Post-discharge body weight and neurodevelopmental outcomes among very low birth weight infants in Taiwan: A nationwide cohort study

Abstract

BackgroundPremature infants are at high risk for developmental delay and cognitive dysfunction. Besides medical conditions, growth restriction is regarded as an important risk factor for cognitive and neurodevelopmental dysfunction throughout childhood and adolescence and even into adulthood. In this study, we analyzed the relationship between post-discharge body weight and psychomotor development using a nationwide dataset.Materials and methodsThis was a nationwide cohort study conducted in Taiwan. Total of 1791 premature infants born between 2007 and 2011 with a birth weight of less than 1500 g were enrolled into this multi-center study. The data were obtained from the Taiwan Premature Infant Developmental Collaborative Study Group. The growth and neurodevelopmental evaluations were performed at corrected ages of 6, 12 and 24 months. Post-discharge failure to thrive was defined as a body weight below the 3rd percentile of the standard growth curve for Taiwanese children by the corrected age.ResultsThe prevalence of failure to thrive was 15.8%, 16.9%, and 12.0% at corrected ages of 6, 12, and 24 months, respectively. At corrected ages of 24 months, 12.9% had low Mental Developmental Index (MDI) scores (MDI<70), 17.8% had low Psychomotor Developmental Index (PDI) scores (PDI<70), 12.7% had cerebral palsy, and 29.5% had neurodevelopmental impairment. Post-discharge failure to thrive was significantly associated with poor neurodevelopmental outcomes. After controlling for potential confounding factors (small for gestational age, extra-uterine growth retardation at discharge, cerebral palsy, gender, mild intraventricular hemorrhage, persistent pulmonary hypertension of newborn, respiratory distress syndrome, chronic lung disease, hemodynamic significant patent ductus arteriosus, necrotizing enterocolitis, surfactant use and indomethacin use), post-discharge failure to thrive remained a risk factor.ConclusionThis observational study observed the association between lower body weight at corrected age of 6, 12, and 24 months and poor neurodevelopmental outcomes among VLBW premature infants. There are many adverse factors which can influence the neurodevelopment in NICU care. More studies are needed to elucidate the causal relationship.

Relationship of Prenatal Care to Poor Postnatal Outcomes in Infants Requiring Neurodevelopmental Assessment

“…Meanwhile, other examples of aforementioned neurological conditions showed very similar prevalence in the NPC and PC groups in both the NICU and the well-baby nursery. Though seemingly counterintuitive, this pattern is consistent with previous studies that show development of these pathologies is strongly correlated with the infant's gestational age [21] [24], which is especially pertinent in the NICU cohort, and whose distribution was similar between NPC and PC groups. However, as mentioned earlier, this might imply that seeking and completing prenatal care appropriately can benefit the mother-infant dyad by lowering the maternal risks associated with pregnancy, potentially increasing the birth weight of the infant and lowering the risk for developing pulmonary complications [25] [26] Open Access Library Journal [27].…”

“…Also notable was that birth weights were lower in the NPC group in both the NICU and newborn nursery, causing them to be more susceptible to medical complications. Also, the NPC group in the NICU showed a longer duration of respiratory support, a factor that contributed to a longer NICU stay (25.7 days in NPC group; 24.5 days in PC group) and chronic pulmonary conditions requiring further medical attention later in life [21]. When these chronic pulmonary conditions co-occur with low birth weight, they can significantly compromise the health of children later on in life.…”

“…When these chronic pulmonary conditions co-occur with low birth weight, they can significantly compromise the health of children later on in life. This is particularly significant, as most NPC mothers in this study reside in a jurisdiction where environmental conditions in some instances may further complicate pre-existing chronic lung conditions in their children [21] [22] [23].…”

Risk factors for postdischarge growth retardation among very-low-birth-weight infants: A nationwide registry study in Taiwan

“…20 Hsu et al also found that SGA was a significant factor for postdischarge failure to thrive in another nationwide cohort study in Taiwan. 14 Since postdischarge GR correlated to poorer neurodevelopmental outcomes, it is important to give adequate nutrition support for catch-up growth in SGA VLBW infants. 14 However, postnatal rapid weight gain in SGA infants seemed to be associated with increased fat mass and cardiovascular disease in later life.…”

“…15 Furthermore, the growth of VLBW infants may be affected by perinatal, cultural, ethnic, or environmental factors. 5,8,10,13,14,16 The present study described the prevalence of postdischarge GR among VLBW infants in Taiwan and identified possible risk factors for postdischarge GR from nationwide registry data.…”