Increased Risk of Malaria During the First Year of Life in Small-for-Gestational-Age Infants: A Longitudinal Study in Benin
Gino AgbotaManfred AccrombessiGilles CottrellYves Martin‐PrévelJacqueline MiletSmaïla OuédraogoDavid CourtinAchille MassougbodjiAndré GarciaMichel CotValérie Briand
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According to the Developmental Origins of Health and Diseases paradigm, the fetal period is highly vulnerable and may have profound effects on later health. Few studies assessed the effect of small-for-gestational age (SGA), a proxy for fetal growth impairment, on risk of malaria during infancy in Africa.We used data from a cohort of 398 mother-child pairs, followed from early pregnancy to age 1 year in Benin. Malaria was actively and passively screened using thick blood smear. We assessed the effect of SGA on risk of malaria infection and clinical malaria from birth to 12 months, after stratifying on the infant's age using a logistic mixed regression model.After adjustment for potential confounding factors and infant's exposure to mosquitoes, SGA was associated with a 2-times higher risk of malaria infection (adjusted odds ratio [aOR] = 2.16; 95% confidence interval [CI], 1.04-4.51; P = .039) and clinical malaria (aOR = 2.33; 95% CI, 1.09-4.98; P = .030) after age 6 months.Results suggest higher risk of malaria during the second semester of life in SGA infants, and argue for better follow-up of these infants after birth, as currently for preterm babies.Background Small-for-gestational age (SGA) infants should be identified before birth because of an increased risk of adverse perinatal outcomes. The objective of this study was to assess the impact of fetal growth rate by gestational age on the prediction of SGA and to identify the optimal time to initiate intensive fetal monitoring to detect SGA in low-risk women. We also sought to determine which the ultrasonographic parameters that contribute substantially to the birthweight determination. Methods This was a retrospective study of 442 healthy pregnant women with singleton pregnancies. There were 328 adequate-for-gestational age (AGA) neonates and 114 SGA infants delivered between 37+0 and 41+6 weeks of gestation. We compared the biparietal diameters (BPD), head circumferences (HC), abdominal circumferences (AC), femur lengths (FL), and estimated fetal weights (EFW) obtained on each ultrasound to determine which of these parameters was the best indicator of SGA. We created receiver operating characteristic curves, calculated the areas under the curves (AUCs), and analyzed the data using multivariable logistic regressions to assess the ultrasound screening performances and identify the best predictive factor. Results Among the four ultrasonographic parameters, the AC measurement between 24+0~28+6 weeks achieved a sensitivity of 79.5% and a specificity of 71.7%, with an AUC of 0.806 in the prediction of SGA. AC showed consistently higher AUCs above 0.8 with 64~80% sensitivities as gestational age progressed. EFW measurements from 33+0~35+6 gestational weeks achieved a sensitivity of 60.6% and a specificity of 87.6%, with an AUC of 0.826. In a conditional growth model developed from the linear mixed regression, the value differences between AC and EFW in the SGA and AGA groups became even more pronounced after 33+0~35+6 weeks. Conclusion Healthy low-risk women with a low fetal AC after 24 weeks’ gestation need to be monitored carefully for fetal growth to identify SGA infants with a risk for adverse perinatal outcomes.
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Abstract The growth of 90 infants of low birthweight (1500–2499 g) has been studied longitudinally from birth to 2 years of age. Seventy‐five per cent of those infants were of birthweight that was appropriate‐for‐gestational age (AGA) and of mean gestational age 33.6 weeks (boys) and 34.5 weeks (girls). Twenty‐four per cent were small‐for‐gestational age (SGA) and of mean gestational age 39.4 weeks (boys) and 38.5 weeks (girls). The data showed that, when gestational age was considered, the growth of AGA infants was similar to that of full‐term infants of normal birthweight; SGA infants displayed accelerated growth (‘catch‐up’), particularly in the first months of life with upward percentile crossing from below the 5th toward the 50th. These results provide further evidence of the need to consider gestational age and whether AGA or SGA when assessing the growth of low birthweight infants.
