic trial aiming to prevent childhood obesity, the setting being municipal maternity health care clinics. The participants (n = 185) were mothers at risk of developing gestational diabetes mellitus and their offspring. The children of the intervention group mothers were born between 2009 and 2010, and children of the control group in 2008. The intervention started between 10-17 gestational weeks and consisted of individual counselling on diet and physical activity by a public health nurse, and two group counselling sessions by a dietician and a physiotherapist. The expectant mothers also received a written information leaflet to motivate them to breastfeed their offspring for at least 6 months. We report the proportion of mothers with pathological glucose tolerance at 26-28 weeks' gestation, the mother's gestational weight gain (GWG) and newborn anthropometry. Infant weight gain from 0 to 12 months of age was assessed as weight-for-length standard deviation scores (SDS) and mixed effect linear regression models. RESULTS: Intervention group mothers had fewer pathological oral glucose tolerance test results (14.6% vs. 29.2%; 95% CI 8.9 to 23.0% vs. 20.8 to 39.4%; p-value 0.016) suggesting that the intervention improved gestational glucose tolerance. Mother's GWG, newborn anthropometry or infant weight gain did not differ significantly between the groups. CONCLUSION: Since the intervention reduced the prevalence of gestational diabetes mellitus, it may have the potential to diminish obesity risk in offspring. However, results from earlier studies suggest that the possible effect on the offspring's weight gain may manifest only later in childhood. TRIAL REGISTRATION: Clinical Trials gov: NCT00970710.

No association between overweight and asthma or allergy in adolescence after wheezing in infancy.

AIMS: The aim of the study was to evaluate the association between weight status and asthma, allergy and respiratory symptoms in adolescents with bronchiolitis in infancy. SUBJECTS AND METHODS: At age 15-18 years, a questionnaire was sent to 96 study subjects hospitalized for wheezing at age <24 months and followed up subsequently. Sixty-seven (70%) of them answered. Weight and height data for body mass index (BMI) calculation were available in 60 (63%) cases. Asthma, allergy, respiratory symptoms and the use of asthma medication were compared between overweight or obese and normal weight groups constructed by age- and sex-specific BMI standard deviation scores (BMI-SDS). Population controls matched for sex, and birth month and place, were recruited for this study phase at age 15-18 years. RESULTS: Eleven (18.3%) study subjects were overweight (BMI-SDS >0.78 in males and >1.16 in females) and only 3 (5.0%) were obese (BMI-SDS >1.70 in males and >2.10 in females) at 16.5 (median) years of age. Overweight or obesity had no significant association with doctor-diagnosed or self-reported asthma, allergy or the use of inhaled corticosteroids. The negative results were confirmed by adjusted analyses. CONCLUSION: Weight status had no association with asthma or allergy in adolescence after wheezing in infancy.

Charting infants' motor development at home using a wearable system: validation and comparison to physical growth charts.

