0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Persistence of Underweight Status Among Late Preterm Infants FREE

Neera K. Goyal, MD, MSc; Alexander G. Fiks, MD, MSCE; Scott A. Lorch, MD, MSCE
[+] Author Affiliations

Author Affiliations: Divisions of Neonatology and Hospital Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati (Dr Goyal); Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati (Dr Goyal); The Pediatric Research Consortium, Center for Biomedical Informatics, and Pediatric Generalist Research Group (Dr Fiks), Divisions of General Pediatrics (Dr Fiks) and Neonatology (Dr Lorch), Department of Pediatrics, and Center for Outcomes Research (Dr Lorch), The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and Center for Clinical Epidemiology and Biostatistics (Drs Fiks and Lorch) and Leonard Davis Institute for Health Economics (Dr Lorch), University of Pennsylvania School of Medicine, Philadelphia.


Arch Pediatr Adolesc Med. 2012;166(5):424-430. doi:10.1001/archpediatrics.2011.1496.
Text Size: A A A
Published online

Objective To determine the association of late preterm gestation (34-36 weeks' gestation) with underweight status in infancy.

Design Retrospective cohort study.

Setting Thirty-one primary care sites within a hospital-owned network, from January 1, 2007, through June 30, 2009.

Participants Seven thousand eight hundred sixty-six infants with gestational ages ranging from 34 to 42 weeks, followed up through the first 18 months of life. Analytic sample consisted of 7624 infants examined at 6 months of age; 7132, at 1 year; and 6957, at 18 months.

Main Exposure Late preterm (34-36 weeks), early term (37-38 weeks), or full-term (39-42 weeks) gestation.

Main Outcome Measures Weight-for-age z score of 2 or less at 6, 12, and 18 months.

Results Compared with full-term gestation, late preterm gestation was associated with increased adjusted odds ratios (AORs) of weight-for-age z score of 2 or less at 6 months (AOR, 3.48 [95% CI, 2.17-5.72]) and 12 months (2.22 [1.07-4.61]). At 18 months, this association was not significant (AOR, 1.62 [95% CI, 0.69-3.84]). After exclusion of infants who were small for their gestational age, late prematurity was associated with underweight status when defined as a decline from birth weight of more than the 10th percentile to a weight-for-age z score of 2 or less at 6 months (AOR, 3.35 [95% CI, 1.76-6.38]) and 12 months (2.72 [1.02-7.27]) but not 18 months (1.88 [0.64-5.55]).

Conclusions There is an association between late prematurity and underweight status in the first year of life. Further research is needed to determine the effect of this growth pattern on developmental outcomes and to optimize nutritional management.

Figures in this Article

Recently, awareness has increased of the risk for morbidity and mortality associated with late preterm birth, defined as birth at 34 to 36 weeks' completed gestation. In the past 2 decades, the US birth rate in this group has increased; late preterm infants now constitute more than 70% of all preterm infants and substantially contribute to the use of health care resources in the neonatal period.16 Many studies demonstrate an increased risk for a variety of neonatal complications, including rehospitalization and death in late preterm infants compared with full-term infants.710 Evidence also exists that in the first year of life, late preterm infants have a propensity for more severe illness, worse neurodevelopmental outcomes, and higher health care costs.1116 However, further research is needed to systematically measure outcomes in early childhood for this population, as has been done for infants born at very preterm gestations.

One important outcome for children born preterm is growth and physical development. For late preterm infants, intrauterine growth restriction has been shown to be common, which increases the already high risk for morbidity and mortality.1719 Late preterm infants may also be more susceptible to feeding difficulties, including breastfeeding failure, which may place them at higher risk for poor weight gain or failure to thrive in early infancy.20,21 However, very few studies to date evaluate the effect of late prematurity on growth outcomes in early childhood after controlling for these factors.

