Factors influencing the growth of preterm infants in the first two years of life

Rover, Milene de Moraes Sedrez; Rugolo, Lígia Maria Suppo de Souza; Viera, Cláudia Silveira

doi:10.1590/1984-0462/2025/43/2024297

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ORIGINAL ARTICLE • Rev. paul. pediatr. 43 • 2025 • https://doi.org/10.1590/1984-0462/2025/43/2024297 linkcopy

Factors influencing the growth of preterm infants in the first two years of life

Fatores que influenciam o crescimento de prematuros nos primeiros dois anos de vida

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: To identify maternal and neonatal factors associated with growth outcomes in preterm infants (PT) born before 33 weeks of gestation, assessed at 24 months corrected age (CA).

Methods: Prospective cohort study with PT <33 weeks’ gestation, discharged from the Neonatal Intensive Care Unit of a university hospital between 2019 and 2021, followed at the high-risk outpatient clinic. Variables analyzed: Maternal — sociodemographic aspects, gestational morbidities, selfefficacy score (confidence that parents have in their ability to perform the tasks of parenthood); Newborn — data from birth, hospital stay and post-discharge, measures of weight, height and head circumference at birth, discharge and follow up (seven evaluations). Outcome: Z scores of anthropometric measurements and growth failure (Z score <-2) at 24 months CA. Data were analyzed by hierarchical logistic or linear regression models in blocks.

Results: 99 PT with a mean gestational age of 30.2±2.0 weeks were studied. Intrauterine growth restriction (fetus that fails to reach its growth percentage, caused by maternal/placental factors) and being born small for gestational age (<10^th percentile according to Fenton’s calculator) were predictors of growth failure. Time to achieve full enteral feeding, necrotizing enterocolitis and maternal self-efficacy were associated with anthropometric measurements at 24 months.

Conclusions: The growth of PT in the first 24 months CA is influenced by the nutritional condition at birth, nutritional evolution during hospitalization and maternal self-efficacy. Optimizing nutritional practices for PT and stimulating maternal self-efficacy are possibilities for improving growth in the early years.

Keywords:
Premature newborn; Growth; Risk factors; Self-efficacy

		1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
1. Weight (Period 7)	p	-
1. Weight (Period 7)	p	-
2. Height (Period 7)	p	0.585 *	-
2. Height (Period 7)	p	<0.001	-
3. Head circumference (Period 7)	p	0.525 *	0.305 †	-
3. Head circumference (Period 7)	p	<0.001	0.004	-
4. Self-efficacy - Factor 1	p	-0.276 †	-0.119	-0.270 ‡	-
4. Self-efficacy - Factor 1	p	0.009	0.268	0.012	-
5. Self-efficacy - Factor 2	p	-0.106	-0.285 †	-0.077	0.646 *	-
5. Self-efficacy - Factor 2	P	0.324	0.007	0.480	<0.001	-
6. Self-efficacy - Factor 3	p	-0.172	-0.052	-0.210	0.838 *	0.689 *	-
6. Self-efficacy - Factor 3	p	0.110	0.629	0.052	<0.001	<0.001	-
7. Breastfeeding time	p	-0.047	-0.029	0.195	0.155	0.016	0.058	-
7. Breastfeeding time	p	0.728	0.830	0.146	0.225	0.904	0.650	-
8. Age of mother	p	-0.128	-0.018	-0.023	0.296 †	0.103	0.229 ‡	0.123	-
8. Age of mother	p	0.235	0.868	0.831	0.003	0.312	0.023	0.336	-
9. Number of children	p	-0.164	-0.128	-0.182	0.320 †	0.179	0.244 ‡	0.173	0.419 *	-
9. Number of children	p	0.128	0.233	0.094	0.001	0.076	0.015	0.176	<0.001	-
10. Number of pregnancies	p	-0.230 ‡	-0.130	-0.202	0.314 †	0.234 ‡	0.246 ‡	0.226	0.476 *	0.807 *	-
10. Number of pregnancies	p	0.031	0.226	0.062	0.002	0.020	0.014	0.075	<0.001	<0.001	-
11. Gestational age	p	0.277 †	0.157	0.306 †	0.064	0.048	0.017	-0.008	-0.017	0.058	-0.017	-
11. Gestational age	p	0.009	0.145	0.004	0.529	0.634	0.870	0.953	0.867	0.571	0.869	-
12. Time to reach full enteral feeding	p	-0.535 *	-0.342 †	-0.436 *	0.091	0.104	-0.145	-0.150	0.063	0.108	0.136	-0.608 *	-
12. Time to reach full enteral feeding	p	<0.001	0.001	<0.001	0.370	0.306	0.153	0.240	0.534	0.289	0.179	<0.001	-
13. Length of stay in NICU	p	-0.436 *	-0.315 †	-0.490 *	-0.032	-0.023	-0.020	-0.010	0.083	-0.008	0.080	-0.825 *	0.753 *	-
13. Length of stay in NICU	p	<0.001	0.003	<0.001	0.753	0.824	0.847	0.938	0.417	0.938	0.429	<0.001	<0.001	-
14. % of weight loss	p	-0.141	-0.062	-0.007	-0.117	-0.028	-0.115	0.124	-0.046	0.004	-0.002	-0.123	0.142	0.038	-
14. % of weight loss	p	0.194	0.569	0.949	0.252	0.785	0.263	0.338	0.653	0.969	0.983	0.231	0.166	0.713	-
15. Time to regain birth weight	p	-0.087	0.038	0.047	-0.093	-0.044	-0.082	0.030	-0.085	-0.054	-0.041	-0.090	0.024	0.003	0.618	*
15. Time to regain birth weight	p	0.425	0.730	0.671	0.366	0.667	0.425	0.817	0.410	0.599	0.691	0.383	0.816	0.981	<0.001

