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The prognostic significance of postnatal growth in very low--birth weight infants
Insights
Catch-up growth is crucial for infants with intrauterine growth restriction or extrauterine growth failure. Successful catch-up growth by 8 months corrected age indicates a positive prognosis for very low-birth-weight infants.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Perinatal Medicine
Background:
- Intrauterine growth restriction (IUGR) and extrauterine growth failure impact infant development.
- Assessing the prognostic significance of catch-up growth in high-risk infants is essential.
Purpose of the Study:
- To evaluate the relative importance of different types of growth failure.
- To determine the prognostic significance of catch-up growth in very low-birth-weight (VLBW) infants.
Main Methods:
- Prospective follow-up of 192 VLBW infants to 8 months corrected age.
- Categorization of appropriate-for-gestational age (AGA) and small-for-gestational age (SGA) infants based on weight for age at term and 8 months.
- Analysis of correlates of subnormal weight and neurodevelopmental outcomes.
Main Results:
- Many AGA infants experienced subnormal weight by term, with a significant proportion achieving catch-up growth by 8 months.
- SGA infants showed varying patterns of catch-up growth, with some achieving it by term and others by 8 months.
- Failure to thrive or catch up by 8 months was associated with lower developmental quotients, smaller head circumferences, and increased neurosensory impairment.
Conclusions:
- Intrauterine and/or postnatal growth failure prior to term is not necessarily detrimental if catch-up growth occurs later.
- Catch-up growth by 8 months corrected age is a key indicator of favorable neurodevelopmental outcomes in VLBW infants.
- Neonatal risk score, chronic disease, and hospitalization duration are significant correlates of subnormal weight in VLBW infants.
Abstract:
To examine the relative importance of intrauterine growth failure, extrauterine growth failure before or after term, and the prognostic significance of catch-up growth, 192 very low--birth weight infants (less than 1.5 kg) were followed prospectively to 8 months corrected age. One hundred fifty-four appropriate--for--gestational age (AGA) and 38 small--for--gestational age (SGA) infants were categorized into normal and subnormal (less than -2 SD) weight for age groups at term (40 weeks) and at 8 months corrected age. By term, 71 AGA infants had subnormal weight; 41 of these caught up by 8 months, and an additional 13 AGA infants failed to thrive between term and 8 months. Of the SGA infants, three caught up in weight by term, and an additional 16 caught up by 8 months. Significant correlates of subnormal weight included neonatal risk score, incidence of chronic disease, and extended hospitalization. The AGA and SGA infants who failed to thrive or failed to catch up in weight by 8 months had lower mean Bayley developmental quotients (p less than 0.005), smaller head circumferences (p less than 0.005), and a higher rate of neurosensory impairment (p less than 0.01) than the AGA infants with normal fetal and postnatal growth. Intrauterine and/or postnatal growth failure prior to term was not of sinister prognostic significance if catch up occurred thereafter.