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Feeding preterm infants after hospital discharge: growth and development at 18 months of age
R J Cooke1, N D Embleton, I J Griffin
1Special Care Baby Unit, Royal Victoria Infirmary, Newcastle Upon Tyne, United Kingdom. R.J.Cooke@ncl.ac.uk
Insights
Preterm infant formula improves growth up to 18 months, but does not affect development. Sex impacts growth and developmental outcomes in high-risk infants.
Area of Science:
- Neonatal nutrition
- Pediatric growth and development
- Infant feeding practices
Background:
- Preterm infants fed preterm formula exhibit improved growth post-discharge compared to those on term formula.
- Early growth differences in preterm infants warrant investigation into long-term effects on growth and development.
Purpose of the Study:
- To assess if enhanced early growth in preterm infants fed preterm formula is linked to improved later growth and neurodevelopmental outcomes.
- To evaluate the long-term impact of different infant formulas on growth and development up to 18 months corrected age.
Main Methods:
- Randomized controlled trial involving preterm infants (birth weight ≤1750 g, gestation ≤34 wk) assigned to preterm formula, term formula, or a combination.
- Anthropometric measurements (weight, length, occipitofrontal circumference) taken at 12 weeks, 6, 12, and 18 months corrected age.
- Bayley Scales of Infant Development II administered at 18 months to assess mental (MDI) and psychomotor (PDI) development.
Main Results:
- Growth differences observed at 12 weeks were sustained through 18 months.
- At 18 months, boys on preterm formula were heavier, longer, and had larger head circumference than boys on term formula.
- No significant differences in MDI or PDI were found between formula groups, but boys generally had lower MDI than girls, particularly those on term formula.
Conclusions:
- Early nutrition with preterm formula has lasting positive effects on growth in preterm infants up to 18 months corrected age.
- Infant feeding strategies do not appear to influence neurodevelopmental outcomes (MDI, PDI) by 18 months corrected age.
- Sex is a significant factor influencing growth and developmental assessments in high-risk preterm infants, necessitating consideration in analyses.
Abstract:
We have shown that preterm infants fed a preterm formula grow better than those fed a standard term infant formula after hospital discharge. The purpose of this follow-up study was to determine whether improved early growth was associated with later growth and development. Preterm infants (< or =1750 g birth weight, < or =34 wk gestation) were randomized to be fed either a preterm infant formula (discharge to 6 mo corrected age), or a term formula (discharge to 6 mo), or the preterm (discharge to term) and the term formula (term to 6 mo). Anthropometry was performed at 12 wk and 6, 12, and 18 mo. Mental and psychomotor development were assessed using the Bayley Scales of Infant Development II at 18 mo. Differences in growth observed at 12 wk were maintained at 18 mo. At 18 mo, boys fed the preterm formula were 1.0 kg heavier, 2 cm longer, and had a 1.0 cm greater occipitofrontal circumference than boys fed the term formula. Boys fed the preterm formula were also 600 g heavier and 2 cm longer than girls fed the preterm formula. However, no differences were noted in MDI or PDI between boys fed the preterm formula and boys fed the term formula or between the boys fed preterm formula and girls fed the preterm formula. Overall, boys had significantly lower MDI than girls (mean difference, 6.0; p < 0.01), primarily reflecting lower scores in boys fed the term formula. Thus, early diet has long-term effects on growth but not development at 18 mo of age. Sex remains an important confounding variable when assessing growth and developmental outcome in these high-risk infants.
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