Neonatal infection with Neisseria meningitidis: analysis of a 97-year period plus case study.

Neisseria meningitidis is one of the major causes of meningitis in children and adolescents, but it is rarely found during the neonatal period. Here, we describe a neonate with meningococcal sepsis who was admitted to the hospital on postnatal day 10, and we discuss the clinical features of neonatal infection with N. meningitidis in relation to the literature (analysis of a 97-year period).

Assessment of knowledge of pediatric nurses related with drug administration and preparation.

AIM: Aim of this study is to determine the levels of knowledge related with drug administration and drug administration errors of nurses who care for pediatric patients. MATERIAL AND METHODS: The study data were obtained from the nurses who were working in the departments of pediatrics in two education and research hospitals in the province of Istanbul and who accepted to participate in the study. The questionnaire form of the study was established by the investigators in accordance with the experiences and literature information. A total of 31 questions related with drug preparation, calculation and administration together with the general working properties of the individual were filled out by face to face interview. The data were evaluated using percent and chi-square tests. The study was initiated after ethics committee approval was obtained from Sisli Hamidiye Etfal Education and Research Hospital (365/2013). RESULTS: The study was conducted with 98 nurses who accepted the questionnaire. The education levels of the participants were as follows: undergraduate (48%), high school (32.7%), associate degree (12.2%), master's degree (6.1%) and postgraduate (1%). It was found that 88.8% of the participants worked in a patient-centered fashion and 11.2% worked in a work-centered fashion. The frequency of interruption/distraction during preparation of treatment was found to be 92.9%. It was found that the frequency of checking by two people during preparation or administration of high risk drugs was 64.3% and the conditions under which drugs should be kept were found to known correctly with a rate of 76.5%. It was found that undergraduate healthcare workers were more successful in converting units (p= 0.000). It was found that powder weight of drugs was considered with a rate of 85.7% in calculation. CONCLUSIONS: Conclusively, it was found that nurses who worked in pediatric wards did not receive a standard education in terms of drug administration and preparation. It was found that undergraduate nurses were more successful in calculating doses, the process of drug preparation was interrupted with a rate of >90% and the rate of checking by two people was low.

Acute kidney injury in a single neonatal intensive care unit in Turkey.

BACKGROUND: Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity. METHODS: Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function. RESULTS: The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI. CONCLUSIONS: Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

Early Aggressive Parenteral Nutrition Induced High Insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) Levels Can Prevent Risk of Retinopathy of Prematurity.

OBJECTIVE: To evaluate early aggressive vs. conservative nutrition and its effect on Retinopathy of Prematurity (ROP) in <32 weeks of gestation neonates. METHODS: A prospective, randomized, clinical study was conducted in NICU with a total of 75 preterm infants. In the intervention group, infants received early aggressive nutrition immediately after birth, in the control group infants were started on conventional parenteral nutrition (PN). Blood samples were obtained for Insulin-like growth factor 1 (IGF-1) and insulin-like growth factor binding protein 3 (IGFBP3) levels before commencement of PN on the first postnatal day, and from week 1 to 6 every week. All the infants were examined for ROP. FINDINGS: Infants in the early aggressive group had a reduction in the risk of ROP of 5% (2 from 40); the number of infants needed treatment averaged 3.7 (2.7 to 5.2). A total of 11 neonates in the conventional group were detected having ROP (P<0.05). Overall, IGF-I levels were higher in the aggressive PN (APN) vs the conventional PN (CPN). ROP development was higher in the CPN compared to the APN. IGF-1levels were lower in ROP developers compared with non-ROP in the APN group. There was no difference in IGF-I levels in ROP developers versus non-ROP in the CPN group. IGF-1 levels were lower in the CPN group compared with the APN group in the third week in ROP developers. There was a correlation between ROP and IGF-1 levels. Through ROC analysis, IGF-1 was demonstrated as being a sensitive marker for ROP. CONCLUSION: IGF-1 levels were higher in the APN group versus the CPN group. This may indicate that IGF-1 levels simply being higher is not enough; rather, that being higher above a cutoff value may prevent ROP.

Effects of aggressive parenteral nutrition on growth and clinical outcome in preterm infants.

