To evaluate the growth trajectory of head circumference and neurodevelopment, and to correlate head circumference with cognitive, language, and motor outcomes during the first two years.
Prospective ...cohort study in a tertiary hospital including 95 newborns under 32 weeks or 1500 g. Neonates who developed major neonatal morbidities were excluded. The head circumference was measured at birth, at discharge, and at term-equivalent age, 1, 3, 5, 12, 18, and 24 months of corrected age, and the Bayley Scales (Bayley-III) were applied at 12, 18 and 24 months of corrected age to assess cognitive, language and, motor domains. Scores below 85 were classified as mild/moderate deficits and scores below 70 as severe deficits. The association between head circumference Z score and Bayley scores was assessed using Pearson's correlation. The study considered a significance level of 0.05.
There was a decrease of -0.18 in the head circumference Z score between birth and discharge and the catch-up occurred between discharge and 1 month (an increase of 0.81 in the Z score). There was a positive correlation between head circumference and Bayley scores at 18 months. There was also a positive correlation between head circumference at discharge and at 5 months with the three domains of the Bayley.
Serial measurements of head circumference provide knowledge of the trajectory of growth, with early catch-up between discharge and 1 month, as well as its association with neurodevelopment. Head circumference is therefore a valuable clinical marker for neurodevelopment, especially in very preterm newborns.
Background:
The efficacy of minimally invasive techniques for addressing isolated sagittal craniosynostosis decreases with age; thus, timely referral is critical. We sought to identify a screening ...tool using data from well-child visits. We hypothesized that many infants with sagittal craniosynostosis, but no macrocephaly based on growth chart plotting, in fact have a relative macrocephaly.
Methods:
All infants with CT and surgically/pathologically confirmed isolated sagittal craniosynostosis were identified. Growth chart data was collected (head circumference (HC), weight, crown-to-toe-length, and World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) percentiles and deviation (z-scores)). Relative macrocephaly was defined as head circumference >2SD from size (weight and/or length).
Results:
Initial pilot screen indicated that WHO growth chart data has utility as a screening tool. Subsequent retrospective case-control study with area under the curve (AUC) analysis revealed that HC:length ratio ≥0.71 is indicative of isolated sagittal craniosynostosis as young as 1 week of age, while HC:length ratio ≥0.67 represents the maximization of sensitivity (0.89) and specificity (1.00) as early as 2 weeks old. Prospective internal validation with logistic regression demonstrated that at ages 1 to 2 months greater discriminatory value HC:length ratio was observed.
Conclusions:
When length is added to head circumference as a screening tool we may identify an abnormal growth pattern beginning as early as 1 week. This represents an opportunity to design an automated alert easily programed into the electronic medical records and may prompt pediatricians to refer patients to craniofacial surgeons early.
BACKGROUND: Local and worldwide prenatal charts for estimated fetal weight and postnatal charts for head circumference are gender specific. However, prenatal head circumference nomograms are not ...gender customized. OBJECTIVE: This study aimed to create gender-customized curves to assess between-gender head circumference differences and to study the clinical significance of using such gender-customized curves. STUDY DESIGN: A single-center retrospective study was conducted between June 2012 and December 2020. Prenatal head circumference measurements were obtained from routine estimated fetal weight ultrasound scans. Postnatal head circumference measurement at birth and gender were retrieved from computerized neonatal files. Head circumference curves were created, and the normal range was defined for the male and female subpopulations. After applying gender-specific curves, we analyzed the outcome of cases classified as microcephaly and macrocephaly according to non–gender-customized curves, which were reclassified as normal according to gender-specific curves. For these cases, clinical information and postnatal long-term outcomes were retrieved from patients’ medical records. RESULTS: The cohort included 11,404 participants (6000 males and 5404 females). The curve for male head circumference was significantly higher than the female curve for all gestational weeks (P<.0001). Applying gender customized curves resulted in fewer cases of male fetuses defined as 2 standard deviations above the normal range and female fetuses defined as 2 standard deviations below of the normal range. Cases reclassified as normal head circumference after the application of gender-customized curves were not related to increased adverse postnatal outcomes. The rate of neurocognitive phenotypes was not higher than the expected rate in both male and female cohorts. Polyhydramnios and gestational diabetes mellitus were more common in the normalized male cohort, whereas oligohydramnios, fetal growth restriction, and cesarean delivery were more common in the normalized female cohort. CONCLUSION: Prenatal gender-customized curves for head circumference can reduce the overdiagnosis of microcephaly in females and macrocephaly in males. According to our results, gender-customized curves did not affect the clinical yield of prenatal measurements. Therefore, we suggest that gender-specific curves be used to avoid unnecessary workup and parental anxiety.