Models		B	Error	χ²	p-value	OR	95%CI
Height*
	No IUGR	-1.66	0.82	4.09	0.043	0.19	[0.04, .095]
	TPN	-1.59	1.13	1.98	0.160	0.20	[0.02, 1.87]
Weight†
	SGA	2.70	0.85	10.15	0.001	14.83	[2.82, 77.93]
	RDS	-0.47	1.18	0.16	0.694	0.63	[0.06, 6.37]
HC‡
	SGA	2.71	0.94	8.33	0.004	15.00	[2.39, 94.32]

Models		B	Error	95%CI	β	t	p-value
Weight
Block 1 (R²=0.31; F=3.66)*
	Children	-0.13	0.22	[-0.57, 0.31]	-0.13	-0.60	0.552
	Preterm (no)	-0.001	0.41	[-0.84, 0.83]	-0.0005	-0.00	0.997
	IURG (no)	-0.16	0.46	[-1.10, 0.78]	-0.05	-0.35	0.725
	Pregnancies	0.07	0.21	[-0.36, 0.50]	0.08	0.32	0.747
	Experience with children (no)	-0.03	0.32	[-0.69, 0.62]	-0.01	-0.10	0.920
	Partner (yes)	-0.22	0.33	[-0.89, 0.44]	-0.09	-0.68	0.500
Block 2 (R²=0.40; ΔR²=0.09; F=2.27)†
	Vaginal delivery	0.06	0.29	[-0.52, 0.64]	0.03	0.22	0.830
	Gestational age	-0.15	0.10	[-0.35, 0.06]	-0.26	-1.43	0.162
	Adequate for gestational age	-0.57	0.58	[-1.75, 0.61]	-0.14	-0.97	0.336
Block 3 (R²=0.57; ΔR²=0.17; F=3.15)*
	Time to achieve full enteral feeding	-0.03	0.02	[-0.07, 0.008]	-0.35	-1.58	0.121
	Sepsis (no)	0.63	0.39	[-0.15, 1.42]	0.26	1.63	0.110
	Laser therapy (no)	0.20	0.68	[-1.19, 1.58]	0.04	0.29	0.775
	NEC (no)	-1.86	0.91	[-3.69, -0.02]	-0.30	-2.05	0.048
	TPN	0.79	0.43	[-0.08, 1.67]	0.34	1.84	0.074
Block 4 (R²=0.58; ΔR²=0.01; F=0.64)
	Breastfeeding time	-0.01	0.02	[-0.05, 0.02]	-0.10	-0.81	0.421
	Self-efficacy	-0.006	0.007	[-0.02, 0.008]	-0.11	-0.83	0.413
Height
Block 1 (R²= 0.19; F = 1.96)†
	Pregnancies	0.09	0.24	[-0.41, 0.59]	0.10	0.37	0.714
	Preterm (no)	-0.03	0.52	[-1.09, 1.03]	-0.01	-0.07	0.949
	Children	-0.04	0.25	[-0.55, 0.48]	-0.04	-0.14	0.888
	Experience with children (no)	0.15	0.40	[-0.66, 0.96]	0.06	0.39	0.700
	IUGR (no)	0.42	0.54	[-0.68, 1.52]	0.13	0.78	0.441
Block 2 (R²=0.32; ΔR²=0.13; F=3.65)*
	Gestational age	0.14	0.14	[-0.14, 0.43]	0.27	1.02	0.317
	SGA (no)	-1.36	0.68	[-2.75, 0.03]	-0.33	-2.00	0.054
Block 3 (R²=0.41; ΔR²=0.09; F=0.87)†
	Time to achieve full enteral feeding	0.004	0.02	[-0.04, 0.04]	0.06	0.22	0.828
	Sepsis (no)	0.58	0.50	[-0.45, 1.61]	0.25	1.15	0.261
	BPD (no)	-0.71	0.61	[-1.97, 0.54]	-0.29	-1.16	0.256
	ROP (no)	-0.24	0.37	[-1.01, 0.52]	-0.10	-0.64	0.524
	Laser therapy (no)	0.24	0.78	[-1.34, 1.83]	0.05	0.31	0.756
	TPN	0.52	0.56	[-0.62, 1.67]	0.23	0.94	0.357
	Readmission (no)	0.34	0.46	[-0.59, 1.28]	0.12	0.75	0.462
Block 4 (R²=0.53; ΔR²=0.12; F=2.45)†
	Self-efficacy	-0.02	0.009	[-0.04, -0.0007]	-0.37	-2.12	0.043
	Breastfeeding time	-0.02	0.02	[-0.06, 0.02]	-0.11	-0.77	0.445