BACKGROUND: Early neurodevelopmental care and research are in urgent need of practical methods for quantitative assessment of early motor development. Here, performance of a wearable system in early motor assessment was validated and compared to developmental tracking of physical growth charts. METHODS: Altogether 1358 h of spontaneous movement during 226 recording sessions in 116 infants (age 4-19 months) were analysed using a multisensor wearable system. A deep learning-based automatic pipeline quantified categories of infants' postures and movements at a time scale of seconds. Results from an archived cohort (dataset 1, N = 55 infants) recorded under partial supervision were compared to a validation cohort (dataset 2, N = 61) recorded at infants' homes by the parents. Aggregated recording-level measures including developmental age prediction (DAP) were used for comparison between cohorts. The motor growth was also compared with respective DAP estimates based on physical growth data (length, weight, and head circumference) obtained from a large cohort (N = 17,838 infants; age 4-18 months). FINDINGS: Age-specific distributions of posture and movement categories were highly similar between infant cohorts. The DAP scores correlated tightly with age, explaining 97-99% (94-99% CI 95) of the variance at the group average level, and 80-82% (72-88%) of the variance in the individual recordings. Both the average motor and the physical growth measures showed a very strong fit to their respective developmental models (R2 = 0.99). However, single measurements showed more modality-dependent variation that was lowest for motor (σ = 1.4 [1.3-1.5 CI 95] months), length (σ = 1.5 months), and combined physical (σ = 1.5 months) measurements, and it was clearly higher for the weight (σ = 1.9 months) and head circumference (σ = 1.9 months) measurements. Longitudinal tracking showed clear individual trajectories, and its accuracy was comparable between motor and physical measures with longer measurement intervals. INTERPRETATION: A quantified, transparent and explainable assessment of infants' motor performance is possible with a fully automated analysis pipeline, and the results replicate across independent cohorts from out-of-hospital recordings. A holistic assessment of motor development provides an accuracy that is comparable with the conventional physical growth measures. A quantitative measure of infants' motor development may directly support individual diagnostics and care, as well as facilitate clinical research as an outcome measure in early intervention trials. FUNDING: This work was supported by the Finnish Academy (314602, 335788, 335872, 332017, 343498), Finnish Pediatric Foundation (Lastentautiensäätiö), Aivosäätiö, Sigrid Jusélius Foundation, and HUS Children's Hospital/HUS diagnostic center research funds.

Lifestyle counseling during pregnancy and offspring weight development until four years of age: follow-up study of a controlled trial.

BACKGROUND: Fetal conditions are known to be partly responsible for the child's risk for obesity. Our pilot study aimed to determine the effect of gestational lifestyle counseling on the offspring weight gain until 4 years of age and to estimate power for future studies. DESIGN AND METHODS: First-time pregnant mothers participated in a controlled trial conducted in maternity health clinics during 2004 - 2006. The intervention included individual counseling on physical activity and diet, and an option to attend supervised group exercise sessions. The participant mothers (N = 109) received a follow-up questionnaire concerning 13 repeated growth measurements of their offspring. Response rate to the follow-up questionnaire was 66.1% (N = 72/109). RESULTS: The increase of BMI z-score between 24-48 months was not significantly slower among the intervention group offspring (95% CI -0.025 to 0.009, p = 0.34) compared to control group. Z-scores for weight-for-length/height did not differ between groups when the period 0-48 months was analyzed (95% CI -0.010 to 0.014, p = 0.75). CONCLUSIONS: In this pilot study gestational lifestyle counseling did not significantly slow the weight gain of the offspring. Gestational intervention studies with at least 300 mothers per group are needed to confirm the possible effect on offspring's risk for obesity. TRIAL REGISTRATION: Current Controlled Trials ISRCTN21512277.

Epidemiology of Disorders Associated with Short Stature in Childhood: A 20-Year Birth Cohort Study in Finland.

Background: Many primary and secondary disorders disturb growth and cause short stature (height below -2 SDS) in childhood. Growth monitoring programs aim at their early detection but are not evidence-based: epidemiology of childhood growth disorders is poorly characterized, and no consensus exists on priority target conditions. Herein, we describe population-based epidemiological data on several primary and secondary growth disorders associated with short stature in childhood. Materials and Methods: This retrospective population-based 20-year birth cohort study examined 1 144 503 children (51% boys) born in Finland between 1998 and 2017, with 16.5 million care notifications including medical diagnoses. The first occurrences of key primary or secondary growth disorders were identified in multiple registers. Median ages at diagnosis (MAD), and age- and sex-specific cumulative incidences (CMI) from birth until 16 years of age were determined. Results: Turner syndrome was the most common primary growth disorder (CMI 52 per 100 000 at 16 years, MAD 4.0 years). Most primary growth disorders were diagnosed before the age of 4 years, and thereafter, secondary growth disorders increased in number. MAD of growth hormone deficiency (GHD) was 8.7 (boys) and 7.2 years (girls). At 16 years, the CMI of GHD was higher in boys than in girls (127 versus 93 per 100 000, respectively), whereas the CMI of hypothyroidism was higher in girls (569 versus 306 per 100 000). Celiac disease was the most common secondary growth disorder and more common in girls than in boys (988 versus 546 per 100 000 at 16 years, respectively). Conclusion: These population-based epidemiological data indicate that childhood growth monitoring should be age- and sex-specific. In the early childhood, the focus should be on primary growth disorders, and from preschool age also on secondary growth disorders. These results provide evidence for improving growth monitoring programs and diagnostic practices targeting on Turner syndrome, GHD, hypothyroidism, and celiac disease.

