Seham Elmrayed

Objective Weight-for-length (WFL) is recommended for assessing weight status in infants under 2 years, although body mass index (BMI) may be an alternative. We compared weight classifications using WFL and BMI and assess their ability to predict later obesity. Study Design: This longitudinal study analysed public health data from Calgary, Canada (2000–2018). Growth measures from full-term infants under 2 years and children aged approximately 4.5 years were assessed using World Health Organization growth standards. Classification agreement and predictive performance were examined. Results Among 191,956 children, 51% were male. WFL and BMI showed moderate-to-strong agreement. Areas under the receiver operating characteristic curve for predicting later overweight and obesity ranged from 67.7%–79.2% for BMI and 65.7%–80.0% for WFL. Infant overweight/obesity classifications (> 2 z-scores) poorly predicted later status. Conclusion BMI and WFL showed comparable classification and predictive performance. Further research should evaluate BMI-based infant growth monitoring.

Background: Antimicrobial resistance (AMR) is a pressing public health challenge in the Eastern Mediterranean Region (EMR), with Streptococcus pneumoniae being a major contributor due to its role in invasive pneumococcal disease (IPD). Pneumococcal conjugate vaccines (PCVs) have shown promise in reducing vaccine-type IPD and AMR, yet significant barriers persist. Objective: This review examines the impact of PCVs on AMR, serotype distribution, and vaccine coverage in pediatric populations within the EMR, emphasizing the interplay between vaccination strategies and AMR trends. Content: The introduction of PCVs, particularly PCV13, has led to reductions in vaccine-type IPD and AMR in several EMR countries. For example, post-PCV13 penicillin susceptibility in Saudi Arabia improved from 37 to 100% in invasive isolates, and Lebanon reported significant reductions in vaccine-type AMR. However, challenges such as inconsistent vaccination coverage (e.g., 76% in Yemen, absent in Egypt), socio-political instability, and the emergence of non-vaccine serotypes (NVTs) as per shown in the 73.5% of isolates in Omani children and the high multidrug resistance (MDR) rates (e.g., 85.7% in Yemen) undermine these benefits. Serotype replacement phenomena, driven by ecological shifts, are increasingly contributing to disease burden and AMR. While PCVs reduce the need for antibiotics and limit selective pressures driving resistance, high rates of MDR and inadequate antibiotic stewardship remain concerns. Strengthened vaccination programs, high-valency vaccines, and robust surveillance systems are critical to addressing these challenges. Conclusion: PCVs play a pivotal role in mitigating AMR and reducing pneumococcal disease burden in the EMR. However, suboptimal vaccine coverage, NVT emergence, and persistent AMR highlight the need for comprehensive strategies, including enhanced coverage of higher valency vaccines, robust surveillance, targeted public health interventions, strengthened antibiotic stewardship, and improved regional collaboration. Addressing these issues can significantly reduce the AMR burden and improve health outcomes across the region.

Background: Anaemia prevalence among Egyptian children under 5 years of age increased from 27.2% in 2014 to 43% in 2024, primarily attributed to iron deficiency anaemia (IDA). The World Health Organization and the United Nations International Children's Emergency Fund recommend iron-fortified foods and supplements to combat IDA. In the absence of longitudinal data among Egyptian children with anaemia, a microsimulation and cost-effectiveness analysis was conducted to evaluate the economic and health impacts of consuming iron-fortified cereals (IFC) in reducing IDA prevalence among Egyptian children under 2 years of age.Methods: Data of 1707 children under 2 years of age from Egyptian Family Health Survey 2021 (EFHS) were used to create a virtual cohort of 100,000 through Monte Carlo simulations, stratified by age, gender, wealth index, and anaemia severity. A Markov model projected transitions in anaemia severity over 10 years for IFC and non-IFC consumers. Costs for IFC and home-based foods were derived from market research and existing literature, with cost-effectiveness evaluated using the incremental cost-effectiveness ratio (ICER), indicating the additional cost required to gain one additional unit of effectiveness (in our case the disability-adjusted life years [DALYs]) when two approaches are compared.Results: The per-day cost of home-based food was 0.37 United States Dollar (USD) per child, with an additional 0.17 USD for IFC consumers. Based on 5% IFC consumption (EFHS 2021) anaemia prevalence was projected to reduce to 32% over 10 years. DALYs averted among IFC consumers were 0.006 DALY/day and 22 DALYs over a period of 10 years. The obtained ICER of −4.14 suggests that an IFC intervention can be more effective and less costly than no intervention.Conclusion: IFC interventions among Egyptian children under 2 years of age are crucial for reducing IDA. IFC consumption lowers DALYs and offers significant cost savings over 10 years, making it an effective health and economic strategy. With 4.058 million children under 2 years of age in Egypt, IFC interventions could save 7.79 million USD for 1 day of disability averted. This study provides evidence-based policy insight, urging prioritisation of IFC recommendation in public health strategies to combat IDA in children and reduce economic burdens.

