Maternal plasma transforming growth factor-β1 (TGF-β1) and newborn size: the Araraquara Cohort Study

Abstract Objective To investigate associations of maternal and cord blood cytokine patterns with newborn size and body composition. Methods This cross-sectional study involved 70 pregnant women and their healthy newborns selected from the "Araraquara Cohort Study". Newborn anthropometric measurements were recorded at birth. Body composition was evaluated by air displacement plethysmography. Maternal blood samples were collected from pregnant women between 30 and 36 weeks of gestation, and umbilical cord blood samples were collected immediately after placenta discharge. The concentrations of the cytokines were determined in plasma by ELISA. Multiple linear regression models were used to assess associations between maternal and cord blood cytokine concentrations and newborn anthropometry and body composition measurements. Results Maternal plasma TGF-β1 concentration was inversely associated with newborn weight (β= -43.0; p= 0.012), length (β= -0.16, p= 0.028), head circumference (β= -0.13, p= 0.004), ponderal index (β= -0.32, p= 0.011) and fat-free mass (β= -0.05, p= 0.005). However, the association persisted just for head circumference (β= -0.26; p= 0.030) and ponderal index (β= - 0.28; p= 0.028), after adjusting for pre-gestational BMI, gestational weight gain, gestational age, hours after delivery, newborn sex, smoking and alcohol consumption. Conclusions Maternal plasma TGF-β1 concentration may be involved in the regulation of newborn size, mainly head circumference and ponderal index. Further cohort studies are necessary to investigate the role of TGF-β1 in different trimesters of pregnancy and its effect during the early stages of fetal development.

Breastfeeding practices and head circumference in young children: a systematic review

ABSTRACT OBJECTIVE To review observational studies on the association between breastfeeding (BF) practices and head circumference (HC) of children < 2 years old. METHODS A systematic review was conducted using the following electronic databases of health sciences: PubMed, Latin American and Caribbean Literature in Health Sciences (Lilacs), Web of Science and Scopus. We selected observational studies published in any language from January 01, 2010 to November 19, 2021, from different populations that investigated the association between BF practice and HC among healthy children < 2 years old. Titles and abstracts were screened independently by two evaluators. RESULTS From the 4,229 articles identified, 24 were included in this review: 6 cross-sectional, 17 longitudinal, and 1 case-control. The studies varied in their definition of the variables for BF and in reporting its practice, frequency, duration, and feeding method. Regarding HC, the authors analyzed the mean differences, abnormal values (z-score above + 2SD or below -2SD according to the World Health Organization (WHO) growth standards, 2007), and longitudinal growth parameters. The findings of this review suggest that BF may have a positive relationship with HC at the beginning of life. CONCLUSIONS Our findings suggest that BF, especially exclusive BF, may play a protective role against abnormal HC values in young children. However, more robust evidence with standardized BF indicators and WHO growth standards (2007) are required.

Evaluación de la antropometría en neonatos sanos. No todas las medidas son relevantes / Anthropometry assesment in healthy neonates. Not all measurements are relevant

Resumen Las medidas antropométricas se han usado para evaluar el crecimiento fetal y neonatal, además de determinar factores de riesgo de forma temprana. Clásicamente se han tomado el peso, talla, perímetro cefálico, torácico y abdominal. Son usadas para establecer condiciones como peso bajo o elevado para la edad gestacional, y con base en esto poder definir riesgos tempranos y tardíos. Otra medida sumamente importante es el perímetro cefálico, misma que determina neonatos con potencial riesgo neurológico. Estas tres medidas son clave como parte de la evaluación inicial neonatal, además de que se incluyen en el seguimiento del crecimiento y desarrollo infantil. No obstante, otras mediciones rutinarias como el perímetro torácico y abdominal, en neonatos con adaptación espontánea y exploración física normal (neonatos sanos), puede que aporten poco acerca del estado de salud neonatal. Estas últimas medidas no forman parte de los parámetros de seguimiento del crecimiento infantil, ni cuentan con gráficas de percentiles extrapolables para género y edad gestacional. Todas estas medidas están condicionadas por múltiples factores como genética, raza y nutrición, entre otros. Es momento de analizar las medidas rutinarias al momento del nacimiento de neonatos sanos, y priorizar las extrapolables a implicaciones clínicas relevantes.