Prevalence of Thinness, Overweight, Obesity, and Central Obesity in Finnish School-Aged Children: A Comparison of National and International Reference Values.

INTRODUCTION: The global epidemic of obesity concerns children, and monitoring the prevalence is of highest priority. Body mass index (BMI) with age- and sex-specific cutoff values determines weight status in children, although multiple reference systems exist. Our aim was to compare the prevalence for thinness, normal weight, overweight, and obesity in Finnish school-aged children according to national and international reference values, as well as to determine which cutoff values for overweight agree with the criteria for central obesity. METHODS: This study includes 10,646 children aged 9-12 years from the Finnish Health in Teens cohort. Height, weight, and waist circumference were measured in 2011-2014. BMI (weight [kg]/height [m]2) and the waist-to-height ratio (WHtR; waist [cm]/height [cm]) were calculated. The WHtR cutoff of >0.5 indicated central obesity. We compared the sex-specific prevalence of thinness, overweight, and obesity using the International Obesity Task Force (IOTF), World Health Organization (WHO) and Finnish (FIN) BMI-for-age reference values, as well as these three against central obesity based on the WHtR. RESULTS: The prevalence of thinness, overweight, and obesity were 11.0%, 12.7%, and 2.6%, respectively, using IOTF; 2.6%, 15.9%, and 5.2% using WHO; and 5.1%, 11.4%, and 2.2% using FIN. Overweight and obesity were more common in boys than girls using WHO and FIN, while thinness was more common in girls using IOTF and FIN. IOTF versus WHO exhibited moderate agreement (κ = 0.59), which improved for IOTF versus FIN (κ = 0.74). Of those classified as overweight by WHO, 37% and 47% were regarded as normal weight according to IOTF and FIN, respectively. The prevalence of central obesity was 8.7%, and it was more common in boys than girls. WHO provided the highest sensitivity: 95% of individuals with central obesity were classified with overweight or obesity. Using FIN provided the highest specificity (93%). CONCLUSION: Our findings show that WHO overestimates the prevalence of overweight and obesity, while IOTF overrates thinness. Thus, comparing prevalence rates between studies requires caution. The novelty of this study is the comparison of the cutoff values for overweight with central obesity. The choice of reference system affects the generalizability of the research results.

Maternal Smoking During Pregnancy and Offspring Head Growth in Comparison to Height and Weight Growth Up to 6 Years of Age: A Longitudinal Study.

BACKGROUND: Maternal smoking during pregnancy causes fetal growth retardation. Thereafter, it has been associated with excessive childhood weight gain and decreased linear growth in the offspring. However, it is not known whether head circumference (HC), the surrogate of brain size in childhood, is altered after intrauterine tobacco exposure. We assessed the association of maternal smoking during pregnancy with offspring HC growth up to age 6 years in comparison with length/height growth and weight gain. METHODS: We combined data from Medical Birth Register and longitudinal growth data from primary care of 43,632 children (born 2004-2017). Linear mixed effects models were used for modeling, adjusting for potential perinatal and socioeconomic confounders. RESULTS: At birth, maternal smoking during pregnancy was associated with a mean deficit of 0.19 standard deviation score (SDS) (95% CI: -0.25, -0.12) in HC, -0.38 SDS (95% CI: -0.43, -0.32) in length, and -0.08 SDS (95% CI:-0.14, -0.02) in weight-for-length. HC in smokers' children failed to catch up to that of non-smokers' children. Height of smokers' infants reached that of non-smokers' infants by 12 months but declined thereafter. Weight-for-height of smokers' infants exceeded the level of non-smokers' infants at 3 months and remained significantly elevated thereafter. HC in the offspring of mothers who quit smoking in the first trimester was not deficient, but their weight-for-height was elevated. CONCLUSION: HC of smokers' children is still deficient at age 6 years. Since most of the head growth occurs during the first 2 years of life, the defect may be permanent. In smokers' children, weight gain was excessive up to 6 years and height was deficient at 6 years consistent with previous literature. Efforts should be made to encourage pregnant women to quit smoking in the beginning of the pregnancy.

