Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

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Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03510-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiajia Jing ◽

Yiheng Dai ◽

Yanqi Li ◽

Ping Zhou ◽

Xiaodong Li ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Postnatal Growth ◽

Weight Increase ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Growth Outcomes

Abstract Background Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. Methods A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. Results A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Conclusions Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

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The Presence of the d3-Growth Hormone Receptor Polymorphism Is Negatively Associated with Fetal Growth but Positively Associated with Postnatal Growth in Healthy Subjects

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2007-0176 ◽

2007 ◽

Vol 92 (7) ◽

pp. 2758-2763 ◽

Cited By ~ 34

Author(s):

Rikke Beck Jensen ◽

Signe Vielwerth ◽

Torben Larsen ◽

Gorm Greisen ◽

Henrik Leffers ◽

...

Keyword(s):

Birth Weight ◽

Fetal Growth ◽

Gestational Age ◽

Growth Velocity ◽

Intrauterine Growth Restriction ◽

Postnatal Growth ◽

Third Trimester ◽

Intrauterine Growth ◽

Prenatal Growth ◽

Ghr Gene

Abstract Context: A common polymorphism in the GH receptor (GHR) gene has been linked to increased growth response in GH-treated patients. No former study has focused on the association to prenatal growth. Objective: The aim of the study was to evaluate the association between the d3-GHR isoforms and spontaneous pre- and postnatal growth. Design: A prospective study was conducted on third-trimester fetal growth velocity (FGV), birth weight, birth length, and postnatal growth. Setting: The study was conducted at Copenhagen University Hospital. Participants: A total of 115 healthy adolescents were divided into those born small for gestational age (SGA) and appropriate for gestational age with or without intrauterine growth restriction. Main Outcome Measures: FGV was measured by serial ultrasonography, birth weight, birth length, and adolescent height. Isoforms of the d3-GHR gene (fl/fl, d3/fl, and d3/d3) were determined. Results: The prevalence of the d3-GHR isoforms was 50% but differed among the groups (P = 0.006), with a high prevalence (88%) in the group born SGA with verified intrauterine growth restriction. The d3-GRH allele were associated with decreased third-trimester FGV (P = 0.05) in SGA subjects. In the entire cohort, carriers of the d3-GHR allele had a significantly increased height (−0.10 vs. 0.34 sd score; P = 0.017) and change in height from birth to adolescence compared with carriers of the full-length GHR allele (0.57 vs. −0.02 sd score; P = 0.005). Conclusions: This study showed an increased spontaneous postnatal growth velocity in the carriers of the d3-GHR allele. Interestingly, we found the opposite effect on prenatal growth in the SGA group, with a decreased FGV in carriers of the d3-GHR allele.

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Growth Assessment in Preterm Children from Birth to Preschool Age

Nutrients ◽

10.3390/nu12071941 ◽

2020 ◽

Vol 12 (7) ◽

pp. 1941

Author(s):

Simone Ceratto ◽

Francesco Savino ◽

Silvia Vannelli ◽

Luisa De Sanctis ◽

Francesca Giuliani

Keyword(s):

Preterm Infant ◽

Preterm Infants ◽

Gestational Age ◽

Postnatal Growth ◽

Child Growth ◽

Preschool Age ◽

World Health ◽

Growth Standards ◽

Size At Birth

Preterm infant growth is a major health indicator and needs to be monitored with an appropriate growth curve to achieve the best developmental and growth potential while avoiding excessive caloric intake that is linked to metabolic syndrome and hypertension later in life. New international standards for size at birth and postnatal growth for preterm infants are available and need implementation in clinical practice. A prospective, single center observational study was conducted to evaluate the in-hospital and long-term growth of 80 preterm infants with a mean gestational age of 33.3 ± 2.2 weeks, 57% males. Size at birth and at discharge were assessed using the INTERGROWTH-21ST standards, at preschool age with World Health Organization (WHO) child growth standards. The employment of INTERGROWTH-21ST Preterm Postnatal longitudinal standards during the in-hospital follow-up significantly reduced the diagnosis of short term extrauterine growth restriction when compared to commonly used cross sectional neonatal charts, with significant lower loss of percentiles between birth and term corrected age (p < 0.0001). The implementation of a package of standards at birth, preterm postnatal growth standards and WHO child growth standards proved to be consistent, with correlation between centile at birth and at follow-up, and therefore effective in monitoring growth in a moderate and late preterm infant cohort without chronic or major morbidities. Infants identified as small for gestational age at birth showed significantly more frequently a need for auxological referral.