Abstract Anthropometric measurements are used to assess fetal and neonatal growth and determine early risk factors. Classically, weight, height, head circumference, thoracic and abdominal circumference are the usual measures. They are used to identify conditions such as low or high weight for gestational age and, based on this, to determine early and late risks. Another important measurement is head circumference, which determines neonates with potential neurological risk. These three measures are key as part of the initial neonatal evaluation, and they are also a part of the child's growth monitoring and development. However, other routine measurements such as chest and abdominal circumferences, in newborns with spontaneous adaptation and normal physical examination (healthy neonates) may provide little information about the neonatal health status. These last measurements are not part of the child growth monitoring parameters, nor do they have percentile graphs that can be extrapolated to gender and gestational age. All these measures are conditioned by multiple factors such as genetics, race, and nutrition, among others. It is time to analyze routine measures at the time of birth of healthy newborns and prioritize those that can be extrapolated to relevant clinical implications.

Childhood Head Growth And Educational Attainment In An Indian Cohort

Background: There is minimal information about the association of head growth at different stages of childhood with cognitive ability. Objective: To determine the relationship of newborn head size and head growth during infancy, childhood and adolescence with attained education, a proxy for cognitive ability. Study design: Prospective birth cohort study. Setting: Married women living in South Delhi between 1969 and 1973. Participants: The New Delhi Birth Cohort study followed up 8030 newborns born in 1969-1973 with head circumference, weight and height measurements at birth and 6-12 monthly until adulthood. Of these, 1526 men and women were followed up at the age of 26-32 years. Outcomes: Association between years of schooling, as an indicator of cognitive ability, and newborn head circumference and conditional measures of head growth during infancy, childhood and adolescence. Results: In unadjusted analyses, newborn head size was positively associated with years of education [(? (95% CI)=0.30 (0.14 to 0.47) years per SD head circumference], as was head growth from birth to 6 months [? (95% CI)=0.44 (0.28 to 0.60) years per SD conditional head growth], 6 months to 2 years [? (95% CI)=0.31 (0.15 to 0.47) years per SD conditional head growth] and 2 to 11 years [? (95% CI)=0.20 (0.03 to 0.36) years per SD conditional head growth]. There were similar findings for height and body mass index (BMI). In the adjusted model containing all growth measures, gestational age, and socioeconomic status (SES) at birth as predictors, only SES was positively associated with educational attainment. Conclusion: Educational attainment in this population is positively associated with socioeconomic status and its influence on inter-related early life (fetal, infant and childhood) factors like nutritional status and brain growth.

The study on brain biometry and cerebral hemodynamics in fetuses with hypoplastic left heart syndrome in the second trimester of gestation / 中华超声影像学杂志

Objective:To explore the changes of biparietal diameter, head circumference and cerebrovascular hemodynamics in fetuses with hypoplastic left heart syndrome (HLHS) during middle pregnancy.Methods:The biparietal diameter, head circumference, middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI) and MCA-PI/UA-PI (CPR) of 41 fetuses with HLHS(HLHS group) were retrospectively analyzed from January 2015 to December 2019 in Beijing Anzhen Hospital, and were compared with those of 82 normal fetuses matched for gestational age at the same period (control group).Results:The Z-scores of head circumference, MCA-PI and CPR in with HLHS group were lower than in control group(all P<0.05); Head circumference in HLHS group were weakly and positively correlated with the MCA-PI and CPR ( r=0.385, 0.416; all P<0.05). Conclusions:There are some changes in the head circumference and cerebral hemodynamics in fetuses with HLHS during mid-gestational age, and the head circumference is weakly and positively correlated with MCA-PI and CPR, which has clinical significance.

A study on breastfeeding initiation in low birth weight and very low birth weight babies and their developmental outcome with special reference to kangaroo mother care

