Growth of Belgian and Norwegian children compared to the WHO growth standards: Prevalence below -2 SD and above +2 SD and the effect of breastfeeding
Section for Pediatrics, Department of Clinical Medicine, University of Bergen, 5021 Bergen, Norway. Archives of Disease in Childhood
(Impact Factor: 2.9).
11/2009; 96(10):916-21. DOI: 10.1136/adc.2009.166157
New national growth references have been published in Belgium and Norway. The WHO recommends universal use of their 2006 Child Growth Standards based on data from breastfed children.
To compare the growth of Belgian and Norwegian children with the WHO standards.
6985 children 0-5 years of age from Belgium and Norway.
Proportion of children below -2 SD and above +2 SD of the WHO standards was calculated for length/height, weight, body mass index and head circumference. Average SD scores of exclusively breastfed children of non-smoking mothers were compared with national reference data and with the WHO standards.
Generally, the number of Belgian and Norwegian children below -2 SD lines of the WHO standards was lower and above +2 SD higher than expected. The largest differences were for head circumference (0.97% Belgian and 0.18% Norwegian children below -2 SD, 6.55% Belgian and 6.40% Norwegian children above +2 SD) and the smallest for length/height (1.25% Belgian and 1.43% Norwegian children below -2 SD, 3.47% Belgian and 2.81% Norwegian children above +2 SD). The growth pattern of breastfed children of non-smoking mothers was in both countries more alike the local national growth references than the WHO standards.
There are significant deviations in the proportion of children outside normal limits (±2 SD) of the WHO standards. This was true for all children, including those who were exclusively breastfed. Hence, adoption of the WHO growth charts could have consequences for clinical decision-making. These findings advocate the use of national references in Belgium and Norway, also for breastfed children.
Available from: Andrew John Holland
- "e l s e v i e r . c o m / l o c a t e / e a r l h u m d e v decisions are often based on data extracted by an often ethnicallyhomogenous native population   and may not be applicable to children of non-Caucasian and immigrant parents . For example, Asian infants have less severe hyaline membrane disease but worse retinopathy of prematurity . "
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ABSTRACT: BACKGROUND: Immigration is increasingly common worldwide and its impact on neonatal intensive care unit outcomes is uncertain. AIMS: To determine the outcomes of children of immigrant mothers admitted to NICUs in New South Wales (NSW), Australia, between 2000 and 2006. STUDY DESIGN: Record linkage study of routinely collected state-based health databases. SUBJECTS: Infants of Australian-born (9813, 81.9%) and overseas born mothers (2166, 18.1%). OUTCOME MEASURES: NICU and childhood outcomes to a maximum 5years of age. RESULTS: Immigrant mothers came from 122 countries, 897 (44%) from high income regions. Australian born mothers were more likely to be teenaged (Odds Ratio, 95% confidence interval: 3.07, 2.21-4.26), use drugs (3.55, 2.49-5.06) and suffer an antepartum hemorrhage (1.29, 1.14-1.48). They were less likely to have gestational diabetes (0.45, 0.38-0.54), fetal distress (0.75, 0.66-0.85) and intrauterine growth restriction (0.80, 0.67-0.93). Their infants were more likely to be admitted to the NICU for prematurity but less likely to have low 5min Apgar scores (0.81, 0.69-0.93) or a congenital abnormality (0.79, 0.70-0.90). Infants of Middle-Eastern mothers had the lowest hospital survival rate (88.5%). Children of immigrant Asian mothers were least likely to be rehospitalized after NICU discharge (1.66, 1.27-2.17). CONCLUSIONS: NICU outcomes are affected by maternal country of birth even within the same ethnic group. Further study regarding the impact of paternal race and immigration status and duration of residency will provide data for the changing cultural environment of global perinatal care.
Available from: Jessie M Hulst
- "There are, however, concerns about the use of the new charts because of the risk of underestimation or overestimation of the prevalence of under-and overweight in specific countries. In 2009 the new WHO standards were compared with the new national growth curves of Belgian and Norwegian children  . There were significant deviations in the proportion of children outside normal limits of the WHO standards. "
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ABSTRACT: Malnutrition in hospitalized children is still very prevalent, especially in children with underlying disease and clinical conditions. The purpose of this review is to describe current issues that have to be taken into account when interpreting prevalence data. Weight-for-height and height-for-age standard deviation scores are used for classification for acute and chronic malnutrition, respectively. Body mass index for age can also be used for the definition of acute malnutrition but has a few advantages in the general pediatric population. The new World Health Organization child-growth charts can be used as reference but there is a risk of over- and underestimation of malnutrition rates compared with country-specific growth references. For children with specific medical conditions and syndromes, specific growth references should be used for appropriate interpretation of nutritional status. New screening tools are available to identify children at risk for developing malnutrition during admission. Because of the diversity of medical conditions and syndromes in hospitalized children, assessment of nutritional status and interpretation of anthropometric data need a tailored approach.
Available from: hvidovrehospital.dk
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