Stunting in developing countries continues to be a major public health problem. Measuring head circumference (HC) during clinical anthropometric assessment can help predict stunting. The aim of this ...study was to assess burden and determine the predictors of low HC (<- 2 SD) at birth and during first 2 years of life in a semi- urban settlement of Vellore.
The study uses baseline data and serial HC measurements from the birth cohort of MAL-ED study, where 228 children from Vellore completed follow-up between March 2010 to February 2014. Analysis of baseline, maternal and paternal characteristics, micro-nutrient status and cognition with HC measurements was performed using STATA version 13.0 software.
The mean HC (±SD) at 1st, 12th and 24th month were 33.37 (1.29) cm, 42.76 (1.23) cm and 44.9 (1.22) cm respectively. A third of the infants (75/228) had HC less than - 2 SD at first month of life, and on follow-up, 50% of the cohort had HC ≤ -2 SD both at 12th and 24th month. Low HC measurements at all three time-points were observed for 21.6% (46/222) infants. Low HC was significantly associated with stunting in 37.3% (OR = 10.8), 57.3% (OR = 3.1) and 44.4% (OR = 2.6) children at 1st, 12th and 24th month respectively. Bivariate analysis of low HC (<- 2 SD) at 12th month showed a statistically significant association with lower socioeconomic status, low paternal and maternal HC and low maternal IQ. Multivariable logistic regression analysis showed maternal (AOR = 0.759, 95% CI = 0.604 to 0.954) and paternal (AOR = 0.734, 95% CI = 0.581 to 0.930) HC to be significantly associated with HC attained by the infant at the end of 12 months.
One-third of the children in our cohort had low head circumference (HC) at birth, with one-fifth recording low HC at all time-points until 2 years of age. Low HC was significantly associated with stunting. Paternal and maternal HC predicted HC in children. HC measurement, often less used, can be a simple tool that can be additionally used by clinicians as well as parents/caregivers to monitor child growth.
Background Early brain overgrowth (EBO) in autism spectrum disorder (ASD) is among the best replicated biological associations in psychiatry. Most positive reports have compared head circumference ...(HC) in ASD (an excellent proxy for early brain size) with well-known reference norms. We sought to reappraise evidence for the EBO hypothesis given 1) the recent proliferation of longitudinal HC studies in ASD, and 2) emerging reports that several of the reference norms used to define EBO in ASD may be biased toward detecting HC overgrowth in contemporary samples of healthy children. Methods Systematic review of all published HC studies in children with ASD. Comparison of 330 longitudinally gathered HC measures between birth and 18 months from male children with autism ( n = 35) and typically developing control subjects ( n = 22). Results In systematic review, comparisons with locally recruited control subjects were significantly less likely to identify EBO in ASD than norm-based studies ( p < .001). Through systematic review and analysis of new data, we replicate seminal reports of EBO in ASD relative to classical HC norms but show that this overgrowth relative to norms is mimicked by patterns of HC growth age in a large contemporary community-based sample of US children ( n ~ 75,000). Controlling for known HC norm biases leaves inconsistent support for a subtle, later emerging and subgroup specific pattern of EBO in clinically ascertained ASD versus community control subjects. Conclusions The best-replicated aspects of EBO reflect generalizable HC norm biases rather than disease-specific biomarkers. The potential HC norm biases we detail are not specific to ASD research but apply throughout clinical and academic medicine.
Exposure to environmental pollutants during pregnancy may cause adverse birth outcomes in newborns. This study examined links between exposure to various residential environmental characteristics ...during pregnancy and newborn birth weight/head circumference, using the Taiwan Birth Cohort Study (TBCS) database with 14,829 subjects. We conducted simple and multiple linear regression analyses to find out the associations between residential environmental characteristics (molds, environmental tobacco smoke ETS, household insecticide use, and home renovation or painting) and birth outcomes (birthweight, head circumference), and adjusting for demographics and environmental variables. The standardized beta coefficients were calculated. We also analyzed whether the associations varied by newborn sex and maternal body mass index (BMI). The regression analysis indicated that molds on multiple walls at the residence were significantly associated with lower birthweight (standardized β = −0.025, p = 0.003) and with smaller head circumference (standardized β = −0.023, p = 0.008) than no mold on walls after adjustment. Exposure to ETS did not result in significance for birthweight reduction but a significant reduction in head circumference (standardized β = −0.018, p = 0.047). The birthweight reductions associated with molds were −0.024 SD (standard deviation) for boys and −0.028 SD for girls, whereas the head circumference reduction with molds was sex-specific, being only significant for girls (standardized β = −0.029, p = 0.021). The analysis on BMI-separated data indicated that all significance occurred to mothers having normal BMI. Mold presence correlated significantly with reduced birth weight and head circumference, while ETS exposure only reduced head circumference. Girls and mothers with normal BMI were more affected by these reductions than boys or under/overweight mothers.
