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Purpose To research the origins of the 2500 g cutoff for low birth weight and the evolution of indicators to identify newborns at high mortality risk. Description Early research concluded “prematurity”, measured mainly through birth weight, was responsible for increased health risks. The World Health Organization’s original prematurity definition was birth weight ≤2500 g. 1960s research clarified the difference between gestational age and birth weight leading to questions of the causal role of birth weight for health outcomes. Focus turned to two etiologies of low birth weight, preterm births and intrauterine growth restriction, which were both causally associated with morbidity and mortality but through different pathways; a standard cutoff based on gestational age or customized cutoff was debated. Assessment While low birth weight can be due to preterm or intrauterine growth restriction (or both), the historic 2500 g cutoff remains the standard by which the majority of policy makers define low birth weight and use it to predict perinatal and infant adverse outcomes. Conclusion Current efforts to refocus research on preterm births and poor intrauterine growth are important to understanding the direct causes of mortality rather than low birth weight as a convenient surrogate. Such distinctions also allow researchers and practitioners to test and target interventions outcomes more effectively.

BackgroundIt is unknown if adults born <28 weeks or <1000 g since surfactant has been available are reaching their full airway growth potential.ObjectiveTo compare expiratory airflow at 25 years and from 8 to 25 years of participants born <28 weeks or <1000 g with controls, and within the preterm group to compare those who had bronchopulmonary dysplasia with those who did not.MethodsAll survivors born <28 weeks or <1000 g in 1991–1992 in Victoria, Australia, were eligible. Controls were born contemporaneously, weighing >2499 g. At 8, 18 and 25 years, expiratory airflows were measured and the results converted to z-scores. Outcomes were compared between groups at age 25 years, and trajectories (change in z-scores per year) from childhood were contrasted between groups.ResultsExpiratory airflows were measured at 25 years on 164 of 297 (55%) preterm survivors and 130 of 260 (50%) controls. Preterm participants had substantially reduced airflow compared with controls at age 25 years (eg, zFEV1; mean difference −0.97, 95% CI −1.23 to –0.71; p<0.001). Preterm participants had lower airflow trajectories than controls between 8 and 18 years, but not between 18 and 25 years. Within the preterm group, those who had bronchopulmonary dysplasia had worse airflows and trajectories than those who did not.ConclusionsYoung adults born <28 weeks or <1000 g in the surfactant era, particularly those who had bronchopulmonary dysplasia, have substantially reduced airway function compared with controls. Some are destined to develop COPD in later adult life.

Objective To develop models and a graphical tool for predicting survival to discharge without major morbidity for infants with a gestational age (GA) at birth of 22–32 weeks using infant information at birth. Design Retrospective cohort study. Setting Canadian Neonatal Network data for 2003–2008 were utilised. Patients Neonates born between 22 and 32 weeks gestation admitted to neonatal intensive care units in Canada. Main outcome measure Survival to discharge without major morbidity defined as survival without severe neurological injury (intraventricular haemorrhage grade 3 or 4 or periventricular leukomalacia), severe retinopathy (stage 3 or higher), necrotising enterocolitis (stage 2 or 3) or chronic lung disease. Results Of the 17 148 neonates who met the eligibility criteria, 65% survived without major morbidity. Sex and GA at birth were significant predictors. Birth weight (BW) had a significant but non-linear effect on survival without major morbidity. Although maternal information characteristics such as steroid use, improved the prediction of survival without major morbidity, sex, GA at birth and BW for GA predicted survival without major morbidity almost as accurately (area under the curve: 0.84). The graphical tool based on the models showed how the GA and BW for GA interact, to enable prediction of outcomes especially for small and large for GA infants. Conclusion This graphical tool provides an improved and easily interpretable method to predict survival without major morbidity for very preterm infants at the time of birth. These curves are especially useful for small and large for GA infants.

We reconsider the effect of very low birth weight classification on infant mortality. We demonstrate that the estimates are highly sensitive to the exclusion of observations in the immediate vicinity of the 1,500-g threshold, weakening the confidence in the results originally reported in Almond, Doyle, Kowalski, and Williams (2010).

Low birth weight (LBW) affects, specially, low-and middle-income countries and is associated with impairments in growth and the development of neuromotor skills. This study evaluated the influence of birth weight on body composition, cardiometabolic and physical fitness and motor coordination in school-age children in Matola, province of Maputo – Mozambique. Quantitative cross-sectional study carried out with school-age children of both genders. Children were divided into three groups: low birth weight (LBW: n  = 15); insufficient birth weight (IBW: n  = 43) and normal birth weight (NBW: n  = 87). Anthropometric parameters, physical fitness and neuromotor performance were evaluated. The groups were compared by one-way Anova or Kruskal–Wallis test and correlations between the studied variables were investigated using Spearman’s test and partial correlation. LBW does not seem to affect anthropometric parameters in this age group. On the other hand, it seems to compromise performance during sprint running and VO 2 maximum. Furthermore, a negative correlation was found between birth weight and body fat, sprint running and monopedal jumping. Birth weight also showed a positive correlation with VO 2 maximum. Thus, our data suggest that LBW is related to lower performance in the speed and VO 2 maximum tests, even after adjustments for age, gender and actual BMI.

