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Size and Growth After NICU Discharge in Extremely Low-Birth-Weight or Extremely Preterm Infants

Mandy B Belfort1, Lucy T Greenberg2,3, Danielle E Y Ehret2,4

  • 1Department of Pediatrics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts.

Pediatrics
|September 4, 2025
PubMed

Insights

Extremely low-birth-weight (ELBW) and extremely preterm (EPT) infants show significant catch-up growth after neonatal intensive care unit (NICU) discharge. However, these vulnerable children remain smaller than peers by 18-24 months corrected age.

Area of Science:

  • Neonatalogy and Pediatrics
  • Growth and Development Studies
  • Public Health and Epidemiology

Background:

  • Extremely low-birth-weight (ELBW) and extremely preterm (EPT) infants represent a vulnerable population requiring specialized growth monitoring.
  • Understanding growth trajectories and size indicators post-neonatal intensive care unit (NICU) discharge is crucial for long-term health outcomes.
  • Identifying factors influencing growth in ELBW/EPT infants can inform targeted interventions.

Purpose of the Study:

  • To describe size indicators at 18-24 months corrected age in ELBW/EPT infants.
  • To analyze growth patterns from NICU discharge to 18-24 months corrected age.
  • To examine infant and maternal determinants affecting size and growth outcomes in this cohort.

Main Methods:

  • Utilized data from 7301 ELBW/EPT children across 77 Vermont Oxford Network hospitals.
  • Assessed size indicators (weight, length, head circumference, BMI z scores) using WHO standards at 18-24 months corrected age.
  • Quantified growth via z score changes in weight and head circumference from NICU discharge to follow-up using multivariate regression.

Main Results:

  • ELBW/EPT infants experienced a median weight gain of 0.74 z scores from NICU discharge to 18-24 months.
  • Despite catch-up growth, infants remained lighter than reference standards (median z score -0.26) at follow-up.
  • Factors like small-for-gestational-age (SGA) status, NICU weight faltering, and surgical necrotizing enterocolitis predicted faster weight gain but smaller final size.

Conclusions:

  • ELBW/EPT infants demonstrate substantial, though incomplete, catch-up growth between NICU discharge and 18-24 months corrected age.
  • Persistent size deficits highlight the long-term impact of prematurity and low birth weight.
  • Further research into optimizing growth and development in this high-risk population is warranted.
Abstract

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