In this study, we analyzed the association of late preterm birth with underweight status at 6, 12, and 18 months of life using electronic health record data from a large pediatric primary care network. We also examined the association of underweight status with early term gestation (37-38 weeks), which has not been previously described. Given the prevalence of late preterm and early term births, a better characterization of the growth patterns of these children adds to our understanding of the implications of recent birth trends. Such data may also alert pediatric practitioners to the need for closer monitoring of infants who may otherwise be assumed to be at a normal risk for faltering growth.

STUDY POPULATION AND SETTING

We conducted a retrospective cohort analysis of infants born at 34 to 42 weeks' gestation from January 1 through December 31, 2007. The study was conducted at 31 practices caring for more than 235 000 children and adolescents within The Children's Hospital of Philadelphia Pediatric Research Consortium, a multistate, hospital-owned, primary care practice–based research network. Study sites included 4 urban teaching practices, where one-third of children have private insurance, and 26 urban or suburban practices not involved in resident teaching, where most of the children are privately insured. All practices used a commercially available ambulatory electronic health record (EpicCare; Epic Systems Corp) for physician documentation and order entry. The Children's Hospital of Philadelphia institutional review board approved the study.

Eligible subjects included children in the network who visited practices for well-child care (WCC) within the first 30 days of life and were followed up for at least 18 months. We excluded children with major congenital anomalies and hereditary disorders because their patterns of growth often vary significantly from those of unaffected children. These diagnoses were identified in the chronic problem list for each patient on the basis of codes assigned from the International Classification of Diseases, Ninth Revision, and were clustered into homogeneous categories using a taxonomy previously developed for acute health problems (eTable).22

PREDICTOR AND OUTCOME VARIABLES

The primary aim of this study was to assess the association of underweight status with late preterm birth in this cohort at 6, 12, and 18 months of age using anthropometrical data from the electronic health record. Gestational age was recorded as part of routine care based on available birth hospital discharge records. We categorized infants as late preterm (34-36 completed weeks of gestation), early term (37-38 completed weeks), and full-term (39-42 completed weeks).

In a 2006 review article by Olsen23 on specific growth outcomes used to define growth failure, weight-for-age was the predominant choice of indicator with cutoff values primarily at the fifth percentile. We extracted weight data from WCC visits (Current Procedural Terminology codes 99381, 99382, 99391, and 99392) occurring closest to 6 months (range, 4-8 months), 12 months (range, 10-14 months), and 18 months of age (range, 16-20 months), based on the recommended schedule for preventive pediatric care.24 At each of these intervals, we calculated a z score using the World Health Organization 2006 growth curves, adjusting for the child's age at measurement, sex, and gestational age.25 We defined underweight as an attained weight-for-age z score of 2 or less, which represents the cutoff for measurements less than the fifth percentile. As a standardized procedure for preventative visits in each practice site, patient weight was recorded with the patient unclothed using a calibrated, digital scale. We limited observations to preventative visits because children during acute care visits often remain clothed and weights are less likely to be accurate.

In addition to static measurements of attained growth, measurements of growth velocity or slow weight gain have increasingly been used in the literature to define growth failure.2628 Therefore, we also evaluated growth by repeating the analysis after exclusion of infants born small for gestational age (SGA), so that all infants remaining in the sample had a birth weight for gestational age greater than the 10th percentile (Figure). We then evaluated which infants experienced a fall in weight-for-age category to less than the fifth percentile at 6, 12, or 18 months of age. This measurement has been used in previous studies as a measure of growth failure.23,29

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Flowchart of study sample. Boxes to the right of the main flow show the reasons infants were excluded from the study. Dark gray sections represent infants included for analysis at 6, 12, and 18 months. Light gray sections represent the sample after exclusion of infants born small for gestational age (SGA). WCC indicates well-child care.

