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Early Extra-Uterine Growth Restriction in Very-Low-Birth-Weight Neonates with Normal or Mildly Abnormal Brain MRI:
Paolo Massirio1, Marcella Battaglini1,2, Irene Bonato1
1Neonatal Intensive Care Unit, Maternal and Neonatal Department, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy.
Insights
Extra-uterine growth restriction (EUGR) in very-low-birth-weight (VLBW) neonates is linked to developmental delays. Improved post-discharge nutrition and family education are crucial for better outcomes in these infants.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Pediatric Nutrition
Background:
- Extra-uterine growth restriction (EUGR) is a frequent complication in very-low-birth-weight (VLBW) neonates, posing a risk for impaired neurodevelopment.
- Early identification and intervention are critical for optimizing long-term outcomes in VLBW infants.
Purpose of the Study:
- To investigate the association between weight growth patterns and neurodevelopmental outcomes in VLBW neonates.
- To identify specific growth parameters that may serve as predictors for developmental quotients (DQ) in early childhood.
Main Methods:
- Retrospective analysis of 288 VLBW neonates born between 2012-2018 with minimal or no MRI brain lesions.
- Assessment of EUGR using weight z-scores at term equivalent age (TEA), 6, and 12 months, and changes in z-scores.
- Evaluation of neurodevelopment using the Griffiths Mental Development Scale II (GMDS II) at 2 and 3 years of corrected age.
Main Results:
- A higher weight z-score at 6 months was significantly associated with a better global developmental quotient (DQ) at 2 years (OR 0.74; p=0.01).
- EUGR at 6 months correlated with poorer scores in locomotor, personal/social, language, and performance domains at 2 years.
- EUGR at 6 months was also linked to reduced language and practical reasoning DQ at 3 years.
Conclusions:
- Suboptimal weight z-score at 6 months is an independent risk factor for significantly impaired neurodevelopment in VLBW infants.
- Enhanced post-discharge nutritional support and comprehensive family nutritional education are recommended to improve developmental trajectories.
Abstract:
Extra-uterine growth restriction (EUGR) is a common complication and a known risk factor for impaired development in very-low-birth-weight (VLBW) neonates. We report a population of 288 patients with no or with low-grade MRI lesions scanned at a term equivalent age (TEA) born between 2012 and 2018. Griffiths Mental Development Scale II (GMDS II) at 2 and 3 years, preterm complications and weight growth were retrospectively analyzed. EUGR was defined for weight z-score ˂ 10 percentile at TEA, 6 and 12 months of correct age or as z-score decreased by 1-point standard deviation (SDS) from birth to TEA and from TEA to 6 months. Multivariate analysis showed that a higher weight z-score at 6 months is protective for the global developmental quotient (DQ) at 2 years (OR 0.74; CI 95% 0.59-0.93; p = 0.01). EUGR at 6 months was associated with worse locomotor, personal/social, language and performance DQ at 2 years and worse language and practical reasoning DQ at 3 years. In conclusion, a worse weight z-score at 6 months of age seems to be an independent risk factor for significantly reduced GMDS in many areas. These results suggest that we should invest more into post-discharge nutrition, optimizing family nutritional education.
