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Growth in very preterm children: Head growth after discharge is the best independent predictor for cognitive outcome
Karen Lidzba1, Susanne Rodemann1, Rangmar Goelz2
1University Children's Hospital Tübingen, Department of Pediatric Neurology and Developmental Medicine, Hoppe-Seyler-Str. 1, 72076 Tübingen, Germany.
Insights
Head growth after hospital discharge is the strongest predictor of cognitive outcomes in very low birth weight (VLBW) and very preterm (VP) infants. Further research is needed to identify interventions for improving head growth in these vulnerable infants.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Neuroscience
Background:
- Assessing the impact of growth on cognitive development in very low birth weight (VLBW) and very preterm (VP) infants is complex due to confounding factors.
- Previous research has not clearly established the specific growth parameters most critical for long-term neurodevelopmental outcomes in this population.
Purpose of the Study:
- To investigate the association between different growth parameters and the long-term cognitive and motor outcomes of VLBW/VP infants.
- To identify which specific period of growth, particularly head circumference growth, is most predictive of neurodevelopmental trajectories.
Main Methods:
- A prospective longitudinal study involving 136 VLBW/VP infants (<32 weeks gestation).
- Anthropometric measurements (weight, length, head circumference) were collected at birth, hospital discharge, and school-age (6.7-10.0 years).
- Cognitive and motor functions were assessed using standardized tests (Kaufman Assessment Battery for Children, Movement Assessment Battery for Children).
Main Results:
- Growth from birth to discharge significantly predicted cognitive outcomes for weight, length, and head circumference.
- Head growth between hospital discharge and school-age emerged as the strongest independent predictor of cognitive outcome.
- Unlike other growth parameters, head growth post-discharge was not significantly influenced by prenatal factors or neonatal morbidities.
Conclusions:
- Head circumference growth after hospital discharge is a critical determinant of cognitive outcomes in VLBW/VP infants.
- These findings highlight the importance of monitoring and potentially intervening in post-discharge head growth to optimize neurodevelopmental trajectories.
- Further studies are warranted to elucidate the determinants of head growth during this period and to develop targeted interventions.
Background:
The contribution of growth parameters to the cognitive outcome of very low birth weight (VLBW)/very preterm (VP) infants is difficult to disentangle from other preterm-birth related factors.
Aims:
We hypothesized that long-term cognitive and motor outcome of VLBW/VP infants is most strongly associated with growth in head circumference after hospital discharge.
Study Design:
Single-centre prospective longitudinal study: anthropometric measures at different time points (birth, discharge, school-age).
Subjects:
136 VLBW/VP infants (<32weeks gestation/birth weight<1.500g).
Outcome Measures:
Cognitive and motor function (Kaufman Assessment Battery for Children; Movement Assessment Battery for Children) at school-age (6.7-10.0years, mean=8.2).
Results:
In hierarchical multiple regression analyses, growth from birth to discharge significantly predicted cognitive outcome (weight: R2change=0.063, p=0.014; length: R2change=0.078, p=0.007; HC: R2change=0.050, p=0.030), as well as weight gain (R2change=0.096, p=0.001) and head growth (R2change=0.134, p<0.001) from discharge to school-age. While most growth parameters, especially those from birth to discharge, were significantly influenced by prenatal growth and immaturity related morbidity (R2=0.151 to 0.605, all p≤0.001), head growth after discharge was not (R2=0.029, p=0.461).
Conclusions:
Amongst all anthropometric measures, head growth between discharge and school-age is the best independent predictor for cognitive outcome in VLBW/VP infants. Determinants of head growth after discharge need further studies to identify targets for intervention.
