Department of Pediatrics/Neonatology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Pediatric Endocrinology, VU University Medical Center, PO Box 7057, 1007 MB, Amsterdam, The Netherlands.
Pediatr Res. 2019 Feb;85(3):283-292. doi: 10.1038/s41390-018-0139-0. Epub 2018 Aug 16.
Increasing numbers of preterm-born children survive nowadays, and improving long-term health and neurodevelopment is becoming more important. Early-life growth has been linked to neurodevelopmental outcomes. We aimed to study whether this association has changed with time.
We studied two cohorts of preterm-born children (gestational age ≤32 weeks and/or birth weight ≤1500 g) from 1983 (n = 708) and 2003-2006 (n = 138), respectively. We distinguished four early-life growth patterns at 3 months corrected age: appropriate for gestational age (AGA) with or without growth restriction (AGA GR+/AGA GR-), and small for gestational age (SGA) with or without catch-up growth (SGA CUG+/SGA CUG-). Intelligence quotient (IQ), neuromotor function, and behavior were assessed at ages 19 and 8 years, respectively, for the cohorts.
In the 2003-2006 cohort, less children had early-life GR. In both cohorts, SGA CUG- subjects had unfavorable growth trajectories and neurodevelopmental outcomes (IQ β -6.5, 95% confidence interval (CI) -9.8; -3.2, P < 0.001; neuromotor score β -1.9%, 95% CI -3.2; -0.6, P = 0.005), while SGA CUG+ subjects were comparable to adequately grown subjects.
Although the incidence of adverse growth patterns decreased between the cohorts, possibly indicating improvements in care over time, the impact of these growth patterns on neurodevelopmental outcomes was not significantly different. Achieving adequate early-life growth may be crucial for improving neurodevelopmental outcomes, especially for preterms born SGA.
如今，越来越多的早产儿存活下来，提高长期健康和神经发育水平变得越来越重要。生命早期的生长与神经发育结局有关。我们旨在研究这种关联是否随时间而变化。
我们研究了分别来自 1983 年（n=708）和 2003-2006 年（n=138）的两批早产儿（胎龄≤32 周和/或出生体重≤1500g）队列。我们在 3 个月校正年龄时区分了四种生命早期的生长模式：适于胎龄（AGA）伴或不伴有生长受限（AGA GR+/AGA GR-），以及小于胎龄（SGA）伴或不伴有追赶生长（SGA CUG+/SGA CUG-）。对于这两个队列，分别在 19 岁和 8 岁时评估智商（IQ）、神经运动功能和行为。
在 2003-2006 年的队列中，早期生长受限（GR）的儿童较少。在两个队列中，SGA CUG-的儿童具有不良的生长轨迹和神经发育结局（IQ β-6.5，95%置信区间（CI）-9.8；-3.2，P<0.001；神经运动评分β-1.9%，95%CI-3.2；-0.6，P=0.005），而 SGA CUG+的儿童与充分生长的儿童相当。
尽管两个队列之间不良生长模式的发生率有所下降，这可能表明随着时间的推移护理有所改善，但这些生长模式对神经发育结局的影响并无显著差异。实现生命早期的充分生长可能对改善神经发育结局至关重要，尤其是对出生时为 SGA 的早产儿。
