Extrauterine growth restriction: universal problem among premature infants / Restrição de crescimento extrauterino: problema universal entre os prematuros

ABSTRACT Objective: To analyze the growth rate of premature infants in the first weeks of life and factors associated with extrauterine growth restriction. Methods: This is a cross-sectional study of 254 premature infants in a neonatal intensive care unit conducted from January 1, 2008 to December 31, 2010. Infants who died or had malformations incompatible with life were excluded. Median weight curves according to gestational age were constructed for the first four weeks of life. The Fenton growth chart calculations provided the weight Z-scores. Extrauterine growth restriction was defined as corrected weight-for-age Z-score ≤-2. Perinatal, morbidity, and health care variables were analyzed. The Poisson regression model yielded the prevalenceratios . Associations between extrauterine growth restriction and the perinatal, morbidity, and care variables were investigated. Poisson regression controlled possible confounding factors. Results: The frequency of extrauterine growth restriction was 24.0%. Most (85.0%) small-for-gestational-age infants developed extrauterine growth restriction; 55.3% of extrauterine growth restriction cases involved small-for-gestational-age infants. Premature infants with gestational age >32 weeks did not recover the median birth weight until the third week of life and had a higher frequency of small-for-gestational-age. The Z-scores of non-small-for-gestational-age infants decreased more after birth than those of small-for-gestational-age infants. extrauterine growth restriction was associated with small-for-gestational-age (PR=6.14; 95%CI=3.33-11.33;p <0.001) and time without enteral diet (PR=1.08; 95%CI=1.04-1.13; p =0.010). Conclusion: Extrauterine growth restriction occurs in premature infants of all gestational age. The participation of small-for-gestational-age and nutritional practices in its genesis is noteworthy. We suggest prospective studies of all premature infants. The implementation of best care practices, individualized for small-for-gestational-age infants, to improve nutrient supply can minimize the problem.

RESUMO Objetivo: Analisar o crescimento de prematuros nas primeiras semanas de vida e fatores associados à restrição de crescimento extrauterino. Métodos: Estudo transversal realizado entre 01/01/2008 e 31/12/2010 com 254 prematuros em unidade de terapia intensiva. Excluíram-se óbitos e malformações incompatíveis com a vida. Construíram-se curvas de medianas de peso para as quatro primeiras semanas de vida de acordo com a idade gestacional. Calcularam-se escores-Z do peso pela planilha Fenton growth chart calculations. Definiu-se restrição de crescimento extrauterino pelos escores-Z do peso ≤-2 para a idade corrigida na alta hospitalar. Analisaram-se associações entre variáveis perinatais, assistenciais e morbidades com a restrição de crescimento extrauterino. Utilizou-se a regressão de Poisson para controlar os possíveis fatores de confundimento. Resultados: A frequência de restrição de crescimento extrauterino foi de 24%. Dos pequenos para a idade gestacional, 85% evoluíram com restrição de crescimento extrauterino. Prematuros com idade gestacional >32 semanas não recuperaram medianas de peso ao nascer até a terceira semana de vida, e, dentre eles, estava a maior frequência de pequenos para a idade gestacional. Os não pequenos para a idade gestacional apresentaram maior queda do escore-Z de peso do nascimento à alta quando comparados aos pequenos para a idade gestacional. Associaram-se à restrição de crescimento extrauterino nascer pequeno para a idade gestacional (RP=6,14; IC95%=3,33-11,33; p<0,001) e tempo sem dieta enteral (RP=1,08; IC95%=1,04-1,13; p=0,010). Conclusão: A restrição de crescimento extrauterino ocorre entre prematuros de todas as idades gestacionais, ressaltando--se a participação do nascimento pequeno para a idade gestacional e das práticas nutricionais na sua gênese. Sugerem-se estudos prospectivos que envolvam todos os prematuros. A implementação de boas práticas assistenciais que visem melhorar a oferta nutricional e individualizada para os pequenos para a idade gestacional pode minimizar o problema .

Household Food Insufficiency and Child Nutritional Status in Urban Slum, Dhaka, Bangladesh.

