Slow or Poor Infant Weight Gain

Johns Hopkins Gazette: June 24, 1996

Slow or Poor Infant Weight Gain | Johns Hopkins Medicine

Testosterone levelmay predict weight loss in HIV men

Declining testosterone in HIV-positive men may be an early signal for the dangerous weight loss that occurs when AIDS develops. Adrian S.

Dobs, an associate professor of medicine and lead author of the study, told the annual meeting of the International Congress of Endocrinology that “helping them prevent or slow weight loss may become an important new treatment for AIDS.”

In a related study, Hopkins researchers recently found that HIV-positive men who lose too much weight before developing AIDS are at risk for earlier death than those who maintain their weight.

Two other ongoing Hopkins studies are investigating whether testosterone injections and testosterone skin patches help HIV-positive men regain lean body weight, possibly increasing life span and improving their quality of life. If the studies show the hormone is effective, researchers plan to test whether testosterone should be given before weight loss preventswasting.

Laser treatment forkneesmay cause lasting damage

A surgical laser commonly used to repair knee joints may repair the knee in the short term but cause hidden damage to surrounding cells, worsening the injury in the long term.

“Our findings suggest that even when there's no visual evidence of damage, significant cell death in the articular cartilage may occur following exposure to the laser's energy,” Hopkins assistant professor of orthopedic surgery Leigh Ann Curl told the annual meeting of the American Orthopedic Society for Sports Medicine.

“This laser may generate lethal heat to cartilage cells that hasn't been previously recognized,” said the animal study's lead author.

Surgeons use the arthroscopic laser, called pulsed holmium: YAG, for a variety of knee-joint repairs because it effectively cuts tissue, causes simultaneous blood clotting and was believed to cause little or no harm to surrounding cells. An arthroscope is a thin, flexible tube for viewing and treating the inside of joints.

Schizophrenia genessought among Ashkenazim

A new Hopkins medical study may help locate genes that contribute to the development of schizophrenia among Ashkenazi Jews.

Although there is no indication yet that schizophrenia occurs more frequently in this or any other ethnic, racial or religious population, this population is ideal for the study because they tend to marry within their faith, said Ann Pulver, an associate professor of psychiatry and the study's director.

“Culturally self-contained populations this give you a greater chance of finding genes, because there are clearer lines of inheritance that you can trace back many generations,” she said.

Schizophrenia affects approximately 1 percent of the population. Symptoms include hallucinations, emotional impairment, paranoia, lack of motivation and inability to experience pleasure.

If you or someone you know has symptoms of schizophrenia, and you would to participate in this study, please call Pulver toll-free at 1-888-289-4095. Baltimore residents call 955-0455.

Babies who inhaletopsoil dust could become 'floppy'

Physicians at the Johns Hopkins Children's Center recently treated a 4-month-old baby who developed botulism after inhaling topsoil dust.

Infant botulism is a rare, but treatable, neurological disorder caused by bacteria found in many soils and households.

It results from ingestion of Clostridium botulinum spores that germinate and produce toxin in the infant's intestines and attack nerve fibers connected to muscle causing temporary paralysis.

Previously healthy infants ages 2 to 4 months are at greatest risk; however, cases have been recorded with infants up to 11 months. Symptoms of infant botulism, which generally evolve over several days, include constipation, lethargy, poor feeding (by bottle or breast), weak cry, diminished gag reflex and general weakness often called “floppy infant.”

Left untreated, the child could die of respiratory failure.

There is no cure for infant botulism, which occurs 75 to 100 times each year nationally (with clusters of incidents in California, Utah and southeastern Pennsylvania.

) Most patients must be placed on a ventilator for weeks or even months to allow the toxin to leave the immune system.

During this time, patients are nourished by nasogastric tube feedings and as the paralysis lessens, physical therapy can help the child regain muscle usage.

Most cases of infant botulism have unknown causes, said Tom Crawford, director of the pediatric neuromuscular clinic at the Children's Center.

