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Linear Growth Trajectories, Catch-up Growth, and Its Predictors Among North Indian Small-for-Gestational Age Low

Bireshwar Sinha^1,2, Tarun Shankar Choudhary^3,4, Nitika Nitika¹

¹Centre for Health Research and Development, Society for Applied Studies, New Delhi, India.

Frontiers in Nutrition

|June 10, 2022

Insights

Small-for-gestational-age, low birthweight infants show poorer linear growth and higher stunting risk. Interventions like institutional delivery and exclusive breastfeeding can improve growth in these vulnerable infants.

Area of Science:

Pediatrics
Neonatology
Public Health

Background:

Low birthweight small-for-gestational-age (SGA-LBW) infants face increased risks of poor postnatal growth.
Linear growth patterns in SGA-LBW infants are understudied in South Asian populations, including India.

Purpose of the Study:

To compare linear growth trajectories of SGA-LBW infants versus appropriate-for-gestational-age LBW (AGA-LBW) infants in the first 6 months.
To assess catch-up growth in SGA-LBW infants and identify factors associated with poor growth outcomes.

Main Methods:

Analysis of data from a randomized controlled trial involving 8,360 low birthweight infants (1,500-2,250 g).
Comparison of length, linear growth velocity, length-for-age z-score (LAZ), and stunting between SGA-LBW and AGA-LBW groups.
Generalized linear models used to identify factors linked to poor catch-up growth in SGA-LBW infants.

Main Results:

SGA-LBW infants exhibited higher stunting risk, lower length, and lower LAZ scores compared to AGA-LBW infants up to 6 months.
Linear growth velocity was lower in SGA-LBW infants from birth to 28 days but higher from 3 to 6 months.
55% of SGA-LBW infants achieved catch-up growth by 6 months; lower socioeconomic status, high birth order, home birth, male sex, term delivery, non-exclusive breastfeeding, and pneumonia were associated with poor catch-up.

Conclusions:

SGA status at birth significantly impacts postnatal linear growth, irrespective of gestational age.
Promoting institutional deliveries, exclusive breastfeeding, and timely pneumonia management can enhance linear growth in SGA-LBW infants.

Read full analysis

Abstract

Background:

Low birthweight small-for-gestational-age (SGA-LBW) (birthweight below the 10th percentile for gestational age; SGA-LBW) infants are at an increased risk of poor postnatal growth outcomes. Linear growth trajectories of SGA-LBW infants are less studied in South Asian settings including India.

Objectives:

To describe the linear growth trajectories of the SGA-LBW infants compared with appropriate-for-gestational-age LBW (AGA-LBW) infants during the first 6 months of life. In addition, we estimated catch-up growth (ΔLAZ > 0.67) in SGA-LBW infants and their performance against the WHO linear growth velocity cut-offs. Additionally, we studied factors associated with poor catch-up growth in SGA-LBW infants.

Methods:

The data utilized came from an individually randomized controlled trial that included low birthweight (LBW) infants weighing 1,500-2,250 g at birth. A total of 8,360 LBW infants were included. For comparison between SGA-LBW and AGA-LBW infants, we presented unadjusted and adjusted estimates for mean differences (MDs) or risk ratios (RRs) for the outcomes of length, linear growth velocity, length for age z-score (LAZ) score, and stunting. We estimated the proportion of catch-up growth. Generalized linear models of the Poisson family with log links were used to identify factors associated with poor catch-up growth in SGA-LBW infants.

Results:

Low birthweight small-for-gestational-age infants had a higher risk of stunting, lower attained length, and a lower LAZ score throughout the first 6 months of life compared with AGA-LBW infants, with differences being maximum at 28 days and minimum at 6 months of age. The linear growth velocity in SGA-LBW infants compared with AGA-LBW infants was significantly lower during the birth-28 day period [MD -0.19, 95% confidence interval (CI): -0.28 to -0.10] and higher during the 3- to 6-month period (MD 0.17, 95% CI: 0.06-0.28). Among the SGA-LBW infants, 55% showed catch-up growth for length at 6 months of age. Lower wealth quintiles, high birth order, home birth, male child, term delivery, non-exclusive breastfeeding, and pneumonia were associated with the higher risk of poor catch-up in linear growth among SGA-LBW infants.

Conclusion:

Small for gestational age (SGA) status at birth, independent of gestational age, is a determinant of poor postnatal linear growth. Promotion of institutional deliveries, exclusive breastfeeding, and prevention and early treatment of pneumonia may be helpful to improve linear growth in SGA-LBW infants during early infancy.

Clinical Trial Registration:

[https://clinicaltrials.gov/], identifier [NCT02653534].

Keywords:

catch-up growth (CUG)growth faltering linear growth low birthweight (LBW) infant small for gestational age (SGA)

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