Postnatal Growth in Preterm Infants and Later Health Outcomes: A Systematic Review

Acta Paediatrica. 2015;104(10):974-986

In preterm infants, poor postnatal growth is associated with adverse neurocognitive outcomes; conversely, rapid postnatal growth is supposedly harmful for future development of metabolic diseases. Initial evidence that early exposure to environmental cues can alter the risk of developing metabolic diseases in humans came from associations between low birthweight and higher incidence of coronary heart disease or glucose intolerance. While rapid catch-up growth confers potential advantages for preterm infants in terms of short-term survival and later cognitive outcome, it may increase the risk of metabolic disease later in life.

The objective of the present review was to summarise the available evidence on postnatal growth in preterm infants in relation to the potential neurodevelopmental benefits and adverse metabolic outcomes and attempt to identify critical postnatal windows during which growth might influence these outcomes. Observational studies reported consistent positive associations between postnatal weight or head growth and neurocognitive outcomes; however, there was limited evidence from the few intervention studies. Evidence linking postnatal weight gain to later adiposity and other cardiovascular disease risk factors in preterm infants was also limited.

The dissonance between findings of intervention and observational studies examined raises the possibility of confounding by diseases, or other factors that affect both growth and cognition.  Future nutritional intervention studies in preterm and term infants should report effects on weight gain and growth, as well as later body composition and neurocognitive outcomes.

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