BACKGROUND: The goal of nutrition in the preterm infant is to achieve postnatal growth approximating normal fetal growth. During the early postnatal period, protein intake must be sufficient to achieve normal postnatal growth in extremely low-birthweight infants. The aim of this study was to test the hypothesis that giving higher amounts of amino acids and lipids to infants born at <34 gestational weeks (GW) may improve growth at the 40th week of gestation and have a positive preventive effect on development of retinopathy of prematurity (ROP). METHODS: Fifty-three neonates born at <34 GW and hospitalized in the neonatal intensive care unit (NICU) were included in this prospective study. They were randomly divided into two groups. Group 1 received aggressive parenteral nutrition (PN) (amino acids 3 g/kg per day and lipids 2 g/kg per day on first day of life). Group 2 received conventional PN (amino acids 1.5 g/kg per day and lipids 1 g/kg per day on first day of life). The anthropometric measurements, clinical outcomes and serum levels of insulin-like growth factor-I (IGF-I), IGF binding protein (IGFBP) and thyroid hormones were compared between groups. RESULTS: At 40 weeks of gestation, height, head circumference and serum IGF-I and IGFBP3 were statistically higher in the group receiving aggressive PN. Thyroid hormones were not affected by aggressive PN. The lower levels of IGF-I and IGFBP3 in the group receiving conventional PN were negatively correlated with development of ROP. CONCLUSION: Aggressive PN seems to positively affect neonates' anthropometric measurements at the 40th gestational week and the development of ROP. These effects may be related to high levels of IGF-I and IGFBP3.

Frequency and risk factors of fetal malnutrition among liveborn singleton term neonates using a computerised perinatal database, 2000-2006.

AIM: The aim of this study was to determine the frequency, risk factors and anthropometric measurements of fetally malnourished, liveborn singleton term neonates. METHODS: The computed delivery room data of 11.741 liveborn singleton term neonates was used to compare malnourished and nourished newborns. RESULTS: Of the total subjects, 577 (4.9%) were malnourished. There were no differences between the groups with regard to gender distribution, Apgar scores, maternal parity, smoking during pregnancy and type of delivery. Maternal age and neonatal gestational age (GA) were significantly lower in malnourished newborns (P < 0.001). Birthweight (BW), birth length (BL) and head circumference (HC) were significantly lower in the malnourished group compared with well-nourished group (P < 0.001). Mean BW (g) was 2724.7 ± 17.0 in the malnourished group versus 3234.3 ± 3.8 in the well-nourished group; BL (cm) was 47.8 ± 0.1 in malnourished versus 49.5 ± 0.0 in well-nourished neonates; HC (cm) was 33.25 ± 0.1 in the malnourished versus 34.3 ± 0.0 in the well-nourished group. Between the groups, there were significant differences in the ratio of small, appropriate and large for GA (P < 0.001). Of the malnourished newborns, 35.5% were small for GA, 63.3% were appropriate for GA and 1.2% were large for GA. CONCLUSION: Fetal malnutrition (FM) still exists despite the advances in current obstetric care. Neonates of adolescent mothers and of low GA are particularly at risk for FM. The BW, BL and HC of fetally malnourished neonates are lower than that of well-nourished neonates. Like term singleton appropriate and small for GA neonates, term singleton large for GA neonates could also have been fetally malnourished.

Healthcare-associated infections in a Neonatal Intensive Care Unit in Turkey.

