Abstract
This study aims to determine demographic or perinatal characteristics in premature infant according to head growth, identify clinical factors affecting growth catch-up, and find differences in developmental outcomes according to catch-up states based on Korean Neonatal Network (KNN) data. This nationwide prospective cohort study of Korean Neonatal Network (KNN) data analyzed premature infants with very low birth weight (< 1,500 g) between 2014 and 2017. A total of 253 eligible infants who had completed Bayley scales of infant and toddler development (BSID) 3rd were assigned into two groups: a catch-up (CU) group with head circumference above the 10th percentile and a no catch-up (NCU) group with head circumference below the 10th percentile at 18-24 months of corrected age (CA). Most (81.4%, 203/253) premature infants exhibited catch-up growth at 18-24 months of CA. Rates of microcephaly, intraventricular hemorrhage (IVH), bronchopulmonary dysplasia (BPD), sepsis, necrotizing enterocolitis (NEC), length of NICU stay, ventilation care, and parenteral nutrition were significantly greater in the NCU group (P < 0.05). On multiple linear regression analysis, the BPD status was the most clinical factor affecting catch-up head growth after adjusting for gestational age, birth weight, and birth head circumference (adjusted OR 4.586, 95% CI 1.960-10.729)At 18-24 months of CA, the NCU group exhibited lower developmental indices and higher rate of developmental delay than the CU group. Motor developmental delay was the most significant factor relevant to catch-up head growth and the motor development index difference between the two groups was only statistically significant after adjusting for four major neonatal morbidities: IVH, BPD, sepsis, and NEC status (adjusted OR 10.727, 95% CI 1.922-59.868). Thus, the developmental outcome of very low birth weight (VLBW) infants at 18-24 months of CA might be dependent on whether head growth was caught up. Key clinical factors determining the catch-up status were BPD and NEC status, length of parenteral nutrition, and ventilator care. Thus, measurements of head circumference at 18-24 months of CA can predict developmental delays of VLBW infants.