“Honey and corn syrup may be a source and are not recommended for infants under a year,” he says. “As for aerosolized topsoil, I don't want parents to be so concerned that they're afraid to take their babies outdoors.

I suggest keeping them away from blowing topsoil and look for symptoms,” he said.

Race plus roaches:Abreathtaking link

African Americans are far more ly than Caucasians to develop asthma linked to cockroach sensitivity, according to research from the Johns Hopkins Children's Center.

Researchers found that among the 80 Baltimore youth sampled, the African American child was 16.4 times more ly than a Caucasian child to be sensitive to allergens left behind by cockroach droppings and saliva. And poor children or those from cities were 11.9 times more ly to be affected by roach infestation than those from middle or high income families.

The study, reported in the June issue of The Journal of Allergy and Clinical Immunology, is also the first to report that children in the most infested homes are the most sensitive to the allergens, a clear indication of dose responsiveness, the researchers said.

“We honestly don't know why race plays a role independent of poverty,” said Peyton Eggleston, professor of pediatrics and co- author of the study.

Eggleston speculated that racially based genetic differences, important in the regulation of immune responses, hold a clue.

Eggleston said the researchers hope to use this information to perform further studies that better their understanding of the root causes of cockroach allergen.

British, U.S.medicalgiants celebrate 50-year alliance

Two giants of medicine–Johns Hopkins and London's Guy's Hospital–celebrated this past weekend in London the 50th anniversary of an unusual trans-Atlantic partnership that began during World War II.

While the official topic of the conference was “Molecular Medicine: The Dream, the Promise, the Reality,” more than 30 leading scientists, clinicians and health care administrators from each institution gathered at Guy's Hospital to reminisce about their ongoing relationship.

After Allied medical units from Johns Hopkins and Guy's worked together in North Africa, Guy's dean suggested that an exchange program would “maintain the friendship, cooperation and exchange of ideas which has been one of the better things which have come this War.”

Since 1946, two physicians a year from each institution have traveled to their sister institution for a month, and hundreds of medical students have spent elective study periods overseas.

The first Hopkins surgeon on the exchange program, Alfred Blalock, introduced heart surgery to England, while immunologists from Hopkins and Guy's collaborated for years on an insect allergy project that advanced understanding of the field. And despite the differences in the British and U.S.

health systems, administrative teams also have participated in the exchange, resulting in the introduction of decentralized management at Guy's, for instance.

Originally established as an exchange scheme between Guy's Hospital and The Johns Hopkins University School of Medicine, it has evolved into a program involving the United Medical and Dental School (UMDS) of Guy's and St.

Thomas's and the NHS Trust, together with The Johns Hopkins Hospital and University.

Over the years, the program has brought the staffs of both institutions closer together, and academic and clinical collaborations have developed as a result.

This year, for the first time, Hopkins' nursing leaders–the dean of The Johns Hopkins University School of Nursing and the vice president for nursing of The Johns Hopkins Hospital–also participated in the celebration. Their counterparts at Guy's & St. Thomas's Hospitals and the Royal College of Nursing invited them to establish linkages with nursing in England that parallel the physicians' relationship.

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Source: https://pages.jh.edu/gazette/aprjun96/jun2496/briefs.html

American Babies Are Less ly to Survive Their First Year Than Babies in Other Rich Countries

Slow or Poor Infant Weight Gain | Johns Hopkins Medicine

Babies born in America are less ly to reach their first birthday than babies born in other wealthy countries in the Organisation for Economic Co-operation and Development (OECD), a new study found.

While infant mortality rates have declined across the OECD since 1960, including in America, the U.S.

has failed to keep pace with its high-income peers, according to a report published in the journal Health Affairs.

Compared to 19 similar OECD countries, U.S. babies were three times more ly to die from extreme immaturity and 2.