OBJECTIVE: To determine the incidence, risk factors, mortality rate, antibiotic susceptibility and causative agents of healthcare-associated infections (HAIs) in the Neonatal Intensive Care Unit. DESIGN: Prospective, cohort. SETTING: A 38-bed, teaching, referral, neonatal intensive-care unit. PARTICIPANTS: All patients in the neonatal intensive care unit who did not have any sign of infection at admission and remained hospitalized for at least 48 hours. METHODS: The study was conducted between January 2009 and January 2011. Healthcare-associated infection was diagnosed according to the criteria of CDC. Risk factors for HAI were analyzed with univariate and multivariate regression analysis. RESULTS: The incidence of HAI was found to be 16.2%. Blood stream infection was observed as the most common form of HAI (73.2%). The mortality rate was 17.3%. Antenatal steroid use, cesarean section, male gender, low birth weight, parenteral nutrition, percutaneous and umbilical catheter insertion, mechanical ventilation and low Apgar scores were found to be related with HAI (P<0.05). A 10% reduction in infection rate as a consequence of the application of a new total parenteral nutrition guideline was observed. Coagulase negative staphylococci (44. 4%) and Klebsiella pneumoniae (25.9%) were the most common etiologic agents isolated from cultures. Methicillin resistance of coagulase-negative staphylococci and ESBL resistance of Klebsiella pneumoniae were 72% and 44%, respectively. CONCLUSIONS: Antenatal steroid was found to be associated with HAI. Newly applied total parenteral nutrition guidelines reduced the attack rate of infection. Efforts should be focused on developing more effective prevention strategies to achieve better outcomes.

Relationship between oxygen saturation and umbilical cord pH immediately after birth.

BACKGROUND: The aim of this study is to determine the relationship between oxygen saturation (SpO(2)) by pulse oximetry levels and umbilical cord arterial pH values in healthy newborns during the first 15 minutes of life. METHODS: The study was performed with healthy term, appropriate-for-gestational-age newborn infants. The infants were divided in two groups: umbilical cord arterial blood pH value ≤7.19 (group 1) and >7.19 (group 2); SpO(2) levels during the first 15 minutes of life were compared between groups. RESULTS: The study was completed with 129 infants (33 in group 1 and 96 in group 2). A significant correlation was found between first-measured preductal and postductal SpO(2) levels by pulse oximetry and umbilical cord arterial pH values ([r²:0.72(0.62 -0.79); p < 0.001] and [r²:0.32(0.25 - 0.54); p < 0.001], respectively). In group 1, infants had lower SpO(2) levels at both preductal and postductal measurements during the first 11 minutes of life and time to reach ≥90% SpO(2) level was longer compared with infants in group 2. CONCLUSION: Determination of umbilical arterial blood pH values, in addition to clinical findings and oxygen saturation measurements, might be helpful in deciding the concentration of oxygen and whether or not to continue oxygen supplementation in the delivery room.

Effect of low versus high early parenteral nutrition on plasma amino acid profiles in very low birth-weight infants.

OBJECTIVE: To study the efficacy of early high doses parenteral nutrition (PN) versus early low dose with progressive increments PN regimens, we performed a prospective randomized study in very low birth-weight infants. STUDY DESIGN: Forty-one appropriate gestational age preterm infants with birth weights ranging from 750-1500 g were randomly assigned into two groups. In Group 1, infants started on 3.0 g/kg/day amino acids (AA) and 3 g/kg/day of 20% lipid; in Group 2, AA and lipid were started on 1 g/kg/day, and advanced over 3 days to a maximum 3 g/kg/day. Blood samples were obtained for AA concentrations before starting of the PN, and at the 7th and 14th days. RESULTS: The mean (±SD) birth weight was 1335 g (240), gestational age was 29.7 weeks (1.7) of the study group. The mean body weight and head circumference was similar in the Group 1 and Group 2 at the 14th postnatal days. There was no difference in the blood levels of triglyceride, blood urea nitrogen, creatinine, ammonia, lactat and bicarbonate in the two groups. There was no significant difference in the concentrations of AA except for arginine and asparagine. On day 14, the mean arginine concentrations were significantly higher and asparagine concentrations were lower in Group 2. CONCLUSION: Although earlier more aggressive administration of AA and fat is not associated with any significant metabolic abnormalities, growth rates and plasma AA concentrations of the infants were similar to infants who AA and lipid given lower in the first day of life.

New intrauterine growth percentiles: a hospital-based study in Istanbul, Turkey.

