Association between Slow and Rapid Weight Gain before 36 Weeks of Corrected Age and 6-Year-Developmental Quotient in Infants Born at <26 Weeks of Gestation

Abstract

Objective

The postnatal growth of preterm infants is influenced by various factors; however, the association between growth and long-term outcomes in extremely preterm infants remains unclear. Therefore, we aimed to determine the association between 6-year development and body weight (BW) at 36 weeks of corrected age (CA) in extremely preterm infants.

Study Design

We conducted a retrospective observational study including extremely preterm infants born at < 26 weeks of gestation. We defined the key standard deviation score (SDS) using BW at birth and evaluated the association between BW-related values at 36 weeks of CA and the 6-year developmental quotient (DQ).

Results

This study included 90 infants. The absolute difference between changes in the BW SDS from birth and the median changes in DQ ≥ 85 infants was significantly greater in infants with a DQ < 85 than ≥85 (median [interquartile range]: 0.80 [0.29, 1.31] vs. 0.34 [0.13, 0.55]; p = 0.001). After adjustment by the logistic regression analysis for DQ < 85, the absolute difference was statistically significant (odds ratio: 4.99, 95% confidence interval: 1.71–14.5). The correlation coefficient between the absolute difference and DQ was −0.35 (p < 0.001). There were no significant associations between a DQ < 85 and SDS or changes in SDS from birth.

Conclusion

For infants born at <26 weeks of gestation, slow and rapid weight gain were associated with a low 6-year DQ when using values representing individual body sizes at birth. Individual backgrounds should be considered to avoid both slow and rapid weight gain for the growth management of these infants for at least up to 36 weeks of CA. Further research is needed to determine which body size has a positive impact on the long-term outcomes of infants.

Key Points

• The median change in BW SDS was a key factor for DQ.

• Slow/rapid weight gain were related to a low 6-year DQ.

• Individual backgrounds may be important in neonatal intensive care unit care.

Keywords

extremely preterm infants - growth and development - neonate - preterm infants - precision nutrition - precision medicine

Authors' Contributions

M.H. conceptualized and designed the study, analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. K.H., S.H., and K.W. contributed to the writing and revision of the manuscript. All authors approved the final manuscript as submitted and agreed to be accountable for all aspects of this study.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki.

Data Availability Statement

The datasets generated and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Publication History