Background: Kangaroo Mother Care (KMC) was developed for caring of low birth weight (LBW) babies in developing countries. Study was done with the objective to evaluate the factors affecting initiation of breast feeding and effect of Kangaroo Mother Care (KMC) on morbidity problems and developmental outcome in Low Birth Weight (LBW) and Very Low Birth Weight (VLBW) babies.Methods: Prospective follow-up cohort study was carried out at Neonatal Intensive Care Unit (NICU) at Narayana medical college hospital Nellore from January 2018 to December 2019 and details of neonates were recorded on prestuctured proforma. Kangaroo mother care was given to one group. ASQ 3 questionnaire was used to assess the developmental outcome of the infants.Results: In this study, 100 babies were divided into two groups, case group consists of 50 babies where KMC is given and another control group consists 50 babies where KMC is not given. Mean gestational age for case and control group babies were 34.5 and 33.7 weeks respectively. Mean Birth weight in cases (1700 gr) and control (1580) grams respectively. Number of Male babies were more in cases (51%) and Group B (53%). Main factors affecting the initiation of breastfeeding in babies are LSCS (62% and 48%), RDS (50% and 40%), Apnea (24% and 25%) and seizures (20% and 14%) respectively in case and controls. Rates of exclusive breastfeeding is significantly increased in cases (90%) when compared to control (72%). Morbidity in cases is comparatively lesser than controls. At 6 months of corrected gestational age, mean weight in cases (5.2 kg) is significantly more than mean weight in control (4.7 kg). Significant development is noticed in communication (p=0.036), gross motor (0.04), and fine motor (0.05) compare to controls. Percentage of babies who acquired better personal social skills are more in cases (80%).Conclusions: The main factors affecting the initiation of breastfeeding in LBW and VLBW babies are LSCS, RDS, not secreted milk and seizures. KMC helps to achieve smooth and early transition to direct breastfeeding, increases the exclusively breastfeeding rate, better growth and developmental outcome and reduces the morbidities in LBW neonates.

Growth standard curves of birth weight, length and head circumference of Chinese newborns of different gestation / 中华儿科杂志

To study and formulate the growth standards for birth weight, length and head circumference of Chinese newborns of different gestation. A cross-sectional survey was carried out by the stratified cluster sampling method from June 2015 to November 2018 in 13 cities including Beijing, Harbin, Xi'an, Shanghai, Nanjing, Wuhan, Guangzhou, Fuzhou, Kunming, Tianjin, Shenyang, Changsha and Shenzhen. A total of 24 375 newborns with gestational age between 24 to 42 weeks were included. The standard percentile-curves of birth weight, length and head circumference for newborn boys and girls in gestational weeks 24 to 42 were established by the generalized additive model for location, scale and shape (GAMLSS). The new reference standard developed in this study was compared with the reference values of China in 1988 and the international Fenton 2013. Among the 24 375 newborns (13 197 males (54.1%),11 178 females (45.9%)), 12 264 were preterm infants and 12 111 were full term infants. The 3(rd), 10(th), 25(th), 50(th), 75(th), 90(th) and 97(th) percentile reference values and curves of birth weight, length and head circumference were obtained for male and female newborns from 24 to 42 gestation weeks. The data showed that birth weight, length and head circumference increased rapidly with the gestational age, but the growth velocity decreased slightly from 37 weeks. For example, the median birth weight for males at 28 weeks, 32 weeks, 37 weeks and 40 weeks was 1 154, 1 805, 2 943 and 3 455 g, respectively. The birth weight, length and head circumference of males at all gestational ages were 87-133 g, 0.2-0.9 cm and 0.3-0.6 cm higher than those of females, respectively. Compared with the percentile curves of birth weight of Chinese reference in 1988, there were significant differences regarding the percentile lines of males and females, especially the 10(th), 50(th), and 90(th) percentile values of birth weight were significantly higher than the reference values in 1988 from 37 to 42 gestation weeks. For example, the median birth weight at 40 weeks in the study was 115-242 g higher than that in 1988. Compared with the standard reference of Fenton 2013, the reference curve at 50(th) percentile of birth weight in this study was 13-81 g slightly higher than that of Fenton 2013 before 33 weeks, and then it was gradually lower than that of Fenton 2013 and the difference was 148-367 g at 41 to 42 weeks of gestation. The 10(th) percentile curve of Fenton 2013 was 11-64 g lower than that of this study in both males and females before 40 weeks. This study created a new national growth standard of birth weight, body length and head circumference for Chinese neonates at 24 to 42 weeks of gestation, which can be used for the growth and nutrition evaluation of newborns at birth and preterm infants in the early postnatal period. The 10(th) percentile and the 3(rd) percentile of growth standards could be suggested as the cut-off point for identifying small for gestational age and severe small for gestational age, respectively.