OBJECTIVE: To develop gender and gestation-specific growth percentiles for singleton live-born neonates and to compare new weight for age unisex percentiles with Lubchenco unisex percentiles. METHODS: Cross-sectional birth data were collected from the neonatal registry from January 2000 to April 2006 (n = 15.509). After exclusion, the sample included 15.112 neonates. RESULTS: Newly developed weight for age, charts were compared with Lubchenco unisex percentiles, 91.8% of the subjects were classified in the same way (Kappa = 0.74, P < 0.001). Small for gestational age (SGA) and large for gestational age (LGA) according to the Lubchenco percentiles differed from the new percentiles (Mc Nemar test, P < 0.001). The percentage of SGA neonates was underestimated by Lubcheno percentile (5.8% vs. 10.6%, respectively), whereas the percentage of LGA neonates was overestimated by Lubcheno percentile (10.3% vs. 9.3%, respectively). CONCLUSION: New growth chart for newborn delivered at different gestational ages have been established, which can be used to define SGA and LGA in Turkish neonates. Studies comparing the Lubchenco percentiles with new percentiles are needed.

Oxygen saturation levels during the first minutes of life in healthy term neonates.

The oxygen support during neonatal resuscitation is not completely defined by evidence-based science. We, therefore, aimed to determine the oxygen saturation (SpO(2)) levels within the first 15 minutes of life and to evaluate the effect of delivery routes, gender and measurement sites on the mean time to reach preductal and postductal SpO(2) levels of 90% among healthy term neonates. The sensors were placed at the right hand for preductally and the left hand for postductally SpO(2) measurements. In this prospective observational study, 141 healthy term neonates were included. Seventy-one (50.3%) of the babies were female, and 77 (54.6%) were delivered by caesarean section. Mean gestational age was 38.8 ± 1.1 weeks and mean birth weight was 3,082 ± 425.7 g. Overall, it took 7.5 ± 2.8 and 9.5 ± 3.2 min to reach oxygen saturation levels ≥ 90% preductally and postductally, respectively. The lengths of time to reach ≥ 90% preductal and postductal SpO(2) levels were 6.9 ± 2.8 and 8.4 ± 3.2 min for vaginal delivery and 8.0 ± 2.8 and 10.4 ± 2.9 min for caesarean section, respectively. Thus, the time to reach SpO(2) levels ≥ 90% was prolonged in the postductal measurements and in the neonates born by caesarean section. Gender was found to have no effect on duration to reach 90% SpO(2) levels at both preductal and postductal measurements. The measurement site and the type of delivery must be taken into consideration when oxygen saturation was measured in term healthy newborn in delivery room immediately after birth.

A comparison of different methods of temperature measurements in sick newborns.

We aimed to compare the accuracy of digital axillary thermometer (DAT), rectal glass mercury thermometer (RGMT), infrared tympanic thermometer (ITT) and infrared forehead skin thermometer (IFST) measurements with traditional axillary glass mercury thermometer (AGMT) for intermittent temperature measurement in sick newborns. A prospective, descriptive and comparative study in which five different types of thermometer readings were performed sequentially for 3 days. A total of 1989 measurements were collected from 663 newborns. DAT and ITT measurements correlated most closely to AGMT (r = 0.94). The correlation coefficent for IFST and RGMT were 0.74 and 0.87, respectively. The mean differences for DAT, ITT, RGMT and IFST were +0.02°C, +0.03°C, +0.25°C and +0.55°C, respectively. There were not any clinical differences (defined as a mean difference of 0.2°C) between both mean AGMT&DAT and AGMT&ITT measurements. Our study suggests that tympanic thermometer measurement could be used as an acceptable and practical method for sick newborn in neonatal units.

The evaluation of polycythemic newborns: efficacy of partial exchange transfusion.

OBJECTIVES: To evaluate the clinical characteristics and risk factors of symptomatic and asymptomatic polycythemic neonates performed partial exchange transfusion (PET) and to determine the time of resolution of symptoms and effect of PET on short-term morbidity. METHODS: This prospective cohort study was conducted with symptomatic (hematocrit; Hct>65% plus a clinical symptom) and asymptomatic (Hct level>70% without any symptoms) neonates who underwent PET due to polycythemia. RESULTS: Among the patients performed PET, 43 (69.3%) were symptomatic and 19 (30.7%) asymptomatic. Persistent pulmonary hypertension and minor problems like hypoglycemia, hypocalcemia, hyperbilirubinemia, and thrombocytopenia improved in all patients within 24 h, 2.5 ± 1.0, 3.1 ± 1.4, 56.2 ± 16.9, and 53.5 ± 10.5 h, respectively, after PET (in except one symptomatic neonate with hypoglycemia). In symptomatic group, in three patients with suspected necrotizing enterocolitis (NEC) prior to PET stage IIa NEC developed. No other clinical and ultrasonographic findings were observed after PET. CONCLUSIONS: Early morbidities, due to polycythemia may be reversed with PET within a short time. PET did not increase or cause any complications except NEC. The issue that either NEC was a sign of polycythemia or a complication of PET could not be definitely outlined.