The percentages of low birth weight (LBW) increased from 7.7% in 2005 to 11.3% in 2011 and declined to 8.1% in 2017. For very low birth weight (VLBW) individuals, the proportion declined −1.0% annually, from 2.5% in 2005 to 1.4% in 2017. Among moderately low birth weight (MLBW) individuals, the proportion first increased 12.8% annually, from 5.0% in 2005 to 9.3% in 2011, and then declined −3.8% annually, from 9.4% in 2011 to 7.0% in 2017. The percentages of macrosomia monotone decreased from 4.0% in 2005 to 2.5% in 2017, an annual decline of −4.0%. Multiple regression analyses showed that boys, maternal age, hypertensive disorders complicating pregnancy (HDCP), and diabetes were significant risk factors for LBW. Boys, maternal age, gestational age, HDCP, diabetes, and maternal BMI were significant risk factors for macrosomia. Although the relevant figures declined slightly in our study, it is likely that LBW and macrosomia will remain a major public health issue over the next few years in China. More research aimed at control and prevention of these risk factors for LBW and macrosomia and their detrimental outcome in the mother and perinatal child should be performed in China.

To determine the effect of dual-strain probiotics on the development of necrotizing enterocolitis (NEC), mortality and nosocomial bloodstream infections (BSI) in preterm infants in German neonatal intensive care units (NICUs). A multi-center interrupted time series analysis. 44 German NICUs with routine use of dual-strain probiotics on neonatal ward level. Preterm infants documented by NEO-KISS, the German surveillance system for nosocomial infections in preterm infants with birth weights below 1,500 g, between 2004 and 2014. Routine use of dual-strain probiotics containing Lactobacillus acidophilus and Bifidobacterium spp. (Infloran) on the neonatal ward level. Incidences of NEC, overall mortality, mortality following NEC and nosocomial BSI. Data from 10,890 preterm infants in 44 neonatal wards was included in this study. Incidences of NEC and BSI were 2.5% (n = 274) and 15.0%, (n = 1631), respectively. Mortality rate was 6.1% (n = 665). The use of dual-strain probiotics significantly reduced the risk of NEC (HR = 0.48; 95% CI = 0.38-0.62), overall mortality (HR = 0.60, 95% CI = 0.44-0.83), mortality after NEC (HR = 0.51, 95% CI = 0.26-0.999) and nosocomial BSI (HR = 0.89, 95% CI = 0.81-0.98). These effects were even more pronounced in the subgroup analysis of preterm infants with birth weights below 1,000 g. In order to reduce NEC and mortality in preterm infants, it is advisable to add routine prophylaxis with dual-strain probiotics to clinical practice in neonatal wards.

The mechanisms behind handedness formation in humans are still poorly understood. Very low birthweight is associated with higher odds of left-handedness, but whether this is due to low birthweight itself or premature birth is unknown. Handedness has also been linked to development, but the role of birthweight behind this association is unclear. Knowing that birthweight is lower in multiple births, triplets being about 1.5 kg lighter in comparison with singletons, and that multiples have a higher prevalence of left-handedness than singletons, we studied the association between birthweight and handedness in two large samples consisting exclusively of triplets from Japan (n = 1,305) and the Netherlands (n = 947). In both samples, left-handers had significantly lower birthweight (Japanese mean = 1,599 g [95% confidence interval (CI): 1,526–1,672 g]; Dutch mean = 1,794 g [95% CI: 1,709–1,879 g]) compared with right-handers (Japanese mean = 1,727 g [95% CI: 1,699–1,755 g]; Dutch mean = 1,903 g [95% CI: 1,867–1,938 g]). Within-family and between-family analyses both suggested that left-handedness is associated with lower birthweight, also when fully controlling for gestational age. Left-handers also had significantly delayed motor development and smaller infant head circumference compared with right-handers, but these associations diluted and became nonsignificant when controlling for birthweight. Our study in triplets provides evidence for the link between low birthweight and left-handedness. Our results also suggest that developmental differences between left- and right-handers are due to a shared etiology associated with low birthweight.

Background Racial/ethnic disparities in birth weight persist within the USA. Purpose The purpose of this study is to examine the association between maternal everyday discrimination and infant birth weight among young, urban women of color as well as mediators (depressive symptoms, pregnancy distress, and pregnancy symptoms) and moderators (age, race/ethnicity, and attributions of discrimination) of this association. Methods A total of 420 women participated (14–21 years old; 62 % Latina, 38 % Black), completing measures of everyday discrimination and moderators during their second trimester of pregnancy and mediators during their third trimester. Birth weight was primarily recorded from medical record review. Results Path analysis demonstrated that everyday discrimination was associated with lower birth weight. Depressive symptoms mediated this relationship, and no tested factors moderated this relationship. Conclusions Given the association between birth weight and health across the lifespan, it is critical to reduce discrimination directed at young, urban women of color so that all children can begin life with greater promise for health.

Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (OR adj 4.36, 95% CI [2.32–8.18]), hypertensive disorders in pregnancy (OR adj 2.72, 95% CI [2.28–3.24]), weight gain < 5 kg (OR adj 2.37, 95% CI [1.99–2.83]), smoking at late pregnancy (OR adj 2.04, 95% CI [1.60–2.59]), previous low birthweight (OR adj 2.22, 95% CI [1.79–2.75]), nulliparity (OR adj 1.81, 95% CI [1.60–2.05]), underweight (OR adj 1.61, 95% CI [1.36–1.92]) and socioeconomic status (SES) < 5th centile (OR adj 1.23, 95% CI [1.05–1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery.