Accelerated postnatal head growth follows preterm birth

Jason Cockerill ¹, Sabita Uthaya ¹, Caroline J Dore ² and Neena Modi ^1*

¹ Imperial College London, United Kingdom
² Medical Research Council, United Kingdom

^* To whom correspondence should be addressed. E-mail: n.modi{at}imperial.ac.uk.

Accepted 29 November 2005

Abstract

Objectives: Poor growth after preterm birth, particularly poor head growth, is associated with impaired neurodevelopmental outcome. We aimed to evaluate weight gain and head growth between birth and term in a contemporary cohort of preterm infants, taking into account breast milk intake and illness severity.

Methods: We studied inborn infants 32 weeks gestation who remained in the neonatal unit up to 37 weeks postmenstrual age. We expressed weight and head circumference (HC) as standard deviation score (SDS), growth between birth and discharge as SDS gain (SDSG), and illness severity and breast milk exposure as the number of days of level 1 (full) intensive care (%L1IC) and the number of days breast milk was received (%BM) as a percentage of days from birth to discharge.

Results: Infants showed poor postnatal weight gain but accelerated head growth There was a highly significant fall in weight SDS between birth and discharge (mean (SD) weight SDS, birth -0.31 (0.96), discharge -1.32 (1.02), p<0.001) and a highly significant increase in HC SDS (mean (SD) HC SDS, birth - 0.52 (0.95), discharge -0.03 (1.25), p=0.003). %L1IC had a highly significant negative impact upon weight SDSG (p=0.006) and %BM had a significant positive impact upon HC SDSG (p=0.043).

Conclusion: Accelerated postnatal head growth suggests catch-up after antenatal restraint. This raises the possibility that poor neurocognitive outcomes after extremely preterm birth may in part be consequent upon poor intrauterine brain growth. As postnatal head growth may be facilitated by breast milk, there is an urgent need to evaluate the optimal use of breast milk in preterm neonates. Illness severity is a significant determinant of poor postnatal weight gain.

Keywords: accelerated growth, breast milk,, head growth, preterm infant, weight gain

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