Background: Experts recommend assessing preterm infant growth against fetal growth patterns. However, obtaining accurate estimates of healthy fetal growth from preterm infants is challenging as many had intrauterine faltering growth.Objectives: To improve preterm infant growth assessments by developing Fenton third‐generation sex‐specific preterm growth charts based on anthropometric distributions of preterm infants without abnormal fetal growth. We also aimed to evaluate the consistency of the new charts' growth velocities.Data Sources: From the last search for the 2013 Fenton growth charts to November 2024, MEDLINE and EMBASE databases, grey literature, as well as US Vital statistics and iNeo Consortium.Study Selection and Data Extraction: We followed systematic review methodology to identify population‐based sex‐specific anthropometric estimates of preterm cohorts without abnormal fetal growth beginning ≤ 24 weeks of gestation. Specified a priori, outcomes included newborn sex‐specific estimates of birthweight, length, and head circumference.Synthesis: We followed PRISMA guidelines. Literature screening and quality assessment were performed in duplicate. We harmonised weight, length, and head circumference weighted‐average meta‐analyses with the World Health Organization growth standard and rescaled the charts' x‐axis from completed gestational weeks to exact gestational age (weeks and days).Results: Seven studies from 15 countries (Australia, Brazil, Canada, China, Finland, Israel, Italy, Japan, Netherlands, New Zealand, Sweden, Switzerland, Spain, United Kingdom and United States) were included, representing 4.8 million births 22–42 weeks of gestation. 174,184 were < 30 weeks gestational age. The Fenton third‐generation preterm growth charts' weights showed improved growth velocity across percentiles with consistent declines for weight, length and head circumference velocity as post‐menstrual age increased. The birthweight meta‐analysis curves had similar shapes to fetal ultrasound estimates.Conclusions: The Fenton third‐generation preterm infant growth chart curves demonstrate improved and more uniform slopes across percentiles and closer alignment with fetal ultrasound estimates, offering a growth standard for preterm infants.Prospero Registration: CRD42024589756

Objective: To evaluate the effect of age correction up to 36 months of age for growth assessments of extremely preterm (<28 weeks) and very preterm (28 to <32 weeks) infants. Study Design: This longitudinal analysis used data from the Preterm Infant Multicenter Growth Study (2001–2014). Results: 1,416 children were included (Median gestational age = 27 weeks). Chronological age-based weight, height, and head circumference z-scores were consistently lower than those based on corrected age for all ages (0, 4, 8, 21 and 36 months) by up to −5.2 (95% confidence interval −5.4, −5.1) z-scores for length at term. Using chronological age, higher proportions of children were misclassified as having suboptimal growth (up to 72.9% misdiagnosed as stunted and 89.8% misdiagnosed as underweight at term). Conclusion: For extremely and very preterm children, age correction is required for all growth measures through 36 months of corrected age.

Background: Concerns are prevalent about preterm infant long‐term growth regarding plotting low on growth charts at discharge, stunting, underweight, high body fat and subsequent cardiometabolic morbidities.Objectives: To examine (a) longitudinal growth patterns of extremely and very preterm infants to 3 years corrected age (CA) (outcome), categorised by their birthweight for gestational age: small, appropriate and large for gestational age (SGA, AGA and LGA, respectively) (exposure); and (b) the ability of growth faltering (<−2 z‐scores) to predict suboptimal cognitive scores at 3 years CA.Methods: Post‐discharge head, length, weight and weight‐4‐length growth patterns of the PreM Growth cohort study infants born − 2 z‐scores improved with age. The highest proportions <−2 z‐scores for length (24.2%) and weight (24.0%) were at 36 gestational weeks. The proportion with small heads was low by 0 months CA (1.8%). By 3 years CA, only a few children plotted lower than −2 z‐scores for length, weight‐4‐length and weight ( + 2 z‐scores were rare (2.1% at 3 years CA). Those born SGA had higher proportions with shorter heights (16.7% vs. 5.2%) and lower weights (27.8% vs. 3.5%) at 3 years CA compared to those born AGA. The ability of growth faltering to predict cognitive scores was limited (AUROC 0.42, 95% CI 0.39, 0.45 to 0.52, 95% CI 0.41, 0.63).Conclusions: Although children born <30 weeks gestation without major neonatal morbidities plot low on growth charts at 36 weeks CA most catch up to growth chart curves by 3 years CA.

