Primary follow-up care in a multidisciplinary setting enhances catch-up growth of very-low-birth-weight infants

Catch-up growth of head circumference of very low birth weight, small for gestational age preterm infants and mental development to adulthood

OBJECTIVE

To examine the influence of postnatal energy quotient (EQ, energy intake/kg body weight per day) on head circumference (HC) growth and mental development of very low birth weight (VLBW), small for gestational age (SGA, <10th percentile) preterm infants.

STUDY DESIGN

SGA VLBW preterm infants (n = 46) with primarily symmetric intrauterine growth restriction were compared with 62 appropriate for gestational age (AGA) VLBW preterm infants and 73 term infants from the Bonn Longitudinal study.

RESULTS

Twenty-seven of 46 (59%) of the SGA preterm infants showed complete HC catch-up growth by the age of 12 months, but mostly before 6 months after term (HC catch-up group). These infants had significantly higher mean EQs from day 2 to 10 than the group of 19 infants without HC catch-up (EQ, 95 vs 78). Mean EQs correlated significantly with developmental and intelligence quotients (DQ/IQ) from 18 months to 6 years. As adults, the HC of the HC catch-up group was not significantly different from that of the AGA preterm infants, the term infants, and their parents. The group without HC catch-up had smaller HC as adults.

CONCLUSIONS

Our data suggest that early postnatal high-energy nutrient intake for SGA preterm infants is needed to promote HC catch-up growth and to prevent negative consequences of undernutrition.

Growth and energy and protein intake of preterm newborns in the first year of gestation-corrected age

CONTEXT

There are few longitudinal studies that analyze the growth and nutritional status parameters of children born prematurely.

OBJECTIVE

To evaluate the growth and dietary intake of preterm newborns in the first year of gestation-corrected age.

DESIGN

Prospective clinical study.

SETTING

Tertiary care hospital.

PATIENTS

19 children (7 male) who were born prematurely, with birth weight between 1000 g and 2000 g, which was adequate for the gestational age.

PROCEDURES

At 3, 6, 9 and 12 months of gestation-corrected age, children were evaluated in relation to weight, height and cephalic perimeter, using the National Center for Health Statistics as the standard reference, and the Rozalez-Lopez and Frisancho standards for brachial perimeter and triceps and subscapular skinfolds. The calculated dietary intake was compared to the Recommended Dietary Allowances.

MAIN MEASUREMENTS

The Z score was calculated for the weight/age, height/age and weight/height relationships, and the percentiles of the perimeters and skinfolds were considered. Dietary intake records were made using the 24-hour Dietary Recall and the Food Frequency Intake Questionnaire methods. The Virtual Nutri software was used to calculate energy and protein intake.

RESULTS

The weight/age, height/age and weight/height relationships and the brachial perimeter and triceps skinfold were statistically greater in the first semester in relation to the second. The cephalic perimeter remained above the 50th percentile for the ages studied and there was no difference in the subscapular skinfold between the first and second semesters, remaining below the 50th percentile. The calorie and protein intake, although statistically lower in the first than in the second semester, always remained above the recommended.

CONCLUSIONS

The pace of growth is greater in the first semester than in the second, not reaching the standard expected for full-term newborns, with the exception of the cephalic perimeter, which remains adequate. Calorie/protein intake shows an inverse relationship with growth speed, remaining above the recommended for full-term newborns, although with difficulty in depositing subcutaneous fat, in spite of the high caloric intake.

Growth patterns and nutritional factors associated with increased head circumference at 18 months in normally developing, low-birth-weight infants

OBJECTIVE

To identify patterns of growth, nutrition practices, and feeding behaviors associated with normal Denver II developmental screening results at 18 months of age.

DESIGN

A retrospective review of hospital medical charts was conducted to collect discharge diagnosis and dietary data. Developmental clinic charts were reviewed to collect growth and diet data, Denver II results, and medical data from 4-, 9-, and 18-month visits.

SUBJECTS/SETTING

Twenty-eight children were identified from a review of developmental clinic records in a midwestern children's hospital. Criteria were single or twin birth, birth weight of 2,000 g or less, follow up at the hospital developmental clinic, and completion of 3 screening visits.

STATISTICAL ANALYSES PERFORMED

National standards were used to calculate z scores. Patterns of growth were analyzed using analysis of variance. Stepwise forward linear regression analysis was done to construct a model predicting head circumference at 18 months of age.

RESULTS

Significant catch-up growth (P = .0006) occurred as length z score increased from -0.87 at 4 months of age to -0.45 at 18 months. A regression model predicting head circumference at age 18 months was developed that included nutrition and growth variables such as head circumference at 9 months, type of parenteral amino acids administered in the hospital, z score of weight at 4 months' adjusted age, and time of first enteral feeding.

APPLICATIONS

Interventions designed to support breast-feeding in the hospital and at home are indicated as is increased emphasis on monitoring growth. Delays in growth need to be treated aggressively; for example, nutrition interventions should begin by the age of 4 months if weight gain is not appropriate.