Introduction: Malnourished children are about 20% in the developing world. Food insecurity is a key risk factor for child malnutrition. Food insuffi ciency, an extreme form of household food insecurity, can aff ect physiological mechanisms that are linked to an individual’s nutritional status. Food-insuffi cient children are also more likely to have poorer health status and to experience a range of negative academic and psychosocial outcomes. Methods: We administered a cross-sectional socioeconomic survey to 354 households in research site, including a validated food insuffi ciency measurement questionnaire, and obtained anthropometric measurements from children aged 12 to 24 months. We used chi-square tests to assess the relationship between household food insuffi ciency and nutritional status of children. Results: Average age of study children was 18 months and standard deviation was (± 3.2 months). Th e status of household food insuffi ciency was 56%. Th e prevalence of underweight, stunting and wasting was 24%, 36% and 8% respectively. Th e household food insuffi ciency was signifi cantly (p<0.05) associated with underweight and stunting but not with wasting (p>0.05). Discussion: Th e study results indicate that food insuffi ciency is associated with stunting and underweight but not with wasting in urban slum of Bangladesh. We also found that child malnutrition is associated with mother’s education, father’s education, monthly family income and people per room.

Perfil nutricional e fatores associados à ocorrência de desnutrição entre crianças indígenas Kaingáng da Terra Indígena de Mangueirinha, Paraná, Brasil / Nutritional profile and factors associated with malnutrition in Kaingáng children on the Mangueirinha Indigenous Reserve, Paraná State, Brazil

Este estudo objetivou avaliar o estado nutricional de crianças indígenas e verificar os fatores associados à ocorrência de agravos nutricionais. Foram avaliadas 141 crianças Kaingáng de 0 a 60 meses de idade da Terra Indígena de Mangueirinha, Paraná, Brasil, por meio das medidas de peso e altura ou comprimento. Realizaram-se entrevistas com a aplicação de um questionário sobre condições materno-infantis e sócioeconômicas. Segundo os parâmetros da Organização Mundial da Saúde (2006), 24,8 por cento das crianças apresentavam déficit de altura para idade (AI), 9,2 por cento baixo peso para idade (PI), 2,1 por cento baixo peso para altura (PA) e 2,1 por cento baixo peso segundo o índice de massa corporal para idade (IMCI). De acordo com o NCHS (1977), 19,9 por cento das crianças apresentaram baixa AI, 9,2 por cento baixo PI e 1,4 por cento baixo PA. O sobrepeso chegou a 6,4 por cento, segundo o IMCI. O baixo peso ao nascer e os materiais utilizados na construção das paredes das casas estiveram estatisticamente associados com déficits antropométricos. Este estudo mostra que as crianças Kaingáng estão inseridas em um contexto marcado por precárias condições de vida, que estão associadas com indicadores desfavoráveis do estado nutricional.

The goal of this study was to evaluate the nutritional status of indigenous children and to investigate factors associated with nutritional deficits. Weight and height measurements were obtained for 141 Kaingáng children from 0 to 5 years of age living on the Mangueirinha Indigenous Reserve in Paraná State, Brazil. Data on maternal and infant conditions and socioeconomic characteristics were also gathered through face-to-face interviews. Based on World Health Organization criteria (2006), 24.8 percent of the children presented low height-for-age (HA), 9.2 percent low weight-for-age (WA), 2.1 percent low weight-for-height (WH), and 2.1 percent low weight according to body mass index for age (BMIA). Based on NCHS criteria (1977), 19.9 percent of the children presented low HA, 9.2 percent low WA, and 1.4 percent low WH. 6.4 percent were overweight according to BMIA. Low birth weight and non-masonry housing construction were associated statistically with nutritional deficits. The Kaingáng children are subject to poor living conditions, associated with deficits in their nutritional profile.

Nutritional problems in children aged 1-24 months: comparison of hill-tribe and Thai children.

A cross-sectional survey was conducted in Maecham district, Chiang Mai. The objective was to determine the magnitude of nutritional problems in children aged 1-24 months, both of hill-tribe and Thai communities, where breast-feeding is highly prevalent. Three hundred and fifty nine children were recruited, 252 were hill-tribe (Karen and Lahu), and 107 were Thai children. Anthropometric measurements were taken and mothers were interviewed. In a group of hill-tribe children, the prevalence of malnutrition (Z score of weight for age < -2) was 25.0 compared with 12.1 per cent for Thai children (p <0.01). The prevalence was highest in children aged between 12-24 months. This corresponded to the time children were weaned. The prevalence of stunting (Z score of height for age < -2) in hill-tribe and Thai children was 25.4 and 12.1 per cent respectively (p <0.01). There was no significant difference of wasting (Z score of weight for height < -2) between hill-tribe and Thai children, 9.1 and 8.4 per cent respectively. The mean (SD) Z scores of weight for age, weight for height, and height for age for both groups declined significantly as the age increased (p <0.001). In conclusion, this study revealed the nutritional problems of young hill-tribe children were more severe than those of Thai children. The factors that could be related with this, were socioeconomic status, as also genetics, as well as cultural beliefs concerning child raising. Such ethnic minorities therefore should be considered as special cases in programs of health and nutrition promotion.