Calf circumference to detect low birth weight babies: a comparative study

Background: In developing countries 15 per cent of infants weigh less than 2,500 grams at birth .It is not possible to provide expensive weighing scales to the community members and families due to logistic (carrying a heavy scale) and operational (inability of Trained Birth Attenders to read) problems. Therefore it is essential to find out an alternative method for the estimation of birth weight. Almost 60 per cent of newborns in developing countries are not weighed. Which can lead to an underestimation of the incidence of low birth weight. That's why' we done' present study' to know the simple indicators to detect low birth weight babies. Aim of this study to compare calf circumference with other Low birth weight indicators as a reliable predictor of low birth weight babies.Methods: It is a cross-sectional study done during period 2018 January to 2018 October done at Niloufer Hospital Hyderabad. Statistical analysis is done using SPSS (version 17) statistical software. For comparison Pearson's Correlation coefficients used.Results: The best correlation was observed with both calf circumference (r=0.818) and head circumference (r=0.744) for identifying babies with birth weight <2 kg. For babies with birth weight <2.5 kg, calf circumference had the highest order of correlation (r = 0.986) followed closely by head circumference (r=0.886).Conclusion: In the absence of a weighing machine, simple measurements like calf circumference is the best indicator in identifying low birth weight babies (<2.5kg) at birth.

Sonographic Assessment of Normal Fetal Cerebral Lateral Ventricular Diameter at Different Gestational Ages

Abnormal dilatation of ventricles has been shown to be the most common abnormality of the brain & fetus in most of the geographical zones, but the normal dimension of the fetal lateral ventriclein south-southgeopolitical zones of Nigeria has not been evaluated.The aim of this study was to determine the normal feto-lateral ventricular diameter using ultrasound at different gestational ages. Measurement of the fetal-lateral ventricular diameter was obtained from 685 fetuses of pregnant mothers that met the inclusion criteria during routine ultrasound scan in Calabar metropolis. Measurement of the ventricular diameter was taken at the levelof the atria, measured according to Australian society for ultrasound in medicineguidelines.Original ResearchArticle

Prevalence of small for gestational age term neonates and its surrogate marker

Background: The incidence of low birth weight babies continues to be high in India at about 30% in contrast to 5-7% in developed countries. Perinatal, neonatal and infant mortality as well as morbidity is associated with low birth weight (LBW) neonates of which, it is the Small for Gestational Age (SGA) neonates that are at increased risk. Henceforth, it becomes important to study the prevalence of SGA babies and to compare various anthropometric measurements among term neonates for assessing as to which of these could be taken as surrogate markers of small for gestational age babies.Methods: It was a cross sectional study conducted over a period of 2 years among 100 term neonates delivered in a private medical college in Puducherry, India.Results: The prevalence of low birth weight babies and small for gestational age was found to be 40% and 30% respectively. Using mid arm circumference as a predictor, the sensitivity, specificity, positive predictive value and negative predictive value of SGA was found to be 100%, 57.14%, 50% and 100% respectively. Using MAC/HC ratio as a predictor, the sensitivity, specificity, positive predictive value and negative predictive value was found to be 46.67%, 100%, 100% and 81.4% respectively.Conclusions: In predicting SGA babies, mid arm circumference has the highest sensitivity whereas MAC/HC ratio has the highest specificity followed by mid arm circumference. Present study concluded that mid arm circumference and ratio of MAC/HC are very helpful in identifying SGA neonates among term neonates.

Preliminary study on radiation dose optimization for patients with head CT / 中华放射医学与防护杂志

