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Catch up growth and its determinants in low birth weight babies: a study using Z scores
A R Bavdekar1, U V Vaidya, S A Bhave
1Department of Pediatrics, K.E.M. Hospital Research Centre, Rasta Peth, Pune.
Insights
Low birthweight (LBW) survivors showed rapid early growth but lagged behind controls by age 4. Catch-up growth in LBW infants was influenced by early weight and height, highlighting the need for accessible growth charts.
Area of Science:
- Pediatrics
- Neonatology
- Growth and Development
Background:
- Low birthweight (LBW) infants face long-term growth challenges.
- Neonatal Intensive Care Unit (NICU) survivors require ongoing growth monitoring.
- Understanding catch-up growth patterns is crucial for LBW infant outcomes.
Purpose of the Study:
- To longitudinally track growth trends in LBW survivors compared to normal birthweight controls.
- To assess catch-up growth achievement at 4 years of age in LBW infants.
- To identify key determinants of catch-up growth in LBW populations.
Main Methods:
- Longitudinal follow-up of 247 LBW survivors and 164 controls from birth to 4 years.
- Growth parameters (weight, height, head circumference) analyzed using mean Z scores.
- Multiple regression analysis to determine predictors of catch-up growth.
Main Results:
- LBW infants exhibited rapid initial growth, but growth faltering occurred later compared to controls.
- By age 4, only 30.8% of LBW infants achieved catch-up weight, with lower rates for height (22.8%) and head circumference (26.5%).
- Weight and height at 1 year, and maternal weight, were significant predictors of catch-up growth in LBW infants.
Conclusions:
- Z scores effectively demonstrate growth trends and facilitate comparisons in LBW populations.
- Early growth trajectories and specific factors influence long-term catch-up growth in LBW infants.
- Simplified, community-accessible growth charts incorporating Z scores are recommended for LBW monitoring.
Abstract:
Two hundred and forty seven low birthweight (LBW) survivors of our Neonatal Intensive Care Unit and 164 normal birthweight controls were followed up longitudinally from birth to 4 years and their growth trends (weight, height, head circumference) were expressed as mean Z scores in 500 g birthweight categories. Whereas LBW's demonstrated rapid growth in the first 6 months of life, followed by generally parallel trends with some tendency to rise, controls showed distinct growth faltering especially after one year. Only 30.8% of LBWs (and 49% of controls) were within the designated catch up levels for weight by age 4 years. The corresponding number for catch up of height and head circumference in LBW's was 22.8% and 26.5%, respectively. On multiple regression analysis, the most important determinants of catch up (at 4 years) in LBW's were weight at 1 year (beta = 0.51), height at 1 year (beta = 0.31) and mother's weight (beta = 0.04). Thus, Z scores enabled the demonstration of changing growth trends, simultaneous comparisons with local controls and international standards and comparison within indices. Growth charts incorporating Z score should be made available in a simplified manner for use in the community.