3 times more ly to experience sudden infant death syndrome between 2001 and 2010, the most recent years for which comparable data is available across all the countries. If the U.S.

had kept pace with the OECD’s overall decline in infant mortality since 1960, that would have resulted in about 300,000 fewer infant deaths in America over the course of 50 years, the report found.

The reasons the U.S. has fallen behind include higher poverty rates relative to other developed countries and a relatively weak social safety net, says lead author Ashish Thakrar, medical resident at the Johns Hopkins Hospital and Health System.

“The poorer children are, the worse their health outcomes are,” says Thakrar, whose team found that poverty among U.S. children has been higher than in the 19 comparable OECD countries since the mid 1980s.

Premature delivery and low birthweight have been consistently associated with poverty, which affects over 20% of U.S. children, the second highest percent among 35 developed nations, according to a 2013 United Nations Children’s Fund report.

Thakrar’s team used membership in the OECD as a proxy for similar nations to the U.S., and narrowed the group to 19 members for which 50 years of high-quality data was available, known as the OECD19.

Thakrar’s research supports a 2013 National Academy of Medicine report, which found Americans’ health has fallen behind that of other high-income countries. “Their big conclusion is that the gap stems from risky health behavior and a fragmented health system,” Thakrar says.

Child mortality in the U.S., defined as deaths of children age 1 to 19, has wise seen slower declines than in other developed nations. The numbers in the U.S. are partly driven by gun deaths. From 2001 to 2010, 15-to-19-year-olds were 82 times more ly to die from gun violence in the U.S. than in other wealthy countries.

Thakrar also attributes the higher U.S. child and infant mortality rates to a lack of preventative care. While the U.S.

spends the most on health care per capita compared to OECD nations, some of them have stronger public benefits programs, Thakrar says. “We spend more on health care that’s taking care of children that are already sick,” he says.

“But we spend far less money on welfare programs to keep children from becoming sick, and on keeping them safe from injuries.”

Methodology

Membership in the OECD was used as a proxy for similar nations to the U.S. The group was narrowed to OECD members with 50 years of high-quality data, minus the U.S. It includes: Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Iceland, Ireland, Italy, Japan, the Netherlands, New Zealand, Norway, Spain, Sweden, Switzerland and the United Kingdom.

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Contact us at editors@time.com.

Source: https://time.com/5090112/infant-mortality-rate-usa/

Managing Poor Weight Gain in Your Breastfed Infant

Slow or Poor Infant Weight Gain | Johns Hopkins Medicine

Linkedin Pinterest Breastfeeding Your Baby

Sometimes, a breastfed baby will gain weight more slowly than he or she should.

This could be because the mother isn't making enough milk, the baby can't get enough milk the breast, or the baby has a medical problem. Your baby's healthcare provider should evaluate any instance of poor weight gain.

Often, a certified lactation consultant can help. Below are some general tips for addressing poor weight gain in a breastfed baby.

Check the schedule 

  • Watch for signs from your baby that he or she wants to feed. Your baby should wake and “cue” to breastfeed about 8 to 12 times in 24 hours by rooting, making licking or sucking motions, bobbing his or her head or bringing his or her hand to the face or mouth. It is important for you to recognize these feeding cues and put your baby to your breast when he or she cues. Don't wait for your baby to cry. Crying is a late feeding cue. Usually a baby latches and breastfeeds better if he or she does not have to wait until he or she is crying, frustrated, or too tired to feed. Putting a baby off to try to get the baby to go longer between feedings and frequently offering a pacifier instead of the breast when a baby demonstrates feeding cues are often linked to poor weight gain.
  • Many mothers find milk production increases and babies' weight gains improve if they and their babies let chores and activities go for 2 or 3 days, so they can breastfeed, more or less, around the clock. When a baby is not breastfeeding, the mother holds him or her skin-to-skin on her chest, which often helps her become more sensitive to the baby's feeding cues.
  • If your baby is a “sleepy” baby who does not cue to feed at least 8 times in 24 hours, you will have to wake the baby to feed frequently–about every 2 hours during the daytime and evening hours and at least every 3 to 4 hours at night until weight gain improves.
  • It can help to write down when your baby nurses, on which side, and for how long for a full 24 hours, if not longer. Take this record to your healthcare provider or lactation consultant to help find and fix the problem. 