Objective To investigate the effect of adjusting tube current time product (mAs) according to head circumference index on head CT image quality and organ-specific-dose level based on Monte Carlo analysis platform.Methods A total of 92 patients including children and adolescents with different clinical symptoms undergoing head CT scan were prospectively selected between September 2017 and June 2018 in the First Hospital of Jilin University.Without limiting the size of the head circumference,there were 22 patients were selected as conventional group by random number table,whose head circumference was 48.1-59.2 cm.Low dose group was divided into following three subgroups according to different head circumferences:A group 54.1-57.0 cm (n=22);B group 51.1-54.0 cm (n=26) and C group 48.1-51.0 cm (n=22).Tube current time product was 250 mAs for conventional group,200 mAs for A group,150 mAs for B group and 100 mAs for C group,respectively.The organ-specific-radiation doses (brain,eye lens and salivary gland) were recorded by Monte Carlo analysis platform and the subjective and objective image quality score was evaluated.Analyses of the differences between four groups were compared with image quality score as well as organ-specific-radiation dose by single factor variance.Results Radiation dose to brain was conventional group (34.37±3.62),A group (25.91±0.99),B group (23.18±6.11) and C group (17.38 ± 3.23) mSv,respectively.The difference was of statistical significance in the four groups (F=54.51,P＜0.05).Dose to eye lens was conventional group (41.54± 1.04),A group (33.03±0.35),B group (26.18±2.72) and C group (20.88±4.45) mSv,with statistical significance in difference between the four groups (F=189.75,P＜0.05).Dose to salivary gland was conventional group (35.04 ± 4.94),A group (25.92 ± 0.99),B group (22.93 ± 6.54) and C (14.96±2.67) mSv,respectively,with statistical significance in difference between the four groups (F=65.74,P＜0.05).Image quality scores were respectively conventional group (4.97±0.13),A group (4.77 ± 0.49),B group (4.60 ± 0.49) and C group (3.98 ± 0.61),respectively,with statistical significance between them (F=3.89,P＜0.05),but without statistical significance in difference between the four groups (P ＞ 0.05).The signal-to-noise ratios of gray matter in A,B and C groups were conventional group (18.69 ± 3.55),A group (16.76 ± 2.87),B group (15.05 ± 2.80) and C group (13.65±2.53),respectively,without statistical significance in difference between the four groups (P＞ 0.05);The signal-to-noise ratios of white matter in conventional group (17.46±3.72),A group (15.54± 2.81),B group (13.71±2.43) and C group (11.77±2.18),respectively,without statistical significance in difference between the four groups (P＞0.05).Conclusions Adjusting the tube current time product (mAs) according to head circumference index of children and adolescents can make scanning program more personalized and reduce organ-specific-radiation doses to sensitive organs without compromise of image quality.

Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients

Background: Diabetes Mellitus is a complex disease with varying degree of systemic and oral complications. The prognosis is quite favorable if a disease is diagnosed in early stages. Since a large number of patients seek dental treatment routinely, screening procedures for early detection of subclinical cases can help in diagnosis of asymptomatic diabetes. Aim: The present study was undertaken to evaluate if gingival crevicular blood can be used for the estimation of blood glucose levels in periodontitis patients. Material and Methods: A prospective study was carried out comprising 150 patients Group A comprised of 75 subjects with gingivitis and group B comprised of 75 subjects with periodontitis. For gingival crevicular blood glucose (GCBG) level estimation, the blood was drawn onto the glucometer strip after gently probing the gingival sulcus and the readings were recorded. At the same time, blood Vijayendra Pandey, Akhilesh Chandra, Deepak Kumar, Anup Kumar Singh, Priyankesh, Alok Kumar Gupta. Estimation of gingival blood glucose using a sensitive self-monitoring device in periodontitis patients. IAIM, 2019; 6(6): 51-56. Page 52 was also collected from the index finger onto the glucometer strip for the capillary finger-prick blood glucose (CFBG) sample. Both the values were compared and statistical analysis of data was performed. Results: The mean GCBGL and CFBGL in group A was 98.43 mg/dl ± 18.62 and 103.48 mg/dl ± 13.90 respectively, while in group B it was 136.37 mg/dl ± 36.95 and 141.62 mg/dl ± 51.84, respectively. There was no statistically significant difference (p> 0.05) between the two values in both the groups. Conclusion: It can be concluded that GCBG levels are positively correlated with CFBG levels. Therefore, clearly indicating that gingival crevicular blood collected during diagnostic periodontal examination may be an excellent source of blood sample for glucometric analysis.

Frequency Of Anencephaly And Its Associated Anomalies

Introduction: Anencephaly accounts for one of the most common birth defects & is associated with a highmortality & morbidity. The objective was to determine frequency of anencephaly and its associated anomalies,risk factors, clinical presentations & assess maternal awareness on folic acid supplementation and its preventiverole in occurrence of anencephaly.Materials and Methods: The study includes 60 anencephalic fetuses (23 males & 37 females) of 20-30 weeks. Thefetuses were examined for external abnormalities & dissected. Measurements of crown heel, crown rump, headcircumference, foot length, & weight were taken. All the major organs were weighed & data recorded. The sampleswere fixed with 10% buffered formaldehyde. The internal anomalies were noted.Results: The number of deliveries was 57429 deliveries. 23(38.4%) were males & 37(61.6%) were females. Thefrequency of anencephaly in 2014 was 15134/9 (0.06%), in 2015 16361/21 (0.13%). Weight of 40% were <500gms,35% were between 500-1000gms & 25% <1000. Maternal age in 83.4% were 21-35 years, in <20 years & >40 yearswere 1.6% & in 36-40 years were 13.4%. Associated anomalies were present in 42 (70%) fetuses. Out of 42fetuses, those who had associated anomalies were 17 (40.4%) males and 25 (59.6%) were females. All the fetuseshad Acrania (100%) & 19 (45.3%) fetuses had spina bifida; there were no anomalies found in reproductivesystem.