MODEL BUILDING AND STATISTICAL ANALYSIS

We identified infants born SGA using standard growth curves for birth weight and gestational age developed by Alexander et al.30 We included these children in our primary analysis because SGA status is often associated with medical indications for late preterm delivery and growth outcomes.18,31 Other clinical and demographic covariates to adjust for potential confounding were evaluated on the basis of previous studies of risk factors for inadequate weight gain, including sex, socioeconomic status, and feeding method.3236 We obtained information on delivery method (cesarean vs vaginal) and feeding method (any breastfeeding vs formula only) by searching electronic health record text for documented birth history and visit notes. We also evaluated the contribution of medically significant gastroesophageal reflux disease (prescription of an H2 histamine receptor antagonist or proton pump inhibitor) because evidence suggests that the condition may be associated with differences in growth potential or nutritional intake.3739 To adjust for social and environmental factors, we included patient race (black, white, or other) and insurance status (private insurance at any time during the study vs none). We also approximated annual family income by linking 5-digit zip codes to US Census tract data and grouping them according to the percentage of residents living below the federal poverty level.40,41

We used logistic regression to test the independent association of each potential clinical or demographic covariate with the outcome measure. We then assessed correlation between covariates using bivariate analyses; if 2 variables were colinear, such as insurance type and income, we chose 1 for multivariable analysis to avoid overadjustment bias.42 We built our base multivariable model and added interaction terms between gestational age and other covariates, such as sex and race. Several factors, including breastfeeding and delivery method, were not significantly associated with the outcome in univariable or multivariable analysis and were removed. No interaction term remained statistically significant after adjustment for multiple testing. Covariates included for the final model were gestational age category, SGA, sex, race, annual family income, and gastroesophageal reflux disease. A secondary analysis excluded SGA infants from the sample. Analyses were performed using commercially available statistical software (STATA, version 11.0; StataCorp).

MISSING DATA

For 581 infants in the study cohort, gestational age data were missing. Because physicians may have been less likely to document gestational age information for full-term infants compared with preterm infants, missing data were likely nonrandom. For regression analyses, we used multiple imputation to impute gestational age for these infants using birth weight, sex, race, insurance status, annual family income, and delivery method. With this technique, we pooled analyses from 5 imputed data sets, adjusting standard errors for missing data uncertainty.43 Results shown are for the total sample, including infants with imputed gestational age. To confirm results, we also repeated all analyses excluding infants with missing gestational age data; statistical significance and effect sizes did not change (data not shown).

STUDY POPULATION

Of the original data set containing all infants born in the first half of 2007 and seen within the practice network by 30 days of life, 8216 infants were born at 34 to 42 weeks' gestation and were followed up until at least 18 months of age (Figure). We excluded 350 patients with major congenital or hereditary disorders. Although all remaining 7866 children received care in the practice network through the first 18 months of life, not every child had a documented WCC visit at the recommended ages for preventive pediatric care. Only 7624 had a WCC visit near 6 months of age, 7132 had a WCC visit near 1 year of age, and 6957 had a WCC visit near 18 months (Figure). We conducted χ2 analysis to assess characteristics of children who did not have WCC visits at these age intervals compared with those who did and were included in the analytic sample (Table 1). Overall, children who did not have WCC visits at 6, 12, or 18 months had a similar gestational age distribution compared with children with WCC visits. However, children without WCC visits were significantly less likely to be white, to be privately insured, or to live in higher income areas. Table 1 demonstrates the gestational age distribution of children with WCC visits at 6, 12, and 18 months (approximately 7.2% were late preterm, 22.8% were early term, and 70.0% were full-term). Table 2 depicts the unadjusted association of potential covariates with gestational age category; late preterm infants were significantly more likely to be born SGA compared with full-term infants.

