Growth in the Neonatal Intensive Care Unit Influences Neurodevelopmental and Growth Outcomes of Extremely Low Birth Weight Infants

American Academy of Pediatrics (AAP) - Tập 117 Số 4 - Trang 1253-1261 - 2006
Richard A. Ehrenkranz1, Anna M. Dusick2, Betty R. Vohr3, Linda L. Wright4, Lisa A. Wrage5, W. Kenneth Poole5
1Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
2University of Indiana, Indianapolis, Indiana
3Department of Pediatrics, Brown University, Providence, Rhode Island
4National Institutes of Child Health and Human Development, Bethesda, Maryland
5RTI International, Research Triangle Park, North Carolina

Tóm tắt

OBJECTIVES. The objectives of this study were to assess whether (1) in-hospital growth velocity is predictive of neurodevelopmental and growth outcomes at 18 to 22 months’ corrected age among extremely low birth weight (ELBW) infants and (2) in-hospital growth velocity contributes to these outcomes after controlling for confounding demographic and clinical variables.METHODS. Infants 501 to 1000 g birth weight from a multicenter cohort study were divided into quartiles of in-hospital growth velocity rates. Variables considered for the logistic-regression models included gender, race, gestational age, small for gestational age, mother’s education, severe intraventricular hemorrhage, periventricular leukomalacia, age at regaining birth weight, necrotizing enterocolitis, late-onset infection, bronchopulmonary dysplasia, postnatal steroid therapy for pulmonary disease, and center.RESULTS. Of the 600 discharged infants, 495 (83%) were evaluated at 18 to 22 months’ corrected age. As the rate of weight gain increased between quartile 1 and quartile 4, from 12.0 to 21.2 g/kg per day, the incidence of cerebral palsy, Bayley II Mental Developmental Index (MDI) <70 and Psychomotor Developmental Index (PDI) <70, abnormal neurologic examination, neurodevelopmental impairment, and need for rehospitalization fell significantly. Similar findings were observed as the rate of head circumference growth increased. The in-hospital rate of growth was associated with the likelihood of anthropometric measurements at 18 months’ corrected age below the 10th percentile values of the Centers for Disease Control and Prevention 2000 growth curve. Logistic-regression analyses, controlling for potential demographic or clinical cofounders, and adjusted for center, identified a significant relationship between growth velocity and the likelihood of cerebral palsy, MDI and PDI scores of <70, and neurodevelopmental impairment.CONCLUSIONS. These analyses suggest that growth velocity during an ELBW infant’s NICU hospitalization exerts a significant, and possibly independent, effect on neurodevelopmental and growth outcomes at 18 to 22 months’ corrected age.

Từ khóa


Tài liệu tham khảo

Ehrenkranz RA, Younes N, Lemons JA, et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics. 1999;104:280–289

Lemons JA, Bauer CR, Oh W, et al. Very-low-birth-weight outcomes of the NICHD Neonatal Research Network, January 1995 through December 1996. Pediatrics. 2001;107(1). Available at: www.pediatrics.org/cgi/content/full/107/1/e1

Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants?Pediatrics. 2001;107:270–273

Cooke RJ, Ainsworth SB, Fenton AC. Postnatal growth retardation: a universal problem in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:F428–F430

Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth. Obstet Gynecol. 1996;87:163–168

Hay WW, Jr, Lucas A, Heird WC, et al. Workshop summary: nutrition of the extremely low birth weight infant. Pediatrics. 1999;104:1360–1368

Dobbing J. Nutritional growth restriction and the nervous system. In: Davison AN, Thompson RHS, eds. The Molecular Basis of Neuropathology. London, United Kingdom: Edward Arnold; 1981:231–233

Levitsky DA, Strupp BJ. Malnutrition and the brain: changing concepts, changing concerns. J Nutr. 1995;125:2212S–2220S

Grantham-McGregor S. A review of studies of the effect of severe malnutrition on mental development. J Nutr. 1995;125:2233S–2238S

Brown JL, Pollitt E. Malnutrition, poverty and intellectual development. Sci Am. 1996;274(2):38–43

Fanaroff AA, Wright LL, Stevenson DK, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, May 1991 through December 1992. Am J Obstet Gynecol. 1995;173:1423–1431

Stevenson DK, Wright LL, Lemons JA, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstet Gynecol. 1998;179:1632–1639