Received: 08 May 2024

Accepted: 05 November 2024

Article published online:
04 December 2024

• References

• 1 Morisaki N, Belfort MB, McCormick MC. et al; Neonatal Research Network of Japan. Brief parenteral nutrition accelerates weight gain, head growth even in healthy VLBWs. PLoS One 2014; 9 (02) e88392
• 2 Cormack BE, Jiang Y, Harding JE, Crowther CA, Bloomfield FH. Relationships between neonatal nutrition and growth to 36 weeks' corrected age in ELBW babies-secondary cohort analysis from the provide trial. Nutrients 2020; 12 (03) 760
• 3 Marques PC, Rocha G, Flor-DE-Lima F, Guimarães H. Extrauterine growth restriction at discharge in very-low-birth weight infants: a retrospective study in a level III neonatal intensive care unit. Minerva Pediatr (Torino) 2022; 74 (05) 553-561
• 4 Klevebro S, Lundgren P, Hammar U. et al. Cohort study of growth patterns by gestational age in preterm infants developing morbidity. BMJ Open 2016; 6 (11) e012872
• 5 Hack M, Flannery DJ, Schluchter M, Cartar L, Borawski E, Klein N. Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med 2002; 346 (03) 149-157
• 6 Roberts G, Cheong J, Opie G. et al; Victorian Infant Collaborative Study Group. Growth of extremely preterm survivors from birth to 18 years of age compared with term controls. Pediatrics 2013; 131 (02) e439-e445
• 7 Fenton TR, Nasser R, Creighton D. et al. Weight, length, and head circumference at 36 weeks are not predictive of later cognitive impairment in very preterm infants. J Perinatol 2021; 41 (03) 606-614
• 8 Belfort MB, Rifas-Shiman SL, Sullivan T. et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 2011; 128 (04) e899-e906
• 9 Cordova EG, Cherkerzian S, Bell K. et al. Association of poor postnatal growth with neurodevelopmental impairment in infancy and childhood: comparing the fetus and the healthy preterm infant references. J Pediatr 2020; 225: 37-43.e5
• 10 Greenbury SF, Angelini ED, Ougham K. et al. Birthweight and patterns of postnatal weight gain in very and extremely preterm babies in England and Wales, 2008-19: a cohort study. Lancet Child Adolesc Health 2021; 5 (10) 719-728
• 11 Vizzari G, Morniroli D, Tiraferri V. et al. Postnatal growth of small for gestational age late preterm infants: determinants of catch-up growth. Pediatr Res 2023; 94 (01) 365-370
• 12 Stoll BJ, Hansen NI, Bell EF. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Trends in care practices, morbidity, and mortality of extremely preterm neonates, 1993-2012. JAMA 2015; 314 (10) 1039-1051
• 13 Nakanishi H, Suenaga H, Uchiyama A, Kono Y, Kusuda S.. Neonatal Research Network Japan. Trends in the neurodevelopmental outcomes among preterm infants from 2003-2012: a retrospective cohort study in Japan. J Perinatol 2018; 38 (07) 917-928
• 14 Younge N, Goldstein RF, Bann CM. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017; 376 (07) 617-628
• 15 Bell EF, Hintz SR, Hansen NI. et al; Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Mortality, in-hospital morbidity, care practices, and 2-year outcomes for extremely preterm infants in the US, 2013-2018. JAMA 2022; 327 (03) 248-263
• 16 Ancel PY, Goffinet F, Kuhn P. et al; EPIPAGE-2 Writing Group. Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in France in 2011: results of the EPIPAGE-2 cohort study. JAMA Pediatr 2015; 169 (03) 230-238
• 17 Martínez-Jiménez MD, Gómez-García FJ, Gil-Campos M, Pérez-Navero JL. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants: a scoping review. Eur J Pediatr 2020; 179 (08) 1255-1265
• 18 Fenton TR, Cormack B, Goldberg D. et al. “Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants. J Perinatol 2020; 40 (05) 704-714
• 19 Adair LS, Cole TJ. Rapid child growth raises blood pressure in adolescent boys who were thin at birth. Hypertension 2003; 41 (03) 451-456
• 20 Ong YY, Sadananthan SA, Aris IM. et al. Mismatch between poor fetal growth and rapid postnatal weight gain in the first 2 years of life is associated with higher blood pressure and insulin resistance without increased adiposity in childhood: the GUSTO cohort study. Int J Epidemiol 2020; 49 (05) 1591-1603
• 21 Zhang X, Martin RM, Oken E, Aris IM, Yang S, Kramer MS. Growth during infancy and early childhood and its association with metabolic risk biomarkers at 11.5 years of age. Am J Epidemiol 2020; 189 (04) 286-293
• 22 Hernández MI, Mericq V. Metabolic syndrome in children born small-for-gestational age. Arq Bras Endocrinol Metabol 2011; 55 (08) 583-589
• 23 Washburn L, Nixon P, Snively B, Tennyson A, O'Shea TM. Weight gain in infancy and early childhood is associated with school age body mass index but not intelligence and blood pressure in very low birth weight children. J Dev Orig Health Dis 2010; 1 (05) 338-346
• 24 Luyckx VA, Bertram JF, Brenner BM. et al. Effect of fetal and child health on kidney development and long-term risk of hypertension and kidney disease. Lancet 2013; 382 (9888) 273-283
• 25 Ikusawa MMY, Nakase A, Shiki SK, Kensahou H. . [The Kyoto Scale of Psychological Development Test 2001], technical manual, Kyoto International Social Welfare Exchange Center. Kyoto: Choyodo Printing Co.; 2002
• 26 Kono Y, Mishina J, Yonemoto N, Kusuda S, Fujimura M. Outcomes of very-low-birthweight infants at 3 years of age born in 2003-2004 in Japan. Pediatr Int 2011; 53 (06) 1051-1058
• 27 Kono Y, Mishina J, Yonemoto N, Kusuda S, Fujimura M.. NICU Network Japan. Neonatal correlates of adverse outcomes in very low-birthweight infants in the NICU network. Pediatr Int 2011; 53 (06) 930-935
• 28 Ishii N, Kono Y, Yonemoto N, Kusuda S, Fujimura M.. Neonatal Research Network Japan. Outcomes of infants born at 22 and 23 weeks' gestation. Pediatrics 2013; 132 (01) 62-71
• 29 Kono Y, Yonemoto N, Kusuda S. et al. Developmental assessment of VLBW infants at 18 months of age: a comparison study between KSPD and Bayley III. Brain Dev 2016; 38 (04) 377-385
• 30 Itabashi K, Miura F, Uehara R, Nakamura Y. New Japanese neonatal anthropometric charts for gestational age at birth. Pediatr Int 2014; 56 (05) 702-708
• 31 Bourke J, Wong K, Srinivasjois R. et al. Predicting long-term survival without major disability for infants born preterm. J Pediatr 2019; 215: 90-97.e1
• 32 Rees P, Callan C, Chadda KR. et al. Preterm brain injury and neurodevelopmental outcomes: a meta-analysis. Pediatrics 2022; 150 (06) e2022057442
• 33 Beaino G, Khoshnood B, Kaminski M. et al; EPIPAGE Study Group. Predictors of cerebral palsy in very preterm infants: the EPIPAGE prospective population-based cohort study. Dev Med Child Neurol 2010; 52 (06) e119-e125
• 34 Okada T, Takahashi S, Nagano N, Yoshikawa K, Usukura Y, Hosono S. Early postnatal alteration of body composition in preterm and small-for-gestational-age infants: implications of catch-up fat. Pediatr Res 2015; 77 (1-2): 136-142
• 35 Nguyen TN, Spencer-Smith M, Pascoe L. et al. Language skills in children born preterm (<30 wks' gestation) throughout childhood: associations with biological and socioenvironmental factors. J Dev Behav Pediatr 2019; 40 (09) 735-742
• 36 Villar J, Giuliani F, Barros F. et al. Monitoring the postnatal growth of preterm infants: a paradigm change. Pediatrics 2018; 141 (02) e20172467
• 37 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
• 38 Bertino E, Spada E, Occhi L. et al. Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J Pediatr Gastroenterol Nutr 2010; 51 (03) 353-361
• 39 Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (02) e214-e224
• 40 Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr 2013; 13: 92
• 41 Villar J, Giuliani F, Bhutta ZA. et al; International Fetal and Newborn Growth Consortium for the 21(st) Century (INTERGROWTH-21(st)). Postnatal growth standards for preterm infants: the preterm postnatal follow-up study of the INTERGROWTH-21(st) Project. Lancet Glob Health 2015; 3 (11) e681-e691
• 42 Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med 2008; 359 (03) 262-273