A comparison of magnesium sulphate and sildenafil in the treatment of the newborns with persistent pulmonary hypertension: a randomized controlled trial.

The aim of this prospective, randomized and controlled study was to compare the clinical efficacy of intravenous magnesium sulfate (MgSO4) and oral sildenafil therapies with persistent pulmonary hypertension of the newborn. A total of 34 infants in the MgSO4 group and 31 infants in the sildenafil group completed the study. The time to reach the adequate clinical response [defined as oxygen index (OI) level of <15, a pulmonary artery pressure of < 20 mmHg) was significantly shorter in the sildenafil group (p = 0.002). Duration of mechanical ventilation was longer and the number of the patients requiring inotropic support was higher in the MgSO4 group (p = 0.001 and p = 0.002, respectively). Although among two groups the difference in OI > 5 as speculated in our hypothesis could only be found at 36 h of the treatment, sildenafil was more effective than MgSO4 in the treatment of persistent pulmonary hypertension of the newborns with regard to time to adequate clinical response, duration of mechanical ventilation and support requirement with inotropic agents.

Urticaria due to Urtica dioica in a neonate.

Urticaria is one of the most common dermatoses during the childhood, but it is very rare in the neonates. A 17-day-old infant with a generalized urticaria was admitted to our pediatric emergency unit. The mother of the infant reported having applied water boiled with stinging nettle (Urtica dioica) onto her nipples twice a day (before and after each breastfeeding) for 2 days in order to heal her nipple cracks. Serum total immunoglobulin E (IgE) and specific IgE levels for stinging nettle were high in the infant and the mother. The rashes began to regress within the first day of the hospitalization and disappeared completely on the second day without treatment. The skin prick test with the water boiled with stinging nettle was positive for the infant with significant induration, but not for the mother. Conclusion Reporting the first urticaria case in newborns due to stinging nettle, the authors suggest that breastfeeding mothers should always consult a physician before using skincare products.

Clinical characteristics of neonatal meningomyelocele cases and effect of operation time on mortality and morbidity.

OBJECTIVE: We aimed to evaluate the clinical features, short-term prognosis, and effect of operation time on mortality and morbidity in neonates with meningomyelocele. METHODS: This prospective study was conducted between January 2006 and December 2008. Clinical features, defective area, existence of additional anomalies, operation time, and morbidity and mortality data were recorded. The effect of operation time on mortality and morbidity was evaluated. RESULTS: Patients (n = 28) were assessed during the study period. Mean birth weight, height, and head circumference were found to be 3,160 ± 582 g, 46.2 ± 3.3 cm, and 36.7 ± 4.1 cm, respectively. None of the mothers received folate supplementation. Hydrocephaly (n = 13), pes equinovarus (n = 4), pelvicalyceal ectasia (n = 4), acetabular dysplasia (n = 2), Chiari II malformation (n = 2), and hydronephrosis (n = 2) accounted for additional anomalies. The mean postnatal age for surgical operation was 3.2 ± 2.8 days; mean length of hospital stay was 10.2 ± 9.7 days. The cases operated after 72 h were hospitalized longer, received antibiotherapies for a longer duration and had higher total complication rates (p = 0.04, 0.02, and 0.01, respectively). CONCLUSION: Surgical operation of patients with meningomyelocele within 72 h after delivery significantly reduces not only the duration of hospitalization and antibiotic usage, but also complication rates.

Persistent hyperinsulinemic hypoglycemia with left ventricular hypertrophy and dysrhythmia: a case report.

