Published online December 1, 2008
PEDIATRICS Vol. 122 No. 6 December 2008, pp. 1258-1265 (doi:10.1542/peds.2007-3453)
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ARTICLE

Postdischarge Growth and Development in a Predominantly Hispanic, Very Low Birth Weight Population

George C. Powers, MDa, Rajam Ramamurthy, MDa, John Schoolfield, MScb and Kathleen Matula, PhDa

a Departments of aPediatrics
b Academic Informatics Services, University of Texas Health Science Center at San Antonio, San Antonio, Texas

OBJECTIVES. The goals were to assess postdischarge growth and developmental progress of very low birth weight (birth weight: <1500 g) premature infants in a predominantly Hispanic population and to identify predictors for neurodevelopmental impairment at 3 years of age.

METHODS. A cohort of 135 very low birth weight infants (gestational age: 23 to 35 weeks) were monitored to 3 years of age. Maternal and neonatal characteristics, anthropometric z scores, and developmental performance (using corrected age until 24 months) were analyzed collectively and according to gestational age groups. Specific criteria for failure to thrive and microcephaly were used.

RESULTS. A characteristic pattern of poor weight gain in the first 12 months was followed by accelerated weight gain starting at 18 months, whereas head growth decreased at 18 months, with recovery beginning at 30 months of age. Infants born at gestational age of ≤26 weeks remained growth-impaired at 3 years of age, whereas infants born at gestational age of ≥27 weeks achieved catch-up growth by 30 months of age. Mean developmental scores also decreased in infancy, with improvements in motor development emerging at 18 months and cognitive skills at 30 months. Growth z scores, particularly for head growth, correlated with developmental scores. Infants born at gestational age of ≤26 weeks were most likely to have neonatal morbidities, failure to thrive, and neurodevelopmental impairment. With adjustment for gestational age and neonatal morbidities, Hispanic acculturation, failure to thrive, and microcephaly were predictive of neurodevelopmental impairment.

CONCLUSIONS. Very low birth weight infants exhibited growth patterns that coincided with developmental progress in the first 3 years of life. Birth at gestational age of ≤26 weeks was associated with greatest risk for developmental impairment, whereas failure to thrive and microcephaly increased neurodevelopmental impairment risk regardless of gestational age.

Key Words: very low birth weight • premature infant • Hispanic • growth • development • failure to thrive • microcephaly • acculturation

Abbreviations: BSID-II—Bayley Scales of Infant Development, Second Edition • BPD—bronchopulmonary dysplasia • CI—confidence interval • FTT—failure to thrive • GA—gestational age • IVH—intraventricular hemorrhage • MDI—Mental Developmental Index • NDI—neurodevelopmental impairment • OR—odds ratio • PVL—periventricular leukomalacia • PDI—Psychomotor Developmental Index • ROP—retinopathy of prematurity • SGA—small for gestational age • VLBW—very low birth weight

Accepted Mar 7, 2008.


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