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Growth impairment in very low birthweight children at 12 years: correlation with perinatal and outcome variables
Insights
Growth problems persist in very low birthweight (VLBW) children into adolescence, with smaller head circumference linked to poorer cognitive and educational outcomes. Final adult heights may be significantly shorter than current measurements suggest.
Area of Science:
- Pediatric Endocrinology
- Developmental Pediatrics
- Child Psychology
Background:
- Very low birthweight (VLBW) is associated with potential long-term health and developmental challenges.
- Understanding persistent growth deficits and their contributing factors in VLBW survivors is crucial for optimizing outcomes.
- Early adolescence is a critical period for assessing growth trajectories and neurodevelopmental status in VLBW individuals.
Purpose of the Study:
- To compare adolescent growth in VLBW children versus normal birthweight peers.
- To investigate the influence of parental height, perinatal factors, bone age, and sexual maturation on VLBW growth.
- To examine the relationship between head growth and cognitive/educational performance in VLBW children.
Main Methods:
- Anthropometric measurements (height, weight, occipito-frontal circumference) and pubertal staging in 137 VLBW children and 160 controls (aged 11-13.5 years).
- Bone age assessment (TW2 method) in 70% of VLBW children; parental height data collected via questionnaire.
- Standardized cognitive and educational tests administered; prospective collection of perinatal data.
Main Results:
- VLBW children exhibited significantly lower heights, weight, and occipito-frontal circumference (OFC) compared to controls.
- Short stature in VLBW children was not explained by parental height, pubertal status, or bone age; bone age was advanced.
- Smaller OFC in VLBW children correlated with lower IQ, mathematics, and reading scores; predicted final heights were often below the tenth centile.
Conclusions:
- Growth deficits, particularly in height and head circumference, persist into adolescence for VLBW survivors.
- VLBW children have disproportionately smaller OFCs relative to their stature, potentially impacting cognitive and educational outcomes.
- Final adult heights in VLBW individuals may be more compromised than current adolescent measurements indicate, warranting continued monitoring.
Aim:
To compare the growth of very low birthweight (VLBW) children in early adolescence with that of their normal birthweight peers; to examine the role of factors contributing to growth-parental height, perinatal variables, bone maturity and sexual maturation; to examine the correlation between head growth and cognitive and educational outcome.
Methods:
Standing and sitting heights, weight, occipito-frontal circumference (OFC), skinfold thicknesses and pubertal staging were assessed in 137 VLBW children and 160 controls at 11-13.5 years of age. Ninety six (70%) of the VLBW children had their bone age assessed using the TW2 method. Reported parental heights were obtained by questionnaire. All children had standardised tests of cognitive and educational ability. Perinatal data had been collected prospectively as part of a longitudinal study.
Results:
VLBW children had lower heights, weight, and OFC. Skinfold thicknesses were no different. The children's short stature was not accounted for by difference in parental height, degree of pubertal development, or by retarded bone age. Indeed, the TW2 RUS score was significantly advanced in the VLBW children. Using the bone ages to predict final adult height, 17% have a predicted height below the third centile and 33% below the tenth. Weight was appropriate for height, but there was a residual deficiency in OFC measurements after taking height into account. In the VLBW group smaller head size was associated with lower IQ and mathematics and reading scores.
Conclusions:
Growth problems persist in VLBW children and final heights may be even more abnormal than present heights suggest. VLBW children have smaller OFCs than expected from their short stature alone and this may be associated with poorer educational and cognitive outcomes.