Background Many interstitial lung diseases (ILDs) have clear causal relationships with environmental and occupational exposures. Exposure identification can assist with diagnosis, understanding disease pathogenesis, prognostication and prevention of disease progression and occurrence in others at risk. Despite the importance of exposure identification in ILD, there is no standardised assessment approach. Many questionnaires are in clinical and research use, yet their utility, applicability, relevance and performance characteristics are unknown. Objectives This scoping review aimed to summarise the available evidence relating to ILD exposure assessment questionnaires, identify research gaps and inform the content for a future single evidence-based ILD questionnaire. Methods A scoping review based on Arksey and O’Malley’s methodological framework was conducted. Eligibility criteria: Any questionnaire that elicited exposures specific to ILD was included. A modified COSMIN Risk of Bias Framework was used to assess quality. Sources of evidence: Relevant articles were identified from MEDLINE and EMBASE up to 23 July 2023. Results 22 exposure questionnaires were identified, including 15 generally pertaining to ILD, along with several disease-specific questionnaires for hypersensitivity pneumonitis (n=4), chronic beryllium disease, sarcoidosis and silicosis (1 questionnaire each). For most questionnaires, quality was low, whereby the methods used to determine exposure inclusion and questionnaire validation were not reported or not performed. Collectively the questionnaires covered 158 unique exposures and at-risk occupations, most commonly birds, mould/water damage, wood dust, asbestos, farming, automotive mechanic and miners. Only five questionnaires also provided free-text fields, and 13 queried qualifiers such as temporality or respiratory protection. Conclusions Designing a robust ILD-specific questionnaire should include an evidence-based and relevance-based approach to exposure derivation, with clinicians and patients involved in its development and tested to ensure relevance and feasibility.

The developmental origins of health and disease hypothesis proposes that early exposure to adverse conditions during fetal development and early life have strong detrimental consequences on long-term health and susceptibility to chronic diseases. We conducted a systematic review to critically appraise Barker’s highest cited publications using the risk-of-bias assessment tool (ROBINS-I) and investigate effects of overadjustment by later body weight. Our findings revealed that all included studies displayed high risks of bias, with particular concerns regarding confounding (8/8), selection of reported results (8/8), classification of exposure (7/8), selection of participants (5/8) and high rates of missing data (ranged from 15 to 87%). Later body weight was over-adjusted in most (6/8) of the studies. As all studies displayed high bias risk due to confounding, missing data and overadjustment, evidence is insufficient to support causal relationships between low birthweight and adult disease, warranting caution in clinical application. Protocol registration PROSPERO CRD42023433179

Background: Overweight and obesity and their consequent morbidities are important worldwide health problems. Some research suggests excess adiposity origins may begin in fetal life, but unknown is whether this applies to infants born preterm.Objective: The objective of the study was to assess the association between small for gestational age (SGA) birth and later adiposity and height among those born preterm.Data sources: MEDLINE, EMBASE and CINAHL until October 2022.Study selection and data extraction: Studies were included if they reported anthropometric (adiposity measures and height) outcomes for participants born preterm with SGA versus non‐SGA. Screening, data extraction and risks of bias assessments were conducted in duplicate by two reviewers.Synthesis: We meta‐analysed across studies using random‐effects models and explored potential heterogeneity sources.Results: Thirty‐nine studies met the inclusion criteria. In later life, preterm SGA infants had a lower body mass index (−0.66 kg/m², 95% CI −0.79, −0.53; 32 studies, I² = 16.7, n = 30,346), waist circumference (−1.20 cm, 95% CI −2.17, −0.23; 13 studies, I² = 19.4, n = 2061), lean mass (−2.62 kg, 95% CI −3.45, 1.80; 7 studies, I² = 0, n = 205) and height (−3.85 cm, 95% CI −4.73, −2.96; 26 studies, I² = 52.6, n = 4174) compared with those preterm infants born non‐SGA. There were no differences between preterm SGA and preterm non‐SGA groups in waist/hip ratio, body fat, body fat per cent, truncal fat per cent, fat mass index or lean mass index, although power was limited for some analyses. Studies were rated at high risk of bias due to potential residual confounding and low risk of bias in other domains.Conclusions: Compared to their preterm non‐SGA peers, preterm infants born SGA have lower BMI, waist circumference, lean body mass and height in later life. No differences in adiposity were observed between SGA preterm infants and non‐SGA preterm infants.