F. Serenius

Reporting outcomes of extremely preterm births

Published reports of extremely preterm birth outcomes provide important information to families, clinicians, and others and are widely used to make clinical and policy decisions. Misreporting or misunderstanding of outcome reports may have significant consequences. This article presents 7 recommendations to improve reporting of extremely preterm birth outcomes in both the primary and secondary literature. The recommendations should facilitate clarity in communication about extremely preterm birth outcomes and increase the value of existing and future work in this area.

Patterns of Breastfeeding and Weaning in Saudi Arabia

ABSTRACT. The patterns of breastfeeding and weaning were studied in 4 groups of Saudi children: Privileged urban children; children representing the average urban population; less privileged urban children, and rural children from 3 different areas. The data represented retrospective and actual information and were analyzed according to the life table technique. The median duration of breastfeeding of rural, urban low, urban average and urban privileged children was 17.8 months, 10.8 months, 7.5 months and 2.1 months, respectively. In all groups the rate of breastfeeding was lower in young compared with old mothers. Thus the median duration of breastfeeding was 11.7 months for rural mothers <23 years and 23.6 months for mothers >31 years. Corresponding figures for urban low mothers were 3.4 months and 11.4 months, respectively. By one month 52 percent of privileged and 42 percent of urban low children were started on bottle. By contrast, 26 percent of rural children were started on bottle at 6 months, At 6 months, 6 percent of rural children were started on any kind of solid foods compared with 90 percent of privileged children; at 12 months the figures were 33 and 96 percent, respectively. The data indicated a successive decline in the duration of breastfeeding with increasing affluence, and late introduction of weaning foods to rural children.

Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation

Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive subscales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers’ responses on Achenbach’s Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P <0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ >70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers’ ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.

Attained Grawth of Privileged Saudi Children During the First Three Years of Life

ABSTRACT. The attained growth was assessed in privileged Saudi children 0–36 months of age. Birth weights were measured on all children but subsequent measurements were cross‐sectional. The mean (SD) birth weight of boys, 3362 (445) g, and that of girls 3186 (490) g, did not differ significantly from the means of the NCHS reference. Individual data on weight, height, weight for height and head circumference of older children were standardized according to Western standards. When the material was stratified according to age groups, the differencies were trivial between the standardized means of attained weight, height and weight for height of Saudi children and those of the NCHS reference. Similarly, the standardized mean head circumference was nearly identical with that of the standard of Westrup and Barber. Except for weight for height, the differencies in the distribution of SD scores were trivial compared with the standards. The data indicated that Saudi children have the genetic potential to grow according to Western standards, and that poor growth found in other groups of Saudi children are likely to be caused by environmental rather than by ethnic factors.

Characteristics of the Obstetric Population in a Saudi Maternity Hospital

ABSTRACT. Mothers who delivered in a large Maternity hospital and who represented a large proportion of the obstetric population in Riyadh are described. The mothers were characterized by a high material standard of living, by adequate energy reserves at confinement, by a low rate of pregnancy complications and preterm birth, and by the absence of smoking and of hard physical work during pregnancy. The mothers were also, however, characterized by pregnancies occurring at the extremes of the reproductive age, by short birth intervals, by short maternal stature, by low educational attainment, by poor utilization of antenatal services and by a high rate of previous infant loss, that is by characteristics previously found to consitute riskfactors for adverse perinatal outcome.

Growth and Nutritional Status of Less Privileged Urban Children in Saudi Arabia

ABSTRACT. The attained growth was assessed in a cross‐sectional study of Saudi children 1–71 months of age, growing up in a less privileged area of Riyadh. Individual data on weight, height and weight for height were expressed in SD scores of the NCHS reference and those of triceps skinfold thickness in percent of the reference median. The mean (SD) weight, height and weight for height of the entire material were ‐0.9 (1.0), ‐0.8 (1.0), and ‐0.5 (0.9), respectively and the median tricpes skinfold was 90 percent of the reference median. When stratified by age groups the means were nearly identical with those of the reference populations in the 1–5 month age group. The mean weight and height were significantly below the reference means at 6–11 months, however. There was a similar decline in the mean weight for height and the median tricpes skinfold during the second year of life. The growth deficits of early life remained unchanged or increased slightly up to 6 years. According to WHO citeria, 14 percent of the children were classified as chronically and 3 percent as acutely undernourished. The faltering growth was different from that of privileged Saudi children whose growth pattern was found to resemble that of Western reference populations.

