Association between birth characteristics and coronary disease risk factors among fifth graders.

OBJECTIVE: To evaluate the associations between selected birth characteristics-prematurity and poor intrauterine growth-and risk factors for coronary artery disease detected among children enrolled in the fifth grade. STUDY DESIGN: Children (n = 3054) with matched birth and fifth grade health screening data on body mass index (BMI), systolic blood pressure, and fasting lipid profiles were analyzed using MANOVA with the following independent variables of weight gain by the fifth grade: BMI percentile, normal or overweight/obese (BMI ≥ 85 th percentile), prematurity, and intrauterine growth (ie, small for gestational age [SGA], appropriate for gestational age [AGA], or large for gestational age [LGA]). RESULTS: LGA status at birth was associated with overweight/obesity later in life. In fifth grade, overweight/obese children had elevated systolic blood pressure and abnormal levels of most fasting serum lipids compared with normal-weight children regardless of birth characteristics. Beyond the effects of BMI percentile, preterm infants had higher levels of triglycerides (TG) than term infants by the fifth grade (P < .05). SGA infants who become overweight/obese had higher levels of TGs and very low-density lipoproteins compared with AGA and LGA infants, whether overweight or normal weight (P < .05). CONCLUSION: BMI ≥ 85 th percentile in the fifth grade is associated with abnormalities in most coronary artery risk factors regardless of birth characteristics. Beyond the effects of BMI percentile in the fifth grade, preterm infants had higher TG levels than term infants. SGA infants who were overweight/obese in the fifth grade had higher TG and very low-density lipoprotein levels compared with AGA and LGA infants who were overweight/obese or of normal weight in the fifth grade.

Birth status, child growth, and adult outcomes in low- and middle-income countries.

OBJECTIVE: To assess the impact of being born preterm or small for gestational age (SGA) on several adult outcomes. STUDY DESIGN: We analyzed data for 4518 adult participants in 5 birth cohorts from Brazil, Guatemala, India, the Philippines, and South Africa. RESULTS: In the study population, 12.8% of males and 11.9% of females were born preterm, and 26.8% of males and 22.4% of females were born term but SGA. Adults born preterm were 1.11 cm shorter (95% CI, 0.57-1.65 cm), and those born term but SGA were 2.35 cm shorter (95% CI, 1.93-2.77 cm) compared with those born at term and appropriate size for gestational age. Blood pressure and blood glucose level did not differ by birth category. Compared with those born term and at appropriate size for gestational age, schooling attainment was 0.44 years lower (95% CI, 0.17-0.71 years) in those born preterm and 0.41 years lower (95% CI, 0.20-0.62 years) in those born term but SGA. CONCLUSION: Being born preterm or term but SGA is associated with persistent deficits in adult height and schooling, but is not related to blood pressure or blood glucose level in low- and middle-income settings. Increased postnatal growth is associated with gains in height and schooling regardless of birth status, but not with increases in blood pressure or blood glucose level.

Cardiac function and arterial biophysical properties in small for gestational age infants: postnatal manifestations of fetal programming.

OBJECTIVE: To investigate the differences in cardiac function and arterial biophysical properties between term-born appropriate for gestational age (AGA) infants and small for gestational age (SGA) infants. Our hypothesis was that adaptation to intrauterine growth restriction induces changes in cardiac and arterial indices. STUDY DESIGN: This was a prospective observational echocardiographic evaluation of cardiac and arterial indices in SGA infants and AGA infants. Demographic and echocardiographic data were compared between 20 inborn term SGA infants with birth weight <3rd percentile for gestational age and 20 AGA infants. RESULTS: The Ponderal index was significantly lower and blood pressure was significantly higher in the SGA infants compared with the AGA infants. Left ventricular output was lower in the SGA infants (170 ± 31 mL/kg/min vs 197 ± 39 mL/kg/min). Diastolic dysfunction was greater in the SGA infants (ie, reduced E and A wave velocities, higher E/A ratio [1.08 ± 0.16 vs 0.85 ± 0.07], and prolonged isovolumic relaxation time [73 ± 6.2 ms vs 62.6 ± 3.6 ms]). Aortic intima-media thickness was significantly greater in the SGA infants (822 ± 105 µm vs 694 ± 52 µm), as were arterial wall stiffness index and input impedance. CONCLUSION: Cardiac function and arterial biophysical properties were altered in the SGA infants. The findings complement the information on the association between in utero growth and cardiovascular morbidity in later life.