Association of head circumference with cognitive decline and symptoms of depression in elderly: a 3-year prospective study / 영남의대학술지

BACKGROUND: Brain volume is associated with dementia and depression in the elderly. An easy way to predict relative brain volume is to measure head circumference. In this study, we investigated the relationship between head circumference and cognition as well as depression in a non-demented elderly community.METHODS: Baseline and follow-up surveys were conducted in 2007 and 2010. At baseline, community residents aged 65 years or over (n=382) within a rural area of South Korea were screened for dementia and symptoms of depression and were followed using the same screening battery after 3 years (n=279). Data from anthropometric measurements (head circumference, height, and body weight), demographics, and blood tests were gathered. Neuropsychological tests, including the Korean version of mini-mental state examination (K-MMSE), clinical dementia rating (CDR) including the CDR-sum of boxes, the Korean version of instrumental activities of daily living, and geriatric depression scale (GDS), were performed. None of the 279 subjects followed were demented.RESULTS: Baseline performance on the K-MMSE and GDS was poorer for participants with smaller head circumferences. Follow-up performance on the MMSE was also poorer for participants with smaller head circumferences. Interestingly, participants with smaller head circumference showed worse GDS scores at baseline but on follow-up examination, participants with larger head circumference showed rapid worsening than those with smaller head circumference with marginal significance by ANOVA test. In regression coefficient analysis, GDS decline showed significant difference.CONCLUSION: Head circumference was not associated with cognitive change but was associated with symptoms of depression in non-demented community residents.

Referencias argentinas para la evaluación de proporciones corporales desde el nacimiento hasta los 17 años / Argentine references for the assessment of body proportions from birth to 17 years of age

Introducción. La alteración de las proporciones corporales puede ser indicativa de enfermedad esquelética, por lo cual su detección resulta de gran utilidad clínica. Objetivos. Estimar los centilos de los índices perímetro cefálico/estatura (PC/E) y estatura sentada/estatura (ES/E), y evaluar su utilidad diagnóstica en un grupo de niños con displasia esquelética. Métodos. Los centilos 3, 10, 25, 50, 75, 90 y 97 de ES/E y PC/E fueron estimados por el método LMS, que utiliza la transformación Box-Cox para normalizar la distribución de los datos a cada edad. Se aplicaron los tests Q-Q plot para evaluar la normalidad de los residuos y el Q test para evaluar la bondad de ajuste. Resultados. La muestra incluyó 4818 niñas y 4803 niños sanos de 0 a 17 años de edad. La mediana del índice ES/E para la edad cayó desde valores de 0,67 al nacer hasta 0,57 a los 4 años. A los 12 años, alcanzó valores de 0,52 y 0,53 para varones y mujeres, respectivamente, y se mantuvo así hasta los 17 años de edad. La mediana del índice PC/E cayó desde 0,45 a los 6 años hasta 0,34 a los 17 años de edad en ambos sexos. Los puntajes Z del ES/E en 20 niños con diagnóstico de hipocondroplasia mostraronmejor la desproporción corporal que la utilización del índice ES/E no ajustado por edad. Conclusiones. Los centilos estimados de PC/E y ES/E muestran que, en el período prepuberal, ocurren los mayores cambios en las proporciones corporales. Estas referencias facilitan una detección más temprana de desproporción corporal en niños con displasia esquelética.

Introduction. Abnormal body proportions may indicate skeletal disorders; therefore, their detection has great clinical significance. Objectives.To estimate centiles for head circumference/height (HC/H) and sitting height/height (SH/H) ratios, and assess their diagnostic usefulness among a group of children with skeletal dysplasia. Methods. Centiles 3, 10, 25, 50, 75, 90 and 97 for HC/H and SH/H ratios were estimated with the LMS method using Box-Cox transformation to normalize data distribution for each age. Q-Q plot tests were applied to evaluate normality of residuals and the Q test to calculate goodness-of-fit. Results. The sample included 4818 girls and 4803 boys, all healthy, between 0-17 years old. The median of the SH/H ratio for each age decreased from 0.67 at birth to 0.57 at age 4. At 12 years of age, values reached 0.52 and 0.53 for males and females, respectively, remaining unchanged until age 17. The median of the HC/H ratio decreased from 0.45 at 6 years old to 0.34 at 17 years old for both sexes. Z-scores for SH/H among 20 children diagnosed with hypochondroplasia were better at showing abnormal proportions than the SH/H ratio not adjusted by age. Conclusions.Estimated centiles for HC/H and SH/H ratios show that the most dramatic changes in body proportions occur in the prepubertal period. These references allow an earlier detection of abnormal body proportions in children with skeletal dysplasia.