Perinatal mortality in a Saudi maternity hospital.

ABSTRACT. Perinatal mortality was analyzed in infants to mothers who delivered at the main Maternity hospital in Riyadh and who represented a large proportion of the obstetric population in the city. The crude perinatal mortality rate was 39.8 per 1000 births. The hirth weight‐specific mortality rates were compared with the corresponding Swedish rates. The ratio between the birth weight‐specific mortality rates in Riyad and Sweden increased from the lightest to the heaviest hirth weight category. Thus the perinatal mortality rate was 2.3 times higher in infants less than 1500 g, and 8.8 times higher in infants with birth weights of 3500 g and more. Similarly, the ratio between the gestational age‐specific mortality rates in Riyadh and Sweden increased with advancing gestational age. The perinatal mortality rate of infants less than 28 weeks was 1.6 times higher, and that of term infants 4.8 times higher than in Sweden. The findings indicated shortcomings in the obstetric services. The perinatal mortality rate of teenage mothers, who comprised 17 percent of the material, was 9.1 times the Swedish rate. Other risk groups were para 0 mothers and mothers with a previous infant loss.

Growth and Nutritional Status of Rural Preschool Children in Saudi Arabia

ABSTRACT. The attained growth was assessed in a cross‐sectional study of Saudi children 0–71 months of age, from 3 different geographical areas of rural Saudi Arabia. individual data on weight, height, weight for height and head circumference were expressed in SD scores of international standards, and data on upper arm muscle and fat areas in percent of the reference median values. The mean (SEM) weight, height, weight for height and head circumference of the entire material were ‐1.7 (0.05), ‐1.6 (0.06), ‐0.9 (0.05) and ‐1.6 (0.06), respectively. The median upper arm muscle area was 79 percent, and fat area 57 percent of the reference medians. The differencies in mean weight, height and weight for height were trivial between the 3 geograhical areas. All mean values, except that of weight for height were clearly below the means of the reference in children 0–5 months. All mean values declined significantly, however, during the next 6 months. The growth deficits thus obtained remained unchanged or increased slightly up to 6 years. According to WHO criteria, 41 percent were classified as chronically, and 12 percent as acutely undernourished. The growth pattern of rural Saudi children was similar to that of children in most developing countries and distinctly different from that of privileged Saudi children, whose growth pattern resembled that of Western reference populations.

Two-thirds of adolescents who received active perinatal care after extremely preterm birth had mild or no disabilities.

Active perinatal care (APC) increases the survival of extremely preterm (EPT) infants, but may increase the rate of disabilities. We examined neurodevelopmental outcomes in adolescents aged 10–15 years who were born EPT and received APC in two Swedish tertiary care centres.

Causes of perinatal death at a Saudi maternity hospital

ABSTRACT. The time, cause and avoidahility of perinatal deaths were analyzed in infants who were delivered in the main Maternity hospital in Riyadh and who represented a large proportion of all births in the city. The crude perinatal mortality rate was 39.8 per 1000 births. Of all deaths 53 percent occurred either intrapartum or within 24 hours of birth. The mortality rate in this time period was 9 times higher, and the intrapartum mortality rate 16 times higher than the corresponding Swedish rates. The causes of death were classified according to Wigglesworth. Of all deaths, 37 percent were due to asphyxial conditions in labor, 32 percent to conditions associated with preterm birth, and 17 percent to malformations. The perinatal mortality rates caused by asphyxia, preterm birth and malformations were 14.7, 12.6 and 6.7 per 1000 births, respectively. 75 percent of infants who died from asphyxia were born at term, and nearly half of the preterm deaths were associated with severe asphyxia at birth. Avoidable factors were found in 74 percent of the deaths. The high rate of asphyxia indicated deficiences in the obstetric management and a high priority should be given to the strengthening of the obstetric service.