Table Graphic Jump LocationTable 1. Clinical and Demographic Characteristics of Children With and Without WCC Visits at 6, 12, and 18 Months
Table Graphic Jump LocationTable 2. Clinical and Demographic Characteristics by Gestational Age Categorya
UNADJUSTED ANALYSIS

At 6 months of age, 1.6% of infants had an attained weight-for-age z score of 2 or less. This percentage differed significantly by gestational age, with 4.9% of late preterm infants and 2.5% of early term infants having an attained weight-for-age z score of 2 or less, compared with 0.9% of full-term infants (P < .001). At 12 months, fewer infants, or 0.9% of the cohort, were underweight by this measure. Differences by gestational age remained significant, with 2.1% of late preterm infants and 1.2% of early term infants meeting this criterion for underweight vs 0.6% of full-term infants (P = .001). At 18 months, the percentage of children with a weight-for-age z score of 2 or less declined in all groups (1.4% of late preterm infants, 0.9% of early term infants, and 0.6% of term infants). Although underweight status remained more common among late preterm infants compared with full-term infants, the difference was no longer statistically significant.

MULTIVARIABLE ANALYSIS

In multivariable regression analysis, late preterm birth compared with full-term birth was associated with a significantly higher adjusted odds ratio (AOR) of low attained weight-for-age at 6 months (AOR, 3.48 [95% CI, 2.17-5.72]) and 12 months (2.22 [1.07-4.61]) (Table 3). At 18 months, this association was not significant (AOR, 1.62 [95% CI, 0.69-3.84]). At 6 months but not 12 or 18 months, birth at 37 to 38 weeks' gestation was also associated with an increased AOR for low attained weight-for-age (AOR, 2.02 [95% CI, 1.32-3.08]). Being born SGA was a significant independent predictor of underweight status through 18 months of age. We did not demonstrate any interaction effect between gestational age and SGA.

Table Graphic Jump LocationTable 3. Multivariable Associations of Predictors With Low Attained Weighta

After exclusion of SGA infants, we also demonstrated an association between late preterm birth and inadequate weight gain when defined as a decline from a birth weight greater than the 10th percentile to a weight-for-age z score of 2 or less (Table 4). Compared with full-term infants, late preterm infants had AORs of 3.35 (95% CI, 1.76-6.38) at 6 months and 2.72 (1.02-7.27) at 12 months for inadequate weight gain; at 18 months, this association was in the same direction but not statistically significant (1.88 [0.64-5.55]).

Table Graphic Jump LocationTable 4. Multivariable Associations of Predictors With Low Attained Weight After Normal Birth Weighta

Our study demonstrates that children born late preterm are at increased risk for underweight status (specified as attained weight less than the fifth percentile) at 6 and 12 months; this trend persists at 18 months but does not reach statistical significance. Our findings support an association of this outcome with late prematurity independent of SGA status, which itself is a strong predictor of being underweight at 6, 12, and 18 months. For late preterm infants with birth weights greater than the 10th percentile who may otherwise be assumed to be “normal,” pediatricians should be attentive to the increased risk for inadequate weight gain beyond the neonatal period.

Many studies have systematically measured growth in early childhood for very preterm infants with and without SGA.4448 However, most of the literature on the physical development of late preterm infants focuses on intrauterine or immediate postnatal growth. As a common complication of late preterm births,18 intrauterine growth restriction significantly increases the risk for several complications in this population, including mortality in the first year of life.17,19

Few studies evaluate early childhood physical growth outcomes of late preterm children.9 One population-based cohort study of 3285 term and late preterm infants born in southern Brazil demonstrates an increased risk for underweight (weight-for-age z score, ≤2) and growth stunting (length-for-age z score, ≤2) in late preterm compared with full-term children at 12 and 24 months.49 In a US study, Gyamfi50 reports no significant difference in height and weight percentiles between 145 late preterm and full-term children at a median age of 48 (range, 32-64) months, with similar results after adjustment for patient race; the author notes, however, that further validation of this finding is warranted with a larger sample size. Our study extends the literature on outcomes of late prematurity by evaluating childhood growth in a large primary care cohort of infants in the United States, adjusting for a variety of clinical and social factors that may contribute to weight status.