Early Detection of Abnormal Growth Associated with Juvenile Acquired Hypothyroidism.

CONTEXT: Development of the typical growth phenotype in juvenile acquired hypothyroidism (JHT), the faltering linear growth with increasing weight, has not been thoroughly characterized. OBJECTIVE: To describe longitudinal growth pattern in children developing JHT and investigate how their growth differs from the general population in systematic growth monitoring. DESIGN: Retrospective case-control study. SETTING: JHT cases from 3 Finnish University Hospitals and healthy matched controls from primary health care. PATIENTS: A total of 109 JHT patients aged 1.2 to 15.6 years (born 1983-2010) with 554 height and weight measurements obtained for 5 years preceding JHT diagnosis. Each patient was paired with 100 healthy controls (born 1983-2008) by sex and age. Longitudinal growth pattern was evaluated in mixed linear models. Growth monitoring parameters were evaluated using receiver operating characteristics analysis. RESULTS: At diagnosis, JHT patients were heavier (mean adjusted body mass index-for-age [BMISDS] difference, 0.65 [95% CI, 0.46-0.84]) and shorter (mean adjusted height-for-age deviation from the target height [THDEVSDS] difference, -0.34 [95% CI, -0.57 to -0.10]) than healthy controls. However, 5 years before diagnosis, patients were heavier (mean BMISDS difference, 0.33 [95% CI, 0.12-0.54]) and taller (mean THDEVSDS difference, 0.29 [95% CI, 0.06-0.52]) than controls. JHT could be detected with good accuracy when several growth parameters were used simultaneously in screening (area under the curve, 0.83 [95% CI, 0.78-0.89]). CONCLUSIONS: Abnormal growth pattern of patients with JHT evolves years before diagnosis. Systematic growth monitoring would detect abnormal growth at an early phase of JHT and facilitate timely diagnosis of JHT.

Changes in body composition by age and obesity status in preschool-aged children: the STEPS study.

BACKGROUND/OBJECTIVES: Obesity in early childhood is associated with increased risk of chronic diseases, but studies of body composition at preschool ages are sparse. Therefore, we examined differences in body composition by sex and obesity status in Finnish preschool-aged children and within-individual changes in body composition in normal and overweight children. SUBJECT/METHODS: Body composition was measured using segmental multifrequency bioimpedance analysis (BIA) in 476 children and in 781 children at age 3 and 5 years, respectively. Of those, 308 had repeated BIA measurements at both ages. BMI-SDS was used for classification of normal weight and overweight children. RESULTS: Sex difference in the amount of lean mass (LM) was already seen at 3 years of age (boys 11.7 kg, girls 11.3 kg; p < 0.001). At 5 years of age, boys had lower fat mass (FM; 3.6 kg vs. 3.9 kg, p < 0.001), lower percent fat mass (%FM; 17.2% vs. 19.1%; p < 0.001), and higher LM (16.0 kg vs. 15.2 kg; p < 0.001) than girls. Overweight children had higher values in FM, %FM, and LM compared with normal weight peers at both ages. Among normal weight children, the increase of LM by age was associated with only minor changes in FM, whereas children who were or became overweight both LM and FM was substantially increased between 3 and 5 years of age. CONCLUSIONS: BIA-assessed body composition differs by sex and obesity status already at age of 3 years. For children who are or become overweight at very young age, the patterns for the changes in LM and FM by age are different than for normal weight children.

