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Updated: May 23, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
The relationship of poor linear growth velocity with neonatal illness and two-year neurodevelopment in preterm
Sara E Ramel1, Ellen W Demerath, Heather L Gray
1Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55454, USA. sramel@umn.edu
Insights
Poor linear growth in very low birth weight (VLBW) infants negatively impacts neurodevelopment. Linear stunting, even after controlling for weight and head size, is linked to lower cognitive function at 24 months corrected age.
Area of Science:
- Neonatalogy
- Pediatric Neurodevelopment
- Growth Monitoring
Background:
- Poor postnatal weight gain in very low birth weight (VLBW) preterm infants is linked to adverse neurodevelopmental outcomes.
- The dose-dependent effects of linear stunting on neurodevelopment in VLBW infants remain understudied.
- Linear growth is closely associated with organ growth, differentiation, and lean body mass.
Purpose of the Study:
- To determine the duration and clinical factors associated with poor linear growth in preterm infants.
- To investigate the relationship between linear growth and neurodevelopmental outcomes in VLBW infants.
- To establish linear growth as a potential biomarker for predicting long-term neurodevelopmental trajectories.
Main Methods:
- Tracking weight, length, and head circumference in 62 VLBW infants from birth to 24 months corrected age (CA).
- Calculating standardized Z-scores (weight, length, head circumference) and analyzing their correlation with inpatient clinical factors using regression models.
- Assessing 24-month neurodevelopmental function in relation to growth status throughout infancy.
Main Results:
- Mean length Z-score (LZ) was significantly lower than weight Z-score (WZ) at hospital discharge and remained below baseline until 24 months CA.
- Illness severity partially explained the reduced LZ at discharge.
- Lower LZ at 4 and 12 months CA, after adjusting for WZ and head circumference Z-score (HCZ), correlated with diminished cognitive function scores at 24 months CA.
Conclusions:
- Both nutritional and non-nutritional factors contribute to linear growth suppression in VLBW infants.
- Linear growth deficits before and after hospital discharge are negatively associated with 24-month neurodevelopmental outcomes.
- Linear growth serves as a crucial biomarker in VLBW infants, reflecting brain growth and clinical status, and can predict long-term developmental trajectories.
Background:
Poor postnatal weight gain in very low birth weight (VLBW) preterm infants has been shown to have a negative effect on neurodevelopment. However, the dose-dependent neurodevelopmental consequences of linear stunting in this population have not previously been assessed. Understanding this relationship is important because organ growth and differentiation are more tightly linked to lean body mass and thus linear growth.
Objective:
To assess the duration and clinical determinants of poor linear growth and its relationship to neurodevelopment in preterm infants.
Methods:
Weight, recumbent length and head circumference were recorded at birth, hospital discharge, and at 4, 12 and 24 months corrected age (CA) in 62 VLBW infants. Standardized Z-scores for weight (WZ), length (LZ) and head circumference (HCZ) were calculated and assessed as a function of inpatient clinical factors using linear regression models. Twenty-four-month neurodevelopmental function was analyzed as a function of growth status.
Results:
Mean LZ was lower than WZ (p = 0.004) at hospital discharge, was related in part to illness severity and remained lower than baseline LZ until 24 months CA. Controlling for WZ and HCZ at each age, lower LZ at 4 and 12 months CA was associated with lower cognitive function scores at 24 months CA (p ≤ 0.03).
Conclusions:
Nutritional and non-nutritional factors influenced the degree of pre- and postdischarge linear growth suppression in VLBW infants, which in turn was negatively associated with developmental outcomes at 24 months CA. Since linear growth correlates with brain growth and indexes a number of clinical factors, it is an important biomarker that can be used in VLBW infants to predict long-term developmental outcomes.
