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The EPICure study: growth and associated problems in children born at 25 weeks of gestational age or less
N S Wood1, K Costeloe, A T Gibson
1School of Human Development, University of Nottingham, UK.
Insights
Extremely preterm infants show poor growth in early childhood. Factors like feeding problems and respiratory illness impact growth, highlighting the need for improved clinical care.
Area of Science:
- Neonatal Medicine
- Pediatric Growth and Development
- Public Health
Background:
- Extremely preterm birth (< 25 weeks 6 days gestation) poses significant challenges for infant development.
- Growth outcomes in this vulnerable population are critical indicators of long-term health.
- The EPICure study provides valuable data on growth trajectories in a defined cohort.
Purpose of the Study:
- To define and analyze growth outcomes in a geographically defined population of extremely preterm infants.
- To identify factors associated with poor growth in this cohort.
- To inform clinical care strategies for improving early childhood growth.
Main Methods:
- The study identified surviving infants born at <= 25 weeks 6 days gestation in the UK and Ireland (1995).
- Growth parameters (weight, head circumference, height, BMI, mid-upper arm circumference) were assessed at 30 months corrected age.
- Growth was correlated with neurodevelopmental assessments, perinatal variables, and clinical factors.
Main Results:
- Infants exhibited smaller measurements across all five growth parameters compared to population norms.
- Despite average birth size, preterm infants had significantly lower weight and head circumference at term-equivalent age.
- Poorer growth was linked to parental-reported feeding problems and prolonged oxygen dependency.
Conclusions:
- Poor early childhood growth is prevalent in extremely preterm infants.
- Prolonged systemic steroid use for chronic lung disease is associated with worsened growth.
- Prioritizing and improving early growth is essential for the clinical management of extremely preterm children.
Aim:
To define growth outcomes of a geographically defined population of extremely preterm babies.
Population:
The EPICure study identified all surviving children in the United Kingdom and Ireland born at < or = 25 weeks 6 days gestation between March and December 1995. Of 308 survivors, 283 (92%) were evaluated at 30 months of age corrected for prematurity.
Methods:
Growth was measured as part of a medical and full neurodevelopmental assessment. Growth parameters were evaluated in relation to other 30 month outcomes and perinatal variables.
Results:
The children were smaller in each of the five growth measures compared with published population norms: mean (SD) standard deviation scores were -1.19 (1.32) for weight, -1.40 (1.37) for head circumference, -0.70 (1.19) for height, -1.00 (1.38) for body mass index, and -0.75 (0.95) for mid-upper arm circumference. Despite being of average size at birth, children were significantly lighter with smaller head circumferences at the expected date of delivery, compared with population norms, and only weight showed later catch up, by 0.5 SD. Poorer growth was found in children whose parents reported feeding problems and with longer duration of oxygen dependency, as a marker for neonatal respiratory illness. Although severe motor disability was associated with smaller head circumference, overall there was no relation between Bayley scores and head growth.
Conclusions:
Poor growth in early childhood is common in extremely preterm children, particularly when prolonged courses of systemic steroids have been given for chronic lung disease. Improving early growth must be a priority for clinical care.
