Perinatal determinants of growth trajectories in children born preterm

Abstract

Background A growing amount of evidence indicates in utero and early life growth has profound, long-term consequences for an individual’s health throughout the life course; however, there is limited data in preterm infants, a vulnerable population at risk for growth abnormalities. Objective To address the gap in knowledge concerning early growth and its determinants in preterm infants. Methods A retrospective cohort study was performed using a population of preterm (< 37 weeks gestation) infants obtained from an electronic medical record database. Weight z-scores were acquired from discharge until roughly two years corrected age. Linear mixed effects modeling, with random slopes and intercepts, was employed to estimate growth trajectories. Results Thirteen variables, including maternal race, hypertension during pregnancy, preeclampsia, first trimester body mass index, multiple status, gestational age, birth weight, birth length, head circumference, year of birth, length of birth hospitalization stay, total parenteral nutrition, and dextrose treatment, were significantly associated with growth rates of preterm infants in univariate analyses. A small percentage (1.32% - 2.07%) of the variation in the growth of preterm infants can be explained in a joint model of these perinatal factors. In extremely preterm infants, additional variation in growth trajectories can be explained by conditions whose risk differs by degree of prematurity. Specifically, infants with periventricular leukomalacia or retinopathy of prematurity experienced decelerated rates of growth compared to infants without such conditions. Conclusions Factors found to influence growth over time in children born at term also affect growth of preterm infants. The strength of association and the magnitude of the effect varied by gestational age, revealing that significant heterogeneity in growth and its determinants exists within the preterm population.

Neonatal morbidities and postnatal growth failure in very low birth weight, very preterm infants

“…11 Similarly, Jasper et al described periventricular leukomalacia and ROP as having a profound and long-term negative effect on growth trajectories in preterm infants. 18 Natarajan et al described significantly increased PNGF in infants with BPD, in a cohort of 357 extremely preterm infants <27 weeks' gestation. 19 Furthermore, Malikiwi et al showed that infants who developed BPD had a lower daily calorie and fluid intake over the first 2 weeks of life, compared with infants with no BPD.…”

“…In a study of 2,521 preterm infants born prior to 30 weeks’ gestation, Klevebro et al found BPD, NEC, IVH and ROP were associated with a decrease in postnatal growth 11 . Similarly, Jasper et al described periventricular leukomalacia and ROP as having a profound and long‐term negative effect on growth trajectories in preterm infants 18 …”

Fenton vs. Intergrowth-21st: Postnatal Growth Assessment and Prediction of Neurodevelopment in Preterm Infants

“…Nutrition and growth are critical to brain development [ 5 , 6 ] and several studies have linked poor postnatal growth in infants to poor neurodevelopmental outcome [ 3 , 4 , 5 , 6 ]. For the preterm infant, growth trajectory is complicated with abrupt loss of maternal nutrients and later adaptation and dependence on postnatal intestinal absorption characterizing the complex biology of gastrointestinal development and varying feeding standards [ 7 ]. Clinical nutritional guidelines for the premature infant continue to be based on expert opinions, highlighting the lack of high-quality evidence in guiding clinicians to determine the exact type and timing of nutritional requirement of the preterm infant.…”

A review of infant growth and psychomotor developmental outcomes after intrauterine exposure to preeclampsia

“…This may suggest a relationship of preeclampsia exposure with accelerated growth independently, or in conjunction with SGA birth that, although associated with impaired infant growth in some infants, is a cause of rapid weight gain in others as a response to intrauterine undernutrition [ 114 , 115 ]. Both Gow et al (2021) [ 31 ] and Jasper et al (2021) [ 32 ] investigated this relationship, and while they reported associations between preeclampsia exposure and weight gain throughout infancy, preeclampsia exposure was no longer a significant contributor to this catch-up growth after full adjustment for confounders like SGA status and maternal BMI. Overall, this suggests that the pathological mechanisms of preeclampsia may have no independent impact on infant weight gain.…”

“…Assessed growth to 6 years. Small sample size ROB: Low Gow (2021) [ 31 ] Prospective cohort PE (84) NTP (298) Weight Weight z-score PE lower Infant sex, GA, NICU/SCN stay length, feeding status, labour onset, mode of delivery Maternal age, weight, BMI, parity, ethnicity, smoking, education Assessed 6-month outcomes ROB: Low Weight gain PE greater Weight z-score gain Rapid weight gain Conditional weight gain ND, any SGA greater than not SGA Length Length z-score PE lower ND Length gain Length z-score gain PE greater ND BMI ND Jasper (2021) [ 32 ] Retrospective cohort PE (659) NTP (1909) Rate of weight z-score gain ND Infant birthweight, GA, head circumference, multiple birth, postnatal hospitalisation, year of birth, mode of delivery, perinatal complications Maternal age, BMI, ethnicity, SES Cohort: preterm infants b Many perinatal exposures assessed, including PE ROB: Low Abbreviations : BMI Body mass index, C-HTN c Complicated hypertension exposed, CVD Cardiovascular disease, FGR Fetal growth restriction, GA Gestational age at birth, GH Gestational hypertension, M/M-PE c Mild/moderate preeclampsia, ND No difference, NICU/SCN Neonatal intensive care unit/special care nursery, NTP Normotensive pregnancy, PE Preeclampsia, ROB Risk of bias, SGA Small for gestational age, S-PE c Severe preeclampsia, VLBW Very low birth weight a All results in the ‘Main Findings’ column are of infant growth outcomes at 2 years, unless specified in the ‘Comments’ column. Any study that continued reporting outcomes beyond 2 years is also specified b Preterm birth was defined as birth < 37 weeks’ gestation.…”