Revisiting head circumference of Brazilian newborns in public and private maternity hospitals / Revisitando o perímetro craniano de recém nascidos brasileiros de maternidades públicas e privadas

ABSTRACT Objective To revisit the head circumference (HC) of newborns in public and private maternity hospitals; to correlate our findings with the gestational age, gender, and type of delivery; and build and validate graphs and curves. Methods This was a prospective study performed on healthy newborns. Differences in HC were analyzed as a function of gestational age, gender, the healthcare system and the type of delivery. Smoothed percentile curves were created using the least mean squares method. Results Of the included newborns, 697 were born in private maternity hospitals and 2,150 were born in public maternity hospitals. In all, 839 were born by vaginal delivery, and 1,311 were born by cesarean delivery. At 37 to 42 weeks of gestation, male newborns had a larger HC than females. Infants born in private maternity and those born by cesarean delivery had a larger HC. Conclusion An important result of the present study is that our analyses allowed us to generate curves and statistically-validated graphs that can be used in clinical neonatal practice.

RESUMO Objetivo Revisitar o perímetro cefálico (PC) de recém nascidos (RN) correlacionando com a idade gestacional (IG), gênero, tipo de parto (TP), sistema de saúde e construir e validar gráficos e curvas. Métodos Estudou-se prospectivamente RN sadios analisando-se as diferenças entre os PC segundo a IG, gênero, TP e sistema de saúde. As curvas suavizadas de percentis foram criadas pelo método LMS (least mean squares). Resultados 692 nasceram em maternidades privadas, 2.150 em maternidade pública, 839 nasceram de parto vaginal e 1.311 parto cesáreo. O gênero masculino apresentou PC maior que o feminino nas IG de 37 a 42 semanas. Os RN de maternidades privadas tiveram PC maior que os de maternidade pública. Os nascidos de parto cesáreo tiveram PC maior que os de parto vaginal. Conclusão Importante consequência deste estudo foi que os resultados permitiram a criação de curvas e gráficos validados estatisticamente de aplicabilidade na prática clínica neonatal.

Head Measurements for the Diagnosis of Craniosynostosis

Objective Craniosynostosis is a group of growth disturbances of the skull, which can result in serious consequences for the children who suffer from it. Early diagnosis provides treatment at the correct time. Most of the time, the pediatrician uses the head circumference (HC) as a parameter for the diagnosis, but the HC does not appear to be changed in this disease, leading to incorrect interpretations. The anteroposterior distance (APD) and biauricular distance (BAD) appear to be more accurate. The aim of this study is to analyze the value of the HC and the ratio between the measurements of the APD and the BAD for this diagnosis. Methods We analyzed the data from 129 children who had already undergone an operation for craniosynostosis at an institution in Southeastern Brazil. These data were compared with the normal standards of the population and statistically analyzed to establish their alterations. Results The HC did not change significantly in cases of craniosynostosis, neither when it was considered as a single disease, nor when considering the different subtypes. The APD/BAD ratio changed significantly in the group. Conclusion The HC does not appear to be useful in the diagnosis of craniosynostosis as an individual parameter. The APD/BAD ratio appears to help in the diagnosis.

Objetivo Craniossinostoses são alterações do crescimento do crânio que podem resultar graves consequências para a criança. O diagnóstico precoce propicia o tratamento correto. O perímetro cefálico (PC) é habitualmente usado como parâmetro para o diagnóstico. Porém, como na maioria das vezes há alteração na forma e não no perímetro, sua utilização isolada pode levar a detecção tardia. As medidas do diâmetro ântero posterior (DAB) e bi auricular (DBA) parecem ser mais precisas. O objetivo do trabalho é analisar o valor do PC no diagnóstico, bem como o da razão entre as medidas DAP/ DBA. Métodos Foram analisadas dados de 139 crianças já operadas no Biocor Instituto, em Minas Gerais. Os dados foram comparados com os parâmetros normais já conhecidos da população. Resultados O PC não se alterou de maneira significativa nas craniossinostoses, seja como um grupo único ou nos subtipos. A razão das medidas DAP/ DBA alterou-se. Conclusão O PC isolado parece não ser útil para o diagnóstico das craniossinostoses. A razão das medidas DAP/ DBA parecendo ter utilidade.

