Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Paris, France.
Centre for Research in Epidemiology and Statistics, INSERM, INRA, Université de Paris, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Paris, France.
Paediatr Perinat Epidemiol. 2021 Nov;35(6):748-757. doi: 10.1111/ppe.12798. Epub 2021 Jul 13.
Despite the limited evidence, accelerated early postnatal growth (EPG) is commonly believed to benefit neurodevelopment for term-born infants, especially those small for gestational age.
To investigate the existence of critical time windows in the association of EPG with neurodevelopment, considering birth size groups.
In the French ELFE birth cohort, 12,854 term-born neonates were classified as small, appropriate or large for gestational age (SGA, AGA, LGA, respectively). Parents reported their child's development by using the Child Development Inventory (CDI-score) at age 12 months and the MacArthur-Bates Development Inventory (MAB-score; 100 score units) assessing language ability at age 24 months. Predictions of individual weight, body mass index (BMI), length, and head circumference (HC) from birth to age 24 months were obtained from repeated measurements fitted with the Jenss-Bayley mixed-effects model. For each infant, conditional gains (CG) in these growth parameters were generated at four-time points (3, 6, 12 and 24 months) representing specific variations in growth parameters during 0-3, 3-6, 6-12, 12-24 months, independent of previous measures. Using multivariable linear regression models, we provided the estimate differences of the neurodevelopmental scores according to variation of each growth parameter CG, by birth size group.
For SGA infants, the MAB-score differed by 5.8 (95% confidence interval [CI] -0.2, 11.8), 6.7 (95% CI -0.1, 13.3), and 9.7 (95% CI 1.9, 17.5) score units when CG in BMI, weight, and HC at 3 months varied from -2 to 1 standard deviation, respectively. For all infants, MAB-score was linearly and positively associated with length conditional gains at 12 months, with stronger magnitude for SGA infants. Results for the CDI-score were overall consistent with those for MAB-score.
For term-born SGA infants, moderate catch-up in HC, BMI and weight within the first 3 months of life may benefit later neurodevelopment, which could guide clinicians to monitor EPG.
尽管证据有限，但加速早期产后生长（EPG）通常被认为有利于足月出生婴儿的神经发育，尤其是那些小于胎龄的婴儿。
考虑到出生时的体重大小，研究 EPG 与神经发育之间关联的关键时间窗口是否存在。
在法国 ELFE 出生队列中，12854 名足月出生的新生儿被分为小于胎龄儿（SGA）、适于胎龄儿（AGA）和大于胎龄儿（LGA）。父母在婴儿 12 个月时使用儿童发育量表（CDI 评分），在 24 个月时使用麦克阿瑟- Bates 发育量表（MAB 评分；100 评分单位）报告其孩子的发育情况。通过重复测量拟合 Jenss-Bayley 混合效应模型，获得从出生到 24 个月时个体体重、体重指数（BMI）、身高和头围（HC）的预测值。对于每个婴儿，在四个时间点（3、6、12 和 24 个月）生成这些生长参数的条件增益（CG），代表 0-3、3-6、6-12、12-24 个月期间生长参数的特定变化，与之前的测量无关。使用多变量线性回归模型，我们根据每个生长参数 CG 的变化，为不同出生体重组的神经发育评分提供了估计差异。
对于 SGA 婴儿，当 BMI、体重和 HC 在 3 个月时的 CG 从-2 到 1 个标准差变化时，MAB 评分分别相差 5.8（95%置信区间 [CI] -0.2，11.8）、6.7（95% CI -0.1，13.3）和 9.7（95% CI 1.9，17.5）分单位。对于所有婴儿，MAB 评分与 12 个月时的长度条件增益呈线性正相关，SGA 婴儿的相关性更强。CDI 评分的结果总体上与 MAB 评分一致。
对于足月出生的 SGA 婴儿，在生命的头 3 个月内，HC、BMI 和体重的适度追赶可能有益于后期的神经发育，这可以指导临床医生监测 EPG。
