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Growth and Eating Behaviours at 2 Years Corrected Age in Extremely Low-Birthweight Babies; Secondary Cohort Analysis
Morgan J Easton1,2, Frank H Bloomfield1,2, Yannan Jiang1,3
1Liggins Institute, University of Auckland, Auckland 1023, New Zealand.
Insights
Growth in extremely low-birthweight infants after neonatal intensive care unit (NICU) discharge is linked to their NICU growth. Slower NICU growth predicted faster early childhood growth, impacting body composition and eating behaviors by age two.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Nutritional Science
Background:
- Early postnatal growth in extremely preterm infants can influence long-term health and development.
- Understanding growth trajectories post-NICU is crucial for optimizing outcomes in extremely low-birthweight (ELBW) infants.
Purpose of the Study:
- To investigate if growth up to two years corrected age (CA) is conditional on neonatal intensive care unit (NICU) growth in ELBW infants.
- To examine the relationship between early growth patterns, body composition, and eating behaviors at two years CA.
Main Methods:
- A conditional growth analysis was performed on 330 ELBW infants from the ProVIDe trial, followed to two years CA.
- Z-score changes for weight, length, and head circumference were analyzed from 36 weeks postmenstrual age (PMA) to two years CA.
- Bioimpedance analysis assessed growth and body composition; the Child Eating Behaviour Questionnaire (CEBQ) evaluated eating behaviors and their relation to BMI.
Main Results:
- Growth from 36 weeks PMA to two years CA was conditional on NICU growth; slower neonatal growth correlated with faster early childhood growth (weight: R²=0.27, length: R²=0.28, head circumference: R²=0.18).
- Fat-free mass index at two years CA positively correlated with weight z-score change from NICU discharge to two years CA (R²=0.50).
- Children with a BMI ≥ 90th percentile at two years CA exhibited significantly different eating behaviors (higher enjoyment, lower satiety/slowness) compared to those with lower BMIs.
Conclusions:
- Post-NICU growth is significantly influenced by NICU growth patterns in ELBW infants.
- Weight changes post-NICU are linked to fat-free mass index, suggesting implications for body composition.
- Eating behaviors at two years CA differ based on BMI percentile, highlighting potential links between growth and feeding patterns.
Abstract:
Early postnatal growth following extremely preterm birth may have long-term effects on growth, eating behaviours and health. Background/Objectives: To determine whether growth to age two years is conditional on growth in the NICU, a conditional growth analysis was performed in a cohort of 330 extremely low-birthweight (ELBW; birthweight < 1000 g) participants in the ProVIDe trial who were followed-up at 2 years corrected age (CA); Methods: We used z-score change for weight, length and head circumference from 36 weeks post-menstrual age to 2 years CA as the end-point-adjusted for birth z-score and z-score change from birth to 36 weeks. Growth and body composition were assessed using bioimpedance analysis. Relationships between eating behaviours and body mass index (BMI) at 2 years CA and growth were assessed using a Child Eating Behaviour Questionnaire (CEBQ) completed by parents at 2 years CA; Results: Growth, or change in z-score, from 36 weeks PMA was conditional upon growth in the NICU, with slower neonatal growth associated with faster early childhood growth (weight: R2 = 0.27, ß-coefficient -0.81 (95% CI: -0.96, -0.66), p < 0.0001; length: R2 = 0.28, ß-coefficient -0.64 (95% CI: -0.76, -0.51), p < 0.0001; head circumference: R2 = 0.18, ß-coefficient -0.61 (95% CI: -0.76, -0.46), p < 0.0001). Fat-free mass index, adjusted for confounding factors, was positively correlated with z-score change from NICU discharge to 2 years CA for weight, but not length (weight: R2 = 0.50, ß-coefficient = 0.87 (95% CI: 0.56, 1.18), p < 0.0001; length: R2 = 0.32, ß-coefficient = 0.01 (95% CI: -0.40, 0.42), p = 0.95). At 2 years CA, CEBQ scores for enjoyment were significantly higher and satiety and slowness significantly lower in children with a BMI ≥ 90th percentile than in children with a BMI ≤ 10th percentile or between the 10th-90th percentile.; Conclusions: Growth from NICU discharge to 2 years CA is conditional upon growth in the NICU, with slower NICU growth linked to faster early childhood growth, and weight z-score changes positively correlated with fat-free mass index. At age 2, children with a BMI ≥ 90th percentile have significantly different eating behaviour assessments by caregivers compared to children with a BMI ≤ 10th percentile or between the 10th-90th percentile; further RCTs are needed to confirm links between nutrition factors and growth outcomes in ELBW infants.
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