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Extreme prematurity, growth and neurodevelopment at 8 years: a cohort study
Leah Hickey1,2,3, Alice Burnett4,3,5,6, Alicia J Spittle3,7,8
1Department of Neonatal Medicine, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia leah.hickey@rch.org.au.
Insights
Growth in extremely preterm infants has not improved over time. However, better early head and weight growth are linked to improved neurodevelopment at age eight.
Area of Science:
- Neonatal research
- Developmental pediatrics
- Growth and development studies
Background:
- Infants born extremely preterm (<28 weeks' gestation) often experience growth deficits and neurodevelopmental impairments compared to term-born infants.
- The long-term impact of growth on neurodevelopment in extremely preterm infants, particularly in relation to advancements like surfactant therapy, requires further investigation.
- Understanding growth trajectories and their association with neurodevelopmental outcomes is crucial for optimizing care for extremely preterm infants.
Purpose of the Study:
- To compare growth patterns from birth to 8 years in extremely preterm infants across three distinct eras (1991-1992, 1997, 2005).
- To examine the association between growth (birth to 2 years, and birth to 8 years) and neurodevelopmental outcomes (cognitive, academic, executive, motor function) at 8 years.
- To determine if these growth-neurodevelopment associations have changed over the studied eras.
Main Methods:
- Prospective observational cohort studies conducted in Victoria, Australia, across three time periods.
- Measurement of weight and head circumference at birth, and weight, head circumference, and height at 2 and 8 years for extremely preterm infants.
- Neurodevelopmental assessments (cognitive, academic, executive function, motor skills) at 8 years, with corrections for prematurity.
Main Results:
- Growth trajectories for extremely preterm infants did not significantly differ across the three eras.
- No substantial changes were observed in the associations between growth and neurodevelopmental outcomes over time.
- Improved weight and head growth from birth to 2 years were consistently associated with better neurodevelopmental functioning at 8 years.
Conclusions:
- Growth in extremely preterm infants has not shown significant improvement in recent decades.
- Early head and weight growth are critical predictors of improved neurodevelopmental outcomes in mid-childhood.
- These findings underscore the importance of monitoring and supporting early growth in extremely preterm infants to foster better long-term neurodevelopment.
Objective:
Infants born extremely preterm (EP, <28 weeks' gestation) exhibit poorer growth and neurodevelopmental impairment in early childhood compared with their term-born peers. Whether poor growth persists and whether associations of growth with neurodevelopmental functioning have changed in the decades since the introduction of surfactant are not well described. This study aims to (1) compare growth from birth to 2 years then 8 years in children born EP between three different eras, and (2) investigate the associations of growth from birth to 2 years then 8 years with cognitive, academic, executive and motor function at 8 years, and if associations have changed over time.
Design:
Prospective observational cohort studies in the State of Victoria, Australia in three discrete eras: 1991-1992, 1997 and 2005. EP children had weight and head circumference measured at birth, and weight, head circumference and height at 2 and 8 years. Cognitive ability, academic performance, executive function and motor skills were assessed at 8 years, corrected for prematurity.
Results:
499/546 (91%) of surviving EP children were fully assessed at 8 years. Growth in children born EP did not differ substantially between eras and associations between growth and neurodevelopment did not change over time. Overall, better weight and head growth from birth to 2 years were associated with improved neurodevelopment at 8 years.
Conclusions:
Growth of children born EP has not improved in more recent eras. Better early head and weight growth are associated with improved neurodevelopment in mid-childhood.