Models		B	Error	95%CI	β	t	p-value
Head circumference
Block 1 (R²=0.30; F=3.57)*
	IUGR (no)	0.47	0.47	[-0.49, 1.43]	0.15	0.99	0.329
	Children	-0.41	0.21	[-0.82, 0.007]	-0.39	-1.99	0.054
	Income >2 MW	-0.41	0.34	[-1.09, 0.27]	-0.16	-1.22	0.228
	Experience with children	-0.46	0.36	[-1.19, 0.26]	-0.18	-1.29	0.204
	Pregnancies	-0.01	0.20	[-0.42, 0.39]	-0.02	-0.07	0.941
	Eclampsia (no)	0.16	0.42	[-0.69, 1.01]	0.06	0.38	0.710
Block 2 (R²=0.46; ΔR²=0.16; F=4.41)*
	Vaginal delivery	-0.25	0.31	[-0.89, 0.38]	-0.11	-0.81	0.423
	SGA (no)	-1.09	0.62	[-2.34, 0.16]	-0.27	-1.76	0.086
	Gestational age	0.10	0.12	[-0.13, 0.34]	0.18	0.88	0.386
Block 3 (R²=0.54; ΔR²=0.08; F=1.21)
	Time to achieve full enteral feeding	-0.03	0.02	[-0.07, -0.0008]	-0.41	-2.07	0.045
	Sepsis (no)	0.70	0.44	[-0.19, 1.59]	0.29	1.59	0.120
	BPD (no)	-0.49	0.53	[-1.56, 0.58]	-0.19	-0.93	0.357
	ROP (no)	-0.05	0.32	[-0.69, 0.60]	-0.02	-0.14	0.888
	Laser therapy (no)	-0.30	0.71	[-1.74, 1.13]	-0.06	-0.43	0.673
	TPN	-0.47	0.46	[-1.39, 0.46]	-0.20	-1.02	0.313
Block 4 (R²=0.57; ΔR²=0.03; F=1.16)
	Self-efficacy	-0.01	0.007	[-0.03, 0.004]	-0.21	-1.46	0.154
	Breastfeeding time	0.006	0.02	[-0.03, 0.04]	0.05	0.38	0.705

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[T1FN1] Notes: *p<0.001; †p<0.01; ‡p<0.05.

[T1FN2] Significant Shapiro-Wilk test for bivariate normality. Measures 1, 2 and 3 are expressed in Fenton’s Z-score.