Postnatal Growth Assessment and Prediction of Neurodevelopment and Long-Term Growth in Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Data Collection
2.2. Definitions of EUGR
2.3. Long-Term Outcomes
2.4. Statistical Analysis
2.5. Ethics Statement
3. Results
3.1. Clinical Characteristics of Study Population
3.2. Association between EUGR and Long-Term Outcomes
3.3. Diagnostic Effectiveness of EUGRF and EUGRIG
4. Discussion
4.1. Difference between EUGRF and EUGRIG
4.2. Factors Associated with EUGR
4.3. Efficient Prediction for Long-Term Outcomes
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
CP | NDI | Growth Failure | |||||||
---|---|---|---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | OR | 95% CI | p Value | |
Maternal characteristics | |||||||||
Maternal age, years | 1.02 | 0.98–1.07 | 0.312 | 1.00 | 0.98–1.03 | 0.782 | 1.00 | 0.97–1.02 | 0.812 |
Maternal HTN | 0.70 | 0.44–1.08 | 0.112 | 1.11 | 0.89–1.38 | 0.354 | 1.93 | 1.51–2.46 | <0.001 |
C/S | 1.19 | 0.80–1.80 | 0.398 | 1.09 | 0.87–1.37 | 0.455 | 2.41 | 1.75–3.40 | <0.001 |
HCAM | 1.08 | 0.73–1.59 | 0.701 | 0.87 | 0.71–1.07 | 0.192 | 0.74 | 0.57–0.95 | 0.019 |
Antenatal steroid | 0.80 | 0.51–1.27 | 0.328 | 0.92 | 0.70–1.21 | 0.540 | 1.21 | 0.86–1.74 | 0.291 |
Infantile characteristics | |||||||||
GA, weeks | 0.81 | 0.74–0.89 | <0.001 | 0.83 | 0.79–0.88 | <0.001 | 0.94 | 0.88–1.00 | 0.037 |
BW, grams | 1.00 | 1.00–1.00 | 0.008 | 1.00 | 1.00–1.00 | <0.001 | 1.00 | 1.00–1.00 | <0.001 |
5 min AS | 0.93 | 0.84–1.03 | 0.140 | 0.87 | 0.83–0.92 | <0.001 | 0.89 | 0.83–0.95 | <0.001 |
Male.sex | 1.01 | 0.71–1.45 | 0.939 | 1.49 | 1.23–1.82 | <0.001 | 1.18 | 0.94–1.50 | 0.157 |
Short-term Neonatal Outcomes | |||||||||
RDS | 1.89 | 1.01–3.87 | 0.060 | 1.75 | 1.30–2.40 | <0.001 | 1.28 | 0.90–1.85 | 0.182 |
Treated PDA | 1.47 | 1.01–2.13 | 0.044 | 1.49 | 1.21–1.84 | <0.001 | 1.67 | 1.30–2.13 | <0.001 |
Moderate to severe BPD | 1.90 | 1.32–2.72 | <0.001 | 2.28 | 1.87–2.78 | <0.001 | 2.57 | 2.03–3.26 | <0.001 |
NEC | 1.70 | 0.87–3.18 | 0.108 | 1.71 | 1.16–2.51 | 0.006 | 1.58 | 0.98–2.46 | 0.050 |
Severe brain injury | 12.59 | 8.17–19.68 | <0.001 | 4.10 | 3.07–5.50 | <0.001 | 1.98 | 1.43–2.71 | <0.001 |
ROP | 12.59 | 8.17–19.68 | <0.001 | 2.04 | 1.58–2.63 | <0.001 | 2.54 | 1.92–3.33 | <0.001 |
Sepsis | 1.22 | 0.79–1.83 | 0.360 | 1.62 | 1.29–2.03 | <0.001 | 1.37 | 1.04–1.78 | 0.022 |
Duration of PN, days | 1.01 | 1.00–1.02 | 0.002 | 1.02 | 1.01–1.02 | <0.001 | 1.02 | 1.01–1.02 | <0.001 |
Length of stay, days | 1.02 | 1.02–1.03 | <0.001 | 1.02 | 1.01–1.02 | <0.001 | 1.02 | 1.02–1.03 | <0.001 |
EUGRF | 1.41 | 0.94–2.14 | 0.101 | 1.59 | 1.30–1.95 | <0.001 | 2.45 | 1.87–3.24 | <0.001 |
