Background: Preterm infants born VLBW can display auxological impairment and long term cognitive disabilities. These outcomes are influenced by the condition of being small for gestational age (SGA), but also by the extra-uterine growth restriction (EUGR). Aim of the study was to detect the influence of gestational age(GA), perinatal growth trend and enteral nutrition during the hospitalization on cognitive and auxological outcomes at peri-pubertal age (PPA).
Methods: Single center prospective study of VLBW discharged free from major disabilities or genetic diagnosis, which were evaluated through an auxological (growth parameters and pubertal stage) and cognitive assessment (Wechsler Intelligence Scale for Children IV-WISC-IV) between 10 and 13 years. Data are expressed as mean ± SD.
Results: 40 VLBW (16M) entered the study. At birth, GA was 28,8(±2,3) weeks and weight was 1035(±257)g; 7 babies (17,5%) were SGA (6/7 born over 30 weeks GA). At discharge, 30 patients (75%) were EUGR, 95% of them born <27 or >30 weeks. Weight increase (WI) during the recovery was 17,4(±4,1) g/die. 30% have been exclusively breastfed. Age at auxological and cognitive assessment was 11,5 (±0,8) years. Height SDS (HSDS) for boys was 0,08 (±1,17) and distance from target height (ΔTH) –0,228 (±0,8), while for girls –0,14 (±1,1) and 0,1 (±0,9), respectively. BMI SDS was –0,19 (±1,34) for boys and 0,5 (±1) for girls. 13% of the whole population showed ΔTH >-1DS, 5.13% presented short stature (height<-2SD) and 48% had BMI<18. No pubertal disorders were found. VLBW who developed EUGR at discharge, showed significantly lower weight SDS (P:0.03) and BMI SDS (P: 0.025) at PPA. Patients who assumed breast milk from birth to discharge demonstrated an higher height SDS (P:0.04) than patients formula fed. WISC-IV assessment showed no minor or moderate cognitive disabilities but one patient, who scored mild mental delay. Neonates born between 27-30 weeks who did not develop EUGR had significantly higher scores in cognition at PPA (IRPQI P:0.01, total QI P<0.01). A WI >18 g/die positively influenced the cognitive outcome at PPA (IRPQI P<0.01, total QI P:0.02).
Conclusion: An adequate growth in NICU during the first weeks of life may prevent EUGR of VLBWs and promote better growth and cognitive outcomes at PPA, independently from GA. A WI >18 g/die promotes cognitive scores at PPA, while breast-feeding boost height growth at PPA.
19 - 21 Sep 2019
European Society for Paediatric Endocrinology