Linear Growth Trajectories, Catch-up Growth, and Its Predictors Among North Indian Small-for-Gestational Age Low Birthweight Infants: A Secondary Data Analysis

Bireshwar Sinha, Tarun Shankar Choudhary, Nitika Nitika, Mohan Kumar, Sarmila Mazumder, Sunita Taneja, Nita Bhandari, Bireshwar Sinha, Tarun Shankar Choudhary, Nitika Nitika, Mohan Kumar, Sarmila Mazumder, Sunita Taneja, Nita Bhandari

Abstract

Background: Low birthweight small-for-gestational-age (SGA-LBW) (birthweight below the 10th percentile for gestational age; SGA-LBW) infants are at an increased risk of poor postnatal growth outcomes. Linear growth trajectories of SGA-LBW infants are less studied in South Asian settings including India.

Objectives: To describe the linear growth trajectories of the SGA-LBW infants compared with appropriate-for-gestational-age LBW (AGA-LBW) infants during the first 6 months of life. In addition, we estimated catch-up growth (ΔLAZ > 0.67) in SGA-LBW infants and their performance against the WHO linear growth velocity cut-offs. Additionally, we studied factors associated with poor catch-up growth in SGA-LBW infants.

Methods: The data utilized came from an individually randomized controlled trial that included low birthweight (LBW) infants weighing 1,500-2,250 g at birth. A total of 8,360 LBW infants were included. For comparison between SGA-LBW and AGA-LBW infants, we presented unadjusted and adjusted estimates for mean differences (MDs) or risk ratios (RRs) for the outcomes of length, linear growth velocity, length for age z-score (LAZ) score, and stunting. We estimated the proportion of catch-up growth. Generalized linear models of the Poisson family with log links were used to identify factors associated with poor catch-up growth in SGA-LBW infants.

Results: Low birthweight small-for-gestational-age infants had a higher risk of stunting, lower attained length, and a lower LAZ score throughout the first 6 months of life compared with AGA-LBW infants, with differences being maximum at 28 days and minimum at 6 months of age. The linear growth velocity in SGA-LBW infants compared with AGA-LBW infants was significantly lower during the birth-28 day period [MD -0.19, 95% confidence interval (CI): -0.28 to -0.10] and higher during the 3- to 6-month period (MD 0.17, 95% CI: 0.06-0.28). Among the SGA-LBW infants, 55% showed catch-up growth for length at 6 months of age. Lower wealth quintiles, high birth order, home birth, male child, term delivery, non-exclusive breastfeeding, and pneumonia were associated with the higher risk of poor catch-up in linear growth among SGA-LBW infants.

Conclusion: Small for gestational age (SGA) status at birth, independent of gestational age, is a determinant of poor postnatal linear growth. Promotion of institutional deliveries, exclusive breastfeeding, and prevention and early treatment of pneumonia may be helpful to improve linear growth in SGA-LBW infants during early infancy.

Clinical trial registration: [https://ichgcp.net/clinical-trials-registry/NCT02653534" title="See in ClinicalTrials.gov">NCT02653534].

Keywords: catch-up growth (CUG); growth faltering; linear growth; low birthweight (LBW) infant; small for gestational age (SGA).

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Sinha, Choudhary, Nitika, Kumar, Mazumder, Taneja and Bhandari.

Figures

FIGURE 1
FIGURE 1
Flowchart showing the number of infants with length measurements included in the analysis.
FIGURE 2
FIGURE 2
Performance of low birthweight small-for-gestational-age (SGA-LBW) infants with respect to different growth cut-offs at 3 and 6 months of age.
FIGURE 3
FIGURE 3
A receiver operating characteristic (ROC) curve of the multivariable model to predict poor catch-up growth in SGA-LBW infants.
FIGURE 4
FIGURE 4
Mean difference (MD) in attained length and length for age z-scores (LAZ) between appropriate-for-gestational-age LBW (AGA-LBW) and SGA-LBW infants.

