Linear Growth and Neurobehavioural Outcome in PT Neonates (<34 Wks) at 37 and 40 Wks of CGA
Condition: PreTerm Birth
MeSH terms: Premature Birth
Study type: Observational

Summary: 
      This study will evaluate the association of linear growth on neurobehavioural outcome in
      preterm neonates at 37 and 40 weeks of (CGA) corrected gestational age.
    

Detailed description: 
      Growth of the preterm infant has historically been defined as weight gain over time. As
      weight gain and nutrition have been more extensively studied and their relationships with
      neurodevelopmental outcomes have been established, other growth parameters and their
      relationships to outcome need to be assessed.

      Large multicenteric studies have demonstrated that poor postnatal weight gain has a negative
      effect on neurodevelopment . However, the neurodevelopmental consequences of linear stunting
      in this population were not assessed .Understanding this relationship is important because
      organ growth and differentiation are more closely linked to lean body mass and thus linear
      growth than to weight gain or fat mass alone. Moreover, weight gain and linear growth are not
      always tightly linked and may be influenced by both nutritional and non nutritional factors.

      Linear growth represents lean body mass and protein accretion and also indexes organ growth
      and development, including the brain. American Academy of Pediatrics (AAP) recommends that
      preterm infants should grow similar to the fetus,but this guideline has been mostly applied
      to weight gain. As already described, the ideal weight gain to optimize neurodevelopmental
      outcomes has been studied extensively. However, ideal linear growth has yet to be defined.
      Intrauterine linear-growth velocity is approximately 1 cm/wk,and therefore is the goal that
      most neonatologists currently follow.Given the increasing evidence that linear-growth
      suppression is associated with poorer cognitive outcomes,length may now be an important
      anthropometric biomarker for later neurodevelopment. Research is needed to determine optimal
      goals of linear growth for preterm infants so as to optimize later growth and
      neurodevelopmental outcomes.

      Recently the role of neurobehaviour has evaluated as early as at 37-40 weeks of CGA and is
      being predicted as an useful adjunct to the 12-18 month full neurodevelopmental assessment
      .Neurobehavioural assessment by tools like NAPI have been shown to correlate with BSID score
      at 18 months of corrected gestational age in preterm neonates.This has tremendous
      implications in terms of initiating an early rehabilitation /stimulation program for these
      neonates..

      There is insufficient data on Correlation of linear growth and neurological outcome in
      preterm VLBW babies in India.With majority of VLBW neonates in India being SGA this assumes
      critical significance as growth faltering is reported to continue as late as 24 months
      postnatally.The linkage of linear growth faltering and poor neurodevelopmental outcome needs
      to be detected early in the India population and corrective strategies need to be instituted
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Haemodynamicaly stable preterm neonates <34 weeks with in 48 hours of admission
      
Keywords: Linear growth and neurodevelopment outcome; < 34 weeks