Evidence Table 7. Studies associating cognitive & neurological development with Failure to Thrive patients compared to healthy control subjects in developed countries Part I

Author, Year, UIDemographicsMaternal / household demographicsInclusion criteriaExclusion criteriaDefinition of FTTStudy design
Mitchell, 1980 80166667Country: USMaternal educ: NDSee Definition of FTTOrganic cause of FTT, single anomalous low wt recorded, clinic registration by age 6 mo, < 3 visitsWt for age < 80% of nl up to age 24 moAmbidirectional longitudinal
Setting: Outpatient clinicIncome: NDControls: wt = 80% of nl, matched for age, sex, mother's age/ marital status & family problems1 fwup at age 3 – 6 y
FTT Ctrl Health insur:
Age(y)2–52–5 FTT-53% Medicaid
Wt/ageNDND Ctrl-49% Medicaid
Ht/lengthNDND
Enrolled : cohort of 312(323)*
Evaluated30282
% Male36.751.8
% Black7070
* See Potential biases column
Hack, 1982 82227864Country: US Gp1 Gp2 VLBW, < 1500g, divided into two groups: SGA < 2 SD or AGANDWt < 2 SD below mean for age @ term and/or @ 8 mo of ageProspective longitudinal
Setting-Recruitment: HospitalMaternal educ <HS1232Assessments at age 40 wk & 8 m
Follow-up: hospital/clinicIncome*2899
Gp1* Gp2† Health insurNDND
Mean age‡32(2.8)29(1.9)* Hollingshead Social Class 4 & 5
Wt/age(g)1141(285)1197(206)
Length(cm)37.9(3.8)38(2.7)
Enrolled||NDND
Evaluated38154
% Male4747
% Black5263
* SGA, † AGA, ‡ wks gestation, || n = 204
Singer, 1984 85057547Country: US NOFTT OFTT NOFTT-unknown organic cause of condition, absence of wt gain during or shortly after hospitalizationNDNDProspective longitudinal
Setting-Recruitment: hospital Ctrl NFTT-documented organic cause of conditionAssessments at age 8 mo, 20 mo, 3 y
Follow-up: NDMaternal educ*12.5(1.4)11.4(1.4)12.5(12.5)Controls -“not FTT”
NOFTT OFTT Ctrl Income: ND
GA(wk)*39(1.8)37(3.5)38(1.8)Health insur: ND
range36–4028–4036–40* At evaluation
PA(wk)†30(7.0)30(7.5)30(10.1)
range20–4421–4420–44
Birth wt284723783027
Enrolled131313
Eval‡111111
Age: 20.6 mo
% Male: ND
Race: ND
Mean (SD), * gestational age, † postnatal
age, ‡ mo follow-up
Haynes, 1984 84233543Country: US FTT1 FTT2 Ctrl Consecutive admissions for NOFTTND< 5 percentile or significant decline from birth wt percentilesProspective longitudinal
Setting: In & Out-patientMaternal educ101110Controls - thriving non-hospitalized patients matched for age, sex, birth wt, & mother's age, ethnicity, number of living children1 assessment 6 mo after intake
Age: NDIncome*379 (0–750)372 (0–950)362 (0–1100)
Wt/age: NDHealth insur: ND
Ht/length: ND* @ mo
FTT1* FTT2† Ctrl
Enrolled/Eval252525
% Sp-Am M444444
Sp-Am F405252
White M364436
White F362428
Black M201220
Black F242420
% Male: ND
* std care & lay health visitor intervention, † std care only; M=male; F=female
Drotar, 1992 92372721Country: US FTT Ctrl Hospitalized for NOFT with nutritional intervention, age 1 – 9 monthsPhysical abuse, residence > 1 hr from hospital, bw < 1500 gmWt < 5th percentile based on NCHS, absence of disease, wt gain in hospital, poor wt velocityProspective longitudinal
Setting: Inpatient with outpatient follow-upMaternal educ10.94 (1.74)11.51 (1.57)Controls matched for age at intake, sex, race, birth order, gestational age, maternal educ & age, family income & size1 fwup at age 42–48 mo
FTT Ctrl Income5446 (5561)7792 (10309)
Mean age*4.92(2.81)5.05(2.85)Health insurNDND
Wt/ageNDNDMean (SD)
Ht/lengthNDND
Enrolled6868
Evaluated4847
% Male7157
Race: Black29(60%)35(74%)
White29(40%)12(26%)
* Age in months, at intake
