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    • Assessment of the growth of children is fundamental to paedi

    2019-05-22

    Assessment of the growth of children is fundamental to paediatrics. Aberrations of growth, whether too little or too much, can be signs of current or past ill health, particularly in the case of poor growth, or portend later ill health, particularly with excessive weight gain. To know whether growth is aberrant, accurate growth reference standards are required. Many standards exist for children born at term. Fewer are available for children born preterm and most have limitations, for example deficiencies in the participant selection or measurement techniques on which they were based. In , José Villar and colleagues describe the creation of growth curves for weight, length, and head circumference that are applicable to healthy singleton preterm babies. The study population was derived from a larger international study cohort of 4607 births for which the expected date of delivery was confirmed and fetal growth was measured extensively. Of these births, 224 (5%) were singleton preterm births. After exclusions, including for fetal growth restriction, 201 singleton neonates born at 26–36 completed weeks of bag price were enrolled into the INTERGROWTH-21 Project Preterm Postnatal Follow-up Study. Weight, length, and head circumference were measured by trained observers within 12 h of birth, every 2 weeks for 2 months, and then every 4 weeks until postnatal age 8 months. The major finding was that all measurements were lower in babies born between 33 and 36 weeks\' gestation than those given in commonly used charts of size at birth for the same postmenstrual age in babies born at those gestational ages. By around 64 weeks\' postmenstrual age (24 weeks\' corrected age), however, values for all measures overlapped with those in the WHO Child Growth Standards for children born at term. The major contribution of the study is that it improves the estimates for postnatal growth for preterm infants, particularly for those born at 33–36 weeks\' gestation. An important limitation of the study is that few babies born before 33 weeks\' gestation could be included, largely because it becomes increasingly difficult to identify healthy babies with decreasing gestational age at birth. Infants born before 33 weeks\' gestation comprise roughly 2% of all births, and 25% of all preterm births. Rather than trying to identify a cohort restricted to healthy babies, the methods could be replicated for all those born earlier than 33 weeks\' gestation and charts constructed for those with and without major morbidities. Ehrenkranz and colleagues produced growth curves for weight for preterm babies in which those with major morbidity grew less well than those without. The main selection criterion for their study, however, was birthweight rather than gestational age.
    Scientific discovery and forward-thinking health policies have fuelled efforts to expand prevention of mother-to-child HIV transmission (PMTCT) services across sub-Saharan Africa. However, nearly a third of HIV-infected women still do not start antiretroviral therapy (ART) during pregnancy, thus exposing their newborns to an unacceptably high risk of HIV infection. If we are to eliminate paediatric HIV and reach the ambitious 90-90-90 goals set forth by the United Nations, new strategies for expanding access are urgently needed. In this issue of , Echezona Ezeanolue and colleagues describe the results of the Baby Shower Trial, a large cluster-randomised study of congregation-based approaches to increase PMTCT uptake. The primary intervention occurred at a monthly baby shower (a reception held in honour of a pregnant women where she plays pregnancy-related games and receives gifts from friends, usually, items she would need during delivery or immediately after birth)sponsored by each participating church. All women received basic health education and a Mama Pack of essential clinical supplies. Women at intervention sites were additionally offered antenatal screening on-site (including for HIV, haemoglobin, malaria, sickle-cell genotype, hepatitis B, and syphilis), locally packaged as part of the Healthy Beginning Initiative. By contrast, women in the control arm sites were encouraged to access antenatal care at local health facilities for routine screening. The primary outcome was HIV testing, confirmed by record review at the participant\'s antenatal clinic in the control arm and by results at the baby shower in the intervention arm. In HIV-infected women, the initiation of ART was also included as a secondary outcome measure.