Growth During Infancy After Extremely Preterm Birth: Associations with Later Neurodevelopmental and Health Outcomes

O’Shea TM, Register HM, Yi JX, Jensen ET, Joseph RM, Kuban KCK, Frazier JA, Washburn L, Belfort M, South AM, Santos HP Jr, Shenberger J, Perrin EM, Thompson AL, Singh R, Rollins J, Gogcu S, Sanderson K, Wood C, Fry RC; ELGAN-ECHO Pulmonary/Obesity Group.

J Pediatr. 2023 Jan; 252:40-47.e5. doi: 10.1016/j.jpeds.2022.08.015. Epub 2022 Aug 18. PMID: 35987367; PMCID: PMC10242541.

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Objective: To evaluate associations between changes in weight, length, and weight/length ratio during infancy and outcomes later in life among individuals born extremely preterm.

Study design: Among participants in the Extremely Low Gestational Age Newborn (ELGAN) study, we measured weight and length at discharge from the neonatal intensive care unit (NICU) and at age 2 years and evaluated neurocognitive, psychiatric, and health outcomes at age 10 years and 15 years. Using multivariable logistic regression, we estimated associations between gains in weight, length, and weight/length ratio z-scores between discharge and 2 years and outcomes at 10 and 15 years. High gain was defined as the top quintile of change; low gain, as the bottom quintile of change.

Results: High gains in weight and weight/length were associated with greater odds of obesity at 10 years, but not at 15 years. These associations were found only for females. High gain in length z-score was associated with lower odds of obesity at 15 years. The only association found between high gains in growth measures and more favorable neurocognitive or psychiatric outcomes was between high gain in weight/length and lower odds of cognitive impairment at age 10 years.

Conclusions: During the 2 years after NICU discharge, females born extremely preterm with high gains in weight/length or weight have greater odds of obesity at 10 years, but not at 15 years. Infants with high growth gains in the 2 years after NICU discharge have neurocognitive and psychiatric outcomes in middle childhood and adolescence similar to those of infants with lower gains in weight and weight/length.