Growth in very preterm children: Head growth after discharge is the best independent predictor for cognitive outcome.

BACKGROUND: The contribution of growth parameters to the cognitive outcome of very low birth weight (VLBW)/very preterm (VP) infants is difficult to disentangle from other preterm-birth related factors.

AIMS: We hypothesized that long-term cognitive and motor outcome of VLBW/VP infants is most strongly associated with growth in head circumference after hospital discharge.

STUDY DESIGN: Single-centre prospective longitudinal study: anthropometric measures at different time points (birth, discharge, school-age).

SUBJECTS: 136 VLBW/VP infants (<32weeks gestation/birth weight<1.500g).

OUTCOME MEASURES: Cognitive and motor function (Kaufman Assessment Battery for Children; Movement Assessment Battery for Children) at school-age (6.7-10.0years, mean=8.2).

RESULTS: In hierarchical multiple regression analyses, growth from birth to discharge significantly predicted cognitive outcome (weight: R2 change =0.063, p=0.014; length: R2 change =0.078, p=0.007; HC: R2 change =0.050, p=0.030), as well as weight gain (R2 change =0.096, p=0.001) and head growth (R2 change =0.134, p<0.001) from discharge to school-age. While most growth parameters, especially those from birth to discharge, were significantly influenced by prenatal growth and immaturity related morbidity (R2 =0.151 to 0.605, all p≤0.001), head growth after discharge was not (R2 =0.029, p=0.461).

CONCLUSIONS: Amongst all anthropometric measures, head growth between discharge and school-age is the best independent predictor for cognitive outcome in VLBW/VP infants. Determinants of head growth after discharge need further studies to identify targets for intervention.