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Association of Growth During Infancy with Neurodevelopment and Obesity in Children Born Very Preterm: The Environmental Influences on Child Health Outcomes Cohort - 09/07/24

Doi : 10.1016/j.jpeds.2024.114050 
T. Michael O'Shea, MD, MPH 1, , Elizabeth T. Jensen, MPH, PhD 2, Joe X. Yi, MS 1, Barry Lester, PhD 3, Judy L. Aschner, MD 4, 5, Annemarie Stroustrup, MD, MPH 6, Xueying Zhang, PhD 7, Monica McGrath, ScD 8, Keia Sanderson, MD, MSCR 1, 9, Robert M. Joseph, PhD 10, Rachana Singh, MD, MS 11, Amanda L. Thompson, PhD 12, Julie Hofheimer, PhD 1, Betty Vohr, MD 13, Elisabeth McGowan, MD 13, Hudson Santos, PhD 14, Rebecca C. Fry, PhD 15
on behalf

of program collaborators for Environmental influences on Child Health Outcomes

  See Acknowledgments for full listing of collaborators.
P.B. Smith, Johns Hopkins, L.P. Jacobson, D.J. Catellier, R. Gershon, D. Cella, P. Parsons, K. Kurunthachalam, T.R. Fennell, S.J. Sumner, X. Du, B. O'Brien, M. Arora, S.L. Teitelbaum, R.O. Wright, H.M. Stapleton, P.L. Ferguson, J.Y. Lee, J. Snowden, S. Merhar, A. Lampland, A. Reynolds, P. Moore, L. Washburn, B. Carter, S. Pastyrnak, C. Neal, L. Smith, J. Helderman, R. Vaidya, R. Obeid, C. Rollins, K. Bear, S. Pastyrnak, M. Lenski, R. Singh, M. Msall, J. Frazier, S. Gogcu, A. Montgomery, K. Kuban, L. Douglass, H. Jara, R. Joseph

1 Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 
2 Department of Epidemiology and Prevention, Wake Forest University, Winston-Salem, NC 
3 Department of Psychiatry and Human Behavior, The Alpert Medical School of Brown University, Providence, RI 
4 Pediatrics, Albert Einstein College of Medicine, Bronx, NY 
5 Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ 
6 Pediatrics, Northwell Health, Cohen Children's Medical Center and the Departments of Pediatrics and Occupational Medicine, Epidemiology & Prevention, Zucker School of Medicine at Hofstra, New Hyde Park, NY 
7 Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY 
8 Department of Epidemiology, Johns Hopkins University, Baltimore, MD 
9 Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, NC 
10 Department of Anatomy and Neurobiology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 
11 Department of Pediatrics, Tufts University School of Medicine, Boston, MA 
12 Department of Anthropology, University of North Carolina, Chapel Hill, NC 
13 Department of Pediatrics, Brown University, Providence, RI 
14 University of Miami School of Nursing and Health Studies, Coral Gables, FL 
15 Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, The University of North Carolina, Chapel Hill, NC 

Reprint requests: T. Michael O'Shea, MD, MPH, Department of Pediatrics, University of North Carolina School of Medicine, 4th Floor UNC Hospitals, Campus Box 7596, Chapel Hill, NC 27599-7596Department of PediatricsUniversity of North Carolina School of Medicine4th Floor UNC HospitalsCampus Box 7596Chapel HillNC27599-7596

Abstract

Objective

To evaluate associations between change in weight z score after neonatal intensive care unit (NICU) discharge and neurodevelopmental outcomes and obesity at 12-48 months of age among individuals born very preterm.

Study design

This secondary analysis used data from infants born very preterm participating in the Environmental influences on Child Health Outcomes cohort (n = 1400). Growth during infancy was calculated as change in weight z score between NICU discharge and follow-up at a mean of 27 months of age. Very low weight gain was defined as a change in weight z score <−1.67; very high weight gain was a change in weight z score >1.67. Neurodevelopmental outcomes included the Bayley Scales of Infant and Toddler Development, Child Behavior Checklist 1.5-5 years, and Modified Checklist for Autism in Toddlers. Multivariable linear regression was used to estimate associations between increase in weight z score and neurodevelopmental outcomes.

Results

Very low weight gain between NICU discharge and follow-up (experienced by 6.4% of participants) was associated with lower scores on cognitive (adjusted mean difference: −4.26; 95% CI: −8.55, −0.04) and language (adjusted mean difference: −4.80; 95% CI: −9.70, −0.11) assessments. Very high weight gain (experienced by 13.6% of participants) was associated with an increased obesity risk (adjusted relative risk: 6.20; 95% CI: 3.99, 9.66) but not with neurodevelopmental outcomes.

Conclusions

Very high weight gain in the first 12-48 months after NICU discharge was associated with a higher risk of obesity at follow-up; very low weight gain was associated with lower scores on cognitive and language assessments.

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Keywords : autistic disorder, behavior, developmental outcomes, extremely premature infant, very preterm birth, weight gain

Abbreviations : BMI, BSID, BSID-II, BSID-III, CBCL, DINE, ECHO, ELGAN, IHDP, IVH, M-CHAT, MDI, NICU, NOVI


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