EUGRIG | 2.49 | 1.73–3.60 | <0.001 | 2.09 | 1.71–2.55 | <0.001 | 1.77 | 1.40–2.24 | <0.001 |
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Characteristics | Fenton | Intergrowth-21 | ||||
---|---|---|---|---|---|---|
EUGRF [N = 1606] | Non-EUGRF [N = 1043] | a p | EUGRIG [N = 977] | Non-EUGRIG [N = 1672] | b p | |
Maternal Characteristics | ||||||
Maternal age, years | 33.0 [31.0; 36.0] | 33.0 [31.0; 36.0] | 0.285 | 33.0 [31.0; 36.0] | 33.0 [31.0; 36.0] | 0.831 |
Maternal HTN | 343 (21.4%) | 343 (32.9%) | <0.001 | 168 (17.2%) | 518 (31.0%) | <0.001 |
Cesarian section | 1170 (72.9%) | 796 (76.3%) | 0.052 | 695 (71.1%) | 1271 (76.0%) | 0.006 |
Histological chorioamnionitis | 629/1374 (45.8%) | 379/950 (39.9%) | 0.006 | 406/824 (49.3%) | 602/1500 (40.1%) | <0.001 |
Antenatal steroid | 1352/1581 (85.5%) | 870/1027 (84.7%) | 0.612 | 823/959 (85.8%) | 1399/1649 (84.8%) | 0.534 |
Infant Characteristics | ||||||
Gestational age, weeks | 27.9 [26.4; 29.4] | 29.1 [27.7; 30.3] | <0.001 | 27.3 [26.0; 28.7] | 29.0 [27.6; 30.1] | <0.001 |
Birth weight, grams | 1030 [850; 1240] | 1140 [940; 1300] | <0.01 | 1000 [840; 1210] | 1120 [900; 1300] | < 0.001 |
5 min AS | 7.0 [6.0; 8.0] | 7.0 [6.0; 8.0] | 0.001 | 7.0 [6.0; 8.0] | 7.0 [6.0; 8.0] | < 0.001 |
Male sex | 815 (50.7%) | 548 (52.5%) | 0.388 | 566 (57.9%) | 797 (47.7%) | <0.001 |
SGAF | 201 (12.5%) | 126 (12.1%) | 0.786 | 73 (7.5%) | 254 (15.2%) | <0.001 |
SGAIG | 273 (17.0%) | 193 (18.5%) | 0.346 | 108 (11.1%) | 358 (21.4%) | <0.001 |
Short-term Neonatal Outcomes | ||||||
Respiratory distress syndrome | 1430 (89.0%) | 842 (80.7%) | <0.001 | 913 (93.4%) | 1359 (81.3%) | <0.001 |
Treated PDA | 516/1563 (33.0%) | 214/1008 (21.2%) | <0.001 | 351/952 (36.9%) | 379/1619 (23.4%) | <0.001 |
Moderate to severe BPD | 582/1602 (36.3%) | 342/1043 (32.8%) | 0.068 | 422/973 (43.4%) | 502/1672 (30.0%) | <0.001 |
Necrotizing enterocolitis | 110/1605 (6.9%) | 27/1043 (2.6%) | <0.001 | 86/976 (8.8%) | 51/1672 (3.1%) | <0.001 |
Severe brain injury | 108 (6.7%) | 39 (3.7%) | <0.001 | 162 (l6.6%) | 122 (7.3%) | <0.001 |
Retinopathy of prematurity | 287/1597 (18.0%) | 89/1033 (8.6%) | <0.001 | 228/971 (23.5%) | 148/1659 (8.9%) | <0.001 |
Sepsis | 397 (24.7%) | 164 (15.7%) | <0.001 | 291 (29.8%) | 270 (16.1%) | <0.001 |
Duration of PN, days | 27.0 [16.0; 44.0] | 17.0 [10.0; 30.5] | <0.001 | 33.0 [19.0; 51.0] | 19.0 [11.0; 31.0] | <0.001 |
Length of stay, days | 77.0 [60.0; 99.0] | 63.0 [50.0; 86.0] | <0.001 | 85.0 [68.0; 107.0] | 64.0 [51.0; 84.5] | <0.001 |
Intergrowth-21 | Univariate Analysis | Multivariate Analysis | ||||||
EUGRIG | Non-EUGRIG | OR | 95% CI | p | aOR | 95% CI | p | |
CP a | 96/300 (32.0%) | 62/390 (15.9%) | 2.49 | 1.73–3.60 | <0.001 | 1.66 | 1.04–2.65 | 0.035 |