Our finding that at 6 months, infants born at 37 to 38 weeks' gestation are also at increased risk for underweight status compared with infants born at later term gestation adds new information; this finding is consistent with previous studies documenting a dose effect of lower gestations on a range of other outcomes.1,17,51,52 The results are of particular interest given recent epidemiologic trends in gestational length for US births. Since 1990, the distribution of gestational age has shifted downward, with an increase in the proportion of births at 37 to 39 and 34 to 36 weeks' gestation.6,53 Given that late preterm and early term deliveries together constitute more than one-third of US births, or roughly 1.5 million deliveries, a 2-fold increase in the odds of faltering growth for these infant groups bears a significant health impact at a population level.54

Our findings may also be significant given the increased awareness of cognitive and neurodevelopmental outcomes associated with late prematurity. Studies have demonstrated increased risk for developmental delay, lower IQ, lower school performance, and cerebral palsy in late preterm children compared with full-term children.11,13,15,16 Although the contribution of inadequate weight gain to cognitive outcomes for this population has not been described, previous studies suggest that failure to thrive in infancy may be associated with adverse cognitive and developmental outcomes.44,55,56 However, the risks of underweight status must also be balanced against evidence suggesting that early rapid weight gain in low-birth-weight infants is associated with increased risk for childhood or adult obesity.57,58 Parents and clinicians should be attentive to the increased risk for underweight status and the potential effect of growth patterns on later childhood health and development for late preterm infants.

This study has several limitations, primarily related to the observational study design and absence of randomization. We lacked data on certain prenatal and postnatal risk factors, including parental size and maternal smoking. Although more detailed information on obstetric and neonatal history, including indication for delivery, was available for some infants, these data were inconsistently documented and therefore not reliable for analysis. Although unobserved factors may have influenced selection into gestational age groups and biased the results, the large AORs make these unmeasured variables less likely to account for observed differences between groups. In addition, because this study was retrospective, we considered measurements of infant length and head circumference as less reliable than weight and therefore did not use them for the primary analysis. Although weight-for-length is often considered to be a more specific indicator of acute risk compared with weight-for-age, weight-for-age remains the most common indicator used in previous studies of growth failure.23 Finally, our ability to characterize infant feeding was limited owing to a lack of systematic documentation. We could not ascertain the extent of formula supplementation for breastfed infants, which may contribute to the lack of statistical significance for this variable. These limitations are balanced by the following multiple strengths: a long follow-up period with growth measured at multiple ages, the ability to adjust for a variety of potentially confounding variables, and the racial and socioeconomic diversity of the cohort, which increases the generalizability of results.

In 2009, more than 357 000 infants born in the United States were late preterm, a group that constitutes 70% of all preterm births.54 Systematic measurement of early childhood outcomes for this population is important to understanding the epidemiologic impact of recent birth trends. We demonstrate an association between late prematurity and underweight status in the first 12 months in a large primary care cohort. Although SGA is a common complication of late preterm birth and a strong predictor of later growth outcomes, we demonstrate that birth at late preterm and low end of normal gestations is an independent risk factor for underweight status in infancy. Further research is needed to validate and extend our findings and to determine the effect of this growth pattern on developmental outcomes and to optimize nutritional management in these children.

Correspondence: Neera K. Goyal, MD, MSc, Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, ML 7009, Cincinnati, OH 45229 (neera.goyal@cchmc.org).

Accepted for Publication: November 6, 2011.

Author Contributions: Dr Goyal had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Goyal, Fiks, and Lorch. Acquisition of data: Goyal and Lorch. Analysis and interpretation of data: Goyal, Fiks, and Lorch. Drafting of the manuscript: Goyal and Fiks. Critical revision of the manuscript for important intellectual content: Goyal, Fiks, and Lorch. Statistical analysis: Goyal and Fiks. Obtained funding: Lorch. Administrative, technical, and material support: Goyal and Fiks. Study supervision: Lorch.

Financial Disclosure: None reported.

Funding/Support: This study was supported by awards K23 HD059919 (Dr Fiks) and R01 HD057168 (Dr Lorch) from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD).

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the NICHD.

