Effect of kangaroo mother care on the growth and morbidity pattern of low birth weight infants: a hospital based cross sectional study

Background: Kangaroo mother care provides Low birth weight babies with warmth, protection from infection and increases the success of breast feeding. Babies who had received KMC care were found to have better neurologic outcome. The aim of the study is to compare the outcome of Kangaroo mother care and conventional method of care among Low birth weight babies in terms of growth and reduction of morbidities such as length of hospital stay, hypothermia and hypoglycemia.Methods: This cross-sectional study included 48 neonates with a birth weight of <2000 grams. Out of them 24 babies received KMC and the other 24 babies were given conventional care with a radiant warmer. The weight gain, length of hospital stay, occurrence of hypothermia and hypoglycaemia were monitored for all babies till discharge.Results: Babies who received KMC had a better weight gain (21.11'2.8 grams/day) versus (15.61'2.6 grams/day) those who received conventional care, and this was found to be statistically significant (p=0.001). Kangaroo mother care provided a statistically significant reduction in the risk of having hypothermia (p=0.03) and hypoglycemia (p=0.04). The babies who received Kangaroo mother care had a shorter length of hospital stay and this was found to be statistically significant (p=0.03).Conclusions: Kangaroo mother care improved the growth and reduced the problems of low birth weight babies such as hypothermia, hypoglycaemia and prolonged hospital stay. Hence, it should be recommended in the care of all these high-risk neonates.

Effects of total parenteral nutrition on postnatal growth in very low birth weight and extremely low birth weight newborns

Background: Prematurity is the most important cause of mortality in Under-5 children responsible for one million deaths/ year. Premature babies are not able to store enough nutrients for their optimal survival; it is essential to provide them total parenteral nutrition. Intravenous lipid infusion in neonates is linked with high risk of sepsis and thrombocytopenia. PN with amino acids and glucose can be imparted to achieve nutritional goal. This trial was intended to assess the effects of various components of amino acid PN on postnatal growth in VLBW and ELBW newborns.Methods: A prospective observational study was conducted from January 2018 - May 2019 in NICU of TMMC and RC which included preterm newborns with birth weight of less than 1500gms who received aminoven infusion. Anthropometric measurements, incidence of hypo/hypercalcaemia, hypo/hyperglycaemia, direct hyperbilirubinemia, incidence of sepsis were evaluated.Results: Out of 22 patients, 12 neonates received high dose aminoven therapy whereas 10 neonates received low dose aminoven therapy. It was seen that rapid rate of increment of amino acids had adequate weight on discharge, 72.72% have adequate growth among the rapid group compared to 36.36% among slower group. No significant changes in calcium metabolism or glucose metabolism were seen in both the groups.Conclusions: In resource limited settings, parenteral nutrition with intravenous amino acids have a better effect on the weight of preterm newborns at discharge when high doses of amino acids infusion started early with rapid increment in the dose.

Growth Patterns in Small for Gestational Age Babies and Correlation with Insulin-like Growth Factor-1 Levels

Objective: Correlation of catch-up growth and Insulin-like Growth Factor -1 levels (IGF-I) inSGA babies. Methods: 50 Full-term Small for Gestational Age children aged 12-18 monthswere analyzed for Catch-up growth (gain in weight and/or length, Standard Deviation Score/SDS >0.67). IGF-1 was measured after post-glucose load using ELISA method andcorrelated with catch-up growth. Results: Mean (SD) birthweight and length were 2.1 (0.3)Kg and 44.4 (3.1) cm, respectively. At enrollment, mean (SD) age, weight and length were15.0 (2.1) months, 7.7 (1.3) Kg, and 72.9 (5.6) cm, respectively. Catch-up growth was notedin 60% children. IGF-1 levels were significantly higher in children showing catch-up growth(56.6 (63.2) ng/mL) compared to those not having catch up growth (8.7 (8.3) ng/mL). IGF-1was positively correlated with both weight and length catch-up. Conclusion: Majority ofSmall for Gestational Age showed catch-up growth by 18 months, which had good correlationwith IGF-1 levels

Heterochronic events in the ontogeny of Columba livia, Coturnix coturnix, and Gallus gallus domesticus / Eventos heterocrónicos en la ontogenia de Columba livia, Coturnix coturnix y Gallus gallus domesticus / Eventos heterocrônicos na ontogenia da Columba livia, Coturnix coturnix e Gallus gallus domesticus

