ASD is associated with a range of prenatal, perinatal, and neonatal factors, with the highest magnitude associations with maternal medication use and neonatal seizure.

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Doctors have no ethical obligation to provide futile treatment. This has been true since the time of Hippocrates who warned physicians not to treat patients who were “overmastered by their disease.” This principle remains valid today but, as the Society for Critical Care Medicine notes, it is difficult to identify treatment as absolutely futile in all but a few clinical situations. Far more common, they note, are “treatments that are extremely unlikely to be beneficial, are extremely costly, or are of uncertain benefit.” These, they say, “may be considered inappropriate and hence inadvisable, but should not be labeled futile.” So what should doctors do when they have a case that seems close to the futility threshold but does not, perhaps, quite cross it? In such cases, is it appropriate to make unilateral decisions to withhold life-sustaining treatment even if the family objects? Or should treatment be provided knowing that it might cause pain and suffering to an infant with no likelihood of benefit? To address these questions, we present a case of an extremely premature infant with a giant omphalocele and ask 3 neonatologists, Dr Dalia Feltman of Evanston Hospital, Dr Theophil Stokes of the Walter Reed Medical Center, and Dr Jennifer Kett, a neonatologist and fellow in bioethics at Seattle Children’s Hospital, to comment.

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Growth-to-discharge progressively improved from 1997 to 2012, but Z-scores remained below the reference median for weight, length and head circumference. Length Z-scores were consistently significantly less than for weight, and body mass index Z-scores have been above the reference median since 2002. Prospective studies are needed to quantify anthropometric trends in relation to body composition and to current nutritional strategies.

Background: Waist circumference:length ratio (WLR) and ponderal index (PI) appear to be useful markers of visceral and total adiposity, respectively. However, there are no normative birth data across the full range of gestational ages. Methods: In this retrospective cohort study of 500 preterm and 1,426 full-term infants, born in 1998 and 2008 at three military hospitals, the percentile growth curves for WLR and PI were calculated. There were no sex differences, and results were combined to obtain values from 26 to 42 wk gestation. results: Between 26 and 42 wk gestation, median birth WLR increased from 0.55 to 0.62, and median PI increased from 21.1 to 25.6. The adjusted mean WLR at birth among infants born <34 wk increased from 0.55 in 1998 to 0.58 in 2008 (P = 0.048), suggesting that early-preterm infants born in 2008 had greater abdominal adiposity than those born in 1998. conclusion: We report normative birth data for WLR and PI in preterm and full-term infants by gestational age and sex. WLR and PI may be useful as clinical markers of visceral and overall adiposity. In conjunction with other anthropometric measures, WLR and PI may be useful to monitor postnatal nutrition and growth and assess risk for later obesity and cardiometabolic disorders. Many studies have shown that excess body adiposity, especially visceral adiposity, increases the risk for later cardiometabolic disorders. Measuring the waist circumference (WC) (1) has been used in adults, adolescents, and children as a simple and inexpensive population-based strategy for a clinical practice-based estimate of visceral adiposity (1). Elevated WC was associated with diabetes, coronary artery disease, morbidity, and mortality in adult North American, Asian, and European populations (2-4). WC has been shown to correlate with the risk of type 2 diabetes, in some cases better than weight, height, body mass index (BMI), or skinfold thickness (5). The ratio of standing height to WC has been utilized in some studies to normalize for age, sex, and race/ethnicity. The waist circumference:height ratio (WHtR) was closely associated with coronary risks such as hypertension, hyperglycemia, hypertriglyceridemia, hypercholesterolemia, and lower levels of high-density lipoprotein (3). WHtR was a better predictor of metabolic syndrome than BMI in Mexican children aged 6-12 y (6). Data for infants, however, are lacking. There are some very limited population-based norms in infants born full term for WC and waist circumference:length ratio (WLR) based on supine length, but there are no birth data in infants born preterm (7,8).In current practice, neonatologists aim to achieve postnatal growth rates comparable to intrauterine growth based on estimated gestational age (EGA) and weight (9). But weight by itself tells only a little about the overall body composition. The BMI has been used to evaluate growth and as a surrogate indicator of obesity. However, the BMI has not been utilized in infants, and it does not reliably distinguish between growth in lean and that in fat...