Latching and positioning

  • Be sure your baby is mainly uncovered during breastfeeding. A baby that is bundled papoose-style may get much too warm and comfy, and he or she is more ly to doze off too quickly during feedings. If there is a chill in the air, drape a sheet or light blanket over you and the baby, as needed.
  • If your baby falls asleep within minutes of latching on, massage your breast as he or she nurses. This can provide a burst of milk and re-trigger sucking. You can do this by stroking downward and inward on the breast.
  • Make sure your baby is latching on correctly. The latch should be comfortable to you. Your baby's lips should be flanged outward “fish lips.” The tongue should be under your breast. A large amount of your breast tissue should be in the baby's mouth. 
  • In general, avoid “switch nursing.” That is, breastfeeding at one breast for a few minutes, then the other, and then back again. This may interfere with your baby getting enough of the calorie-rich hindmilk, which your baby gets more of as a feeding continues on one breast. However, the “switch” strategy sometimes stimulates the “sleepy” baby so he or she wakes up and starts sucking again.

If your healthcare provider recommends supplementing

  • Use your own expressed milk first for any alternative feedings.
  • Use an alternative feeding method if it is recommended by your healthcare provider or a certified lactation consultant (IBCLC). There are many alternative feeding options, so let them know if a recommendation does not “feel right” for you. Alternative feeding methods include:
    • Cup feeding
    • A tube system with a special feeding tube taped to the breast or a finger (Supplemental Nursing System, or SNS)
    • Syringe feeding
    • An eyedropper
    • Spoon-feeding
    • Bottle-feeding
  • Several methods require assistance from a professional, such as a certified lactation consultant (IBCLC) so you can use them correctly.

    Depending on your baby and the cause of the problem, some methods may work better than others. Also, discuss bottle nipple type with the IBCLC if you bottle-feed any supplement.

    Some types of bottle nipples are less ly to interfere with breastfeeding than others.

Maintaining or increasing your milk supply

  • Pump your breasts after as many daily breastfeedings as possible, especially if you are uncertain whether your baby is effectively removing milk during breastfeeding. Many women find that trying for 8 times per day is manageable and helpful for their milk supply. 
  • Pumping will remove milk effectively, so your breasts will know to make more milk. Pumping will also express supplemental milk for feeds. Milk can be removed from the breast by manual hand expression, a hand pump, a battery-powered pump, or an electric breast pump. If frequent and prolonged pumping is anticipated, a hospital-grade, electric pump can be very helpful. 

Checking baby's weight

  • Your baby should be weighed on a frequent and regular basis until he or she is gaining weight at a satisfactory rate. Digital scales are available that allow a healthcare provider or a certified lactation consultant (IBCLC) to get precise pre- and post-feeding weights to measure how much milk a baby takes in during a particular breastfeeding. Although this can be helpful, babies take in different amounts at different feedings throughout a 24-hour period. Therefore, a professional may recommend that parents rent this type of scale so a baby can be weighed before and after different feedings. They also may suggest recording only a daily or weekly weight, depending on the situation.

Call your baby's healthcare provider

If your baby ever shows signs of dehydration, call your baby's healthcare provider right away. Some signs of dehydration in a baby include:

  • Fewer stools and wet diapers than usual
  • Dry lips
  • Sunken fontanelle (soft spot)
  • Dark circles around the eyes
  • Appearing more tired than usual

If breastfeeding is properly managed, yet the baby still is not gaining enough weight, it is ly that some other factor is affecting milk production or the baby's ability to breastfeed effectively. Always consult your own, and your baby's healthcare provider.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/breastfeeding-your-baby/mismanaged-breastfeeding

Race Disparities and Decreasing Birth Weight: Are All Babies Getting Smaller?