References

    1. Arcangeli T, Thilaganathan B, Hooper R, Khan KS, Bhide A. Neurodevelopmental delay in small babies at term: a systematic review. Ultrasound Obstet Gynecol. (2012) 40:267–75. 10.1002/uog.11112
    1. Murray E, Fernandes M, Fazel M, Kennedy SH, Villar J, Stein A. Differential effect of intrauterine growth restriction on childhood neurodevelopment: a systematic review. BJOG. (2015) 122:1062–72. 10.1111/1471-0528.13435
    1. Prendergast AJ, Humphrey JH. The stunting syndrome in developing countries. Paediatr Int Child Health. (2014) 34:250–65. 10.1179/2046905514Y.0000000158
    1. Walker SP, Wachs TD, Grantham-McGregor S, Black MM, Nelson CA, Huffman SL, et al. Inequality in early childhood: risk and protective factors for early child development. Lancet. (2011) 378:1325–38. 10.1016/S0140-6736(11)60555-2
    1. Lee AC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, et al. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21(st) standard: analysis of CHERG datasets. BMJ. (2017) 358:j3677. 10.1136/bmj.j3677
    1. Danaei G, Andrews KG, Sudfeld CR, Fink G, McCoy DC, Peet E, et al. Risk factors for childhood stunting in 137 developing countries: a comparative risk assessment analysis at global, regional, and country levels. PLoS Med. (2016) 13:e1002164. 10.1371/journal.pmed.1002164
    1. Schlaudecker EP, Munoz FM, Bardají A, Boghossian NS, Khalil A, Mousa H, et al. Small for gestational age: case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine. (2017) 35(48 Pt A):6518–28.
    1. Campisi SC, Carbone SE, Zlotkin S. Catch-up growth in full-term small for gestational age infants: a systematic review. Adv Nutr. (2019) 10:104–11. 10.1093/advances/nmy091
    1. Leroy JL, Frongillo EA, Dewan P, Black MM, Waterland RA. Can children catch up from the consequences of undernourishment? Evidence from child linear growth, developmental epigenetics, and brain and neurocognitive development. Adv Nutr. (2020) 11:1032–41. 10.1093/advances/nmaa020
    1. Mericq V, Ong KK, Bazaes R, Peña V, Avila A, Salazar T, et al. Longitudinal changes in insulin sensitivity and secretion from birth to age three years in small- and appropriate-for-gestational-age children. Diabetologia. (2005) 48:2609–14. 10.1007/s00125-005-0036-z
    1. Soto N, Bazaes RA, Peña V, Salazar T, Avila A, Iñiguez G, et al. Insulin sensitivity and secretion are related to catch-up growth in small-for-gestational-age infants at age 1 year: results from a prospective cohort. J Clin Endocrinol Metab. (2003) 88:3645–50. 10.1210/jc.2002-030031
    1. Mazumder S, Taneja S, Dube B, Bhatia K, Ghosh R, Shekhar M, et al. Effect of community-initiated kangaroo mother care on survival of infants with low birthweight: a randomised controlled trial. Lancet. (2019) 394:1724–36. 10.1016/S0140-6736(19)32223-8
    1. Ministry of Health and Family Welfare. Home Based Newborn Care Operational Guidelines [Internet]. New Delhi: Ministry of Health and Family Welfare; (2014).
    1. World Health Organization and the United Nations Children’s Fund (UNICEF). Recommendations for Data Collection, Analysis and Reporting on Anthropometric Indicators in Children Under 5 Years Old. Contract No.: Licence: CC BY-NC-SA 3.0 IGO. Geneva: UNICEF; (2019).
    1. Taneja S, Sinha B, Upadhyay RP, Mazumder S, Sommerfelt H, Martines J, et al. Community initiated kangaroo mother care and early child development in low birth weight infants in India-a randomized controlled trial. BMC Pediatr. (2020) 20:150. 10.1186/s12887-020-02046-4
    1. Mazumder S, Taneja S, Dalpath SK, Gupta R, Dube B, Sinha B, et al. Impact of community-initiated kangaroo mother care on survival of low birth weight infants: study protocol for a randomized controlled trial. Trials. (2017) 18:262. 10.1186/s13063-017-1991-7
    1. R Core Team. R: A Language and Environment for Statistical Computing. Vienna: R Foundation for Statistical Computing; (2020).
    1. World Health Organization. WHO Child Growth Standards and the Identification of Severe Acute Malnutrition in Infants and Children: A Joint Statement by the World Health Organization and the United Nations Children’s Fund. Geneva: World Health Organization; (2009).
