Sudha Chaudhari

Pune low birth weight study — Growth from birth to adulthood

ObjectiveTo assess the growth, adiposity and blood pressure of non-handicapped low birthweight children at 18 years.DesignProspective cohort study.SettingInfants born between 1987-1989 with birthweight less than 2000g, discharged from a neonatal special care unit of a referral hospital and followed up till the age of 18 years.MethodsThe height, weight, and head circumference were measured. Measurements for adiposity, blood pressure, parental height and weight were recorded.ResultsThe cohort of 161 low birth weight (LBW) infants was divided into three groups according to their gestation — preterm SGA (n=61), full term SGA (n=30) and preterm AGA (n=70). 71 full term AGA infants served as controls. Preterm SGA males had height of 164.5 cms (162–166.9, 95% CI) which was significantly less (mean deficit = 5.7 cms) than that of controls (P=0.02). However, PTSGA children were short inspite of normal midparental height. Preterm SGA and AGA children had smaller head circumference. There was no evidence of adiposity and no child had hypertension. Mid-parental height was an important determinant of height in LBW children. Both parentss’ weight and BMI were important determinants of weight and BMI, respectively in all LBW children.ConclusionPreterm SGA males were short, but there was no difference in the weight of the LBW group and controls. Preterms had smaller head circumference. There was no evidence of adiposity or hypertension.

Clinical predictors of outcome in hypoxic ischaemic encephalopathy in term neonates

Thirty-eight full-term infants with hypoxic ischaemic encephalopathy were followed up prospectively to determine simple predictors of outcome at 1 year. Three predictors of outcome, based on clinical examination alone, were evaluated. These were presence of seizures, grading of encephalopathy and neurobehavioural assessment at discharge from the hospital. Development was assessed using the Bayley scales of infant development, and a mental and motor quotient below 85 was considered to be delayed development. At 1 year, 15 infants showed delayed development; five of them had cerebral palsy. Predictive values were determined for each indicator. Seizures per se did not affect the outcome. All infants with mild encephalopathy were normal. The predictive value of moderate-to-severe encephalopathy was 50%. Abnormal neurobehaviour at the age of 7 days or at discharge, if earlier, was found to be the best predictor of outcome with a predictive value of 91.6%.

Early intervention programme through the high risk clinic-Pune experience

The K.E.M. Hospital Pune India committed itself in 1979 to the care of handicapped children by establishing its TDH Rehabilitation Center. The center has grown over the years into a major multidisciplinary unit providing diagnostic and therapeutic services to all handicaps under one roof. Approximately 2000 new patients are assessed annually. Investigating the causes of disability it was found that a large proportion arise from problems experienced during the perinatal period. Neonatal services were thus upgraded in 1982 through the establishment of a Neonatal Intensive Care Unit (NICU) now handling approximately 900 admissions per year. The resultant increase in survival of the small preterm high-risk infant was heartening but a need was recognized to monitor childrens outcomes and extend neonatal services. The High Risk Clinic (HRC) was launched in 1987. The authors discuss their experience with intervention programs conceived and developed through High Risk Clinics with the back-up services of the Rehabilitation Center and NICU of the K.E.M. Hospital. The Pune experience emphasizes the need for linking the NICU HRC and Rehabilitation Center to improve the quality of life beyond neonatal survival. This conclusion is reached after observing how NICU-based services are incomplete without adequate specialized follow-up services best provided through an HRC with a committed multidisciplinary team coordinated by a pediatrician/neonatologist. Moreover developmental assessments should be optimized to evaluations at three and twelve months incorporated in routine visits; a stimulation and occupational therapy-oriented program must be introduced very early and monitored frequently; and the success of the early intervention program depends substantially on parental involvement.

Pune low birth weight study — Birth to adulthood — Cognitive development

ObjectiveTo assess the cognitive development of non-handicapped low birth weight (LBW) infants at 18 years.DesignProspective cohort study.SettingInfants born between 1987–1989 with birth weight less than 2000g and discharged from a neonatal special care unit were followed up till the age of 18 years.MethodsThe intelligence quotient (IQ) was determined by Raven’s progressive matrices. Assessment of adjustment and aptitude was done.ResultsThe cohort of 161 LBW infants was divided into three groups according to their gestation — preterm SGA (n=61), full term SGA (n=30) and preterm AGA (n=70). 71 full term AGA infants served as controls. The IQ of the study group (Percentile 39.3) was significantly lower than that of controls (Percentile 54.9) (P=0.002). Preterm SGA subjects had the lowest IQ (Percentile 35.5), though just within normal limits. Males from the study group had significantly lower IQ than male controls (P=0.03). The IQ of PTSGA subjects of college educated mothers (P=0.004) and belonging to higher socio-economic class (P=0.04) was significantly higher. On the differential aptitude test, PTSGA subjects were poor in speed and mechanical reasoning. The 18 year IQ could be best predicted by IQ at 6 and 12 years.ConclusionPreterm SGA children have the lowest IQ at 18 years, males have lower IQ. Maternal education and socioeconomic status have great impact on cognitive development. Good prediction of the 18 year IQ can be done by the 6 and 12 year IQ.

Components of Metabolic syndrome at 22 years of age–Findings from Pune low birth weight study

ObjectiveTo study the early markers of Metabolic syndrome in a cohort of low birth weight (LBW) children followed up since birth, at the age of 22 years.DesignProspective cohort study.SettingTertiary-care hospitalParticipantsNeonates weighing less than 2000 g discharged from a neonatal special care unit were followed up prospectively; 153 cases and 77 controls were assessed at 22 years of age.MethodsFasting, 30 minute and 120 minute glucose and insulin after a bolus of 75g of glucose was determined. Insulin resistance was calculated. A lipid profile was also done. Anthropometric measurements were taken and abdominal fat was determined by magnetic resonance imaging.Main outcomePrevalence of the five components of Metabolic Syndrome as described by the International Diabetic Federation (IDF).Results65.1% of the cohort was born small for gestational age. All three components of Metabolic syndrome were present in only three cases and none of the controls. However, two components were present in 25 (16.4%) cases and 5 (6%) controls (P=0.039). Cases in the lowest quartile of birthweight who became big at 22 years had significantly higher fasting insulin (P=0.001), Homeostatic Model Assessment–Insulin Resistance (Homa-IR) (P=0.001) and higher systolic blood pressure. Sum of skinfold thickness at 4 sites correlated significantly with fasting insulin and HOMA-IR, and was a stronger correlate compared to BMI, waist circumference and MRI fat. There was no difference in the biochemical parameters between appropriate for gestational age and small for gestational age infants.ConclusionPrevelence of three or more components of Metabolic syndrome was low in LBW children at 22 years, but of two components was high. Those ‘Small at birth and big at 22 years’ had high insulin resistance.