Published online November 1, 2006
PEDIATRICS Vol. 118 No. 5 November 2006, pp. e1452-e1465 (doi:10.1542/peds.2006-1069)
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ARTICLE

Growth in 10- to 12-Year-Old Children Born at 23 to 25 Weeks' Gestation in the 1990s: A Swedish National Prospective Follow-up Study

Aijaz Farooqi, MDa, Bruno Hägglöf, MD, PhDb, Gunnar Sedin, MD, PhDc, Leif Gothefors, MD, PhDa and Fredrik Serenius, MD, PhDa

a Department of Pediatrics, Institute of Clinical Sciences, University Hospital, Umeå, Sweden
b Department of Child and Adolescent Psychiatry, Institute of Clinical Sciences, University Hospital Umeå
c Department of Women's and Children's Health, Section for Pediatrics, Uppsala University, Uppsala, Sweden

BACKGROUND. Knowledge of long-term growth of extremely preterm infants in relation to gestational age is incomplete, and there are concerns regarding their poor growth in early childhood. As part of a longitudinal study of a national cohort of infants born at <26 weeks' gestation (extremely immature), growth development from birth to the age of 11 years was examined, and correlates of growth attainment were analyzed.

METHODS. Two hundred forty-seven extremely immature children were born alive from April 1990 through March 1992 in the whole of Sweden, and 89 (36%) survived. Growth and neurosensory outcomes of all extremely immature survivors were evaluated at 36 months of age. Eighty-six (97%) extremely immature children were identified and assessed at 11 years of age. In this growth study, 83 extremely immature infants (mean [SD]: birth weight, 772 g [110 g]; gestational age, 24.6 weeks [0.6 weeks]) without severe motor disability were followed up prospectively from birth to 11 years old and compared with a matched group of 83 children born at term. z scores for weight, height, head circumference, and BMI were computed for all children. We also examined gender-specific longitudinal growth measures. Predictors of 11-year growth were studied by multivariate analyses.

RESULTS. Extremely immature children were significantly smaller in all 3 growth parameters than the controls at 11 years. Extremely immature children showed a sharp decline in weight and height z scores up to 3 months' corrected age, followed by catch-up growth in both weight and height up to 11 years. In contrast to weight and height, extremely immature children did not exhibit catch-up growth in head circumference after the first 6 months of life. The mean BMI z scores increased significantly from 1 to 11 years in both groups. The mean BMI change between 1 and 11 years of age was significantly larger in extremely immature than in control participants. Extremely immature girls showed a faster weight increase than extremely immature boys, whereas catch-up growth in height and head circumference was similar in these groups. Multiple-regression analyses revealed that preterm birth and parental height were significant predictors of 11-year height, and group status (prematurity) correlated strongly with head circumference.

CONCLUSIONS. Children born at the limit of viability attain poor growth in early childhood, followed by catch-up growth to age 11 years, but remain smaller than their term-born peers. Strategies that improve early growth might improve the outcome.

Key Words: growth • extremely immature

Abbreviations: EI—extremely immature • VLBW—very low birth weight • ELBW—extremely low birth weight • CVD—cardiovascular disease • NSI—neurosensory impairment • HC—head circumference • EDD—expected date of delivery • SES—socioeconomic status • SGA—small for gestational age • CI—confidence interval • PNS—postnatal steroids

Accepted Jun 8, 2006.


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