Summary Background: a series of events take place in a precise spatial and temporal context during the development of any organism. Typically, certain ontogenetic processes are consistent with the proper completion of previous events. Objective: to identify possible heterochronic events that may relate to altricial and precocious development patterns. Methods: we analyzed the ontogeny of three species of birds with two different development models: Columba livia (semialtricial 2), Coturnix coturnix, and Gallus gallus domesticus (precocial 2). The starts and endings of thirteen morphological events were compared, from hour 16 of incubation to the time of hatching. Results: while no differences in the sequence of developmental events were found, the events of the maturation stage in the altricial kind started earlier compared to the precocial species. Ontogenetic acceleration events in C. livia and C. coturnix explain how these species reach a level of morphological development similar to that of G. gallus domesticus, but with shorter incubation period. Conclusion: the results provide information not considered in the literature of the specialty about heterochronic events in early developmental stages of poultry.

Resumen Antecedentes: durante el desarrollo de cualquier organismo, tienen lugar una serie de eventos en un contexto espacial y temporal preciso. Comúnmente, ciertos procesos ontogenéticos son congruentes con la adecuada culminación de eventos previos. Objetivo: identificar posibles eventos heterocrónicos que pueden relacionarse con los patrones de desarrollo altriciales y precoces. Métodos: se analizó la ontogenia de tres especies de aves con dos modelos de desarrollo diferentes: Columba livia (semialtricial 2), Coturnix coturnix y Gallus gallus domesticus (precocial 2). Se comparó el inicio y la finalización de trece eventos morfogenéticos, desde las 16 h de incubación hasta el momento de la eclosión. Resultados: si bien no se observaron diferencias en la secuencia de eventos del desarrollo, en la especie altricial los eventos de maduración se iniciaron antes que en las especies precoces. La aceleración de eventos ontogenéticos en C. livia y C. coturnix explicaría cómo estas especies alcanzan un grado de desarrollo morfológico semejante al de G. gallus domesticus pero en un periodo de incubación menor. Conclusión: los resultados de este trabajo aportan información sobre eventos heterocrónicos en las etapas temprana del desarrollo de las aves, no consideradas en la literatura de la especialidad.

Resumo Antecedentes: durante o desenvolvimento de qualquer organismo ocorrem uma série de eventos num contexto espacial e temporal preciso. Comumente, certos processos ontogênicos são consistentes com a conclusão correta de eventos anteriores. Objetivo: identificar possíveis eventos heterocrônicos que podem estar relacionados a padrões de desenvolvimento altriciais e precoces. Métodos: Foi analisada a ontogenia de três espécies de aves com dois modelos diferentes de desenvolvimento: Columba livia (semialtricial 2), Coturnix coturnix e Gallus gallus domesticus (precoce 2). Foram comparados o início e o fim de treze eventos morfogenéticos, a partir das 16 h de incubação até a eclosão. Resultados: embora não foram observadas diferenças na sequência de eventos do desenvolvimento, na espécie altricial os eventos de maturação iniciaram-se mais cedo do que nas espécies precoces. A aceleração de eventos ontogênicos em C. coturnix C. livia pode explicar como essas espécies atingem um grau de desenvolvimento morfológico semelhante ao G. gallus domesticus em um período de incubação mais curto. Conclusão: os resultados deste estudo fornecem informação sobre eventos heterocrônicos nas fases iniciais do desenvolvimento das aves, não são considerados na literatura da especialidade.

Crecimiento pre y postnatal asociados a sobrepeso corporal en escolares de Bayamo / Pre and postnatal growth as related to overweight among Bayamo school-age children

OBJETIVO: identificar la asociación entre factores prenatales y relacionados con el primer año de vida y su influencia en el sobrepeso corporal de edades ulteriores. MÉTODOS: se realizó un estudio observacional, retrospectivo, analítico, de casos y controles en el municipio Bayamo con 200 escolares con sobrepeso corporal y 200 niños normales de 6-11 años de edad, de la misma zona de residencia, nacidos de madres con similar edad gestacional de 37-42 semanas, homogéneos en edad y sexo y con historia de no afecciones de salud. En el análisis estadístico se estimó el riesgo asociado como Odd Ratio. RESULTADOS: se mostró una fuerte asociación entre el sobrepeso corporal en la edad escolar y la ganancia de peso excesiva en los primeros 4 meses de vida, bajo peso, reducida longitud supina y circunferencia cefálica en el momento del nacimiento y hábito de fumar, insuficiente ganancia de peso corporal, bajo IMC y enfermedades de la madre durante el embarazo. CONCLUSIONES: estos factores deben ser considerados en la prevención de la obesidad infantil. La ganancia de peso acelerada en los primeros meses de vida de niños nacidos con afectación del crecimiento fetal debe ser prevenida.

