Time to Regain Birthweight and Association with Neurodevelopmental Outcomes among Extremely Preterm Newborns

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Abstract

Objective

Determine association between time to regain birthweight and 2-year neurodevelopment among extremely preterm (EP) newborns.

Study Design:

Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating time to regain birthweight, time from birth to weight nadir, time from nadir to regain birthweight, and cumulative weight loss with 2-year corrected Bayley Scales of Infant and Toddler Development 3rd edition.

Results

Among n = 654 EP neonates, those with shorter nadir-to-regain had lower cognitive scores (2–4 days versus ≥ 8 days: −3.5, [CI −7.0, 0.0]; ≤1 day versus ≥ 8 days: −5.0, [CI −10.2, 0.0]) in fully adjusted stepwise forward regression modeling. Increasingly cumulative weight loss was associated with lower cognitive scores (−50 to <−23 percent-days: −4.0, [95% CI −7.6, −0.4]) and language scores (≤−50 percent-days: −5.7, [CI −9.8, −1.6]; −50 to <−23 percent-days: −6.1, [CI −10.2, −2.0]).

Conclusion

Faster nadir-to-regain and prolonged, severe weight loss are associated with adverse 2-year neurodevelopmental outcomes.

Trial registration

PENUT Trial Registration: NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273

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Most cited references 25

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Simulation study of confounder-selection strategies.

George Maldonado, Sander Greenland (1993)

In the absence of prior knowledge about population relations, investigators frequently employ a strategy that uses the data to help them decide whether to adjust for a variable. The authors compared the performance of several such strategies for fitting multiplicative Poisson regression models to cohort data: 1) the "change-in-estimate" strategy, in which a variable is controlled if the adjusted and unadjusted estimates differ by some important amount; 2) the "significance-test-of-the-covariate" strategy, in which a variable is controlled if its coefficient is significantly different from zero at some predetermined significance level; 3) the "significance-test-of-the-difference" strategy, which tests the difference between the adjusted and unadjusted exposure coefficients; 4) the "equivalence-test-of-the-difference" strategy, which significance-tests the equivalence of the adjusted and unadjusted exposure coefficients; and 5) a hybrid strategy that takes a weighted average of adjusted and unadjusted estimates. Data were generated from 8,100 population structures at each of several sample sizes. The performance of the different strategies was evaluated by computing bias, mean squared error, and coverage rates of confidence intervals. At least one variation of each strategy that was examined performed acceptably. The change-in-estimate and equivalence-test-of-the-difference strategies performed best when the cut-point for deciding whether crude and adjusted estimates differed by an important amount was set to a low value (10%). The significance test strategies performed best when the alpha level was set to much higher than conventional levels (0.20).

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Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants.

Betty R. Vohr, Alastair Poole, Lisa Wrage … (2006)

The objectives of this study were to assess whether (1) in-hospital growth velocity is predictive of neurodevelopmental and growth outcomes at 18 to 22 months' corrected age among extremely low birth weight (ELBW) infants and (2) in-hospital growth velocity contributes to these outcomes after controlling for confounding demographic and clinical variables. Infants 501 to 1000 g birth weight from a multicenter cohort study were divided into quartiles of in-hospital growth velocity rates. Variables considered for the logistic-regression models included gender, race, gestational age, small for gestational age, mother's education, severe intraventricular hemorrhage, periventricular leukomalacia, age at regaining birth weight, necrotizing enterocolitis, late-onset infection, bronchopulmonary dysplasia, postnatal steroid therapy for pulmonary disease, and center. Of the 600 discharged infants, 495 (83%) were evaluated at 18 to 22 months' corrected age. As the rate of weight gain increased between quartile 1 and quartile 4, from 12.0 to 21.2 g/kg per day, the incidence of cerebral palsy, Bayley II Mental Developmental Index (MDI) <70 and Psychomotor Developmental Index (PDI) <70, abnormal neurologic examination, neurodevelopmental impairment, and need for rehospitalization fell significantly. Similar findings were observed as the rate of head circumference growth increased. The in-hospital rate of growth was associated with the likelihood of anthropometric measurements at 18 months' corrected age below the 10th percentile values of the Centers for Disease Control and Prevention 2000 growth curve. Logistic-regression analyses, controlling for potential demographic or clinical cofounders, and adjusted for center, identified a significant relationship between growth velocity and the likelihood of cerebral palsy, MDI and PDI scores of <70, and neurodevelopmental impairment. These analyses suggest that growth velocity during an ELBW infant's NICU hospitalization exerts a significant, and possibly independent, effect on neurodevelopmental and growth outcomes at 18 to 22 months' corrected age.

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Longitudinal growth of hospitalized very low birth weight infants.