    1. Leroy J. ZSCORE06: Stata Command for the Calculation of Anthropometric Z-Scores Using the 2006 WHO Child Growth Standards. Boston, MA: Boston College Department of Economics; (2011).
    1. Raaijmakers A, Jacobs L, Rayyan M, van Tienoven TP, Ortibus E, Levtchenko E, et al. Catch-up growth in the first two years of life in extremely low birth weight (ELBW) infants is associated with lower body fat in young adolescence. PLoS One. (2017) 12:e0173349. 10.1371/journal.pone.0173349
    1. WHO. Growth Velocity Based on Weight, Length and Head Circumference: Methods and Development. Geneva: World Health Organization; (2009).
    1. Leger J, Limoni C, Collin D, Czernichow P. Prediction factors in the determination of final height in subjects born small for gestational age. Pediatr Res. (1998) 43:808–12. 10.1203/00006450-199806000-00015
    1. Pradeilles R, Norris T, Ferguson E, Gazdar H, Mazhar S, Bux Mallah H, et al. Factors associated with catch-up growth in early infancy in rural Pakistan: a longitudinal analysis of the women’s work and nutrition study. Matern Child Nutr. (2019) 15:e12733. 10.1111/mcn.12733
    1. Bavdekar AR, Vaidya UV, Bhave SA, Pandit AN. Catch up growth and its determinants in low birth weight babies: a study using Z scores. Indian Pediatr. (1994) 31:1483–90.
    1. Nguyen PH, Headey D, Frongillo EA, Tran LM, Rawat R, Ruel MT, et al. Changes in underlying determinants explain rapid increases in child linear growth in alive & thrive study areas between 2010 and 2014 in Bangladesh and Vietnam. J Nutr. (2017) 147:462–9. 10.3945/jn.116.243949
    1. Itabashi K, Mishina J, Tada H, Sakurai M, Nanri Y, Hirohata Y. Longitudinal follow-up of height up to five years of age in infants born preterm small for gestational age; comparison to full-term small for gestational age infants. Early Hum Dev. (2007) 83:327–33. 10.1016/j.earlhumdev.2006.07.002
    1. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. (2008) 3:17. 10.1186/1751-0473-3-17
    1. Hediger ML, Overpeck MD, Maurer KR, Kuczmarski RJ, McGlynn A, Davis WW. Growth of infants and young children born small or large for gestational age: findings from the third national health and nutrition examination survey. Arch Pediatr Adolesc Med. (1998) 152:1225–31. 10.1001/archpedi.152.12.1225
    1. McLaughlin EJ, Hiscock RJ, Robinson AJ, Hui L, Tong S, Dane KM, et al. Appropriate-for-gestational-age infants who exhibit reduced antenatal growth velocity display postnatal catch-up growth. PLoS One. (2020) 15:e0238700. 10.1371/journal.pone.0238700
    1. Kaur H, Bhalla AK, Kumar P. Longitudinal growth dynamics of term symmetric and asymmetric small for gestational age infants. Anthropol Anz. (2017) 74:25–37. 10.1127/anthranz/2016/0640
    1. Albertsson-Wikland K, Karlberg J. Postnatal growth of children born small for gestational age. Acta Paediatr Suppl. (1997) 423:193–5. 10.1111/j.1651-2227.1997.tb18413.x
    1. Saenger P, Czernichow P, Hughes I, Reiter EO. Small for gestational age: short stature and beyond. Endocr Rev. (2007) 28:219–51. 10.1210/er.2006-0039
    1. Karlberg J, Albertsson-Wikland K. Growth in full-term small-for-gestational-age infants: from birth to final height. Pediatr Res. (1995) 38:733–9. 10.1203/00006450-199511000-00017
    1. Alderman H, Headey D. The timing of growth faltering has important implications for observational analyses of the underlying determinants of nutrition outcomes. PLoS One. (2018) 13:e0195904. 10.1371/journal.pone.0195904
    1. Kang L, Wang H, He C, Wang K, Miao L, Li Q, et al. Postnatal growth in preterm infants during the first year of life: a population-based cohort study in China. PLoS One. (2019) 14:e0213762. 10.1371/journal.pone.0213762
    1. Harding JE, McCowan LM. Perinatal predictors of growth patterns to 18 months in children born small for gestational age. Early Hum Dev. (2003) 74:13–26. 10.1016/s0378-3782(03)00080-x
    1. Cianfarani S, Germani D, Branca F. Low birthweight and adult insulin resistance: the “catch-up growth” hypothesis. Arch Dis Child Fetal Neonatal Ed. (1999) 81:F71–3. 10.1136/fn.81.1.f71

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