614 - Head Circumference and Body Weight Growth Trajectories during Neonatal Intensive Care and Severe Neurodevelopmental Impairment at 18-Months in Infants with Birth Weight ≤ 1250g

Publication Number: 614.5396

Faith Kim, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Toni Iurcotta, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Jennifer Hammond, Columbia University Vagelos College of Physicians and Surgeons, Brooklyn, NY, United States; Marianne Garland, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Rakesh Sahni, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States

Background: Inadequate postnatal growth is suspected to be associated with neurodevelopmental impairment (NDI) in preterm infants. Postnatal anthropometric measurements may serve as a surrogate for severe NDI (SNDI), thereby signaling the need for timely interventions.

Objective: To examine associations between head circumference (HC) and body weight (BW) changes during admission to the neonatal intensive care unit (NICU) and SNDI at 18-month corrected age (CA) in infants with birth weight ≤ 1250g.

Design/Methods: We conducted a retrospective cohort study of infants with birth weight ≤ 1250g admitted to a level IV NICU from 2013 to 2017 and evaluated in a high-risk infant follow up clinic at 18-months CA by 2020. Postnatal growth was assessed using z-scores obtained from gender-specific Fenton growth chart calculator at birth and at discharge from the NICU. Logistic regression and model diagnostics evaluated the relationship between changes in HC and BW z-scores and in HC and BW growth velocity from birth until NICU discharge with presence or absence of SNDI, defined as a Bayley-III motor, language or cognitive composite score ≤ 69 at 18-months CA.

Results: Data were available in 119 patients (gestational age = 27.2 ± 2.2 weeks, birth weight = 870 ± 246 g). A total of 24 patients (20.2%) had evidence of SNDI. Slower weekly head growth velocity (0.67 ± 0.17 vs. 0.73 ± 0.12 cm/week, p < 0.03) and lower birth-to-NICU discharge ∆HC z-scores (-1.61 ± 3.2 vs. -0.77 ± 1.1, p < 0.005) were observed in infants with SNDI compared to those without SNDI (Figure 1). Across all patients, increasing ∆HC z-scores from birth to NICU discharge were associated with higher composite cognitive (p < 0.001) and motor (p < 0.001) scores at 18-months CA (Figure 2). There was no relationship between BW growth velocity or ∆BW z-scores and SNDI at 18-months CA. The incidence of grade 3-4 intraventricular hemorrhage was 3.4% (4/119) and periventricular leukomalacia was 2.7% (3/119) detected on cranial ultrasonography.

Conclusion(s): Poor HC growth trajectory during NICU stay is associated with significant cognitive and motor impairment at 18-months CA in infants with birth weight ≤ 1250g. This information can potentially assist in identifying infants at risk for SNDI and tailoring timely interventions to improve outcomes.

Figure 1
A: Differences (mean±SE) in weight and head circumference z-scores at birth in preterm infants with (red bars) and without (blue bars) severe neurodevelopmental impairment (SNDI) at 18-months corrected age (CA).
B: Differences (mean±SE) in change in weight and head circumference z-score from birth until NICU discharge (∆ z-score) in preterm infants with (red bars) and without (blue bars) SNDI showing poor head growth in infants with SNDI at 18-months CA.
C: Differences (mean±SD) in weight and head growth velocity during NICU stay in infants with and without SNDI.

Figure 2
Relationship between composite cognitive, motor, and language Bayley-III scores at 18-months corrected age and changes in head circumference z-scores from birth to NICU discharge.