In Preterm Infants, Length Growth below Expected Growth during Hospital Stay Predicts Poor Neurodevelopment at 2 Years

Abstract

Background: In preterm infants, neonatal weight growth is associated with neurodevelopmental outcome but is a poor indicator of growth quality. Objective: The aim of this work was to measure the relationship between neonatal length growth and the 2-year neurological outcome in preterm infants. Methods: A total of 2,403 infants enrolled in the LIFT cohort with gestational age less than 34 weeks were studied. Neonatal observed length growth (OLG) was calculated as the change in length Z-score between birth and discharge. Expected length growth (ELG) was estimated based on gestational age, birth weight Z-score, birth length Z-score, gender, and observed neonatal weight growth. The difference between OLG and ELG (∆_OLG-ELG) was calculated as OLG – ELG, and infants were ranked into 3 classes depending on their ∆_OLG-ELG (≤–0.5, –0.49 to 0.49, ≥0.50 Z-score). We explored the relationship between ∆_OLG-ELG and 2-year neurodevelopmental outcome (n = 2,036), and, in a subgroup (n = 85), between ∆_OLG-ELG and body composition at discharge. Results: ELG was strongly predicted from the above-mentioned parameters (R² = 0.73, p = 0.001). OLG correlated closely with gestational age (p = 0.001) but ∆_OLG-ELG did not (p = 1.0). OLG was not associated with a 2-year nonoptimal outcome after adjustment for gestational age, but ∆_OLG-ELG ≤–0.5 was; the crude and adjusted odds ratios were 1.63 and 1.56, respectively. ∆_OLG-ELG correlated negatively with fat mass (R² = 0.29, p = 0.006) before and after adjustment for gestational age. Conclusion: ∆_OLG-ELG is a marker of neonatal growth that does not depend on gestational age, and may reflect quality of growth. A ∆_OLG-ELG ≤–0.5 Z-score is associated with a higher risk for 2-year nonoptimal neurodevelopmental outcome.

Late Growth and Changes in Body Composition Influence Odds of Developing Retinopathy of Prematurity among Preterm Infants

“…While the relationship between gains in body composition compartments and retinopathy of prematurity severity is novel, gains in these compartments are strongly associated with altered neurodevelopmental and metabolic outcomes. Greater gains in fat-free mass in infancy and early childhood are associated with improved speed of processing and overall cognition, while greater gains in fat mass in childhood increase risk for hypertension and insulin resistance [23,24]. Predictors of adverse body composition status (low lean mass and/or high adiposity) are both nutritional and non-nutritional, with risk factors present both prenatally (such as maternal hypertension) and postnatally (such as nutrient intake, steroid exposure, or degree of illness) [25][26][27][28].…”

Neonatal dietitian resourcing and roles in New Zealand and Australia: A survey of current practice

“…Preterm babies are more vulnerable to malnutrition than any other hospital population due to their low nutrient stores at birth, immature nutrient absorption, physiological immaturity, delayed initiation and advancement of intravenous and enteral nutrition and neonatal complications during a time of potentially extremely rapid growth and very high nutritional requirements. Malnutrition results in faltering growth, and both are associated with adverse long‐term neurodevelopmental outcomes . Emerging evidence confirms that for preterm babies optimising nutrition and growth, especially in the first few days and weeks after birth, is vital …”

“…Malnutrition results in faltering growth, and both are associated with adverse long‐term neurodevelopmental outcomes . Emerging evidence confirms that for preterm babies optimising nutrition and growth, especially in the first few days and weeks after birth, is vital …”

“…Malnutrition results in faltering growth, 2 and both are associated with adverse long-term neurodevelopmental outcomes. 3 Emerging evidence confirms that for preterm babies optimising nutrition and growth, especially in the first few days and weeks after birth, is vital. 3,4 While clear evidence for the optimal postnatal nutrition strategy to achieve this neonatal care goal is lacking, systematic reviews, international consensus nutrition recommendations and best practice guidelines based on the available evidence have been published.…”

“…3 Emerging evidence confirms that for preterm babies optimising nutrition and growth, especially in the first few days and weeks after birth, is vital. 3,4 While clear evidence for the optimal postnatal nutrition strategy to achieve this neonatal care goal is lacking, systematic reviews, international consensus nutrition recommendations and best practice guidelines based on the available evidence have been published. [5][6][7] However, surveys of neonatal nutrition practice in the United States, Britain, Europe, New Zealand and Australia demonstrate most neonatal units do not achieve the recommended nutrient intakes for preterm babies.…”