Kelleher, 1993 93234174Country: US FTT Ctrl Gestation age ≤ 37 wks, birth wt ≤ 2500 g, FTTLive outside catchment area, D/C outside recruitment period, D/C or died within 48 hr, hospitalized > 60 d, oxygen support > 90 d, twin, triplet or quadruplet of ineligible child, maternal drug/ alcohol abuse, insufficient Eng skills, psychiatric hospitalization< 5th percentile for gestation corrected age based on NCHS, growth status on “wt curve below that recorded at last regular assessment visit.”Prospective longitudinal
Setting: Primary care clinicMaternal educ*-Controls matched for - birth wt +/- 250 g, maternal education, maternal race, & infant sexFwup at ages 12, 24, 36 mo
FTT Ctrl <HS40.638.1
GA(wk)*33.033.1HS30.029.3
Wt(g)*16791845Some col14.420.8
Enrolled: 842*≥col grad15.011.8
Evaluated180591Income - <10K38.634.5
% Male52.247.910–20K19.923.9
Race: % Black5053.8>20K38.137.4
* At birthHealth insurNDND
* % HS graduate
Skuse, 1994 94253258Country: UKMaternal educ: NDDistrict-centered until 12 mo of age, singleton deliveries of 38–41 wks gestation≤ 3rd centile, no wt dataWt for age ≥ -1.88 by 12 mo of age & sustained 3 mo (based on NCHS)Prospective longitudinal
Setting: OutpatientIncome:Controls matched for sex, age, ethnic origin, bw within 300 g, ordinal position, SESAssessments at age 15 mo & 4 y
FTT Ctrl Income/welfare support- FTT 16, Ctrl 11
Age(mo)*14.6(1.4)14.2(1.4)Health insur: National healthcare
Wt/age†-2.07(.44)10(.96)
Ht/length†-1.27(.94)18(.73)
Enrolled4950
Evaluated4747
% Male4949
% Non-white4334
* Mean (SD), † z score, p <.001
Reif, 1995 95362505Country: Israel FTT Ctrl FTT, < 2 yrs, term infants > 2500g birth wtOrganic cause of FTT, malnutrition, serious perinatal morbidityHt & wt < 5% in ≥ 2 measurements within 6 mo on Hamill PVV, Drizd TA growth chart,Ambidirectional longitudinal
Setting: Outpatient fwupMaternal educ*12.27 (0.29)12.14 (0.24)Controls matched for age, sex, social class, & ethnic affiliation; admitted or evaluated in ER for intercurrent & nonsign diseaseRe-evaluation at mean 5.12 y
FTT Ctrl IncomeNDND
Mean age(y)*6.26.8Health insur: Socialized medicine
Wt/age*18.0536.15* Mean (SD)
Ht/length*2133.55
Enrolled8665
Evaluated6165
% Male52.554
Race: Sephardic3836
Ashkenazi2329
* At re-evaluation
Puckering, 1995 95378341Country: UK FTT Ctrl From inner city population sample - Caucasian born in 1980 with growth data from birth to 4 yearsPrematurity, congenital defects/ diseases affecting growth, no perinatal insultsHt & wt < 10% based on standard British growth charts (Tanner & Whitehouse)Ambidirectional cross-sectional
Setting: OutpatientMaternal educ*15.6 (1.4)15.6 (1.4)Controls matched for sex, gestational age ≥ 38 wks, ethnic origin
FTT Ctrl Income †117
Age(mo)48.9(1.8)48.2(0.8)48%30%
Wt/age(SDS)*-2.01(0.6)-0.32(1.1)Health insur: Socialized medicine
Ht/length(SDS)*-2.24(0.5)-0.6(0.9)* Age leaving full-time education
Enrolled/Eval2323† Income support/welfare
% Male4848
Race: 100% White
* based on NCHS, p < .001
Corbett, 1996 97113595Country: UKMaternal educ: NDFull term singleton with records of 6 or more weights over first 18 months ageNon-Caucasian, “poor growth resulting from major organic disease”Weight deviated downward from maximal centile achieved at 4–8 wks, across ≥ 2 centile lines, & remained at level ≥ 2 measurements ≥ 1 mo - chart based on Tanner & WhitehouseAmbidirectional longitudinal
Setting: ClinicIncome: “…most economically deprived wards in Newcastle”Consecutive controls matched for age & sex5 year follow-up of cases
Age at follow-up: 6–7 yHealth insur: National healthcare