Slow or Poor Infant Weight Gain | Johns Hopkins Medicine

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The mean infant birth weight in the United States increased for decades, but it might now be decreasing.

Given race disparities in fetal growth, we explored race-specific trends in birth weight at Magee-Womens Hospital, Pittsburgh, Pennsylvania, from 1997 to 2011. Among singleton births delivered at 37–41 weeks (n = 70,607), we evaluated the proportions who were small for gestational age and large for gestational age and changes in mean birth weights over time.

Results were stratified by maternal race/ethnicity. Since 1997, the number of infants born small for their gestational ages increased (8.7%–9.9%), whereas the number born large for their gestational ages decreased (8.9%–7.7%). After adjustment for gestational week at birth, maternal characteristics, and pregnancy conditions, birth weight decreased by 2.20 g per year (P < 0.0001).

Decreases were greater for spontaneous births. Reductions were significantly greater in infants born to African-American women than in those born to white women (−3.78 vs. −1.88 per year; P for interaction = 0.010).

Quantile regression models indicated that birth weight decreased across the entire distribution, but reductions among infants born to African-American women were limited to those in the upper quartile after accounting for maternal factors. Limiting the analysis to low-risk women eliminated birth weight reductions.

Birth weight has decreased in recent years, and reductions were greater in infants born to African-American women. These trends might be explained by accumulation of risk factors such as hypertension and prepregnancy obesity that disproportionately affect African-American women. Our results raise the possibility of worsening race disparities in fetal growth.

birth weight, growth restriction, macrosomia, obesity

Editor's note:An invited commentary on this article appears on 4, and the authors’ response appears on 6.

Mean infant birth weight among singletons delivered at term in the United States increased from 1950 through the 1990s (1), but it might now be decreasing (2). Reasons for this trend are not understood. In fact, there have been some reports that babies are getting bigger, although these are from other countries or were limited to births that occurred before 2000 (3–6).

Others have noted that increasing use of induction associated with a higher proportion of full-term infants delivered at earlier gestational ages might be the cause of decreases in birth weight (7). In a recent study, however, Morisaki et al. (8) reported a decrease in birth weight even in a cohort in which gestational length did not change.

Birth weight is a sentinel marker of newborn health, and small changes in its distribution might signal improved or worsening maternal, neonatal, and childhood health. This is of particular importance for African-American women and infants given the race disparities in fetal growth. The percentage of full-term infants with a low birth weight (35 years  3,079  15.