Vohr BR, Wright LL, Dusick AM, et al. Neurodevelopmental and functional outcomes of extremely low birth weight infants in the National Institute of Child Health and Human Development Neonatal Research Network, 1993–1994. Pediatrics. 2000;105:1216–1226

Ogden CL, Kuczmarski RJ, Flegal KM, et al. Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. Pediatrics. 2002;109:45–60

Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA. Growth failure in the preterm infant: can we catch up?Semin Perinatol. 2003;27:302–310

Ziegler EE, Thureen PJ, Carlson SJ. Aggressive nutrition of the very low birth weight infant. Clin Perinatol. 2002;29:225–244

Walsh MC, Kliegman RM, Hack M. Severity of necrotizing enterocolitis: influence on outcome at 2 years of age. Pediatrics. 1989;84:808–814

Sonntag J, Grimmer I, Scholz T, Metze B, Wit J, Obladen M. Growth and neurodevelopmental outcome of very low birthweight infants with necrotizing enterocolitis. Acta Paediatr. 2000;89:528–532

Hintz SR, Kendrick DE, Stoll BJ, et al., for the NICHD Neonatal Research Network. Neurodevelopmental and growth outcome of extremely low birth weight infants after necrotizing enterocolitis. Pediatrics. 2005;115:696–703

Simon NP. Follow-up for infants with necrotizing enterocolitis. Clin Perinatol. 1994;21:411–424

Salhab WA, Perlman JM, Silver L, Broyles RS. Necrotizing enterocolitis and neurodevelopmental outcome in extremely low birth weight infants < 1000 g. J Perinatol. 2004;24:534–540

Frank L, Sosenko IRS. Undernutrition as a major contributing factor in the pathogenesis of bronchopulmonary dysplasia. Am Rev Respir Dis. 1988;138:725–729

Papile LA, Tyson JE, Stoll BJ, et al. A multicenter trial of two dexamethasone regimens in ventilator-dependent premature infants. N Engl J Med. 1998;338:1112–1118

Romagnoli C, Zecca E, Vento G, De Carolis MP, Papacci P, Tortorolo G. Early postnatal dexamethasone for the prevention of chronic lung disease in high risk infants. Intensive Care Med. 1999;25:717–721

Yeh TF, Lin YJ, Huang CC, et al. Early dexamethasone therapy in preterm infants: a follow-up study. Pediatrics. 1998;101(5). Available at: www.pediatrics.org/cgi/content/full/101/5/e7

O’Shea TM, Kothadia JM, Klinepeter KL, et al. Randomized placebo-controlled trial of a 42-day tapering course of dexamethasone to reduce the duration of ventilator dependency in very low birth weight infants: outcome of study participants at 1-year adjusted age. Pediatrics. 1999;104:15–21

Halliday HL, Ehrenkranz RA, Doyle LW. Early postnatal (<96 hours) corticosteroids for preventing chronic lung disease in preterm infants [Cochrane review]. Cochrane Database Syst Rev. 2003;1:CD00146

Halliday HL, Ehrenkranz RA, Doyle LW. Delayed postnatal (>3 weeks) postnatal corticiosteroids for chronic lung disease in preterm infants [Cochrane review]. Cochrane Database Syst Rev. 2003;1:CD00145

AAP, Committee on Fetus and Newborn. Postnatal corticosteroids to treat or prevent lung disease in preterm infants. Pediatrics. 2002;109:330–338

Georgieff MK, Hoffman JS, Pereira GR, Bernbaum J, Hoffman-Williamson M. Effect of neonatal caloric deprivation on head growth and 1-year developmental status in preterm infants. J Pediatr. 1985;107:581–587

Gross SJ, Oehler JM, Eckerman CO. Head growth and developmental outcome in very low-birth-weight infants. Pediatrics. 1983;71:70–75

Hack M, Breslau N, Fanaroff AA. Differential effects of intrauterine and postnatal growth failure in infants of very low birth weight. Am J Dis Child. 1989;143:63–68

Stoll BJ, Hansen NI, Adams-Chapman I, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292:2357–2365

Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E. Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med. 1991;325:231–237

Latal-Hajnal B, Von Siebenthal K, Kovari H, Bucher HU, Largo RM. Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. J Pediatr. 2003;143:163–170

Oh W, Poindexter BB, Peritt R, et al. Association between fluid and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr. 2005;147:786–790

Thông tin
Thông tin xuất bản

American Academy of Pediatrics (AAP)

Tập 117 Số 4

1253-1261

Thông tin tác giả