Growth and Neurosensory Outcomes of Preterm Very Low Birth Weight Infants at 18 Months of Corrected Age

Abstract

To determine the growth and neurosensory outcomes of infants with birth weight ≤ 1,500 g or gestation ≤ 32 wks at 18 months corrected age. This prospective cohort study was conducted at a Level III neonatal unit in India. The neonates with birth weight ≤ 1,500 g or gestation ≤ 32 wks were included in the study. The infants were followed up at 3,6,9,12 and 18 months corrected age. Weight, length and head circumference were plotted on WHO multisite growth reference study (MGRS) charts. Neurological examination was conducted by Amiel-Tison method, hearing was evaluated with brainstem auditory evoked responses, vision assessed with Teller acuity cards, and development assessed with Developmental Assessment Scales for Indian Infants II. During the period from July 2006 through June 2007, there were 141 neonates born at gestation ≤ 32 wks or birth weight ≤ 1,500 g. Seven infants had major malformations, 30 died before discharge, 36 had residence > 20 km and parents of four had refused consent. The remaining 64 neonates were enrolled for follow up. The mean gestation and birth weight were 31(2.4) wks and 1208 (365) g respectively. There were 38 (59%) small for gestation infants. Fifty-five infants completed 18 months follow up for growth outcomes. Seventeen (30.9%; 95% CI 18.3% to 43.5%) infants were undernourished, 28(50.9%; 95% CI 37.3% to 64.6%) were stunted, 8(14.5%; 95% CI 0 to 24) were wasted and 14(25.4%; 95% CI 13.6% to 37.3%) had microcephaly. Infants with birth weight <1,000 g (n = 17) were significantly more affected. Ten (58.8%; p < 0.01) were undernourished, 13(76.5%; p < 0.01) were stunted and 10(58.8%; p < 0.01) had microcephaly. Complete formal neurological evaluation for development, hearing and vision was done in 31 infants. Six of these 31 (19.3%; 95% CI 4.6% to 34.1%) infants had one or more major disabilities. These included cerebral palsy (n = 3), developmental delay (development quotient <70, n = 3), and deafness (n = 3). Very low birth weight infants are at a high risk of neurosensory disability and growth failure. There is a need to create a nation-wide database of these infants for neurodevelopment and growth outcomes.