Persistent hyperinsulinemic hypoglycemia in neonatal period is characterized by insulin hypersecretion. The major feature is severe hypoglycemia, generally unresponsive to routine medical treatment. Subtotal or total pancreatectomy is performed in unresponsive cases. In this case report, we present a newborn with persistent hypoglycemia unresponsive to medical treatment with dysrhythmic left ventricular hypertrophy. The insulin/C-peptide ratio was 58 as a confirmation of diagnosis. Since hypoglycemia persisted after the initial medical treatment, a subtotal pancreatectomy was performed followed by near-total pancreatectomy. A histologic examination revealed diffuse insulin islets. At the 70th post-natal day, death occurred due to heart failure and ventricular dysrhythmia. To our knowledge, severe dysrhythmia and left ventricular hypertrophy in persistent hyperinsulinemic hypoglycemia (PPH) is identified in the patient.

Percutaneously inserted central catheters in the newborns: a center's experience in Turkey.

OBJECTIVE: To evaluate the success rate of insertion of percutaneously inserted central catheters (PICCs) and their duration; and the short- and long-term complications in the neonatal period. STUDY DESIGN: We did a prospective collection and analysis of the data of all infants who underwent PICC placement from January 2005 and through January 2007. During this period there were 139 PICCs inserted in a total of 124 infants. The data of all infants were compiled, including birth weight, gestational age, diagnosis, type of catheter, site of catheter placement, reason for catheter removal, duration of use of the catheter, and the rate of complications. RESULTS: The success rate of PICC insertion was 88.5% with the upper extremity being the most frequently used site. The mean duration of PICC treatment was 11.9 +/- 6.3 days. PICCs were removed electively for 72 times (54.1%) and due to catheter-related complications for 61 times (45.9%). The main complication rate was the mechanical occlusion (12.7%). There were no statistically significant differences in the number of complication rates according to the insertion site, the position of the catheter tip, or the size of the catheter. CONCLUSION: Our initial experience with PICCs is that their use provides life-saving therapy, they are easily inserted and they are convenient. Mechanical complications were the common reason for removal and we did not see complications more serious.

Idiopathic congenital chylothorax presented with severe hydrops and treated with octreotide in term newborn.

Chylothorax is a relatively uncommon condition defined as an abnormal collection of lymphatic fluid within the pleural space. Morbidity of congenital chylothorax (CC) is high, and prognosis is very poor if chylothorax is associated with hydrops fetalis. The optimal treatment of CC has not been defined. Conservative treatment (low-fat high-protein diets with medium chain triglycerides, total parenteral nutrition, pleural drainage) and surgical intervention are performed. However, there is little experience with the use of octreotide therapy in this condition. We report a newborn with CC presented with severe non-immune hydrops and chylothorax resistant to mainly conservative treatment. The patient improved rapidly and the chylothorax disappeared with use of continuous administration of octreotide (10 microg/kg/per hour).

Impaired postnatal growth of infants prenatally exposed to cigarette smoking.

Most of the previous studies have shown a significant inverse relationship between smoking during pregnancy and weight, height and head circumference of infants at birth, but there is limited literature that assesses the head circumference measures of infants of smoker mothers in postnatal follow-up. The aim of this study was to assess the effects of maternal smoking and passive smoking during pregnancy on postnatal anthropometric measures of infants. Infants were divided into 3 groups: infants of smokers (n = 48), passive smokers (n = 57) and nonsmokers (n = 54), and were evaluated for their weight, height and head circumference at birth, 3 months and 6 months of age. Infants of smokers showed significant weight and head circumference deficits at birth compared to nonsmokers' infants (p < 0.05 and p < 0.001, respectively). At 6 months of age, infants of smokers continued to show significant deficits in all 3 measures compared to nonsmokers' infants (p < 0.001 for each), and infants of passive smokers showed only marginal decreases. Moreover, the weight and height growth velocities of the smokers' infants remained deficient, whereas their growth velocity of the head circumferences increased from birth up to 6 months and reached the growth velocity of the nonsmokers' infants. Infants of passive smokers showed a complete catch-up growth at 6 months. This study indicates that smoking during pregnancy results in serious deficits in infants' growth even after birth. Therefore, it is essential to inform smoker women before pregnancy the possible growth retardation of infants.