Sunita Shankaran, L Papile, Richard Ehrenkranz … (1999)

The interpretation of growth rates for very low birth weight infants is obscured by limited data, recent changes in perinatal care, and the uncertain effects of multiple therapies. To develop contemporary postnatal growth curves for very low birth weight preterm infants and to relate growth velocity to birth weight, nutritional practices, fetal growth status (small- or appropriate-for-gestational-age), and major neonatal morbidities (chronic lung disease, nosocomial infection or late-onset infection, severe intraventricular hemorrhage, and necrotizing enterocolitis). Large, multicenter, prospective cohort study. Growth was prospectively assessed for 1660 infants with birth weights between 501 to 1500 g admitted by 24 hours of age to 1 of the 12 National Institute of Child Health and Human Development Neonatal Research Network centers between August 31, 1994 and August 9, 1995. Infants were included if they survived >7 days (168 hours) and were free of major congenital anomalies. Anthropometric measures (body weight, length, head circumference, and midarm circumference) were performed from birth until discharge, transfer, death, age 120 days, or a body weight of 2000 g. To obtain representative data, nutritional practices were not altered by the study protocol. Postnatal growth curves suitable for clinical and research use were constructed for body weight, length, head circumference, and midarm circumference. Once birth weight was regained, weight gain (14.4-16.1 g/kg/d) approximated intrauterine rates. However, at hospital discharge, most infants born between 24 and 29 weeks of gestation had not achieved the median birth weight of the reference fetus at the same postmenstrual age. Gestational age, race, and gender had no effect on growth within 100-g birth weight strata. Appropriate-for-gestational age infants who survived to hospital discharge without developing chronic lung disease, severe intraventricular hemorrhage, necrotizing enterocolitis, or late onset-sepsis gained weight faster than comparable infants with those morbidities. More rapid weight gain was also associated with a shorter duration of parenteral nutrition providing at least 75% of the total daily fluid volume, an earlier age at the initiation of enteral feedings, and an earlier age at achievement of full enteral feedings. These growth curves may be used to better understand postnatal growth, to help identify infants developing illnesses affecting growth, and to aid in the design of future research. They should not be taken as optimal. Randomized clinical trials should be performed to evaluate whether different nutritional management practices will permit birth weight to be regained earlier and result in more rapid growth, more appropriate body composition, and improved short- and long-term outcomes.

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Author and article information

Contributors

Gregory Valentine:

ORCID: http://orcid.org/0000-0002-3055-2987

Thomas Wood:

ORCID: http://orcid.org/0000-0002-1130-2720

Dennis Mayock:

ORCID: http://orcid.org/0000-0002-6190-4842

Sarah Kolnik:

ORCID: http://orcid.org/0000-0003-1397-8430

Katie Strobel:

ORCID: http://orcid.org/0000-0002-7717-0425

Olivia Brandon

Sandra Juul:

ORCID: http://orcid.org/0000-0002-6861-6229

Journal

Journal ID (nlm-ta): Res Sq

Journal ID (publisher-id): ResearchSquare

Title: Research Square

Publisher: American Journal Experts

Publication date (Electronic): 14 September 2023

Electronic Location Identifier: rs.3.rs-3249598

Affiliations

University of Washington

University of Washington - Seattle Children’s Hospital

University of Washington

Author notes

Author Contributions:

GCV and KMP conceptualized the design of the secondary analysis, composed the initial draft of the manuscript, and revised its subsequent versions. TRW performed the statistical analyses. TRW, BAC, DEM, SK, KMS, OCB, KMS, JBL, PJH and SEJ were involved in revisions to the manuscript, and all agreed to the final draft of the manuscript being submitted.

[✉ ] gcvalent@ 123456uw.edu

Author information

Gregory Valentine http://orcid.org/0000-0002-3055-2987

Thomas Wood http://orcid.org/0000-0002-1130-2720

Dennis Mayock http://orcid.org/0000-0002-6190-4842

Sarah Kolnik http://orcid.org/0000-0003-1397-8430

Katie Strobel http://orcid.org/0000-0002-7717-0425

Sandra Juul http://orcid.org/0000-0002-6861-6229

Article

Other ID: 10.21203/rs.3.rs-3249598

DOI: 10.21203/rs.3.rs-3249598/v1

PMC ID: 10543289

PubMed ID: 37790304

SO-VID: bf038143-21e0-4cdf-86d1-0a8a83e6392d

License:

This work is licensed under a Creative Commons Attribution 4.0 International License, which allows reusers to distribute, remix, adapt, and build upon the material in any medium or format, so long as attribution is given to the creator. The license allows for commercial use.

History

Funding

Funded by: National Institute of Neurological Disorders and Stroke of the National Institutes of Health

Award ID: U01NS077953

Award ID: U01NS077955

Time to Regain Birthweight and Association with Neurodevelopmental Outcomes among Extremely Preterm Newborns

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Abstract

Objective

Study Design:

Results

Conclusion

Trial registration

Related collections

Karger: Nutrition and Dietetics

Most cited references 25

Simulation study of confounder-selection strategies.

Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants.

Longitudinal growth of hospitalized very low birth weight infants.

Author and article information

Contributors

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Affiliations

Author notes

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Article

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