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Postnatal Growth Restriction in Preterm Infants: A Major Impact of Nutritional Practices and Methods of Assessment

New Emirates Medical Journal ◽

10.2174/03666211216101414 ◽

2021 ◽

Vol 03 ◽

Author(s):

Atef Alshafei ◽

Mahmoud Galal ◽

Anwar Khan ◽

Yaser Saba ◽

Moustafa Hassan

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Growth Parameters ◽

Caloric Intake ◽

Growth Failure ◽

Postnatal Growth ◽

Protein Supplementation ◽

Growth Restriction ◽

Growth Trajectories ◽

Z Score

Background: Nutritional management of preterm infants represents a significant challenge for most practitioners caring for sick and/or premature babies. Despite aggressive parenteral and enteral alimentation, a considerable number of preterm infants continue to fall far short of expected growth trajectories that match infants of similar gestation in-utero. Postnatal growth failure may be associated with future neurodevelopmental and cognitive impairments. Objective: The aim of the research is to investigate the incidence of postnatal growth restriction (PNGR) and characteristics of nutritional practices and growth parameters in a cohort of preterm infants born <32 weeks’ gestational age (GA) in a single neonatal intensive care unit (NICU). Methodology: This prospective study included 130 preterm infants born <32 weeks’ GA and admitted to the NICU between February 2018 and January 2020. The infants were divided into two groups: A (GA 23–26+6 weeks [n=50]) and B (27–31+6 weeks [n=80]). The association between PNGR and predicting risk factors was evaluated using logistic regression models. Results: PNGR was found in 62 (47%) infants at 28 days of life and increased to 73% of infants at 36 weeks’ postmenstrual age. Low birth weight and GA were independent factors predicting growth failure. PNGR was significantly correlated with birth weight (p < 0.01), length (p < 0.002), and GA (p < 0.03) at birth; however, HC was not a predictor of PNGR at 28 days. At 36 weeks’ PMA or discharge, PNGR was more pronounced in length, with a mean Z-score of -3.0, followed by weight, with a mean Z-score of -2.1, and an HC Z-score of -1.4. Conclusion : PNGR was significantly high in preterm infants <32 weeks’ gestation. A significant nutritional gap still exists between the recommended and actual caloric and protein supplementation, especially in the first few days after birth. Delayed optimization of caloric intake may be insufficient to promote growth trajectories, especially in preterm infants with significant morbidities.

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Growth Velocity of the Preterm Infant Managed with a Standardized Nutritional Protocol in a Tertiary Care Hospital

Faridpur Medical College Journal ◽

10.3329/fmcj.v15i2.53893 ◽

2021 ◽

Vol 15 (2) ◽

pp. 79-84

Author(s):

Mohammad Neamat Hossain ◽

Khalid Ahmed Syfullah ◽

Md Monir Hossain ◽

Gias Uddin Ahmed ◽

Mohammad Masudur Rahaman Khan ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Growth Velocity ◽

Nutritional Support ◽

Very Low Birth Weight ◽

Tertiary Care ◽

Postnatal Growth ◽

Calorie Intake ◽

Care Hospital

Prematurity is one of the major causes of neonatal death in developing countries like Bangladesh. Appropriate protocol for nutritional support of the preterm infants is essential to achieve a postnatal growth rate similar to that of a normal fetus. Objective of the study was to assess the effects of the existing nutritional support protocol of Bangabandhu Sheikh Mujib Medical University (BSMMU) in the early postnatal growth velocity of the preterm infants.This quasi-experimental study was conducted in the Department of Neonatology, BSMMU, Bangladesh from January to December 2015. All admitted infants aged <48 hours and born <_32 weeks of gestational age were included in this study. Infants were provided with nutritional support as per the BSMMU feeding guideline. The subsequent growth of the children was followed up routinely to measure the growth velocity. Of the 38 infants of our study, the mean calorie intake was 66.71 Kcal/kg/day. Overall mean growth velocity of weight, length and occipitofrontal circumference (OFC) up to discharge were 8.97 g/kg/day, 0.85 cm/week, and 0.41 cm/week respectively. Very low birth weight (VLBW) infants got significantly more calories compared to low birth weight (LBW) infants (p = 0.009). Mean growth velocity in weight of LBW infants were 8.18 g/kg/day and VLBW were 9.95 g/kg/day (p = 0.233). At birth, only 2.6% of infants had weight <10th centile, but at discharge, it was 52.6%. Early postnatal nutritional supplementation was not adequate, and postnatal growth failure remains very high in the hospital admitted preterm infants. Faridpur Med. Coll. J. 2020;15(2): 79-84

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Head growth during neonatal intensive care unit stay is related to neurodevelopmental outcome in preterm infants born small for gestational age

10.21203/rs.3.rs-41321/v1 ◽

2020 ◽

Author(s):

Hannah Cho ◽

Ee-Kyung Kim ◽

In Gyu Song ◽

Ju Sun Heo ◽

Seung Han Shin ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Preterm Infants ◽