NDI b | 265/709 (37.4%) | 300/1349 (22.2%) | 2.09 | 1.71–2.55 | <0.001 | 2.09 | 1.71–2.55 | <0.001 |
Growth failure c | 158/956 (16.5%) | 165/1644 (10.0%) | 1.77 | 1.40–2.24 | <0.001 | 1.57 | 1.16–2.13 | 0.004 |
Fenton | Univariate analysis | Multivariate analysis | ||||||
EUGRF | Non-EUGRF | OR | 95% CI | p | aOR | 95% CI | p | |
CP a | 120/488 (24.6%) | 38/202 (18.8%) | 1.41 | 0.94–2.14 | 0.101 | 1.30 | 0.79–2.17 | 0.310 |
NDI b | 377/1209 (31.2%) | 188/849 (22.1%) | 1.59 | 1.30–1.95 | <0.001 | 1.29 | 1.03–1.63 | 0.027 |
Growth failure c | 250/1577 (15.9%) | 73/1023 (7.1%) | 2.45 | 1.87–3.24 | <0.001 | 2.44 | 1.77–3.40 | <0.001 |
EUGRIG (95% CI) | EUGRF (95% CI) | |
---|---|---|
CP | ||
Sensitivity | 60.76 (52.69–68.42) | 75.95 (68.52–82.38) |
Specificity | 52.78 (47.95–57.57) | 30.83 (26.92–34.94) |
Positive predictive value | 32.00 (28.62–35.58) | 24.59 (22.70–26.58) |
Negative predictive value | 78.62 (74.81–81.99) | 81.19 (76.09–85.41) |
Accuracy | 54.92 (50.8–58.98) | 41.16 (37.46–44.94) |
DOR | 1.73 (1.19–2.50) | 1.40 (0.93–2.11) |
NDI | ||
Sensitivity | 46.90 (42.72–51.11) | 66.73 (62.67–70.60) |
Specificity | 70.26 (67.87–72.57) | 44.27 (41.73–46.84) |
Positive predictive value | 37.38 (34.67–40.16) | 31.18 (29.62–32.79) |
Negative predictive value | 77.76 (76.27–79.18) | 77.86 (75.54–80.01) |
Accuracy | 63.85 (61.73–65.93) | 50.44 (48.25–52.62) |
DOR | 2.08 (1.71–2.54) | 1.59 (1.30–1.95) |
Growth Failure | ||
Sensitivity | 48.92 (43.34–54.51) | 77.40 (72.44–81.85) |
Specificity | 64.95 (62.95–66.92) | 41.85 (39.81–43.91) |
Positive predictive value | 16.53 (14.88–18.32) | 15.92 (15.03–16.86) |
Negative predictive value | 89.96 (88.92–90.92) | 92.86 (91.36–94.12) |
Accuracy | 62.96 (61.07–64.82) | 46.28 (44.35–48.22) |
DOR | 1.77 (1.40–2.24) | 2.46 (1.87–3.24) |
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Kim, M.S.; Koh, J.W.; Shin, J.; Kim, S.Y. Postnatal Growth Assessment and Prediction of Neurodevelopment and Long-Term Growth in Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea. J. Clin. Med. 2024, 13, 2930. https://doi.org/10.3390/jcm13102930
Kim MS, Koh JW, Shin J, Kim SY. Postnatal Growth Assessment and Prediction of Neurodevelopment and Long-Term Growth in Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea. Journal of Clinical Medicine. 2024; 13(10):2930. https://doi.org/10.3390/jcm13102930
Chicago/Turabian StyleKim, Min Soo, Ji Won Koh, Jeongmin Shin, and Sae Yun Kim. 2024. "Postnatal Growth Assessment and Prediction of Neurodevelopment and Long-Term Growth in Very Low Birth Weight Infants: A Nationwide Cohort Study in Korea" Journal of Clinical Medicine 13, no. 10: 2930. https://doi.org/10.3390/jcm13102930