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Association between neonatal morbidities and head growth from birth until discharge in very-low-birthweight infants
Rivka H Regev1,2, Shmuel Arnon3,4, Ita Litmanovitz3,4
1Department of Neonatology, Meir Hospital, Sapir Medical Center, Kfar Saba, Israel. regevdr@netvision.net.il.
Insights
Major neonatal morbidities are linked to poor head growth in preterm very-low-birthweight infants. Understanding this association is key to improving head development and outcomes for these vulnerable newborns.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Preterm birth is associated with significant neonatal morbidities.
- Head growth is a critical indicator of neurodevelopment in infants.
- Very-low-birthweight (VLBW) infants are particularly vulnerable to growth disturbances.
Purpose of the Study:
- To investigate the association between major neonatal morbidities and head growth failure (HGF) in preterm VLBW infants.
- To quantify the risk of HGF in relation to specific neonatal complications.
Main Methods:
- A population-based observational study included 12,992 preterm infants (24-32 weeks gestation, birthweight ≤1500g).
- Head growth failure was defined by a decrease in head circumference z-score (>2 for severe, 1-2 for moderate).
- Multinomial logistic regression analysis identified morbidities associated with HGF.
Main Results:
- Severe HGF occurred in 4.5% and moderate HGF in 20.9% of infants.
- Increased odds of HGF were associated with respiratory distress syndrome, bronchopulmonary dysplasia, necrotizing enterocolitis, and sepsis.
- Each unit increase in head circumference z-score at birth was linked to significantly higher odds of both severe and moderate HGF.
Conclusions:
- Major neonatal morbidities are significantly associated with head growth failure in preterm VLBW infants.
- Further research is needed to determine if morbidities directly cause HGF or if it's mediated by nutritional/growth factors.
- Identifying the mechanisms underlying HGF can lead to targeted interventions to improve head growth in this population.
Aim:
To evaluate the possible association between major neonatal morbidities and poor head growth from birth to discharge home in very-low-birthweight (VLBW) infants born preterm.
Method:
Population-based observational study comprising 12 992 infants (6340 male, 6652 female) of 24 to 32 weeks' gestation, and birthweight ≤1500g. Severe head growth failure (HGF) was defined as a decrease in head circumference z-score >2 z-scores, and moderate HGF as a decrease of 1 to 2 z-scores. Multinomial logistic regression analysis was applied to determine morbidities associated with HGF.
Results:
Severe HGF occurred in 4.5% and moderate HGF in 20.9% of infants. Each unit increase in head circumference z-score at birth was associated with increased odds for severe and moderate HGF (odds ratios [OR] 5.29, 95% confidence intervals [CI] 4.67-6.00, and OR 2.38, 95% CI 2.23-2.54 respectively). Both severe and moderate HGF were associated with respiratory distress syndrome (OR 2.03, 95% CI 1.58-2.62, and OR 1.66, 95% CI 1.48-1.85 respectively); bronchopulmonary dysplasia (OR 3.38, 95% CI 2.33-4.91, and OR 1.87, 95% CI 1.52-2.30 respectively); necrotizing enterocolitis (OR 2.89, 95% CI 2.04-4.09, and OR 1.72, 95% CI 1.38-2.16 respectively), and sepsis (OR 2.06, 95% CI 1.69-2.50, and OR 1.38, 95% CI 1.24-1.53 respectively).
Interpretation:
Major neonatal morbidities were associated with HGF in VLBW infants born preterm. Identification of whether this is a direct effect of these morbidities or mediated through nutritional or growth factors may enable interventions to improve postnatal head growth of infants born preterm.
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