Postnatal growth in preterm infants: a comparative analysis for gestational age of underweight versus normal weight and small versus normal head size Postnatal growth in LBW infants


Fawzia Alyafei
Ashraf T Soliman
Vincenzo De sanctis
Nada Alaaraj
Shayma Ahmed
Noor Hamed
Fatima Alkhori
Hamdy Ali
Doaa Alyousef
Mona Shaat
Maya Itani


Preterm, Postnatal growth, follow up


Introduction: Head circumference (HC) is considered a reflection of intracranial volume and brain size, influencing early infant growth. Objectives:  We conducted a two-year study on 65 preterm infants (Gestational Age, GA: 33.5 ± 2.2 weeks, birth weight 1.5-2.5 Kg) categorized at birth into underweight z-score (WAZ <-2) and normal weight z-score (WAZ > -2) groups. They were further divided by head circumference for gestational age z-score (HCZ) (<-1 vs. >-1). Results: Preterm infants with birth WAZ <-2 displayed significant improvements in WAZ at 6 and 12 months, transitioning from -2.8 to -1.5 and -1.1, respectively. Although there was an initial decrease in length-for-age z-score (LAZ), during the first 6 months, these infants exhibited catch-up, improving from -1.5 to - 0.2 Z-score. Weight-for-length z-score (WLZ) improved from -5 at birth to -0.6, -0.84, and -0.47 at 6, 12, and 24 months, respectively. Preterm infants with birth WAZ > -2 experienced a decrease in WAZ during the first 6 months but gradually increased afterward. LAZ initially decreased but improved in subsequent months. WLZ exhibited an upward trend. At birth, infants with smaller HCZ were shorter and lighter, and this trend persisted throughout the first and second year of follow-up. Conclusion: Rapid catch-up in WAZ and LAZ was more pronounced during the first year in preterm infants born underweight for their gestational age. However by the end of the second year, those with small HCZ at birth were shorter and lighter at 2 years compared to those with HCZ >-1.  


