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  • Title: International comparisons of postnatal growth of low birthweight infants with special reference to differences between developing and affluent countries.
    Author: Hofvander Y.
    Journal: Acta Paediatr Scand Suppl; 1982; 296():14-8. PubMed ID: 6961734.
    Abstract:
    A large majority of low birthweight infants are born in developing countries where however, only few follow-up studies have been made. However, there are clear indications that in general the AGA infants catch-up better than the SGA of the same weight. A particularly poor catch-up growth is shown by full-term SGA indicating that if a fetal growth retardations is diagnosed, delivery should be induced prematurely. Social and environmental factors are important for the optimal growth postnatally and particularly so if the environmental conditions are adverse. At this time about 21 million children are born with low birthweight (LBW) below 2500 g corresponding to 17% of all births. 19 million of these LBW or 90% are born in developing countries. Applying 2250 gm instead of 2500 gm as a limit for LBW which many claim would be more nearly defining the high risk for LBW infant would bring the percentage of LBW in South East Asia down to 5 from 10 million infants. The lowest rates in Asia are to be found in East Asia where most countries, in particular China and Japan, have rates comparable to the lowest in Europe. The proportion of full term small for gestational age (SGA) of the LBW varies between 24-57% in developed countries. In Sweden and in the US it is 45%. In Africa it is about the same as in Europe while it is higher in Asia. For example, in India it is 75%. During the past few decades there has been a successively improved prognosis for the LBW. By 1950 the neonatal mortality of infants below 1000 gm was more than 90% and 50-60% of those below 1500 gm developed major handicaps. By now the neonatal mortality of infants below 1000 gm has decreased to 50-60% and for the 1000-1500 gm infants it is only about 15%. Of the survivors only some 10-30% will have major handicaps. An extensive literature reveiw yielding about 350 recent articles concerning the future growth and fate of LBW infants disclosed only a few articles from developing countries with very brief follow-up periods. Most were from the US, Canada, Australia, and a few European countries, mainly England. It is difficult to make a fair comparison between published studies. A few studies with follow-up periods ranging between 3 months and 8 years are reported. On a global basis maternal malnutrition and infections are the most important factors influencing fetal growth. The difference in birth weight between different socioeconomic groups depends to a great extent on these factors. The postnatal growth of any infant is influenced by its nutritional intake and infection rate. In developing countries both these factors are operating negatively on the child and in particular if the infant cannot be breastfed. Breastfeeding is a must for survival both in the short-term and in the longterm perspective. There are clear indications that in general the appropriate for gestational age (AGA) infants catch up better than the SGA of the same weight. A particularly poor catch up growth is shown by full-term SGA indicating that if a fetal growth retardation is diagnosed, delivery should be induced prematurely.
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