OBJECTIVE: describe the relationship between prenatal factors and those occurring during the first year of life, and determine their influence on overweight in later stages. METHODS: an analytical observational retrospective case-control study was conducted in the municipality of Bayamo with 200 overweight school-age children and 200 normal children aged 6-11 years from the same area of residence, born to mothers with similar gestational age of 37-42 weeks, homogeneous as to age and sex, and with a history of good health. The statistical analysis included estimation of the associated risk as odd ratio. RESULTS: a strong association was found between overweight at school age and the following factors: excessive weight gain during the first 4 months of life, low weight, reduced supine length and head circumference at birth, smoking, insufficient weight gain, low BMI and maternal diseases during pregnancy. CONCLUSIONS: these factors should be borne in mind in the prevention of child obesity. Rapid weight gain during the first months of life should be prevented among children born with fetal growth disorders.

Evaluación posalta del crecimiento en prematuros: implicaciones de adoptar las curvas OMS / Post discharge growth assessment in preterm infants: implications of adopting the WHO standards

Introducción. Los estándares para evaluar el crecimiento en los prematuros se han utilizado como referencia desde el año 1986. La introducción de las curvas OMS en la Argentina podría incrementar la detección de los niños con crecimiento subóptimo. Objetivo. Comparar la proporción de retraso del crecimiento en peso, longitud corporal y perímetro cefálico en prematuros con peso al nacer menor de 1500 g (RNMBPN) evaluados por las curvas OMS y las curvas SAP. Pacientes y métodos. Estudio de cohorte en RNMBPN. Se incluyeron las mediciones de peso, longitud corporal y perímetro cefálico, realizadas a las 40, 53, 66, 79 y 92 semanas posmenstruales (± 1 semana). Se registró como variable independiente el sexo para ambas curvas (OMS y SAP). Se analizaron las medias del puntaje Z para ambas curvas mediante la prueba de Student y la diferencia de proporciones mediante la prueba de la χ² (OR; IC 95%). Resultados. Ingresaron 204 niños. Las variables antropométricas al nacer divididas por sexo no mostraron diferencias. El peso y la longitud mostraron una apreciación mayor del crecimiento por las curvas SAP vs. OMS, más en los varones que en las mujeres, y se atenuaron al año de edad. La estatura evaluada por OMS presentó retraso en ambos sexos. La circunferencia craneal no arrojó diferencias. Se encontró una mayor proporción de pacientes con peso por debajo de 2 desviaciones estándar a los 3 meses de edad según OMS (p < 0,01; OR 0,36; IC 95% 0,15 a 0,78), no así para la longitud y el perímetro cefálico. Conclusiones. Este estudio permite sugerir que el cambio de estándar no implicaría una modificación significativa a nuestras prácticas de seguimiento durante el primer año de edad.

Introduction. The WHO standards have been used as a gold standard for growth assessment in preterm infants since 1986. The introduction of the WHO standards in Argentina could improve detection of sub-optimal growth. Objective. To compare the proportion of growth retardation in terms of weight, body height and head circumference in preterm infants with a birth weight less than 1500 g (VLBW) assessed according to the WHO standards and the Sociedad Argentina de Pediatría (SAP) standards. Population and methods. Cohort study in VLBW newborn infants. Measurements included were weight, height and head circumferences measured at 40, 53, 66, 79 and 92 postmenstrual weeks (±1 week). Sex was recorded as an independent outcome measure for both standards (WHO and SAP). Mean Z scores were analyzed for both standards using Student's test, and the difference of proportions was assessed using the c2 test (OR; 95% CI). Results. Two hundred and four infants were included. No differences were observed in anthropometric outcome measures at birth by sex. A greater growth was seen in terms of weight and height as per the SAP standards compared to the WHO standards, which was more marked in male infants than female infants, and which diminished around their first year of life. Growth retardation in terms of height was observed in both males and females assessed with the WHO standards. No differences were observed in head circumference. A higher proportion of patients with a weight below 2 standard deviations at 3 months old was found as per the WHO (p < 0.01; OR: 0.36; 95% CI: 0.150.78), but that was not the case with height and head circumference. Conclusions. This study allows to suggest that changing the standards does not imply a significant modification in our follow-up practice over the first year of life of an infant.

Effect of Two Different Doses of Parenteral Amino Acid Supplementation on Postnatal Growth of Very Low Birth Weight Neonates – A Randomized Controlled Trial.

Objectives: To evaluate the effects of two different doses of parenteral aminoacid supplementation on postnatal growth in Very Low Birth Weight (VLBW) infants receiving partial parenteral nutrition (PPN). Design: Double blinded randomized controlled trial. Settings: Level 3 NICU between February 2008 to February 2010. Participants: 150 inborn babies with birthweight between 900- 1250 g, irrespective of gestational age, were randomized to either of the two interventions of amino acid supplementation. Intervention: Two different initial doses of parenteral amino acids (AA) in the PPN solutions- Low AA group: 1 g/kg/d versus High AA group: 3 g/kg/d from day 1 of life with increment by 1 g/kg every day till a maximum of 4 g/kg/d, until babies tolerated 75% enteral feeds. Main outcome: Average postnatal weight gain (in g/kg/d)) by 28 days of life. Results: Both groups had similar baseline characteristics. The gain in weight, length and head circumference at 28 days were significantly lower in the High AA group. The average weight gain at 28 days was 8.67g/kg/d in the High AA group and 13.15g/kg/d in the Low AA group (mean difference 123.12, 95% CI 46.67 to 199.37, P<0.001). The incidences of neonatal morbidities associated with prematurity were similar in both groups. Conclusion: Higher initial parenteral aminoacid supplementation, in settings where partial parenteral nutrition is administered, results in poor growth in VLBW infants due to inadequate non-protein calorie intake.

Crescimento extrauterino restrito em prematuros / Growth restriction extrauterino of premature infants

Objetivo: Analisar os fatores associados à ocorrência de restrição do crescimento extrauterino de prematuros de muito baixo peso ao nascer em uma unidade de terapia intensiva neonatal. Métodos: Estudo transversal com 58 prematuros de muito baixo peso ao nascer, admitidos em unidade de terapia intensiva neonatal no triênio 2008-2010. A variável dependente restrição do crescimento extrauterino foi dicotomizada em sim ou não com base nas curvas de Xavier et al., com ponto de corte no percentil 5, sendo formados dois grupos: eutróficos e desnutridos. Utilizou-se o teste de Mann-Whitney para as variáveis quantitativas e os testes do Quiquadrado de Pearson e exato de Fisher para as variáveis qualitativas. Resultados: A restrição do crescimento extrauterino se apresentou em 29,3% dos prematuros, na idade corrigida de 36 semanas, associando-se a nascer pequeno para a idade gestacional; estes compreenderam 15,5% dos prematuros. Não houve influência das práticas alimentares avaliadas para a ocorrência de restrição do crescimento extrauterino na população estudada. Conclusões: Alerta-se para a necessidade de qualificar as práticas de assistência pré-natal, visto que nascer pequeno para a idade gestacional é resultado do ambiente intrauterino, assim como para a premência em desvelar a cinética de crescimento e, talvez, individualizar as práticas assistenciais prestadas a essa subpopulação de prematuros.

Es el crecimiento infantil afectado por la depresión materna: revisión sistemática / Does maternal depsression affect infant growth: systematic review

Introducción: La salud mental de la madre influye en la calidad de las interacciones tempranas madre-hijo, comprometiendo el desarrollo del niño. El crecimiento de los niños es una variable importante a analizar. Estudios realizados en Estados Unidos y en Europa muestran una relación entre variaciones de la talla y enfermedades crónicas del adulto. Algunos estudios en países de bajos ingresos evidencian que la depresión post parto tiene un efecto negativo en el crecimiento temprano de sus hijos, sin embargo, hay otros que no encuentran esta relación. El objetivo es realizar una revisión sistemática sobre la relación que existe entre depresión materna y crecimiento infantil Métodos: se realizó una búsqueda bibliográfica en PUBMED sobre el tema en cuestión, publicados en los últimos 10 años. Se incluyeron estudios tipo caso control y de cohorte y niños hasta 4 años de edad. Para medir depresión materna se usó la Escala de Depresión de Edimburgo y la entrevista clínica estructurada del DSM IV o del CIE-10 para Episodio Depresivo Mayor. Resultados: se encontraron 23 artículos, se seleccionaron 11. En 6 de ellos la depresión materna es un factor de riesgo para el crecimiento infantil, en 4 no se encontró relación y en 1 se relacionó con mayor adiposidad infantil. Conclusiones: la depresión materna constituye un factor de riesgo para la alteración del crecimiento infantil en las poblaciones más vulnerables, de bajos ingresos y no representaría un factor de riesgo para poblaciones más privilegiadas, de altos ingresos, pudiendo provocar una alteración transitoria.