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Introduction: the follow-up of small for gestational age (SGA) preterm infants is critical due to their differentiated postnatal growth pattern. Objective: to investigate the weight z-score behavior in SGA preterm infants during a four-week stay in a Neonatal Intensive Care Unit. Methods: a retrospective longitudinal study with data from nutritional anamneses of 190 preterm infants admitted to a Neonatal Intensive Care Unit between January/2017 and December/2019, classified according to nutritional status at birth as either SGA or appropriate for gestational age (AGA). Linear regression was used to verify association between weight z-score with gestational age, birth weight, initiation of enteral nutrition and relative amount of energy and protein administered. Results: SGA preterm infants accounted for 23 % of the study participants. In SGA, the difference in weight score was observed at week 1 when compared to admission (p < 0.05), while in AGA there was a difference sustained during the whole period (p < 0.05). In SGA, the linear regression analysis showed that the change in z-score was explained by time to start of enteral nutrition (p = 0.033), gestational age (p = 0.003) and birth weight (p = 0.001). In AGA the change was explained by gestational age (p = 0.000) and birth weight (p = 0.000). Conclusion: the weight z-score behavior in preterm infants was downward compared to admission, stable at the end of 4 weeks, and different according to nutritional status at birth. In the AGA group the decline in nutritional status was not recovered throughout hospitalization and in the SGA group the unfavorable nutritional status was maintained.Introducción: el seguimiento de los prematuros pequeños para la edad gestacional (PEG) es crítico debido al patrón de crecimiento posnatal diferenciado. Objetivo: investigar el comportamiento de la puntuación z del peso en recién nacidos prematuros PEG durante cuatro semanas de estancia en una unidad de cuidados intensivos neonatales. Métodos: estudio longitudinal retrospectivo con datos de anamnesis nutricionales de 190 prematuros ingresados en una unidad de cuidados intensivos neonatales entre enero/2017 y diciembre/2019, clasificados según el estado nutricional al nacer como PEG o como adecuado para la edad gestacional (AEG). Se utilizó la regresión lineal para verificar la asociación entre la puntuación z del peso con la edad gestacional, el peso al nacer, el inicio de la nutrición enteral y la cantidad relativa de energía y proteínas administradas. Resultados: los bebés prematuros PEG representaron el 23 % de los participantes en el estudio. En el grupo PEG, la diferencia de la puntuación z del peso se observó en la semana 1 en comparación con el ingreso (p < 0,05), mientras que en el grupo AEG hubo diferencia durante todo el período evaluado (p < 0,05). En los PEG, el análisis de regresión lineal mostró que el cambio de la puntuación z se explicaba por el tiempo transcurrido hasta el inicio de la nutrición enteral (p = 0,033), la edad gestacional (p = 0,003) y el peso al nacer (p = 0,001). En el caso de la AEG, el cambio se explicaba por la edad gestacional (p = 0,000) y el peso al nacer (p = 0,000). Conclusión: el comportamiento de la puntuación z del peso en los prematuros fue descendente en comparación con la admisión, estable al final de 4 semanas y diferente según el estado nutricional al nacer. En el caso de los AEG, el estado nutricional no se recuperó a lo largo de la investigación y, en el caso de los PEG, el estado nutricional desfavorable se mantuvo.
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Data on 55 small-for-gestational age (SGA), 56 average-for-gestational age (AGA) and 55 large-for-gestational age (LGA) infants whose growth had been monitored regularly from birth to 12 months are presented. SGA head-chest ratios were high at birth; but by 6 months they were very similar to AGA ratios, with values just below unity. Head-length ratios showed a steady decrement; SGA infants having the highest and LGA infants the lowest values at all ages. Chest-length ratios showed little change up to 6 months, with a steady decrease thereafter. Stem-stature ratios showed a similar pattern; and were confined within a narrow margin from 6 months onwards. These changes seem to be target orientated. We suggest the goal is that proportionality which enables the infant to attain the upright stature; and thus to sit, stand and walk at the appropriate time.
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To compare the incidence of retinopathy of prematurity (ROP) in small-for-gestational age (SGA) infants compared with appropriate-for-gestational age (AGA) infants undergoing eye screening in the Lothian region of south east Scotland 1990-2004.All infants in Lothian born with birth weight <1500 g and/or gestational age <32 weeks underwent eye screening by two experienced paediatric ophthalmologists. The presence of any stage of ROP (1-5), severe (stage 3 or greater) ROP and treated ROP was compared between the SGA and AGA infants using chi(2) or Fisher exact tests. SGA was defined as birth weight below the 10th centile for gestational age.A total of 1413 babies with birth weights <1500 g and/or gestational age <32 weeks underwent eye screening; 329 (23%) were SGA. SGA infants born at gestational ages 26-31 weeks were more likely to develop any stage of ROP (p<0.01) than their AGA peers. SGA infants were also more likely to develop severe ROP (gestational age 26-27 weeks, p<0.01; 28-29 weeks, p = 0.01; 30-31 weeks, p = 0.01).SGA infants who underwent eye screening in the Lothian region of south east Scotland from 1990 to 2004 were significantly more likely to develop ROP and more severe disease than AGA infants.
