113 - Neurodevelopmental Outcome of Preterm Neonates of 26-32 Weeks Gestation with Postnatal Growth Faltering at One Year Corrected Age: a Prospective Cohort Study

Poster Number: 113
Publication Number: 113.393

Background: Postnatal growth faltering is a common clinical problem among very preterm infants in the neonatal ICU. The consequences of PGF on later development have been inadequately studied. We conducted a prospective cohort study to assess the neurodevelopmental outcomes of preterm infants with PGF.

Objective: The primary objective was to compare the proportion of infants with major neurodevelopmental impairment at one year corrected age, among preterm infants (26-32 weeks) with and without PGF.

Design/Methods: Infants of 26- 32 weeks gestation admitted to the neonatal intensive care unit were prospectively enrolled. Weight, length and head circumference were recorded within 24 hours of birth and at discharge. Age- and sex-specific Z-scores were derived using the Fenton growth calculator. Infants with major congenital malformations and those who died before discharge were excluded. Based on weight at discharge and Z-scores, neonates were classified into two groups:
Group 1: Neonates with postnatal growth faltering, defined as a fall of >0.8 in weight Z-score from birth to discharge.
Group 2: Neonates without postnatal growth faltering.
Neurodevelopment was assessed at one year of corrected age using Bayley Scales of Infant and Toddler Development (Bayley-4). Major neurodevelopmental impairment (NDI) was defined as Bayley-4 standard score < 70 in the cognitive, motor, or language domains.

Results: Of 329 infants assessed for eligibility, 85 were excluded. Of the 244 enrolled infants, 105 preterm infants underwent Bayley-4 assessments at one year of corrected age. Enrolled infants had a median gestational age of 31.5 (IQR 30.4- 32.2) weeks and mean birth weight of 1431 (SD 302) g. The incidence of postnatal growth faltering (PGF) was 82.2% (198 infants). Median standard scores in cognitive (95 vs 90) and motor (96 vs 91) domains were higher in infants without PGF; the median language scores were similar (89 vs 89). The differences did not reach statistical significance. A pre-specified subgroup analysis showed that small-for-gestational-age (SGA) infants with PGF had significantly lower language and motor scores when compared to appropriate-for-gestational-age (AGA) infants.

Conclusion(s): Postnatal growth failure was not associated with adverse neurodevelopmental outcomes at one year of corrected age in this study. However, follow-up rates were lower than expected. Among infants with PGF, SGA infants had higher rates of NDI than AGA infants. This needs to be investigated further.