RESUMEN
OBJECTIVE: To evaluate whether the presence of patent ductus arteriosus (PDA) in preterm infants worsens long-term neurodevelopmental outcomes. STUDY DESIGN: This was a secondary observational analysis of data from 1090 preterm low-birthweight infants in the Infant Health and Development Program (IHDP), a multicenter longitudinal cohort study of outcomes assessed from 3 to 18 years of age. Multivariable analysis was adjusted for IHDP treatment group (intervention or follow-up), birth weight, maternal race, maternal education, infant sex, maternal preconception weight, Home Observation Measurement of the Environment (HOME) total score at 12 months, neonatal health index, and gestational age. RESULTS: Of the 1090 patients (49% male) included in the analysis, 135 had a PDA. Mean birth weight (1322 g vs 1871 g; P < .0001) and gestational age (30.2 weeks vs 33.4 weeks, P < .0001) were lower and mean ventilator days (11.8 vs 1.3; P < .0001), vasopressor use (12.6% vs 1.2%; P < .0001), and congestive heart failure (8.9% vs 0.1%; P < .0001) were higher in the PDA group. There were no differences between the PDA and no-PDA groups in maternal education level and HOME total score at age 12 months. Multivariable analysis demonstrated no between-group differences in cognitive development or behavioral competence at age 3, 8, and 18 years. CONCLUSIONS: The presence of a PDA in moderately preterm, low-birthweight infants does not impact long-term neurodevelopmental outcomes.
Asunto(s)
Conducto Arterioso Permeable/diagnóstico , Conducto Arterioso Permeable/tratamiento farmacológico , Recién Nacido de Bajo Peso , Recien Nacido Prematuro , Trastornos del Neurodesarrollo/diagnóstico , Adolescente , Factores de Edad , Niño , Preescolar , Inhibidores de la Ciclooxigenasa/uso terapéutico , Femenino , Estudios de Seguimiento , Humanos , Ibuprofeno/uso terapéutico , Incidencia , Indometacina/uso terapéutico , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Trastornos del Neurodesarrollo/epidemiología , Medición de Riesgo , Tiempo , Factores de TiempoRESUMEN
OBJECTIVE: To examine trade-offs between cognitive outcome and overweight/obesity in preterm-born infants at school age and young adulthood in relation to weight gain and linear growth during infancy. STUDY DESIGN: We studied 945 participants in the Infant Health and Development Program, an 8-center study of preterm (≤37 weeks gestational age), low birth weight (≤2500 g) infants from birth to age 18 years. Adjusting for maternal and child factors in logistic regression, we estimated the odds of overweight/obesity (body mass index [BMI] ≥85th percentile at age 8 or ≥25 kg/m(2) at age 18) and in separate models, low IQ (<85) per z-score changes in infant length and BMI from term to 4 months, from 4 to 12 months, and from 12 to 18 months. RESULTS: More rapid linear growth from term to 4 months was associated with lower odds of IQ <85 at age 8 years (OR, 0.82; 95% CI, 0.70-0.96), but higher odds of overweight/obesity (OR, 1.27; 95% CI, 1.05-1.53). More rapid BMI gain in all 3 infant time intervals was also associated with higher odds of overweight/obesity, and BMI gain from 4-12 months was associated with lower odds of IQ <85 at age 8. Results at age 18 were similar. CONCLUSION: In these preterm, low birth weight infants born in the 1980s, faster linear growth soon after term was associated with better cognition, but also with a greater risk of overweight/obesity at age 8 years and 18 years. BMI gain over the entire 18 months after term was associated with later risk of overweight/obesity, with less evidence of a benefit for IQ.
Asunto(s)
Peso Corporal , Crecimiento , Inteligencia , Aumento de Peso , Adiposidad , Adolescente , Índice de Masa Corporal , Niño , Estudios de Seguimiento , Humanos , Recién Nacido de Bajo Peso , Recién Nacido , Recien Nacido Prematuro , Obesidad/epidemiología , Sobrepeso/epidemiologíaRESUMEN
OBJECTIVE: To characterize growth, fat mass (FM), fat-free mass (FFM), and bone mineral content (BMC) longitudinally in healthy infants fed breast milk (BM), cow's milk formula (CMF), or soy formula (SF) during the first year of life. STUDY DESIGN: Infants were assessed at age 3, 6, 9, and 12 months. Growth was evaluated using standard anthropometric techniques, and body composition was assessed by dual-energy X-ray absorptiometry. Mixed-effects models with repeated measures were used, adjusting for race, socioeconomic status, gestational age, birth weight, birth length, sex, age, and diet history. RESULTS: Compared with infants fed formulas, infants fed BM had higher FM at age 3 months, and lower FFM at age 6-12 months (P < .001). Infants fed SF had greater FFM at age 6 months and 9 months compared with infants fed CMF (P < .001). BMC was higher in infants fed BM and lower in infants fed SF at age 3 months (P < .001), but by age 12 months, BMC was significantly higher in infants fed SF. CONCLUSION: Infants fed CMF and SF had significantly different fat and bone accretion trajectories, and all infants fed formula were significantly different from infants fed BM. Infants fed SF had a leaner body phenotype throughout the first year of life, lower bone mineralization by age 3 months, and greater bone mineral accretion during the first year of life compared with infants fed BM or CMF. Although the body composition profiles are strikingly different in these 3 diet groups, the implications for long-term health outcomes and bone health remain unclear.