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Abstract Today we lack knowledge if size at birth and gestational age interact regarding postnatal growth pattern in children born at 32 gestational weeks or later. This population-based cohort study comprised 41,669 children born in gestational weeks 32–40 in Uppsala County, Sweden, between 2000 and 2015. We applied a generalized least squares model including anthropometric measurements at 1.5, 3, 4 and 5 years. We calculated estimated mean height, weight and BMI for children born in week 32 + 0, 35 + 0 or 40 + 0 with birthweight 50 th percentile (standardized appropriate for gestational age, s AGA) or 3 rd percentile (standardized small for gestational age, s SGA). Compared with children born s AGA at gestational week 40 + 0, those born s AGA week 32 + 0 or 35 + 0 had comparable estimated mean height, weight and BMI after 3 years of age. Making the same comparison, those born s SGA week 32 + 0 or 35 + 0 were shorter and lighter with lower estimated mean BMI throughout the whole follow-up period. Our findings suggest that being born SGA and moderate preterm is associated with short stature and low BMI during the first five years of life. The association seemed stronger the shorter gestational age at birth.
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It is unknown whether children born very preterm (< 32 weeks' gestation) with appropriate size for gestational age, who grow poorly in the first postnatal months (ie, preterm growth restraint), show a similar growth pattern as children born small for gestational age.Childhood growth and adult height of children with preterm growth restraint were compared to those of very preterm small-for-gestational-age and non-preterm-growth-restraint children.Data were drawn from the Project on Preterm and Small-for-Gestational-Age Infants cohort. Preterm growth restraint was considered to have occurred after appropriate-size-for-gestational-age birth and if length and/or weight was below -2 SD score at 3 months postterm.Among 380 very preterm children, 274 experienced no preterm growth restraint and showed near-normal growth, whereas 79 (21%) experienced preterm growth restraint and subsequently displayed a growth pattern similar to that of very preterm small-for-gestational-age children (n = 27). Adult height of these children was -1.1 to -1.2 SD score. Very preterm small-for-gestational-age and preterm-growth-restraint children with a height below -2 SD score at 5 years had an adult height of approximately -2.5 SD score.Childhood growth and adult height were similar in very preterm small-for-gestational-age and preterm-growth-restraint children. These long-term findings further strengthen the plausibility of extending the small-for-gestational-age indication for growth hormone therapy in such a way that preterm-growth-restraint children are no longer excluded if they have a short stature persisting beyond the age of approximately 5 years.
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Background: It has been suggested that the association between birthweight and blood pressure has been overstated as a result of publication bias and, within studies, a lack of adjustment for potentially important maternal and socioeconomic confounding factors and 'overadjustment' for current body size. This study investigates the impact of potential confounding variables on the birthweight–blood pressure association in birth cohort studies from different time periods and geographical locations in Europe. Methods: Data from five European birth cohort studies (from Finland, the UK, and the Faroe Islands) taking part in the European Birth-Lifecourse-Studies (EURO-BLCS) project were analysed. Birthweight was measured at birth in all cohorts and confounding variable information was collected prospectively at subsequent follow-ups in all cohorts. Regression models were used to assess the unadjusted association between birthweight and blood pressure and then to assess the impact of potential maternal and socioeconomic confounding variables and adjustment for later body size. Analyses were carried out in the same way across all five cohorts. Results: Birthweight was consistently negatively associated with systolic blood pressure (SBP) across all cohorts. Gestational age and possibly maternal pre-pregnancy weight, but not socioeconomic status, may be important confounding factors of the relationship between birthweight and SBP. The size of the birthweight–SBP association in adulthood may be larger than in childhood before adjustment for current body size, although a cohort effect cannot be ruled out. Conclusion: This study highlights the value of future cross-cohort comparisons in the investigation of the foetal origins of adult disease.
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