1  3,495 (462)  4,473  17.0  3,487 (469)  3,179  13.3  3,458 (448)   Race/ethnicity    White  16,550  81.0  3,489 (457)  20,457  77.8  3,472 (459)  17,946  75.1  3,446 (452)    African American  2,994  14.6  3,277 (459)  4,425  16.8  3,255 (445)  4,071  17.0  3,233 (439)   Education >16 yearsa  8,114  42.6  3,420 (472)  9,670  48.4  3,503 (449)  9,395  50.7  3,342 (466)   Married  13,993  68.5  3,503 (451)  17,884  68.0  3,489 (451)  14,372  60.2  3,464 (441)   Current smoker  2,637  12.9  3,240 (450)  3,326  12.7  3,234 (454)  2,411  10.1  3,185 (464)   Hypertension    Gestational hypertension  1,238  6.1  3,449 (484)  1,447  5.5  3,426 (478)  1,229  5.1  3,395 (465)    Preeclampsia  430  2.1  3,222 (558)  931  3.5  3,270 (520)  960  4.0  3,262 (484)    Chronic hypertension  246  1.2  3,360 (488)  409  1.6  3,332 (488)  398  1.7  3,323 (484)   Gestational diabetes  633  3.1  3,532 (501)  1,079  4.1  3,463 (467)  1,014  4.2  3,448 (436)   Nulliparous  6,637  32.5  3,396 (455)  8,976  34.2  3,391 (461)  8,644  36.2  3,367 (451)   Adequacy of weight gainb    Inadequate  2,826  15.4  3,250 (447)  2,680  15.9  3,221 (434)    Adequate  5,533  30.1  3,367 (434)  5,376  32.0  3,354 (426)    Excessive  9,997  54.5  3,526 (462)  8,750  52.1  3,507 (455)   Prepregnancy BMIc    Underweight  885  4.6  3,235 (439)  754  4.3  3,227 (446)    Normal weight  11,193  58.2  3,407 (448)  9,857  56.1  3,381 (441)    Overweight  4,145  21.5  3,474 (473)  3,862  22.0  3,442 (468)    Obese  3,018  15.7  3,491 (497)  3,087  17.6  3,476 (476)   Cesarean delivery  3,610  17.7  3,548 (527)  6,131  23.3  3,506 (509)  6,345  26.6  3,478 (492)   Induced labor  12,293  60.1  3,472 (462)  14,465  55.0  3,438 (461)  11,849  49.6  3,411 (451)  Infant characteristics   Female sex  9,871  48.3  3,385 (448)  12,834  48.8  3,360 (445)  11,730  49.1  3,333 (442)   Small for gestational age  1,768  8.6  2,701 (277)  2,400  9.1  2,683 (270)  2,370  9.9  2,690 (264)   Large for gestational age  1,826  8.9  4,217 (313)  2,324  8.8  4,196 (312)  1,837  7.7  4,172 (318) 

Mean birth weight at term decreased from 1997 to 2011 by 3.66 (standard error, 0.40) g per year on average (P < 0.0001; Table 2). Adjustment for gestational week attenuated this to a yearly reduction of 2.17 (standard error, 0.38) g (P < 0.

0001), and additional adjustment for maternal age, smoking, educational level, hypertension, parity, race/ethnicity, marital status, gestational diabetes, and infant sex had minimal influence (decrease of 2.20 (standard error, 0.41) g per year; P < 0.0001). The per-year reduction was larger after we limited the analysis to spontaneous deliveries (2.99-g decrease; P < 0.0001).

Data on prepregnancy BMIs were available beginning in 2003, and adjustment for this variable, along with adequacy of gestational weight gain, resulted in a 3.86-g decrease per year from 2003 through 2011 (P < 0.0001).

As expected, overweight or obese status before pregnancy, higher educational level, being married, having excessive gestational weight gain, gestational diabetes, and infant male sex were all independently associated with higher birth weights. Smoking, African-American race, hypertension before or during pregnancy, inadequate gestational weight gain, and primiparity all were associated with lower birth weights. The decreasing trend in mean birth weight per year remained, however, even after we accounted for these factors.

Table 2.

Delivery Year and Maternal Factors Associated With Variationd in Birth Weight Among Term Deliveries at Magee-Womens Hospital, Pittsburgh, Pennsylvania, 1997–2011

Characteristic . All Term Births, 1997–2011 (n = 70,607) . Spontaneous Deliveries, 1997–2011 (n = 20,576)a . All Term Births, 2003–2011 (n = 36,801) . Estimated Change in Birth Weight, g . P Value . Estimated Change in Birth Weight, g . P Value . Estimated Change in Birth Weight, g . P Value . 
Delivery yearb  −3.66 

Source: https://academic.oup.com/aje/article/183/1/15/2195948

Weight Gain in Infancy and Overweight or Obesity in Childhood across the Gestational Spectrum: a Prospective Birth Cohort Study

Slow or Poor Infant Weight Gain | Johns Hopkins Medicine

1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

Find articles by Guoying Wang

1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

2Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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3University of Illinois at Urbana-Champaign, Champaign, USA.,