Transient Postnatal Gonadal Activation and Growth Velocity in Infancy.

BACKGROUND AND OBJECTIVE: Transient activation of the hypothalamic-pituitary-gonadal axis with a sex steroid surge is observed in boys and girls during the first months of life. However, the role of sex steroids in the regulation of growth has not been substantiated in infancy. We tested the hypothesis that testosterone (T) surge, known to be higher in infant boys than in girls during the transient postnatal gonadal activation regulates linear growth in infants. METHODS: To characterize in detail the linear growth velocity (GV) differences between genders in the normal population in early infancy, we evaluated growth of 18 570 healthy infants (51.0% boys) with 162 003 height measurements from birth to 12 months of age. GV was monitored and compared with serially measured urinary T and estradiol levels and serum insulin-like growth factor 1 levels in 84 healthy infants (45% boys) during the first 6 months of life. RESULTS: GV was significantly faster from birth to 6 months of age in boys than in girls (P ≤ .01). The greatest GV difference, 4.1 cm per year, was observed at 1 month of age, simultaneously with the peak of postnatal gonadal activation. In the mixed model analysis, GV showed a significant positive association with T in both genders (parameter estimate up to 0.62, 95% confidence interval 0.44-0.81). CONCLUSIONS: These results provide a new insight into the regulation of growth in infants and elucidate a novel biological role of the transient postnatal gonadal activation in growth regulation.

Weaker Self-Esteem in Adolescence Predicts Smoking.

BACKGROUND: To study whether weaker self-esteem in adolescence is connected with smoking behavior in adulthood. METHODS: An age cohort born in 1979 responded to the Lawrence Self-Esteem Questionnaire (LAWSEQ) at the age of 16 (n = 1,072). Respondents' smoking behavior was monitored annually during adolescence and 75.3% (n = 813) of them remained nonsmokers during adolescence. A follow-up questionnaire eliciting smoking behavior was sent to the adolescent nonsmokers at the age of 29 years. Response rate at follow-up was 46.2% (n = 376). RESULTS: Weaker self-esteem (LAWSEQ score ≥ 3) during the adolescence was not significantly associated with smoking in adulthood. However, those respondents who had weaker self-esteem in adolescence had increased risk of having been smoking regularly (adjusted OR 1.8, 95% CI 1.1-3.0) although not all of them were smokers at the time of the follow-up. CONCLUSIONS: Those with weaker self-esteem in adolescence are more likely to smoke regularly in adulthood.

Antibiotic exposure in infancy and risk of being overweight in the first 24 months of life.

OBJECTIVE: Antibiotics have direct effects on the human intestinal microbiota, particularly in infancy. Antibacterial agents promote growth in farm animals by unknown mechanisms, but little is known about their effects on human weight gain. Our aim was to evaluate the impact of antibiotic exposure during infancy on weight and height in healthy Finnish children. METHODS: The population-based cohort comprised 6114 healthy boys and 5948 healthy girls having primary care weight and height measurements and drug purchase data from birth to 24 months. BMI and height, expressed as z-scores at the median age of 24 months (interquartile range 24 to 26 months), were compared between children exposed and unexposed to antibiotics using analysis of covariance with perinatal factors as covariates. RESULTS: Exposed children were on average heavier than unexposed children (adjusted BMI-for-age z-score difference in boys 0.13 SD [95% confidence interval 0.07 to 0.19, P < .001] and in girls 0.07 SD [0.01 to 0.13, P < .05]). The effect was most pronounced after exposure to macrolides before 6 months of age (boys 0.28 [0.11 to 0.46]; girls 0.23 [0.04 to 0.42]) or >1 exposure (boys 0.20 [0.10 to 0.30]; girls 0.13 [0.03 to 0.22]). CONCLUSIONS: Antibiotic exposure before 6 months of age, or repeatedly during infancy, was associated with increased body mass in healthy children. Such effects may play a role in the worldwide childhood obesity epidemic and highlight the importance of judicious use of antibiotics during infancy, favoring narrow-spectrum antibiotics.