Gestational Age ◽

Neonatal Intensive Care ◽

Neurodevelopmental Outcome ◽

Z Score ◽

Neurodevelopmental Outcomes ◽

Head Growth ◽

Catch Up

Abstract Background: To investigate postnatal growth patterns and their relationship with neurodevelopment in preterm infants born small for gestational age (SGA).Methods: This study analyzed 90 infants born SGA with birth weight <1,500 g or gestational age <32 weeks. Length, weight, and head circumference (HC) were recorded at birth, 35 weeks postmenstrual age (PMA), 40 weeks PMA, and at 4, 9, and 18 months corrected age (CA). Neurodevelopmental outcomes were assessed using the Bayley-III scales at 18 months CA. Results: Z-score of HC in SGA infants increased from birth to 40 weeks PMA. Failure of head growth catch-up to 10th percentile by 4 months CA and all three parameters by 9 months CA and onwards were associated with worse neurodevelopmental outcomes. Z-score changes in head growth between birth and 35 weeks PMA were significantly associated with neurodevelopmental outcome (p=0.006, adjusted odds ratio 6.964, 95% confidence interval: 1.763-27.506). Conclusions: Head growth during neonatal intensive care unit stay were associated with neurodevelopmental outcomes in preterm SGA infants. Preterm SGA infants are predicted to have optimal neurodevelopment at 18 months CA, if the head growth catch-up is achieved by 4 months CA and length and weight by 9 months CA.

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Impact of Prenatal and/or Postnatal Growth Problems in Low Birth Weight Preterm Infants on School-Age Outcomes: An 8-Year Longitudinal Evaluation

Yearbook of Neonatal and Perinatal Medicine ◽

10.1016/s8756-5005(08)70178-1 ◽

2007 ◽

Vol 2007 ◽

pp. 307-308

Author(s):

H.M. Feldman

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Postnatal Growth ◽

School Age ◽

Longitudinal Evaluation

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Differential Effect of Growth on Development between AGA and SGA Preterm Infants

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093022 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3022

Author(s):

In Gyu Song ◽

Ee-Kyung Kim ◽

Hannah Cho ◽

Seung Han Shin ◽

Jin A. Sohn ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Physical Growth ◽

Growth Spurt ◽

Z Score ◽

Neurodevelopmental Outcomes ◽

Important Indicator ◽

Very Preterm Infants ◽

Growth Measurement ◽

Appropriate For Gestational Age

Predicting developmental outcomes with growth measurement would be beneficial for primary healthcare or in developing countries with low medical resources. This study aimed to identify physical growth measures that indicate neurodevelopment in very preterm infants. Preterm infants, born at <32 weeks’ gestation or weighing <1500 g, were included. We calculated the changes in z-score of weight, length, and head circumference (HC) at different time points: birth, postmenstrual age (PMA) 35 weeks, and 4 and 18 months corrected age (CA). We examined the relationship between growth and Bayley-III scores using linear regression. Among 122 infants, HC at 4 months CA and HC growth between PMA 35 weeks and 4 months CA showed a positive correlation with Bayley-III scores in appropriate-for-gestational-age infants (AGAs). Weight and length increases between birth and 18 months CA were also associated with AGAs’ development. In small-for-gestational-age infants (SGAs), only birthweight’s z-score was associated with improved neurodevelopmental outcomes. HC at 4 months CA was an important indicator of favorable neurodevelopmental outcomes, and head growth spurt between PMA 35 weeks and 4 months CA contributed to this benefit in preterm AGAs. The period and indices should be monitored differently for SGAs and AGAs.

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Fenton vs. Intergrowth-21st: Postnatal Growth Assessment and Prediction of Neurodevelopment in Preterm Infants

Nutrients ◽

10.3390/nu13082841 ◽

2021 ◽

Vol 13 (8) ◽

pp. 2841

Author(s):

Miheret Yitayew ◽

Nayef Chahin ◽

Salem Rustom ◽

Leroy R. Thacker ◽

Karen Hendricks-Muñoz

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Growth Failure ◽

Postnatal Growth ◽

Assessment Tools ◽

Growth Monitoring ◽

Neurodevelopmental Outcomes ◽

Increased Risk ◽

Growth Assessment

Although the survival rate of preterm infants has improved over the years, growth failure and associated impaired neurodevelopmental outcome remains a significant morbidity. Optimal nutrition plays an important role in achieving adequate postnatal growth. Accurate growth monitoring of preterm infants is critical in guiding nutritional protocols. Currently, there is no consensus regarding which growth assessment tool is suitable for monitoring postnatal growth of preterm infants to foster optimal neurodevelopmental outcomes while avoiding future consequences of aggressive nutritional approaches including increased risk for cardiovascular disease and metabolic syndrome. A retrospective single center cohort study was conducted to compare the performance of two growth-assessment tools, Fenton and Intergrowth-21st (IG-21st) in the classification of size at birth, identification of impaired growth and predicting neurodevelopment. A total of 340 infants with mean gestational age of 30 weeks were included. Proportion of agreement between the two tools for identification of small for gestational age (SGA) was high 0.94 (0.87, 0.1) however, agreement for classification of postnatal growth failure at discharge was moderate 0.6 (0.52, 0.69). Growth failure at discharge was less prevalent using IG-21st. There was significant association between weight-based growth failure and poor neurodevelopmental outcomes at 12 and 24 months of age.

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