Growth faltering in Indian preterm infants: a prospective cohort study highlighting modifiable post-discharge feeding...

Preterm and extremely low birth weight infants are at high risk of postnatal growth restriction. This study was done to evaluate the growth trajectories during the first year of life among preterm infants ≤34 weeks' gestation and to identify the modifiable factors associated with undernutrition at 12-13 months corrected age (CA).

This prospective longitudinal cohort study was done in a hospital in South India. The participants were infants born at ≤34 weeks' gestation. They were enrolled at 4-6 months and followed up to 12-13 months CA. The birth details, anthropometric parameters at birth and infant feeding practices were noted initially at 6 months CA and again at 12-13 months CA. The primary outcomes were adverse anthropometric statuses at 12-13 months CA. Multivariable logistic regression identified independent risk factors for adverse outcomes.

Among 201 preterm infants, mean weight, length and head circumference (HC)-for-age Z-scores declined from birth to 12-13 months CA. At 12-13 months CA, 21.9% were underweight, 32.8% were stunted and 48.3% had HC-for-age Z-score (HCAZ) <-2. In multivariable analyses, lower gestational age and extremely low birth weight were associated with higher odds of underweight. Poor complementary feeding practices as indicated by the infant and young child feeding (IYCF) scores were associated with underweight and wasting. Early initiation of complementary feeding (<6 months CA) was associated with higher odds of stunting and HCAZ<-2.

The prevalence of underweight, stunting and HCAZ<-2 increased steadily from birth to 6 months and to 12-13 months. While lower gestational age and birth weight conferred biological risk, early complementary feeding and poor IYCF practices were significant modifiable determinants of adverse growth outcomes.