FTT Ctrl
Wt/ageNDND
Ht/lengthNDND
Enrolled5252
Evaluated4846
% Male: ND
Race: 100% White
Wilensky, 1996 97022837Country: Israel FTT Ctrl FTT infants by review of records who have reached 15 months born in 1991Birth wt < 2500 gm, < 37 weeks, wt/ht ratio > 10 %, organic cause of FTTWt < 3% by NCHS for = 3 months prior to age 15 monthsAmbidirectional cross-sectional
Setting: Community pediatric clinicMaternal educ*13.8 (1.62)13.4 (1.44)Controls from same health clinic matched for birth month, maternal educ, maternal age, parity, and infants' birth wt
FTT Ctrl Income: AFDC 76%
Mean age(m)*2020Health insur: ND
Wt/ageNDND* Mean (SD), based on record review of potential subjects
Ht/lengthNDND
Enrolled†551352
Evaluated5050
% MaleNDND
Race: ND; Maternal country of birth: 68% Israel, 25% Europe/America, 5% N Africa, 2% Asia
* At assessment
Mackner,a 1997 97381196Country: US Maternal* educ Income† Health insurt‡ Original criteria: FTT, , 24 mo, wt/age < 5th %, gestational age = 37 wks & appropriate birth wtHistory of perinatal complications, congenital disorders, chronic illnessWt/age < 5th% by NCHS growth chartsAmbidirectional cross-sectional
Setting: Inner-city hospital prenatal clinicGp110.587089Controls from same site, bet ages 3 – 30 mo, wt/age > 10th %, gestational age = 37 wks & appropriate birth wt
Age* (mo) Mean wt/age Ht/ lngth Enrolled/Eval
Gp1†14±5.3<5%ND27Gp110.587089
Gp2‡14±5.6<5%ND70Gp211.096878
Ctrl1§16±5.9>10%ND23Ctrl111.047482
Ctrl2||18±6.9>10%ND57Ctrl211.728189
% Male: 58* p <0.05, † percent AFDC, ‡ percent Medicaid
Race: 94.4 % African American 5.6% White
* p < 0.001, † FTT & neglect, ‡ FTT only, § Neglect only, || Neither
Drewett, 1999 99284054Country: UK FTT Ctrl At least 1 wt at age 0–2 mo & 2 subsequent wts, thrive index < 5th centile = 2 occasions between 3 & 18 moNDLowest 5% for change of SD score; avg taken of SD scores for all wt bet 0–2 mo, expected wt from 3–18 mo calculated for “thrive index”Ambidirectional longitudinal
Setting: Clinic / home visitsMaternal educ*7266Controls with at least 1 wt at age 0–2 mo & 2 subsequent wts, no thrive index < 10th centile, age ± 1 mo, similar/same residential area or GP practiceFive years from enrollment of 1 y old cases
FTT Ctrl Income: NA
Age(y)8.12(0.62)8.10(0.57)Health insur: National healthcare
Wt(kg)*23.827.9* % left school at 16 y
BMI*14.916.3
Enrolled136136
Evaluated†107/111117/122
% Male‡4038
%White‡9191
* Median, † Psychological / anthropometric
evaluation, ‡ FTT = 107, Ctrl = 117
Kerr,a 2000 20277217Country: US Maternal educ Income* History of FTT & Controls seeMackner 1997 History of perinatal complications, congenital disorders, chronic illnessWt/age < 5th % by NCHS growth chartsAmbidirectional longitudinal
Setting: Inner-city hospital clinicGp111.256Subgroups - Gp2 & Ctrl1: hx of maltreatment defined as at least one report with Child Protective Services (CPS) by age 6, including neglect, physical abuse, & sexual abuseAssessment at age 6 y
Age (mo) Mean wt/age Ht/ lngth Gp210.4(1.7)81
Gp1*73.3±1.9NDNDCtrl111.2(1.4)65
Gp2†74.2±3.2NDNDCtrl211.4(1.9)62
Ctrl1‡73.0±1.2NDNDHealth insur: ND
Ctrl273.5±1.9NDNDMean, * percent AFDC
Evaluated % Male % Race||
Gp1645688
Gp2284887
Ctrl1215394
Ctrl2805197

From: Evidence Tables

Cover of Criteria for Determining Disability in Infants and Children: Failure to Thrive
Criteria for Determining Disability in Infants and Children: Failure to Thrive.
Evidence Reports/Technology Assessments, No. 72.
Perrin EC, Frank DA, Cole CH, et al.

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