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Early-life growth of preterm infants and its impact on neurodevelopment
Charlotte A Ruys1, Jonneke J Hollanders2, Tinka Bröring3
1Department of Pediatrics/Neonatology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands. c.ruys@vumc.nl.
Insights
Improved care has reduced adverse early-life growth in preterm infants, but its impact on neurodevelopment remains significant. Ensuring adequate growth is crucial for better long-term outcomes in these children.
Area of Science:
- Neonatal care and developmental pediatrics.
- Perinatal medicine and child health outcomes.
Background:
- Increasing survival rates of preterm infants necessitate focus on long-term health and neurodevelopment.
- Early-life growth is a known factor influencing neurodevelopmental trajectories in children born prematurely.
- This study investigates potential temporal changes in the association between early growth and neurodevelopment in preterm survivors.
Purpose of the Study:
- To examine if the association between early-life growth patterns and neurodevelopmental outcomes in preterm children has changed over time.
- To compare neurodevelopmental outcomes between cohorts of preterm infants from different eras.
- To identify specific growth patterns associated with adverse neurodevelopmental outcomes.
Main Methods:
- Comparison of two cohorts of preterm infants (gestational age ≤32 weeks and/or birth weight ≤1500g) born in 1983 and 2003-2006.
- Classification of early-life growth at 3 months corrected age into four patterns: AGA GR+, AGA GR-, SGA CUG+, and SGA CUG-.
- Assessment of neurodevelopmental outcomes including Intelligence Quotient (IQ), neuromotor function, and behavior at follow-up ages (19 years for the 1983 cohort, 8 years for the 2003-2006 cohort).
Main Results:
- The later cohort (2003-2006) exhibited a lower incidence of early-life growth restriction (GR).
- Infants classified as Small for Gestational Age with no catch-up growth (SGA CUG-) showed consistently unfavorable growth trajectories and poorer neurodevelopmental outcomes (IQ and neuromotor scores) in both cohorts.
- Infants who were Small for Gestational Age but achieved catch-up growth (SGA CUG+) had neurodevelopmental outcomes comparable to adequately grown infants.
Conclusions:
- While improvements in care have reduced adverse growth patterns in preterm infants over time, their impact on neurodevelopmental outcomes persists.
- Adequate early-life growth is critical for optimizing neurodevelopmental outcomes in preterm survivors.
- Particular attention to achieving adequate growth is essential for preterm infants born Small for Gestational Age (SGA).
Background:
Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time.
Methods:
We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts.
Results:
In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P < 0.001; neuromotor score β -1.9%, 95% CI -3.2; -0.6, P = 0.005), while SGA CUG+ subjects were comparable to adequately grown subjects.
Conclusion:
Although the incidence of adverse growth patterns decreased between the cohorts, possibly indicating improvements in care over time, the impact of these growth patterns on neurodevelopmental outcomes was not significantly different. Achieving adequate early-life growth may be crucial for improving neurodevelopmental outcomes, especially for preterms born SGA.
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