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. 2022 May 24:9:827589.
doi: 10.3389/fnut.2022.827589. eCollection 2022.

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  1   2 , Tarun Shankar Choudhary  3   4 , Nitika Nitika  1 , Mohan Kumar  1   4 , Sarmila Mazumder  1 , Sunita Taneja  1 , Nita Bhandari  1   4
Affiliations

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 et al. Front Nutr. .

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://clinicaltrials.gov/], identifier [NCT02653534].

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

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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.

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.
See this image and copyright information in PMC

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