Additional Contributions: Babette Zemel, PhD, provided a critical review of the manuscript, and Mark Ramos, BScIT, and Robert Grundmeier, MD, assisted with study implementation. We thank the network of primary care physicians, their patients, and the families for their contribution to clinical research through the Pediatric Research Consortium at The Children's Hospital of Philadelphia.

Escobar GJ, Greene JD, Hulac P,  et al.  Rehospitalisation after birth hospitalisation: patterns among infants of all gestations.  Arch Dis Child. 2005;90(2):125-131
PubMed   |  Link to Article
Hibbard JU, Wilkins I, Sun L,  et al.  Respiratory morbidity in late preterm births.  JAMA. 2010;304(4):419-425
PubMed
Khashu M, Narayanan M, Bhargava S, Osiovich H. Perinatal outcomes associated with preterm birth at 33 to 36 weeks' gestation: a population-based cohort study.  Pediatrics. 2009;123(1):109-113
PubMed
Tomashek KM, Shapiro-Mendoza CK, Weiss J,  et al.  Early discharge among late preterm and term newborns and risk of neonatal morbidity.  Semin Perinatol. 2006;30(2):61-68
PubMed
Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants.  Pediatrics. 2004;114(2):372-376
PubMed
Martin JA, Kirmeyer S, Osterman M, Shepherd RA. Born a bit too early: recent trends in late preterm births.  NCHS Data Brief. 2009;(24):1-8
PubMed
Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR. Differences in mortality between late-preterm and term singleton infants in the United States, 1995-2002.  J Pediatr. 2007;151(5):450-456, 456e1
PubMed  |  Link to Article
Young PC, Glasgow TS, Li X, Guest-Warnick G, Stoddard G. Mortality of late-preterm (near-term) newborns in Utah.  Pediatrics. 2007;119(3):e659-e665
PubMed  |  Link to Article
McGowan JE, Alderdice FA, Holmes VA, Johnston L. Early childhood development of late-preterm infants: a systematic review.  Pediatrics. 2011;127(6):1111-1124
PubMed
Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R.Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.  The contribution of mild and moderate preterm birth to infant mortality.  JAMA. 2000;284(7):843-849
PubMed
Morse SB, Zheng H, Tang Y, Roth J. Early school-age outcomes of late preterm infants.  Pediatrics. 2009;123(4):e622-e629
PubMed  |  Link to Article
Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year.  Pediatrics. 2010;126(2):e311-e319
PubMed  |  Link to Article
Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe TL. School outcomes of late preterm infants: special needs and challenges for infants born at 32 to 36 weeks gestation.  J Pediatr. 2008;153(1):25-31
PubMed
McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life.  Pediatrics. 2009;123(2):653-659
PubMed
Petrini JR, Dias T, McCormick MC, Massolo ML, Green NS, Escobar GJ. Increased risk of adverse neurological development for late preterm infants.  J Pediatr. 2009;154(2):169-176
PubMed
Talge NM, Holzman C, Wang J, Lucia V, Gardiner J, Breslau N. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age.  Pediatrics. 2010;126(6):1124-1131
PubMed
Pulver LS, Guest-Warnick G, Stoddard GJ, Byington CL, Young PC. Weight for gestational age affects the mortality of late preterm infants.  Pediatrics. 2009;123(6):e1072-e1077
PubMed  |  Link to Article
Carreno CA, Costantine MM, Holland MG, Ramin SM, Saade GR, Blackwell SC. Approximately one-third of medically indicated late preterm births are complicated by fetal growth restriction.  Am J Obstet Gynecol. 2011;204(3):263.e1-263.e4
PubMed  |  Link to Article
Ortigosa Rocha C, Bittar RE, Zugaib M. Neonatal outcomes of late-preterm birth associated or not with intrauterine growth restriction  Obstet Gynecol Int. 2010;2010:231842
PubMed  |  Link to Article
