Background Very low birth weight (VLBW) premature infants encounter difficulties in development and learning. Despite the prevailing thought that these children catch up gradually over time, there are few published data evaluating serial measurements of growth and development in VLBW infants in the first years of life. Compared to their non-Hispanic counterparts, recent studies show Hispanic VLBW infants may be at an increased risk for neurodevelopmental impairment.
Purpose To evaluate the growth and neurodevelopmental progress in the first 3 years of life of VLBW infants born in a predominantly Hispanic population.
Methods A retrospective cohort study was begun to examine VLBW infants born from 1999-2001 and enrolled in the Premature Infant Development Premiere Program at the University of Texas Health Science Center at San Antonio. Baseline demographic data and the initial hospital course were evaluated along with growth parameters, neurological examination, and developmental assessment using the Bayley Scales of Infant Development-2nd Edition (BSID-II) applied at 6, 12, and 18 months corrected age as well as 24, 30, and 36 months chronologic age.
Results 146 children were enrolled in 1999 with a mean birth weight of 1141 ± 301 g and mean gestational age of 29 ± 2.8 weeks. 68% of the patients were Hispanic. There was a time-dependent trend downward in both the BSID-II mental development index (MDI) and to a lesser extent the Psychomotor Development Index (PDI) until 30 months of age, with apparent catch-up at 36 months. At 6 months of age, the mean MDI was 88 ± 11.5 compared to 80 ± 15 at 18 months, 66 ± 16 at 30 months and 74 ± 18 at 36 months. Coinciding with the MDI, a decreased mean head circumference growth velocity of 0.7 cm/yr was noted between 18 and 30 months which increased to 1.9 cm/yr at 36 months (expected head growth velocity 1.5 and 1.1, respectively). Though there was attrition over time (58% of group), those infants seen at the 24-month visit and beyond showed a similar pattern. 20% of the children were failure to thrive and 61% were referred for early childhood intervention services.
Conclusions Compared to normative values, VLBW infants in a predominantly Hispanic population demonstrate neurodevelopmental impairment over time with a concomitant lag in head growth. These findings have initiated an in-depth study of cultural differences in regards to nutrition and caregiver perceptions of his/her infant.
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