ABSTRACT. Objective. Childhood obesity has contributed to an increased incidence of type 2 diabetes mellitus and metabolic syndrome (MS) among children. Intrauterine exposure to diabetes and size at birth are risk factors for type 2 diabetes mellitus, but their association with MS in childhood has not been demonstrated. We examined the development of MS among large-forgestational-age (LGA) and appropriate-for-gestational age (AGA) children.Study Design. The major components of MS (obesity, hypertension, dyslipidemia, and glucose intolerance) were evaluated in a longitudinal cohort study of children at age 6, 7, 9, and 11 years who were LGA (n ‫؍‬ 84) or AGA (n ‫؍‬ 95) offspring of mothers with or without gestational diabetes mellitus (GDM). The cohort consisted of 4 groups, ie, LGA offspring of control mothers, LGA offspring of mothers with GDM, AGA offspring of control mothers, and AGA offspring of mothers with GDM. Biometric and anthropometric measurements were obtained at 6, 7, 9, and 11 years. Biochemical testing included measurements of postprandial glucose and insulin levels and high-density lipoprotein (HDL) cholesterol levels at 6 and 7 years and of fasting glucose, insulin, triglyceride, and HDL cholesterol levels at 9 and 11 years. We defined the components of MS as (1) obesity (BMI >85th percentile for age), (2) diastolic or systolic blood pressure >95th percentile for age, (3) postprandial glucose level >140 mg/dL or fasting glucose level >110 mg/dL, (4) triglyceride level >95th percentile for age, and (5) HDL level <5th percentile for age.Results. There were no differences in baseline characteristics (gender, race, socioeconomic status, and maternal weight gain during pregnancy) for the 4 groups except for birth weight, but there was a trend toward a higher prevalence of maternal obesity before pregnancy in the LGA/GDM group. Obesity (BMI >85th percentile) at 11 years was present in 25% to 35% of the children, but rates were not different between LGA and AGA offspring. There was a trend toward a higher incidence of insulin resistance, defined as a fasting glucose/insulin ratio of <7, in the LGA/GDM group at 11 years. Analysis of insulin resistance at 11 years in a multivariate logistic regression revealed that childhood obesity and the combination of LGA status and maternal GDM were associated with insulin resistance, with odds ratios of 4.3 (95% confidence interval [CI]: 1.5-11.9) and 10.4 (95% CI: 1.5-74.4), respectively. The prevalence at any time of >2 components of MS was 50% for the LGA/GDM group, which was significantly higher than values for the LGA/ control group (29%), AGA/GDM group (21%), and AGA/ control group (18%). The prevalence of >3 components of MS at age 11 was 15% for the LGA/GDM group, compared with 3.0% to 5.3% for the other groups. Cox regression analysis was performed to determine the independent hazard (risk) of developing MS attributable to birth weight, gender, maternal prepregnancy obesity, and GDM. For Cox analyses, we defined MS as >2 of the following 4 components: obes...

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Increased first-week protein and energy intakes are associated with higher Mental Development Index scores and lower likelihood of length growth restrictions at 18 months in extremely low birth weight infants. Emphasis should be placed on providing more optimal protein and energy during this first week.

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WHAT'S KNOWN ON THIS SUBJECT: It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay.WHAT THIS STUDY ADDS: This is the first study to provide evidence that preterm infants' exposure to adult words in the NICU before the mother' s due date are associated with better cognitive and language outcomes at 7 and 18 months' corrected age.abstract OBJECTIVE: The goal of this study was to test the association of mean adult word counts at 32 and 36 weeks' postmenstrual age in the NICU with Bayley Scales of Infant and Toddler Development, 3rd Edition (Bayley-III), cognitive and language scores. It was hypothesized that preterm infants exposed to higher word counts would have higher cognitive and language scores at 7 and 18 months' corrected age. METHODS:This prospective cohort study included 36 preterm infants with a birth weight #1250 g. Sixteen-hour recordings were made in the NICU by using a digital language processor at 32 and 36 weeks' postmenstrual age. Regression analyses were performed on adult word count per hour, with Bayley-III measures correcting for birth weight.RESULTS: Adult word counts in the NICU were positively correlated with 7-and 18-month Bayley-III scores. For the 32-week recording, in regression analyses adjusting for birth weight, adult word count per hour independently accounted for 12% of the variance in language composite scores (P = .04) and 20% of the variance in expressive communication scores at 18 months (P = .008). For the 36-week recording, adult word count per hour independently accounted for 26% of the variance in cognitive composite scores at 7 months (P = .0049).CONCLUSIONS: Increased amount of parent talk with preterm infants in the NICU was associated with higher 7-and 18-month corrected age Bayley-III language and cognitive scores. These findings offer an opportunity for language intervention starting in the NICU. Pediatrics 2014;133:e578-e584 AUTHORS:

WHAT'S KNOWN ON THIS SUBJECT:It is known that adult language input is important to healthy language development and that preterm infants are at risk for language delay. WHAT THIS STUDY ADDS:This is the first study to provide evidence that very preterm infants begin making vocalizations as early as 8 weeks before their projected due date and make significantly more vocalizations when a parent is present in the NICU. abstract OBJECTIVE: To determine the sound environment of preterm infants cared for in the NICU and to test the hypothesis that infants exposed to more adult language will make more vocalizations. METHODS:This was a prospective cohort study of 36 infants who had a birth weight of Յ1250 g. Sixteen-hour recordings of the infant sound environment were made in the NICU from a digital language processor at 32 and 36 weeks' postmenstrual age. Adult word counts, infant vocalizations, and conversational turns were analyzed. RESULTS:Infant vocalizations are present as early as 32 weeks. Both adult word counts per hour and infant vocalizations per hour increase significantly between 32 and 36 weeks. Infant exposure to language as a percentage of time was small but increased significantly. When a parent was present, infants had significantly more conversational turns per hour than when a parent was not present at both 32 and 36 weeks (P Ͻ .0001). CONCLUSIONS:Preterm infants begin to make vocalizations at least 8 weeks before their projected due date and significantly increase their number of vocalizations over time. Although infant exposure to language increased over time, adult language accounted for only a small percentage of the sounds to which an infant is exposed in the NICU. Exposure to parental talk was a significantly stronger predictor of infant vocalizations at 32 weeks and conversational turns at 32 and 36 weeks than language from other adults. These findings highlight the powerful impact that parent talk has on the appearance and increment of vocalizations in preterm infants in the NICU. Pediatrics 2011;128: 910-916

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We conclude that LGA OGDM have evidence of increasing body size and adiposity with increasing age and that maternal GDM and maternal prepregnant adiposity are significant predictors of their unique growth patterns.