The Relationship Between Growth and Perinatal Factors in Preterm Infants

  • Monique Rijken


In the last few decades an increased survival of very preterm infants has been described, but concerns remain about their neurodevelopmental outcome and catch-up growth. Sub-optimal growth may be the result of a complex interaction of perinatal factors including inadequate nutrition. The more preterm the infant and the lower the birth weight, the higher the risk of poor growth, not only in the immediate postnatal period but also in the long term. Both intrauterine growth retardation and extrauterine growth restriction are associated with lower weight, shorter length, lower weight-for-length ratio, and smaller head circumference later in childhood. Very preterm infants who suffer from serious morbidities like sepsis, prolonged ventilator dependency, bronchopulmonary dysplasia, or necrotizing enterocolitis are at greater risk for postnatal growth restriction, as are infants who received postnatal corticosteroids. Aggressive nutritional support could help to prevent severe growth problems in the very preterm infants and is probably also related to a better neurodevelopmental outcome. However, this is where a dilemma exists for the neonatologist: according to recent research good catch-up growth in preterm infants possibly results in morbidities later in adulthood, like insulin resistance, increased blood pressure, and increased mortality from coronary artery disease later in life. Both bronchopulmonary dysplasia and the postnatal use of dexamethasone are important risk factors for poor growth later in childhood, irrespective of gestational age or birth weight. Severe intracranial ultrasound abnormalities like intraventricular hemorrhage grades 3 and 4, and cystic periventricular leukomalacia are also associated with poor growth later in childhood. This is true not only for head circumference but also for weight and length.


Preterm Infant Bronchopulmonary Dysplasia ELBW Infant Small Head Circumference Severe Neonatal Morbidity 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Appropriate for gestational age


Bronchopulmonary dysplasia


Birth weight




Gestational age


Head circumference


Intrauterine growth retardation/restriction


Intraventricular hemorrhage




Leiden Follow-Up Project on Prematurity


Necrotizing enterocolitis


Preterm growth restriction


Periventricular leukomalacia


Standard deviation score(s)


Small for gestational age






  1. Berry MA, Abrahamowicz M, Usher RH. Pediatrics. 1997;100:640–6.PubMedCrossRefGoogle Scholar
  2. Bracewell MA, Hennessy EM, Wolke D, Marlow N. Arch Dis Child Fetal Neonatal Ed. 2008;93:F108–14.PubMedCrossRefGoogle Scholar
  3. Clark RH, Thomas P, Peabody. Pediatrics. 2003;111:986–90.PubMedCrossRefGoogle Scholar
  4. Daily DK, Kilbride HW, Wheeler R, Hassanein R. J Perinatol. 1994;14:454–60.PubMedGoogle Scholar
  5. Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA. Semin Perinatol. 2003;27:302–10.PubMedCrossRefGoogle Scholar
  6. Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF, Wright LL, KatsikiotisV, Tyson JE, Oh W, Shankaran S, Bauer CR, Korones SB, Stoll, BJ, Stevenson DK, Papile LA. Pediatrics. 1999;104:280–9.PubMedCrossRefGoogle Scholar
  7. Euser AM, de Wit CC, Finken MJ, Rijken M, Wit JM. Horm Res. 2008;70:319–28.PubMedCrossRefGoogle Scholar
  8. Finken MJJ, Dekker FW, de Zegher F, Wit JM, for the Dutch Project on Preterm and Small-for-Gestational-Age-. Pediatrics. 2006;118:640–3.PubMedCrossRefGoogle Scholar
  9. Gibson A, Carney S, Wales JK. Horm Res. 2006;65:75–81.PubMedCrossRefGoogle Scholar
  10. Gortner L, van Husen M, Thyen U, Gembruch U, Friedrich HJ, Landmann E. Eur J Obstet Gynecol Reprod Biol. 2003;110:S93–7.PubMedCrossRefGoogle Scholar
  11. Gutbrod T, Wolke D, Soehne B, Ohrt B, Riegel K. Arch Dis Child Fetal Neonatal Ed. 2000;82:F208–14.PubMedCrossRefGoogle Scholar
  12. Hack M, Schluchter M, Cartar L, Rahman M, Cuttler L, Borawski E. Pediatrics. 2003;112:e30–8.PubMedCrossRefGoogle Scholar
  13. Jordan IM, Robert A, Francart J, Sann L, Putet G. Biol Neonate. 2005;88:57–65.PubMedCrossRefGoogle Scholar
  14. O’Shea TM, Kothadia JM, Klinepeter KL, Goldstein DJ, Jackson BG, Weaver RG, III, Dillard RG. Pediatrics. 1999;104:15–21.PubMedCrossRefGoogle Scholar
  15. Picaud JC, Decullier E, Plan O, Pidoux O, Bin-Dorel S, van Egroo LD, Chapuis F, Claris O. J Pediatr. 2008;153:616–21.PubMedCrossRefGoogle Scholar
  16. Pietz J, Peter J, Graf R, Rauterberg-Ruland I, Rupp A, Sontheimer D, Linderkamp O. Early Hum Dev. 2004;79:131–43.PubMedCrossRefGoogle Scholar
  17. Rijken M. A regional follow-up study at two years of age in extremely preterm and very preterm infants. Thesis, University of Leiden. 2007.Google Scholar
  18. Rijken M, Wit JM, Le Cessie S, Veen S. Early Hum Dev. 2007;83:527–34.PubMedCrossRefGoogle Scholar
  19. Rogers B, Andrus J, Msall ME, Arvedson J, Sim J, Rossi T, Martin D, Hudak M. Dev Med Child Neurol. 1998;40:580–6.PubMedCrossRefGoogle Scholar
  20. Saigal S, Stoskopf B, Streiner D, Paneth N, Pinelli J, Boyle M. Pediatr Res. 2006;60:751–8.PubMedCrossRefGoogle Scholar
  21. Sonntag J. Acta Paediatr. 2000;89:528–32.PubMedCrossRefGoogle Scholar
  22. Soraisham AS, Amin HJ, Al-Hindi MY, Singhal N, Sauve RS. J Paediatr Child Health. 2006;42:499–504.PubMedCrossRefGoogle Scholar
  23. Uhing MR, Das U. Clin. Perinatol. 2009;36:165–76.CrossRefGoogle Scholar
  24. Wang D, Vandermeulen J, Atkinson SA. Pediatr Res. 2007;61:111–6.PubMedCrossRefGoogle Scholar
  25. Wit JM, Finken MJ, Rijken M, de Zegher F. Pediatrics. 2006;117:e793–5.PubMedCrossRefGoogle Scholar
  26. Yeh TF, Lin YJ, Lin HC, Huang CC, Hsieh WS, Lin CH, Tsai CH. N Engl J Med. 2004;350:1304–13.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PediatricsLeiden University Medical CenterLeidenThe Netherlands

Personalised recommendations