Candidate gene analysis: severe intraventricular hemorrhage in inborn preterm neonates.

Intraventricular hemorrhage (IVH) is a disorder of complex etiology. We analyzed genotypes for 7 genes from 224 inborn preterm neonates treated with antenatal steroids and grade 3-4 IVH and 389 matched controls. Only methylenetetrahydrofolate reductase was more prevalent in cases of IVH, emphasizing the need for more comprehensive genetic strategies.

Extracción manual de leche materna para el mantenimiento de la lactancia / Manual removal of breast milk for the maintenance of lactation

Objetivos. Determinar a través de extracción manual, el volumen de calostro, leche de transición y leche materna madura producidos por las madres de niños prematuros y medir el incremento de peso de estos niños alimentados exclusivamente con leche materna madura utilizando sonda orogástrica.Material y métodos. Estudio longitudinal, realizado en el Servicio de Neonatología del Hospital de la Mujer, ciudadde La Paz. Fueron incluidos doce madres y sus hijos prematuros y se aplicó una encuesta con variables sociodemográficas.Se registró la producción por extracción manual, de calostro, leche de transición y leche materna madura y la ganancia diaria de peso de los niños prematuros alimentados exclusivamente con leche materna madura utilizando sonda orogástrica. Resultados. Las madres producen mediante extracción manual, calostro en un promedio de 71 ml/día (+/- 41,6 DE)de 1 a 4 días, leche de transición 207 ml/día (+/- 81,9 DE) de 5 a 10 días y leche madura 333 ml/día (+/- 105,1 DE)de 11 a 17 días. Las madres de niños de Muy bajo peso al nacer (MBPN), producen un mayor volumen de calostro, leche de transición y madura. El volumen de leche madura producida es mayor en madres de niños Pequeños para la edad gestacional (PEG), en comparación con madres de niños Adecuados para la edad gestacional (AEG). Los niños estudiados fueron alimentados exclusivamente con leche materna, de los cuales 83,3...

Objectives. To determine through the manual extraction, the volumes of colostrum, transition milk and mature maternal milk produced by premature children's mothers, and to measure the increase in these children's weight nourished exclusively with mature maternal milk using orogastric tube. Material and methods. A longitudinal study, carried out in the Service of Neonatology at the “Hospital de la Mujer”, in the city of La Paz. Twelve mothers and their premature sons were enrolled, and an inquiry with socio-demographic variables was applied. The maternal production of milk by manual extraction and a daily increase in the premature children’s weight nourished exclusively with mature maternal milk using orogastric tube was registered. Results. Mothers produce through manual extraction an average of 71 ml/day (+/- 41.6 SD) of colostrum between 1 to 4 days; transition milk of 207 ml/day (+/- 81.9 SD) between 5 to 10 days, and mature milk of 333 ml/day (+/- 105.1 SD) between 11 to 17 days.The mothers of children who are Very low birth weight (VLBW) produce a larger volume of colostrum, transition milk and mature milk. The volume of mature milk produced is larger in mothers of children who are Small for gestational age (SGA) in comparison to mothers of children who are Appropriate for gestational age (AGA).The children included in this study were nourished exclusively from maternal milk, from them 83.3% presented an adequate increase in weight. The average increase in weight from the tenth day to the seventeenth day oscillates between 18 and 40 grams per day.Conclusions.The manual extraction of mother’s milk allows for delayed suckle, giving volumes superior to the requirements of the lactant. These findings are important for nutritional education, and are a favorable alternative for mothers of premature children, or mothers who are studying, working or cannot suckle for any other reason.