Sullivan, M. C., McGrath, M. M., Hawes, K., & Lester, B. M. (2008). Journal of Pediatric Health Care, 22, 83-93.

This ambitious prospective and longitudinal study followed 194 preterm infants for 12 years to investigate the long-term effect of birthweight and neonatal morbidities on preterm growth from birth to age 12 years. It is well known that the combination of being born with severe neonatal complications and subsequent long-term NICU hospitalizations creates a series of complex problems including, but not limited, to autonomic and regulatory behaviors synonymous with physiologic stress. Although the evidence is strong that children who are born prematurely and weigh less than 1500 g are likely to grow at slower rates and remain smaller than their full-term counterparts until age 6 to 9 years, little or no research has examined the effects of neonatal morbidities with growth trajectories beyond early school-age years. Five groups of preterm infants recruited at birth comprised the sample of 194: 46 healthy, full-term infants, 29 healthy, preterm infants without medical or neurological illness, 56 medical preterm infants with clinical illness but no neurological involvement, and 29 small-for-gestational-age (SGA) infants with or without medical illness. There were no significant differences in socioeconomic or parental height among the five groups.

At birth and recruitment, two NICU advanced practice nurses extracted the neonatal data on all variables, including height and weight, BMI, and neonatal illness, and calculated an infant risk score using the Hobel neonatal scale (Hobel, Hyvarien, Okada & Oh, 1973). Interrater reliability on this measure was high. Growth measurements were then taken again and corrected for gestational age at 18 months, 30 months, 4 years, 8 years, and 12 years. All children were included in follow-up, including even the most severely impaired. The authors reported many interesting findings. Most notably, they found that neonatal morbidity has a continued effect on height and weight growth trajectories through age 12 years. Full-term infants were taller than preterm infants until age 8, when all but the infants in the SGA group caught up. The preterm infants with neurological illness and the SGA groups both had smaller height measures through age 12 years. The researchers concluded that neonatal morbidity has a significant effect on height and weight growth.

They suggested that nurses working in the NICU and with preterm infants after discharge advise parents to keep a record of their infant's growth, including height, weight, BMI, and head circumference. This information can be helpful in keeping the many pediatric providers who follow NICU graduates up-to-date. Anticipatory guidance by nurses also should include interventions to ensure adequate nutrition and avoid feeding problems that further compromise the preterm infant's growth trajectory. Concern for overweight and obesity in this group was identified as another area for nursing intervention. The authors referred readers to the 2006 NAPNAP position paper on healthy eating and activity, which can further guide nurses in the care of this vulnerable population as they approach adolescence.

Judy Beal

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