Elsevier

The Journal of Pediatrics

Volume 175, August 2016, Pages 93-99.e1
The Journal of Pediatrics

Original Article
Effect of Intra- and Extrauterine Growth on Long-Term Neurologic Outcomes of Very Preterm Infants

https://doi.org/10.1016/j.jpeds.2016.05.027Get rights and content

Objective

To determine whether extrauterine growth is associated with neurologic outcomes and if this association varies by prenatal growth profile.

Study design

For 1493 preterms from the EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) cohort, appropriate for gestational-age (AGA) was defined by birth weight >−2 SD and small for gestational-age (SGA) by birth weight ≤−2 SD. Extra-uterine growth was defined by weight gain or loss between birth and 6 months by z-score change. Growth following–the-curve (FTC) was defined as weight change −1 to +1 SD, catch-down-growth (CD) as weight loss ≥1 SD, and catch-up-growth (CU) as weight gain ≥1 SD. At 5 years, a complete medical examination (n = 1305) and cognitive evaluation with the Kauffman Assessment Battery for Children (n = 1130) were performed. Behavioral difficulties at 5 years and school performance at 8 years were assessed (n = 1095).

Results

Overall, 42.5% of preterms were AGA-FTC, 20.2% AGA-CD, 17.1% AGA-CU, 5.6% SGA-FTC, and 14.5% SGA-CU. Outcomes did not differ between CU and FTC preterm AGA infants. Risk of cerebral palsy was greater for AGA-CD compared with AGA-FTC (aOR 2.26 [95% CI 1.37-3.72]). As compared with children with SGA-CU, SGA-FTC children showed no significant increased risk of cognitive deficiency (aOR 1.41[0.94-2.12]) or school difficulties (aOR 1.60 [0.84-3.03]). Compared with AGA-FTC, SGA showed increased risk of cognitive deficiency (SGA-FTC aOR 2.19 [1.25-3.84]) and inattention-hyperactivity (SGA-CU aOR 1.65 [1.05-2.60]).

Conclusion

Deficient postnatal growth was associated with poor neurologic outcome for AGA and SGA preterm infants. CU growth does not add additional benefits. Regardless of type of postnatal growth, SGA infants showed behavioral problems and cognitive deficiency.

Section snippets

Methods

The EPIPAGE (Étude Épidémiologique sur les Petits Âges Gestationnels [Epidemiological Study on Small Gestational Ages]) 1 is a population-based cohort study recording all live births in 1997 between 22 and 32 weeks' gestation across all maternity units in 9 regions in France (Figure; available at www.jpeds.com). Infants were followed from birth to 8 years of age. Infants with neonatal malformations (n = 426) were excluded. Among the 2242 infants born between 24 and 32 weeks' gestation who were

Results

At 6 months, compared with children with known information on postnatal growth (n = 1489), those without this information (n = 568) more frequently had mothers with non-French nationality (P < .01), received antenatal corticosteroids (78.7% vs 73.3%, P = .013), had a greater mean BW (1412 ± 417.3 vs 1366 ± 382 g, P = .017), and were less frequently breastfed (18.5% vs 23.9%, P < .011) (Table II). Concerning long-term outcome, children with unknown information had significantly more cognitive

Discussion

Our study found differences in the impact of postnatal growth on neurodevelopmental outcomes for SGA and AGA preterm children. For AGA preterm children, growth failure was significantly associated with cerebral palsy. For SGA children, poor postnatal growth was associated with cognitive deficiency and school difficulties, although not significantly. Nevertheless, SGA children remained at risk of cognitive deficiency and behavioral difficulties as compared with children with AGA-FTC.

References (38)

  • K.M. Pfister et al.

    Linear growth and neurodevelopmental outcomes

    Clin Perinatol

    (2014)
  • J.J. Volpe

    Brain injury in premature infants: a complex amalgam of destructive and developmental disturbances

    Lancet Neurol

    (2009)
  • K.K. Ong et al.

    Postnatal growth in preterm infants and later health outcomes: a systematic review

    Acta Paediatr

    (2015)
  • G.C. Powers et al.

    Postdischarge growth and development in a predominantly Hispanic, very low birth weight population

    Pediatrics

    (2008)
  • C. Huang et al.

    Cognition and behavioural development in early childhood: the role of birth weight and postnatal growth

    Int J Epidemiol

    (2013)
  • M.B. Belfort et al.

    Infant growth before and after term: effects on neurodevelopment in preterm infants

    Pediatrics

    (2011)
  • R.A. Ehrenkranz et al.

    Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants

    Pediatrics

    (2006)
  • P.H. Casey et al.

    Impact of prenatal and/or postnatal growth problems in low birth weight preterm infants on school-age outcomes: an 8-year longitudinal evaluation

    Pediatrics

    (2006)
  • A. Fattal-Valevski et al.

    Growth patterns in children with intrauterine growth retardation and their correlation to neurocognitive development

    J Child Neurol

    (2009)
  • Cited by (119)

    • Implementation of a Nutrition Care Bundle and Improved Weight Gain of Extremely Preterm Infants to 36 Weeks Postmenstrual Age

      2022, Journal of Pediatrics
      Citation Excerpt :

      On a broader scale, defining optimal growth for preterm infants in the NICU remains a challenge. Poor growth is strongly associated with adverse neurodevelopmental outcomes,1,2 and overly rapid growth may be associated with metabolic disturbances later in life, although evidence is mixed in this regard.25,26 The complexities of optimal nutritional support for these vulnerable infants cannot be overestimated.

    • Addressing nutritional needs in preterm infants to promote long-term health

      2022, Early Nutrition and Long-Term Health: Mechanisms, Consequences, and Opportunities, Second Edition
    View all citing articles on Scopus

    Supported by INSERM (National Institute of Health and Medical Research, the Directorate General for Health at the Ministry for Social Affairs, Merck-Sharp and Dohme-Chibret, Medical Research Foundation, and the Hospital Program for Clinical Research (2001 nuAOM01117 of the French Department of Health). The 8-year follow up was supported by the Hospital Program for Clinical Research (2004/054/HP) at the French Department of Health and the Wyeth Foundation for Children and Adolescents. The authors declare no conflicts of interest.

    List of additional members of the EPIPAGE Study Group is available at www.jpeds.com (Appendix).

    View full text