Growth impairment in the very preterm and cognitive and motor performance at 7 years

Abstract

Background: Infants born of low birth weight often have poor subsequent growth (especially if they were born very preterm), which has been shown to relate to later motor and cognitive development. Aims: To assess a cohort of preterm infants at the age of 7 years for growth, motor, and cognitive measures, and investigate the effects of growth impairment on school performance. Methods: A cohort of 280 children born before 32 completed weeks of gestation were tested, together with 210 term controls. Results: Pretem children were significantly lighter and shorter than term controls and had smaller heads and lower body mass index (BMI). Median centiles for weight, height, head circumference, and BMI were 25, 25, 9, and 50 for boys and 50, 25, 9, and 50 for girls compared with 50, 50, 50, and 75 for controls. They performed significantly less well on all tests with a mean score of 91 (9.2) on the Developmental Test of Visual-Motor Integration, 89 (14.5) on the Wechsler-III IQ test, and 30.7% scoring at or below the 5th centile on the Movement Assessment Battery for Children. In boys, short stature and small heads were the best predictors of poor performance; in girls, a small head alone was a predictor for poor motor and cognitive performance. Conclusion: Poor postnatal growth in preterm infants, especially of the head, is associated with increased levels of motor and cognitive impairment at 7 years of age. This growth restriction appears to occur largely in the postnatal rather than antenatal period and may be amenable to intervention and subsequent improvement in outcome.

Growth after late-preterm birth and adult cognitive, academic, and mental health outcomes

“…Even though faster growth in infancy and childhood has been shown to benefit neurodevelopment in those born very preterm (<32 weeks) (9)(10)(11)(12), early preterm (<33 weeks) (13), preterm (14), and preterm with extremely low (<1000g) (15)(16)(17)(18) or very low (<1500g) (9,10,(19)(20)(21)(22) birth weight, in some, though not in all studies (23-25), it still remains unknown if faster early growth also benefits neurodevelopment in those born late-preterm. Accordingly, we examined if growth after late-preterm birth predicts neurocognitive functioning, academic performance, or mental health in individuals who were born latepreterm, and who participated in follow-up examinations at 5 and 20 months of corrected age (CA) and 56 months and 25 years of age.…”

Cuidados nutricionais no recém-nascido de muito baixo peso

“…Os nutrientes do leite materno podem ser insuficientes para o crescimento do PT, sendo necessária a suplementação com proteína e fósforo, melhorando o ganho de peso, a resposta metabólica e a mineralização óssea. 17 Em estudo longitudinal 18 de RNPT avaliados aos 7 anos de idade, observou-se alterações típicas do desenvolvimento e crescimento da criança, tais como menor desempenho motor, menor índice no teste de inteligência, menor perí-metro cefálico (PC) e índice de massa corpórea (IMC), além de déficit de crescimento e desenvolvimento cognitivo em longo prazo e lentidão nas atividades. Estas condições clínicas foram relacionadas diretamente ao fatores nutricionais durante internação e no período pós-natal dos RNMBP e PIG.…”

“…Estas condições clínicas foram relacionadas diretamente ao fatores nutricionais durante internação e no período pós-natal dos RNMBP e PIG. 18 Noutro estudo, Clark et al 19 destacam que prematuridade, baixo peso, sexo, necessidade de suporte ventilatório, presença de ECN e uso de esteróides, estão relacionados com déficit de crescimento no período pós-natal e dificuldade na nutrição. Isto leva a uma dificuldade neurosensorial e um pobre acompanhamento escolar, principalmente aqueles que têm o PC com 8 meses abaixo do esperado.…”

“…Cooke e Foulder-Hughes 18 Os déficits de crescimento e desenvolvimento do prematuro são diretamente relacionados aos aspectos nutricionais.…”

Dietary proteins and IGF I levels in preterm infants: determinants of growth, body composition, and neurodevelopment

“…At 11 y of age, 40% of children born before 26 wk of gestation have been reported to have serious neurocognitive impairment and moderate to severe impairment of neuromotor function, vision and hearing was reported in respectively 10, 9, and 2% of cases (3). Preterm birth and postnatal growth restriction have both been associated with impaired neurodevelopmental outcome (4). However, Franz et al found that only a small percentage of the variability, roughly 3%, of the mental processing composite score was explained by growth (5).…”