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1. Sharma D, Shastri S, Sharma P. Intrauterine Growth Restriction: Antenatal and Postnatal Aspects. Clin Med Insights Pediatr. 2016;10:67-83. doi: 10.4137/CMPed.S40070.
2. Kurjak A, Predojevic M, Stanojevic M, et al. Intrauterine growth restriction and cerebral palsy. Acta Inform Med. 2012;18(2):64-82. doi: 10.5455/aim.2010.18.64-82.
3. Suhag A , Berghella V. Intrauterine Growth Restriction (IUGR): Etiology and Diagnosis. Curr Obstet Gynecol Rep.2013;2:102–11.
4. Della Gatta AN, Aceti A, Spinedi SF, et al. Neurodevelopmental outcomes of very preterm infants born following early foetal growth restriction with absent end-diastolic umbilical flow. Eur J Pediatr. 2023;10.1007/s00431-023-05104-y. doi:10.1007/s00431-023-05104-y.
5. Hartkopf J, Schleger F, Keune J, et al. Impact of Intrauterine Growth Restriction on Cognitive and Motor Development at 2 Years of Age. Front Physiol. 2018;9:1278. doi: 10.3389/fphys. 2018.01278.
6. Ni Y, Beckmann J, Hurst JR, et al. Size at birth, growth trajectory in early life, and cardiovascular and metabolic risks in early adulthood: EPICure study. Arch Dis Child Fetal Neonatal. 2021;106(2):149-55. doi:10.1136/archdischild-2020-319328.
7. Ni Y, Lancaster R, Suonpera E, et al. Growth in extremely preterm children born in England in 1995 and 2006: the EPICure studies. Arch Dis Child Fetal Neonatal 2022;107(2):193-200. doi:10.1136/archdischild-2020-321107.
8. Hyodo R, Sato Y, Ito M, et al. Magnetic resonance spectroscopy in preterm infants: association with neurodevelopmental outcomes. Arch Dis Child Fetal Neonatal. 2018; 103(3):F238-F244. doi:10.1136/archdischild-2016-311403.
9. Padilla N, Falcón C, Sanz-Cortés M, et al. Differential effects of intrauterine growth restriction on brain structure and development in preterm infants: a magnetic resonance imaging study. Brain Res. 2011;1382:98-108. doi:10.1016/j.brainres.2011.01.0328.
10. Sacchi C, O'Muircheartaigh J, Batalle D, et al. Neurodevelopmental outcomes following intrauterine growthrRestriction and very preterm birth. J Pediatr. 2021;238:135-44.e10. doi:10.1016/j.jpeds.2021.07.002.
11. Simões RV, Muñoz-Moreno E, Cruz-Lemini M, et al. Brain metabolite alterations in infants born preterm with intrauterine growth restriction: association with structural changes and neurodevelopmental outcome. Am J Obstet Gynecol. 2017;216(1):62.e1-62.e14. doi:10.1016/ j.ajog.2016.09.089.
12. Peretz R, Halevy T, Gafner M, et al. Volumetric Brain MRI Study in Fetuses with Intrauterine Growth Restriction Using a Semiautomated Method. AJNR Am J Neuroradiol. 2022;43(11):1674-9. doi:10.3174/ajnr.A7665.
13. Cheong JL, Hunt RW, Anderson PJ, et al. Head growth in preterm infants: correlation with magnetic resonance imaging and neurodevelopmental outcome. Pediatrics. 2008;121 (6):e1534-e 40. doi:10.1542/peds.2007-2671.
14. Cole TJ, Statnikov Y, Santhakumaran S, Pan H, Modi N. Neonatal Data Analysis Unit and the Preterm Growth Investigator Group. Birth weight and longitudinal growth in infants born below 32 weeks' gestation: a UK population study. Arch Dis Child Fetal Neonatal. 2014;99(1): F34-F40. doi:10.1136/archdischild-2012-303536.
15. Raaijmakers A, Jacobs L, Rayyan M, et al. Catch-up growth in the first two years of life in Extremely Low Birth Weight (ELBW) infants is associated with lower body fat in young adolescence. PLoS One. 2017;12(3):e0173349. doi: 10.1371/journal.pone.0173349.
16. Han, J., Jiang, Y., Huang, J, et al. Postnatal growth of preterm infants during the first two years of life: catch-up growth accompanied by risk of overweight. Ital J Pediatr .2021;47:66
17. Zhao R, Xu L, Wu ML, Huang SH, Cao XJ. Maternal pre-pregnancy body mass index, gestational weight gain influence birth weight. Women Birth. 2018;31(1):e20-e25. doi: 10. 1016/j.wombi.2017.06.003
18. Gong YH, Ji CY, Shan JP. A longitudinal study on the catch-up growth of preterm and term infants of low, appropriate, and high birth weight. Asia Pac J Public Health. 2015;27(2):NP1421-31. doi: 10.1177/1010539513489129.
19. Altigani M, Murphy J F, NewcomeR G, Gray O P. Catch up growth in preterm infants. Acta Pædiatr Scand.1989;357 (Suppl.)
20. Campisi SC, Carbone SE, Zlotkin S. Catch-up growth in full-term small for gestational age infants: a systematic review. Adv Nutr. 2019;10:104–11. 10.1093/advances/nmy091.
21. Yeşinel S, Aldemir EY, Kavuncuoğlu S, et al. Evaluation of growth in very low birth weight preterm babies. Turk Pediatri Ars. 2014;49(4):289-98. doi: 10.5152/tpa.2014.1989.
22. Albertsson-Wikland K, Karlberg J. Natural growth in children born small for gestational age with and without catch-up growth. Acta Paediatr Suppl. 1994;399:64-71. doi:10.1111/j.1651-2227. 1994.tb13292.x
23. González-García L, Mantecón-Fernández L, Suárez-Rodríguez M, et al. Postnatal growth faltering: Growth and height improvement at two years in children with very low birth weight between 2002-2017. Children (Basel). 2022;9(12):1800. doi: 10.3390/children9121800.
24. Toftlund LH, Halken S, Agertoft L, Zachariassen G. Catch-up growth, rapid weight growth, and continuous growth from birth to 6 years of age in very-preterm-born children. Neonatology. 2018;114(4):285-93. doi:10.1159/000489675.
25. Vizzari G, Morniroli D, Tiraferri V, Macchi M, Gangi S, Consales A, Ceroni F, Cerasani J, Mosca F, Giannì ML. Postnatal growth of small for gestational age late preterm infants: determinants of catch-up growth. Pediatr Res. 2023;94(1):365-70. doi: 10.1038/s41390-022-02402-3.
26. Sinha B, Choudhary TS, Nitika N, et al. Linear growth trajectories, catch-up growth, and its predictors among North Indian small-for-gestational age low birthweight infants: A Secondary data analysis. Front Nutr. 2022;9:827589. doi: 10.3389/fnut.2022.827589.
27. Deng Y, Yang F, Mu D. First-year growth of 834 preterm infants in a Chinese population: a single-center study. BMC Pediatr. 2019;19(1):403. doi: 10.1186/s12887-019-1752-8.
28. Martínez-Jiménez M, Gómez-García F, Gil-Campos M, et al. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants: a scoping review. Eur J Pediatr. 2020;179:1255–65.
29. Mericq V , Martinez-Aguayo A , Uauy R, et al. Long-term metabolic risk among children born premature or small for gestational age. Nat Rev Endocrinol.2017;13: 50–62. 1038/nrendo.2016.127.
30. Cheong JL, Hunt RW, Anderson PJ, et al. Head growth in preterm infants: correlation with magnetic resonance imaging and neurodevelopmental outcome. Pediatrics. 2008;121(6):e1534-e 40. doi:10.1542/peds.2007-2671
31. Belfort MB, Rifas-Shiman SL, Sullivan T, et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics. 2011;128(4):e899-e906. doi:10.1542/ peds. 2011-0282.
32. Lee K, Hayes B. Head size and growth in the very preterm infant: a literature review. Res Rep Neonatol. 2015;5:1-7. doi:10.2147/RRN.S74449.
33. Kuban KC, Allred EN, O'Shea TM, et al. Developmental correlates of head circumference at birth and two years in a cohort of extremely low gestational age newborns. J Pediatr. 2009;155 (3):344-9.e93. doi:10.1016/j.jpeds.2009.04.002.
34. Neubauer V, Griesmaier E, Pehböck-Walser N, et al. Poor postnatal head growth in very preterm infants is associated with impaired neurodevelopment outcome. Acta Paediatr. 2013;102 (9):883-8. doi:10.1111/apa.12319.

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