Effect of first-month head-size growth trajectory on cognitive outcomes in preterm infants

Abstract

To examine whether the patterns of head-size growth trajectory in the first month after birth are associated with different susceptibility to cognitive impairment outcomes at age 24 months. This retrospective cohort study included 590 infants of very-preterm survivors born between 2001 and 2016 receiving neurodevelopmental assessment at age 24 months. 403 children were enrolled for analysis after excluding infants with small-for-gestational age and severe brain injury. The head circumference (HC) growth evaluated weekly in the first month after birth compared to the at-birth HC was analyzed using group-based trajectory modeling. Neurocognition outcomes were determined as normal, borderline delay, or impaired using the Bayley Scales of Infant Development. The HC growth dynamics in the first month after birth showed three trajectory patterns: delayed catch-up (31.5%), slow catch-up (54.0%), and fast catch-up (14.5%), which significantly corresponded to different rates of impaired cognition at 19.5%, 6.0%, and 8.5%, respectively (p<0.001). While 60% of the fast catch-up group had normal cognition, only one-third of the delayed catch-up group showed normal cognition. Three neonatal risk factors, gestational age (p=0.006), respiratory distress syndrome requiring surfactant therapy (p=0.012), and hemodynamically significant patent ductus arteriosus requiring intervention (p=0.047) significantly affected HC growth trajectory patterning that led to cognitive impairment outcomes at follow-up. Preterm infants with delayed catch-up of head-size growth in the first month of age is susceptible to cognitive impairment outcome.