Background Trace elements' (TEs) contamination of parenteral nutrition (PN) solutions is an ongoing concern. The aims of this study were 1) to measure actual TE concentrations in PN admixtures compared with ordered concentrations and 2) compare TE intake with current recommendations. Methods PN admixtures from discarded bags were collected from patients receiving home PN and on inpatient wards. Samples were collected from 72 patients (39 inpatients, 33 receiving home PN). Age, percentage energy intake from PN, and PN orders were collected from patients' charts. PN samples were analyzed for TEs, including chromium (Cr) and manganese (Mn), and concentration measurements compared with ordered concentrations and current recommendations. Results Measured Cr and Mn concentrations were higher than ordered concentrations: 5.3 ± 1.7 vs 2.8 ± 1.5 µg/L; P < 0.0001 and 11.9 ± 5.9 vs 0.00 µg/L; P < 0.0001, respectively. Chromium contamination alone accounted for over 100% of current recommendations for patients 0–12 months and between 63% and 92% for children >1 year. Contamination of Mn provided all the measured Mn in PN admixtures, since Mn is excluded from PN orders at our institution. Between 70% and 120% of current Mn recommendations were met from contamination. Conclusions Cr should be excluded from PN admixtures for children 0–12 months and only one‐fourth the current recommendation should be added for pediatric patients >1 year. Manganese should also be excluded from PN admixture for pediatric patients but plasms monitoring 2–3 times per year is recommended for those on long‐term PN.

Objectives Underweight in children is defined by the World Health Organization (WHO) as a body mass index z-score (zBMI) &lt; -2. The objective was to evaluate the relationship between underweight in the first two years of life and zBMI, weight-for-age z score (WAZ), and height-for-age-z score (HAZ) from 2 to 10 years of age. Secondly, to explore whether sex and zBMI growth trajectory in the first two years of life modify these associations. Methods A prospective cohort study was conducted through The Applied Research Group for Kids (TARGet Kids! ) practice-based research network. Healthy children 0–10 years of age in Canada were included. Linear mixed models were used in the primary and secondary analysis to take into account multiple growth measures over time. Results 5,803 children were included in the primary analysis. At baseline the mean age was 4.07 months, and 52.2% were male. In adjusted models, underweight in the first two years was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, 10 years of age (all p values &lt; 0.01). There was evidence that underweight in the first two years was associated with a lower HAZ at 2 years of age (P &lt; 0.01) but not 5 (p = 0.08) and 10 years (p = 0.80). At 10 years of age, females with underweight in the first two years had 0.47 lower zBMI compared to females who did not have underweight, while males with underweight in the first two years had 0.32 lower zBMI compared to males who did not have underweight (all p values &lt; 0.01). Children with underweight and low growth trajectory in the first two years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, 10 years of age compared to children who did not have underweight (all p values &lt; 0.05). Children who had underweight and high growth trajectory in the first two years had similar zBMI (p = 0.06), WAZ (p = 0.67), higher HAZ and lower odds of overweight at 10 years of age (P &lt; 0.05), compared to children who did not have underweight. Conclusions Children with underweight in the first two years of life had lower zBMI, WAZ, and HAZ in later childhood. These relationships were stronger for females and low growth trajectory in the first two years and were attenuated among children with underweight and high growth trajectory in the first two years of life. Funding Sources Canadian Institute of Health Research (CIHR).

Key Points Question Is underweight in the first 2 years of life associated with lower growth in later childhood? Findings This cohort study of 5803 children found that children with underweight in the first 2 years had lower body mass index z score at age 10 years. These difference were greater for girls and children with lower growth rate in the first 2 years. Meaning This cohort study found that underweight in the first 2 years was associated with lower body mass index z score through age 10 years.

Background Underweight occurs when caloric intake is insufficient to maintain growth. While it has long been assumed that underweight in the first 2 years of life is associated with lower growth potential in later childhood, longer term growth outcomes in high income countries are unclear. Objectives The primary objective was to evaluate the relationship between underweight in the first 2 years of life and body mass index z-score (zBMI) in later childhood. Secondly, we examined the relationship between underweight in the first 2 years of life and weight-for-age z-score (WAZ) and height-for-age z-score (HAZ) in later childhood, and how sex and the zBMI growth trajectory in the first 2 years of life modify these associations. Design/Methods This was a prospective cohort study conducted through The Applied Research Group for Kids (TARGetKids!) practice-based research network. Healthy children 0-10 years of age were included. The primary exposure was underweight in the first 2 years of life using zBMI &lt;-2 as per the World Health Organization (WHO). The primary outcome was zBMI, and secondary outcomes were WAZ and HAZ between 2 and 10 years of age. Linear mixed effects models were used for the primary and secondary analysis to take into account multiple growth measures over time. Interaction terms for sex, and the zBMI growth trajectory in the first 2 years of life were used to explore effect modification. Results Among the 5,803 children included in the primary analysis, the mean age was 4.07 months, and 52.2% were male at baseline. In adjusted models, underweight in the first 2 years of life was associated with lower zBMI, lower WAZ, and higher odds of underweight at 2, 5, and 10 years of age (p &lt;0.0001). Underweight in the first 2 years was associated with a lower HAZ at 2 years of age (p&lt;0.0001), but not 5 (p=0.08), or 10 years of age (p=0.8). Females with underweight had lower zBMI and WAZ at 5 and 10 years of age, and lower HAZ at 10 years of age compared to males with underweight (p&lt;0.05). Children with underweight and lower growth trajectory in the first 2 years had lower zBMI, WAZ, HAZ, and higher odds of underweight at 2, 5, and 10 years of age compared to children who did not have underweight (p&lt;0.05). Children with underweight and high growth trajectory in the first 2 years had similar zBMI, WAZ, higher HAZ and lower odds of overweight at 10 years of age (p&lt;0.05), compared to children who did not have underweight. Conclusion Underweight in the first 2 years of life was associated with lower growth in later childhood. These relationships were amplified for females and children with underweight who had low growth trajectory in the first 2 years of life and were attenuated among children with underweight who had high growth trajectory in the first 2 years of life.