Postnatal growth of preterm born children ≤ 750g at birth
M J Claas1, L S de Vries, C Koopman
1Department of Obstetrics, University Medical Centre, Wilhelmina Children's Hospital, Utrecht, The Netherlands.
Insights
Extremely low birth weight (ELBW) infants who experience catch-up growth, particularly in occipital-frontal circumference (OFC), show better cognitive outcomes. Appropriate for gestational age (AGA) ELBW infants maintaining weight above -2 SDS also demonstrate improved cognitive and motor development.
Area of Science:
- Pediatric Growth and Development
- Neonatal Intensive Care Outcomes
- Neurodevelopmental Pediatrics
Background:
- Extremely low birth weight (ELBW) infants face risks of impaired postnatal growth.
- Impaired growth in ELBW infants is linked to delayed cognitive and motor development.
Purpose of the Study:
- To analyze postnatal growth patterns in appropriate for gestational age (AGA) and small for gestational age (SGA) ELBW children.
- To correlate these growth patterns with cognitive and motor outcomes at 5.5 years of age.
Main Methods:
- Retrospective cohort study of 101 ELBW infants (birth weight ≤ 750g).
- Growth parameters (height, weight, OFC) were measured from birth to 5.5 years.
- Cognitive and motor outcomes were assessed at 5.5 years using standardized classifications.
Main Results:
- SGA infants showed catch-up growth in height, weight-for-height, weight, and OFC, though less consistently for weight.
- AGA infants exhibited catch-down growth in height and weight.
- Normal cognitive outcome was more frequent in AGA infants with weight SDS ≥-2 compared to those with catch-down growth.
Conclusions:
- Catch-up growth in height, weight-for-height, and OFC is common in SGA ELBW infants, but weight catch-up is less frequent.
- AGA ELBW infants maintaining weight at or above -2 SDS demonstrate better cognitive and motor development.
- Catch-up growth in OFC is associated with improved cognitive outcomes in ELBW children.
Background:
Extremely low birth weight (ELBW) infants are at risk of impaired postnatal growth. Impaired postnatal growth has been reported to be associated with delayed cognitive and motor development.
Aims:
To describe postnatal growth patterns of appropriate and small for gestational age (AGA and SGA) ELBW children in relation to their cognitive and motor outcome at age 5.5.
Study Design:
Retrospective cohort study.
Subjects:
One hundred one children with a BW ≤ 750g, born between 1996 and 2005 in the University Hospital Utrecht, The Netherlands.
Outcome Measures:
Height (Ht), weight (Wt), occipital-frontal circumference (OFC) at birth, 15 months and 2 years corrected age and 3.5 and 5.5 years. Cognitive and motor outcome at 5.5 years of age, classified as normal (Z-score ≥-1), mildly delayed (-2≤Z-score <-1) or severely delayed (Z-score <-2). AGA (Ht, Wt or OFC at birth ≥-2 SDS) infants were compared with SGA (Ht, Wt or OFC at birth <-2 SDS) infants.
Results:
Between birth and 5.5 years catch-up growth in Ht, weight for height (Wt/Ht), Wt and OFC was seen in 72.2%, 55.2%, 28.6% and 68.9% respectively of the SGA infants. For AGA infants we found substantial catch-down growth in Ht (15.4%) and Wt (33.8%). Cognitive and motor outcome was normal in 76.2% and 41.6% of the 101 children. A significantly higher percentage of normal cognitive outcome was found in AGA infants with Wt growth remaining at ≥-2 SDS compared to AGA infants with catch-down growth (83% vs 63%). Next, SGA infants who caught-up in OFC had a higher prevalence of normal cognitive outcome compared to SGA infants who did not catch-up in OFC. Furthermore, a higher percentage of severely delayed motor outcome was found in SGA infants without catch-up growth in Wt compared to SGA infants who caught-up in Wt (61.5% vs 32.2%).
Conclusions:
Catch-up growth in Ht, Wt/Ht and OFC occurred in the majority of the SGA infants with a BW ≤ 750 g, but was less common in Wt. AGA children who remained their Wt at ≥-2 SDS have a better cognitive and motor developmental outcome at 5.5 years of age. Catch-up growth in OFC was associated with a better cognitive outcome at 5.5 years of age.
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