Growth and neurodevelopment in low birth weight versus normal birth weight infants from birth to 24 months, born in an obstetric emergency hospital in Haiti, a prospective cohort study

Abstract

Background: Low birthweight (LBW) infants are at higher risk of mortality and morbidity (growth, chronic disease and neurological problems) during their life. Due to the high incidence of (pre-) eclampsia in Haiti, LBW infants are common. We assessed the anthropometric growth (weight and length) and neurodevelopmental delay in LBW and normal birthweight (NBW) infants born at an obstetric emergency hospital in Port au Prince, Haiti, between 2014 and 2017.

Methods: Infants were followed at discharge and 3, 6, 12, 15, 18, 21 and 24 months of corrected gestational age. At each visit they underwent a physical checkup (weight, length, physical abnormalities, identification of morbidities). At 6, 12, 18 and 24 months they underwent a neurodevelopmental assessment using the Bayley Scale III (motor, cognitive and communication skills). We modelled the trajectories between birth and 24 months of age of NBW compared to LBW infants for weight, length, and raw scores for Bayley III assessments using mixed linear models.

Results: In total 500 LBW and 210 NBW infants were recruited of which 333 (46.7%) were followed up for 24 months (127 NBW; 60.5% and 206 LBW; 41.2%) and 150 died (LBW = 137 and NBW = 13). LBW and NBW babies gained a mean 15.8 g and 11.4 g per kg of weight from discharge per day respectively. The speed of weight gain decreased rapidly after 3 months in both groups. Both groups grow rapidly up to 6 months of age. LBW grew more than the NBW group during this period (22.8 cm vs. 21.1 cm). Both groups had WHZ scores <- 2 up to 15 months. At 24 months NBW babies scored significantly higher on the Bayley scales for gross motor, cognitive and receptive and expressive communication skills. There was no difference between the groups for fine motor skills.

Conclusion: LBW babies that survive neonatal care in urban Haiti and live up to 24 months of age, perform similar to their NBW for weight, length and fine motor skills. LBW babies are delayed in gross motor, cognitive and communication skills development. Further research on the clinical significance of these findings and long term implications of this neurodevelopmental delay is needed.

Fig. 1

Study participant flow in the study [LBW = low birthweight; NBW = normal birthweight, LFP = lost to follow up]; total deaths = 150 (LBW = 137; NBW = 13); total LFP = 227 (LBW = 157; NBW = 70)

Fig. 2

Weight (cm; dots) and estimated weight (lines) for the NBW and LBW groups

Fig. 3

Length (cm; dots) and estimated length (lines) for the NBW and LBW groups

Fig. 4

Weight-for-Height z scores for the NBW and LBW groups

Fig. 5

Gross and fine motor skills scores (dots) and estimated values (lines) for the NBW and LBW groups (a, b)

Fig. 6

Cognitive skills scores (dots) and estimated values (lines) for the NBW and LBW groups

Fig. 7

Receptive communication skills scores (dots) and estimated values (lines) for the NBW and LBW groups

Fig. 8

Expressive communication skills scores (dots) and estimated values (lines) for the NBW and LBW groups