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•We explored the associations between residential environmental characteristics and birth outcomes.•Molds on walls relate to lower birthweight and smaller head circumference.•Environmental tobacco smoke is linked to reduced head circumference.•The birth outcome reductions appeared to be attributed more to girls than boys.•The birth outcome reductions came mostly from mothers with normal BMI.
Objetivo: Analizar las variaciones del perímetro cefálico (PC) en prematuros menores de 34 semanas expuestos a corioamnionitis histológica (CAH), y observados hasta los 2 años de edad corregida. ...Material y métodos: Estudio de cohorte secundaria de dos estudios prospectivos. Los datos correspondieron a mediciones del PC al nacimiento, a las 40 semanas y a los 2 años de edad corregida. La variación del PC se analizó en los prematuros con y sin exposición a CAH. La CAH se analizó de acuerdo con los subtipos subcorionitis/corionitis, corioamnionitis y corioamnionitis más funisitis. Resultados: De 91 prematuros incluidos, el 41,8 % (38/91) tuvo CAH. El promedio del PC al nacimiento fue de 27,7 cm (percentil 31,2) en los expuestos y de 28,3 cm (percentil 42,1) en los no expuestos (p = 0,039); a las 40 semanas y a los 2 años, los promedios fueron similares. El subtipo corioamnionitis estuvo asociado con un menor PC (p < 0,05). La menor edad gestacional al nacer (p < 0,005) se relacionó con una mayor velocidad de crecimiento craneal. La CAH y el retardo de crecimiento intrauterino (RCIU) fueron los factores determinantes del menor PC en las tres edades evaluadas, y la sepsis confirmada solo tuvo lugar a las 40 semanas. Conclusiones: Los prematuros menores de 34 semanas expuestos a la CAH tuvieron menor percentil de PC al nacimiento; se observó recuperación del percentil de PC a las 40 semanas; y, finalmente, el subtipo corioamnionitisse relacionó con un menor PC a los 2 años de edad corregida. El factor RCIU potencia esta asociación en las tres edades y la sepsis solo a las 40 semanas. Se recomienda realizar futuros estudios para confirmar estos hallazgos
Introduction: Low Birth Weight (LBW) is a commonly encountered problem in developing countries. Growth is the single most important predictor of morbidity and mortality in a LBW infant. LBW babies ...show a pattern of growth, different from normal weighing babies. Aim: To assess the growth pattern of LBW infants in first six months of life. Materials and Methods: This prospective cohort study was done in Department of Paediatrics, of Kilpauk Medical College and Hospital, a tertiary care hospital in Southern India, from September 2019 to August 2020. Total 310 LBW infants, of which 200 were term and rest preterm were included and followed-up at the ages of three and six months. Clinical details including gender, gestational age, order of birth, length of stay in nursery, maternal and neonatal morbidities, type of feeding and intercurrent illness were noted. The weight, length and head circumference of the infants were measured by standard methods and interpreted using appropriate charts. The anthropometric measures were converted into z-score and compared. The outcome variables were statistically analysed using Chi-square test. Results: Out of 310 babies, 172 (55.5%) were girls and 200 (64.5%) were term babies. Six month follow-up rate was 92%. A total of 228 (79%) infants were on exclusive breastfeeding while the remaining 21% were partially breastfed. The prevalence (95% confidence interval) of undernutrition, short stature and microcephaly at six months were 54.9% (48.93-60.76), 62.2% (56.34-67.88) and 30.7% (25.47-36.47), respectively. Fall in standard deviation score of length, weight and head circumference was observed which was more pronounced in preterm than in term infants (p<0.05). Conclusion: Growth faltering is commonly encountered in more than half of LBW infants on six months follow-up, with the effect being more pronounced in preterm more than term infants.
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