Department of Pediatrics, Seoul National University College of Medicine, Daehak-ro, Jongno-gu, Seoul, 101, Republic of Korea.
Department of Pediatrics, Seoul National University Bundang Hospital, Sungnam-Si, Republic of Korea.
Sci Rep. 2021 Mar 25;11(1):6836. doi: 10.1038/s41598-021-86292-1.
Prematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.
早产、出生时的大小和出生后的生长速度是决定早产儿成年后心血管代谢和神经发育结果的重要因素。本研究旨在探讨出生时的大小和出生后生长速度与早产儿的心血管代谢和神经发育结果之间的关系。我们纳入了 56 名胎龄<32 周或出生体重<1500g 的早产儿，并将其分为小于胎龄儿（SGA）和适于胎龄儿（AGA）组。在学龄期评估了体格和心血管代谢参数，并使用第四版韩国韦氏儿童智力量表（K-WISC-IV）评估了智力。通过每个时间段体重 z 评分的变化来计算生长速度。进行多变量分析以探讨不同时间段生长速度与心血管代谢和神经发育结果的关系。42（75%）名儿童被归类为 AGA，25%为 SGA。在学龄期，尽管 SGA 儿童的体重、瘦体重指数和体重指数明显较低，但 SGA 和 AGA 组之间的心血管代谢参数没有差异。在校正胎龄、出生体重 z 评分、出生至出院体重 z 评分变化和性别后，12 个月后体重 z 评分变化与收缩压、腰围和胰岛素抵抗升高相关。K-WISC-IV 的全量表智商（β=0.314，p=0.036）和知觉推理指数（β=0.456，p=0.003）与新生儿重症监护病房内的新生儿体重增长呈正相关。尽管早产儿 SGA 和 AGA 婴儿的心血管代谢结果相当，但不同时间段的生长速度会导致不同的心血管代谢和神经认知结果。因此，在新生儿期早期确保最佳的生长速度可以促进良好的神经认知结果，而 1 年后的适当生长可以预防早产儿不良的心血管代谢结果。
