One‐year anthropometric follow‐up of South African preterm infants in kangaroo mother care: Which early‐life factors predict malnutrition?

Abstract

BackgroundPreterm infants often have poor short‐ and long‐term growth. Kangaroo mother care supports short‐term growth, but longer‐term outcomes are unclear.MethodsThis study analysed longitudinally collected routine clinical data from a South African cohort of preterm infants (born <37 weeks gestation) attending the outpatient follow‐up clinic of a tertiary‐level hospital (Tshwane District, South Africa) for 1 year between 2012 and 2019. At 1 year, small‐for‐gestational age (SGA) and appropriate‐for‐gestational age (AGA) infants were compared with regard to age‐corrected anthropometric z‐scores (weight‐for‐age [WAZ], length‐for‐age [LAZ], weight‐for‐length [WLZ] and BMI‐for‐age [BMIZ]) and rates of underweight (WAZ < −2), stunting (LAZ < −2), wasting (WLZ < −2) and overweight (BMIZ> + 2). Multiple regression analysis was used to investigate associations between maternal/infant characteristics and rates of underweight, stunting, wasting and overweight.ResultsAt 1 year, compared with AGA infants (n = 210), SGA infants (n = 111) had lower WAZ (−1.26 ± 1.32 vs. −0.22 ± 1.24, p < 0.001), LAZ (−1.50 ± 1.11 vs. −0.60 ± 1.06, p < 0.001), WLZ (−0.66 ± 1.31 vs. 0.11 ± 1.24, p < 0.001) and BMIZ (−0.55 ± 1.31 vs. 1.06 ± 1.23, p < 0.001), despite larger WAZ gains from birth (+0.70 ± 1.30 vs. +0.05 ± 1.30, p < 0.001). SGA infants had significantly more stunting (34.2% vs. 9.1%; p < 0.001), underweight (31.2% vs. 7.2%; p < 0.001) and wasting (12.6% vs. 4.3%, p = 0.012), with no difference in overweight (4.5% vs. 7.7%, p = 0.397). In multiple regression analysis, birth weight‐for‐GA z‐score more consistently predicted 1‐year malnutrition than SGA.ConclusionPreterm‐born SGA infants remain more underweight, stunted and wasted than their preterm‐born AGA peers at 1 year, despite greater WAZ gains. Interventions for appropriate catch‐up growth especially for SGA preterm infants are needed.