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2Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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4Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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4Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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2Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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5School of Environmental Science & Public Health, Wenzhou Medical University Center on Clinical & Epidemiological Eye Research, the Affiliated Eye Hospital of Wenzhou Medical University Wenzhou, China

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6Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, USA

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7Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

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6Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

2Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

2Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

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1Department of Population, Family and Reproductive Health, Center on Early Life Origins of Disease, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

2Division of General Pediatrics & Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

3University of Illinois at Urbana-Champaign, Champaign, USA.,

4Division of Endocrinology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, USA

5School of Environmental Science & Public Health, Wenzhou Medical University Center on Clinical & Epidemiological Eye Research, the Affiliated Eye Hospital of Wenzhou Medical University Wenzhou, China

6Department of Pediatrics, Boston University School of Medicine and Boston Medical Center, Boston, USA

7Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, USA

*Present address: AON Service Corporation, Chicago, IL, USA.

Received 2016 Jan 13; Accepted 2016 Jun 27.

Copyright © 2016, Macmillan Publishers LimitedThis work is licensed under a Creative Commons Attribution 4.0 International License. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in the credit line; if the material is not included under the Creative Commons license, users will need to obtain permission from the license holder to reproduce the material. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

This study aimed to investigate the optimal degree of weight gain across the gestational spectrum in 1971 children enrolled at birth and followed up to age 7 years. Weight gain in infancy was categorized into four groups weight gain z-scores: slow (1.28).

Underweight and overweight or obesity (OWO) were defined as a body mass index ≤5th and ≥85th percentile, respectively, for age and gender. In our population, OWO was far more common than underweight (39.7% vs. 3.6%).

Weight gain tracked strongly from age 4 to 24 months, and was positively associated with OWO and an unfavorable pattern of metabolic biomarkers, although the degree of weight gain for the risk was different across gestational categories. Extremely rapid weight gain led to a particularly high risk of OWO among children born early term and late preterm: odds ratio: 3.

3 (95% confidence interval: 1.9 to 5.5) and 3.7 (1.8 to 7.5), respectively, as compared to those with on track weight gain. Our findings suggest that monitoring and ensuring optimal weight gain across the entire gestational spectrum beginning from birth represents a first step towards primary prevention of childhood obesity.

The persistently high prevalence of obesity is a major clinical and public health challenge in the U.S. and globally. Of concern, 8.1% of U.S. infants and toddlers were overweight, and 16.9% of 2- to 19-year-olds were obese in 2011–20121.

More importantly, obesity in young children leads not only to short-term morbidity but also to later obesity and its adverse consequences across the lifespan and generations2,3,4,5. Growing evidence indicates that obesity may originate in early life.

A recent study has lent even further evidence, showing that incident obesity between age 5 and 14 years was more ly to originate at younger ages6. However, questions remain regarding what modifiable early life factors can increase the risk of childhood obesity.

Growth in early infancy is more rapid than at any other time during postnatal life. In particular, infants born preterm or early term usually compensate by engaging in rapid “catch-up” growth in the first year of life.

Although studies of term births suggest that rapid weight gain in early life (ranging from 6 to 24 months) is associated with an increased risk of childhood obesity7,8, there is a lack of prospective birth cohort studies to investigate whether the associations persist across the entire gestational spectrum. Pediatricians monitor infant weight gain closely for “failure to thrive” and make recommendations to increase calories in babies born preterm. However, most current recommendations regarding appropriate growth velocity in infancy and early childhood largely do not consider the long term risk of obesity or metabolic disorders, nor do these recommendations address an infants’ specific gestational age category9. Moreover, current recommendations regarding the age to begin screening for obesity in children do not cover infancy: the U.S. Preventive Services Task Force recommends screening by age 6 years10, whereas the Expert Committee recommends screening by age 2 years11.