Introduction: the mental health of the mother influences the quality of early mother-child interactions compromising the child´s development. The growth of children in an important variable to analyze. Studies in the Unites States and Europe show a relationship between variations in size and adult chronic diseases. Studies in low-income countries show that postpartum depression has a negative effect on the early growth of their children; however, others find no relationship. The goal in to find the relationship between maternal depression and infant growth thought a systematically review. Methods: we performed a literature search of PUBMED on the topic, published in the last 10 years. We included case-control studies and cohort and children up to age 4. To measure maternal depression scale was used Depression Edinburg, the structured clinical interview of DSM-IV or ICD-10 for Major Depressive Episodes. Results : there were 23 articles, 11 were selected, in 6 of them found maternal depression is a risk factor for child growth failure, in 4 there was no relationship and 1 was associated with increases adiposity children. Conclusions: maternal depression is a risk factor for impaired childhood gowth in the population most vulnerable, low-income countries and do not represent a risk factor for more privileged populations, high-income countries and can cause a transient alteration.

Effects of Maternal 5, 10-Methylenetetranhydrofolate Reductase (MTHFR) Genotypes, Serum Homocysteine and B Vitamin Levels on Postnatal Growth in Their Offsprings

Elevated maternal plasma homocysteine concentrations have been associated with adverse pregnancy outcomes. Serum homocysteine levels may be affected by the MTHFR genotypes and the nutritional status of B vitamins including vitamin B2, B6, folate and vitamin B12. We investigated whether postnatal growth measurements were influenced by maternal MTHFR genotypes and their mid-pregnancy serum vitamin B and homocysteine levels. In 130 pregnant women of 24 -28 wks of gestation, the MTHFR genotypes, serum B vitamins and homocysteine concentrations were analyzed. Physical growth status was assessed in their offsprings by measuring height, weight, and head and chest circumferences from birth up to 24 months. Serum homocysteine levels were higher in the subjects with T/T genotype than those with the C/T or C/C. Heights and head and chest circumferences of offsprings from the T/T mothers were significantly lower than those from the C/C or C/T mothers only when the serum homocysteine levels were above the median. The mean height of offsprings from the T/T mothers was significantly lower than those from the C/C and C/T mothers. The mean weight and head circumferences of offsprings born from the mothers whose mid-term pregnancy PLP levels were in the lowest quartile was significantly lower than those from mothers in the highest quartile. Heights and head circumferences of offsprings from the T/T mothers were significantly lower than those from the C/C or C/T mothers only when the serum FAD levels were in the lowest quartile. These results suggest that postnatal growth up to 24 months may be influenced by the maternal C677T MTHFR genotypes, and mid-pregnancy serum homocysteine and vitamin B status.

Variation of sarcomere length, sarcomere number and tetanic tension of skeletal muscle during postnatal growth in mice / 体力科学

The purpose of present study was to investigate the relationship between the increase of sarcomere length, sarcomere number and tetanic tension of the extensor digitorum longus muscles during postnatal growth in mice. The following results were obtained ; 1) The cross-sectional area, length of muscle and fiber length increased rapidly up to 7th week. 2) The sarcomere number increased up to 9 th week, 3) The tetanic tension per cross-sectional area decreased significantly in 7 th week, 4) The maximum value of sarcomere length which was obtained at middle region of the fiber correlated significantly with the tetanic tension per cross-sectional area (the correlation coefficient : r=-0.675) . These observations suggest that the local expansion of sarcomere length during postnatal growth affects the tension development.

Contractile properties of skeletal muscle during postnatal growth in mice: Related to morphological changes / 体力科学

The variation of lengths, cross-sectional areas, weights, tetanic tensions, and passive tensions in extensor digitorum longus muscles in mice were investigated during postnatal growth. The increase of tetanic tension was discussed in relation to morphological changes of muscle. The muscle lengths were measured at right angle of articulatio genus and talocruralis (L<SUB>0</SUB>) . Following results were obtained: 1) The length, cross-sectional area and weight of muscle increased rapidly up to 7 th weeks, and tetanic tension developed significantly in 2 nd to 5 th week. 2) The muscle length (ML), muscle cross-sectional area (MCA) and muscle weight (MW) correlated significantly with the measured tetanic tension (TT) at L<SUB>0</SUB> (the correlation coefficient r=0.852, 0.886 and 0.903 in ML, MCA and MW respectively) . 3) TT/MCA and TT/MW decreased in 7 th to 8 th week. 4) The passive tension at 130% L<SUB>0</SUB>per MCA showed maximum values in 8 th and 9 th weeks. 5) Relative muscle endurance were reduced in 2 nd to 4 th week and reached to steady level after 4 th week. These observations suggest that the functional development of muscle is late for morphological one and/or rapid morphological increment affects the contractile properties of muscle.