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Head growth in sick premature infants--a longitudinal study
Insights
Sick preterm infants experience growth delays, particularly in head circumference, during acute illness. Normal head growth during illness may indicate hydrocephalus, with catch-up growth occurring post-recovery.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Neurodevelopmental Pediatrics
Background:
- Preterm infants with severe neonatal problems exhibit significant growth challenges.
- Understanding brain growth dynamics in sick neonates is crucial for long-term outcomes.
- Distinguishing normal growth patterns from pathological conditions like hydrocephalus is vital.
Purpose of the Study:
- To assess somatic and head circumference growth velocity in sick preterm infants.
- To investigate the relationship between head growth patterns and potential hydrocephalus.
- To determine the impact of acute illness and recovery on infant growth trajectories.
Main Methods:
- Serial weekly measurements of somatic growth and head circumference over ten weeks.
- Study cohort: 41 preterm infants (gestational age 28-32 weeks) with severe neonatal issues.
- Comparison group: Six similar infants with head circumference following intrauterine growth curve.
Main Results:
- Sick infants showed sub-optimal growth velocity, deviating below the normal fetal growth curve during acute illness.
- Head growth normalized and exhibited catch-up growth during the recovery phase.
- Infants whose head circumference tracked the intrauterine curve developed hydrocephalus.
Conclusions:
- Brain growth is impaired in sick preterm infants; normal head growth may signal hydrocephalus.
- Significant 'catch-up' head growth occurs post-recovery, indicating brain plasticity.
- Normal growth in sick, low-birth-weight infants is contingent upon resolution of acute illness, despite adequate energy intake.
Abstract:
Serial weekly measurements of somatic growth and head circumference were made for ten weeks on 41 appropriately grown sick preterm infants (gestational age 28 to 32 weeks) with severe neonatal problems. Twenty-seven (66%) required prolonged assisted ventilation. During the period of acute illness, the velocity of growth for the sick infants was below that of the normal fetus, with deviation away from and below the normal fetal growth curve. During recovery, head growth paralleled that of normal fetal growth, and subsequently rapid "catch-up" growth in head circumference occurred. By comparison, six similar infants, whose head circumference followed the intrauterine growth curve, proved to have hydrocephalus. These results suggest that: (1) the brain participates in the growth retardation associated with being sick and premature and that apparently normal head growth under comparable circumstances may be associated with hydrocephalus; (2) in spite of an energy intake ranging from 80 to 120 kcal/kg/day by the end of the second postpartum week, normal growth in the sick low-birth-weight infant does not occur until their acute illness has resolved.