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Normative early head growth in very-low-birth-weight infants
Insights
Developing normative head growth curves for very-low-birth-weight infants with good neurodevelopmental outcomes is crucial. These curves provide the most appropriate standards for monitoring head growth in this vulnerable population.
Area of Science:
- Neonatalogy
- Pediatric Neurology
- Developmental Pediatrics
Background:
- Accurate head growth monitoring is vital for very-low-birth-weight (VLBW) infants.
- Existing growth charts may not adequately represent VLBW infants with optimal neurodevelopmental outcomes.
- Establishing precise growth trajectories aids in early identification of potential developmental issues.
Purpose of the Study:
- To develop normative head growth curves for VLBW infants.
- To establish standards based on infants with documented good neurodevelopmental outcomes at two years.
- To compare head growth patterns between normocephalic and microcephalic VLBW infants with favorable outcomes.
Main Methods:
- Serial weekly head circumference measurements were collected from 50 VLBW infants.
- Infants were assessed for neurodevelopmental outcome at two years using neurologic examination and the Bayley Mental Developmental Scale.
- Head growth curves were generated for infants with good versus poor neurodevelopmental outcomes, stratified by initial head circumference (normocephalic vs. microcephalic).
Main Results:
- Infants with good outcomes showed distinct head growth patterns compared to those with poor outcomes.
- Normocephalic infants with good outcomes experienced initial head shrinkage followed by consistent weekly increments.
- Microcephalic infants with good outcomes exhibited no initial shrinkage and a significantly greater mean weekly head circumference increment.
- Infants with poor outcomes, regardless of initial head size, demonstrated significantly reduced postnatal head growth.
Conclusions:
- Normative head growth curves derived from VLBW infants with documented good neurodevelopmental outcomes are the most appropriate growth standards.
- These specialized curves are essential for accurate assessment and monitoring of head growth in VLBW populations.
- The findings highlight the importance of considering initial head circumference and neurodevelopmental trajectory when evaluating head growth in VLBW infants.
Abstract:
Normative head growth curves were developed from serial weekly measurements of head circumference in 50 infants with birth weights less than 1500 gm who had good neurodevelopmental outcome at 2 years of age (assessed by neurologic examination and by the Bayley Mental Developmental Scale). Forty-one of the infants with good outcome were normocephalic at birth; after head shrinkage during the first week of life, increments in head circumference averaged 0.49 cm during the second week, 0.79 cm during the third week, and 0.95 cm per week thereafter. Nine infants with good outcome were microcephalic at birth; these infants had no head shrinkage during the first week of life and had a significantly greater mean weekly increment in head circumference of 0.98 cm (P less than 0.008). In contrast, 10 normocephalic and seven microcephalic infants with poor outcome had significantly less postnatal head growth (P less than 0.02 and p less than 0.001, respectively). Head growth curves developed from measurements in infants with documented good short-term developmental outcome are the most appropriate standards for head growth for very-low-birth-weight infants.