Study on reliability of children anthropometric indicators measured by medical students during clinical practice / 重庆医学

Objective To evaluate the reliability of children anthropometric indicators measured by medical students in clini-cal practice .Methods The convenient sampling was adopted to collect the data of the head circumference (HC) ,recumbent length (RL) and crown-rump length (CRL) of infants and young children measured by the students in clinical practice from entering-de-partment training to exiting-department .The re-measured data by clinical teachers were simultaneously collected .The measurement difference were compared between the students and clinical teachers .The measurements reliability was described by using the indi-cators such as the mean absolute differences (MAD) ,percentages of difference within a critical value (PDCV) and so on .Results MAD of HC ,RL and CRL at entering-department were 0 .46 ,0 .55 ,0 .81 cm respectively ,which at exiting-department were 0 .30 , 0 .43 ,0 .51 cm respectively ,the difference were statistically significant (P<0 .05) .PDCV of HC ,RL and CRL belonging to good quality standard at entering-department were 41 .5% ,58 .0% and 36 .0% respectively ,which at exiting-department were increased to 53 .5% ,70 .0% and 59 .0% respectively .PDCV of HC ,RL and CRL belonging to error data were 19 .0% ,10 .0% and 13 .0% re-spectively .Conclusion RL measured by medical students in clinical practice has good quality ,while the bigger errors exist in the measurement values of HC and CRL .

Estimation of Stature from Some Selected Cephalofacial Parameters among Teenage Indigenes of Ogoja Local Government Area Cross River State.

Estimation of stature from body segment parameters finds usefulness in forensic sciences and other medical applications. However, these parameters are highly, sex, race and age dependent. The present study measured some cephalofacial parameters with a view to providing cephalofacial anthropometric parameter that could be used in estimation of stature among teenage indigenes of Ogoja Local Government Area of Cross River State. A total of 300 teenagers (13-19 years), comprising 150 males and 150 females were used. Maximum stature, head circumference, nasal height and nasal width were obtained by direct measurement. The findings of the study showed that males mean values are significantly higher (p<0.05) than females for all parameters: Stature (males, 157.30±6.81; females, 155.70±5.71), head circumference (males, 55.38±1.55; females, 54.62±1.52), nasal height (males, 4.54±0.43; females, 4.39±0.44) and nasal width (males, 4.95±0.50; females, 4.74±0.58). Results of this study reveals that male head circumference significantly (p<0.05) correlate with stature. Hence only male head circumference (HC) could be employed in the estimation of stature using the linear regression equation (11.48 × HC + (-478.70)). The analysis of the measured parameters shows that nasal height and width are not reliable tools for stature prediction amongst Ogoja teenage population.

Longitudinal standards for growth velocity of infants from birth to 4 years born in West Azerbaijan Province of northwest Iran / 한국역학회지

OBJECTIVES: Growth velocity is an important factor to monitor for appropriate child growth. This study presents the growth velocity of infants based on length, weight, and head circumference. METHODS: The subjects of this study were 308 neonates (160 boys and 148 girls) born in West Azerbaijan Province of northwestern Iran who were followed from birth for 4 years. The weights and lengths of the subjects were recorded at birth, 1, 2, 4, 6, and 9 months, and 1, 1.5, 2, 3, and 4 years of age, while the head circumferences were measured just up to 1.5 years of age. In this study, the Lambda-Mu-Sigma (LMS) method using LMS Chartmaker Pro (Institute of Child Health, London, UK) was utilized to obtain growth velocity percentiles. RESULTS: After obtaining growth velocity charts for weight, length, and head circumference (5th, 50th, and 95th percentiles), the researchers could deduce that there was a sharp decrease in the velocity growth charts from birth to 2 years of age but these charts remained relatively stable up to 4 years for both sexes. Growth velocities for the length and weight of boys in the present sample are slightly but not significantly greater than those in girls through the first months of infancy and there was no significant difference between girls and boys up to 4 years. CONCLUSIONS: This paper provided the first local growth velocity standards of length, weight, and head circumference for infants by analyzing longitudinal measurements produced for West Azerbaijan Province, which should be updated periodically. It seems that there has been a significant difference between the growth velocity of infants in northwestern Iran and southern Iran within the past few years.