Using a prospective birth cohort enriched by preterm births, we aimed to investigate weight gain patterns and their associations with the risk of both underweight and OWO as well as metabolic biomarkers during early childhood (median [Interquartile range] age: 6[4–7] years) among children born across the gestational spectrum (full term, early term, late preterm and early preterm). This line of investigation is needed to provide evidence to establish optimal growth targets to balance the need for normal or catch-up growth and reduce the risk of OWO in children. Such information is critical to help identify children at high-risk of developing OWO during early infancy when interventions could be highly cost-effective and have lifelong impact.

Of the 1971 children (980 boys, 991 girls), 1442 were born term (926 full term, 516 early term) and 529 were born preterm (300 late preterm, 229 early preterm). Prenatal and postnatal anthropometric and growth parameters are presented in Table 1.

Compared to those born full term, infants born preterm had lower birthweights and their mothers had higher rates of smoking, diabetes and hypertensive disorders during pregnancy. In total, 39.7% of the children (39.2% of boys and 40.2% of girls) were OWO, whereas only 72 (3.

6%) children were underweight at age 2–7 years.

The characteristics of the study population.

 TermPretermP for trendFull tem (>39 wk)Early term (37–38 wk)Late preterm (34–36 wk)Early preterm (

Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4945912/

Infant Weight Gain Problems

Slow or Poor Infant Weight Gain | Johns Hopkins Medicine
Page Updated on February 12, 2020

Weight is important for your baby –in fact, one of the first things they do when your child is born is weigh the baby.  Furthermore, they monitor his or her weight through the next few years of life.  Infant weight gain problems can indicate a birth injury or underlying medical condition, which is why monitoring it is important.

Sometimes children who are born prematurely or at a lower birth weight are prone to certain birth injuries, while others who are born at a higher birth weight are prone to other birth injuries.

Your child’s weight at birth may have little to do with how he or she will gain weight in the future.  However, weight is still an important factor in your child’s health early on.  A baby who does not gain weight properly may have an underlying medical condition.

Take a look at a few of the conditions that weight gain problems may be a symptom of:

Preeclampsia

Preeclampsia is one of the leading causes of premature birth and low birth weight.  Most often, children are born between 32 and 36 weeks.  Weight gain among infants affected by preeclampsia is extremely important.  There may be other related conditions that keep them underweight.  Such conditions may include elevated blood pressure, signs of distress such as bluish hands and seizures.

Cerebral Palsy

Cerebral palsy is another birth injury which is common among children that are born with a low birth weight.  Often mistaken for a muscular disorder, cerebral palsy is actually a neurological disorder.

  Often, children with cerebral palsy have infant weight gain problems because they have a hard time with nutrition.  Sometimes their digestive tract is one of the affected muscle groups and works abnormally.

Also, sometimes children have a hard time gaining weight because they plainly can’t feed themselves or swallow properly.

Cystic Fibrosis

Cystic fibrosis is an abnormality of the glands, producing extra thick mucus and sweat. Often children with cystic fibrosis experience wheezing, intense nasal blockage, intestinal blockage, constipation and mucus in the lungs (which is why diagnosis often involves a chest x-ray).

  Children born with cystic fibrosis are often underweight and suffer from poor weight gain for possibly their whole life.  While cystic fibrosis is a birth injury related to the glands, the body treats the mucus as an infection.

  As a result, all of the body’s energy goes into fighting the infection rather than properly processing digestion.  This leads to poor weight gain and constipation.

Brain Damage

Your baby may have a hard time properly gaining a healthy amount of weight because there may be something happening neurologically that prevents him or her from processing food properly.

  If your child didn’t breathe for up to 6 minutes at the time of birth, it’s possible that oxygen deprivation at birth could have caused brain damage. Brain damage can damage normal neurological pathways and communications that make your child process food normally.

  Your child may have other symptoms of brain damage including intellectual disability, weak muscle movement, the feeling that they’re just “not there” or even something as extreme as seizures.

Source: https://www.birthinjuryguide.org/birth-injury/symptoms/weight-gain-problems/