Zanardo V, Gambina I, Begley C,  et al.  Psychological distress and early lactation performance in mothers of late preterm infants.  Early Hum Dev. 2011;87(4):321-323
PubMed
Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns.  Semin Perinatol. 2006;30(2):54-60
PubMed
Alessandrini EA, Alpern ER, Chamberlain JM, Shea JA, Gorelick MH. A new diagnosis grouping system for child emergency department visits.  Acad Emerg Med. 2010;17(2):204-213
PubMed
Olsen EM. Failure to thrive: still a problem of definition.  Clin Pediatr (Phila). 2006;45(1):1-6
PubMed
Committee on Practice and Ambulatory Medicine.  Recommendations for preventive pediatric health care.  Pediatrics. 2000;105(3):645-646
PubMed
Grummer-Strawn LM, Reinold C, Krebs NF. Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States [published correction appears in MMWR Recomm Rep. 2010;59(36):1184].  MMWR Recomm Rep. 2010;59(RR-9):1-15
PubMed
Argyle J. Approaches to detecting growth faltering in infancy and childhood.  Ann Hum Biol. 2003;30(5):499-519
PubMed
Olsen EM, Skovgaard AM, Weile B, Petersen J, Jorgensen T. Risk factors for weight faltering in infancy according to age at onset.  Paediatr Perinat Epidemiol. 2010;24(4):370-382
PubMed
Wright CM, Parkinson KN, Drewett RF. How does maternal and child feeding behavior relate to weight gain and failure to thrive? data from a prospective birth cohort.  Pediatrics. 2006;117(4):1262-1269
PubMed
Mackner LM, Black MM, Starr RH Jr. Cognitive development of children in poverty with failure to thrive: a prospective study through age 6.  J Child Psychol Psychiatry. 2003;44(5):743-751
PubMed
Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;87(2):163-168
PubMed
Hokken-Koelega AC, De Ridder MA, Lemmen RJ, Den Hartog H, De Muinck Keizer-Schrama SM, Drop SL. Children born small for gestational age: do they catch up?  Pediatr Res. 1995;38(2):267-271
PubMed
Emond A, Drewett R, Blair P, Emmett P. Postnatal factors associated with failure to thrive in term infants in the Avon Longitudinal Study of Parents and Children.  Arch Dis Child. 2007;92(2):115-119
PubMed
Kelleher KJ, Casey PH, Bradley RH,  et al.  Risk factors and outcomes for failure to thrive in low birth weight preterm infants.  Pediatrics. 1993;91(5):941-948
PubMed
Morgan JB, Lucas A, Fewtrell MS. Does weaning influence growth and health up to 18 months?  Arch Dis Child. 2004;89(8):728-733
PubMed
Blair PS, Drewett RF, Emmett PM, Ness A, Emond AM. Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC).  Int J Epidemiol. 2004;33(4):839-847
PubMed
Elliman A, Bryan E, Elliman A, Walker J, Harvey D. The growth of low-birth-weight children.  Acta Paediatr. 1992;81(4):311-314
PubMed
Dellert SF, Hyams JS, Treem WR, Geertsma MA. Feeding resistance and gastroesophageal reflux in infancy.  J Pediatr Gastroenterol Nutr. 1993;17(1):66-71
PubMed
Hyman PE. Gastroesophageal reflux: one reason why baby won't eat.  J Pediatr. 1994;125(6, pt 2):S103-S109
PubMed
Nelson SP, Chen EH, Syniar GM, Christoffel KK.Pediatric Practice Research Group.  One-year follow-up of symptoms of gastroesophageal reflux during infancy.  Pediatrics. 1998;102(6):e67
PubMed  |  Link to Article
Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? the Public Health Disparities Geocoding Project.  Am J Epidemiol. 2002;156(5):471-482
PubMed
US Census Bureau.  Statistical brief: poverty areas. June 1995. http://www.census.gov/population/socdemo/statbriefs/povarea.html. Accessed August 1, 2010
Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies.  Epidemiology. 2009;20(4):488-495
PubMed
Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications.  Stat Med. 1991;10(4):585-598
PubMed
Claas MJ, de Vries LS, Koopman C,  et al.  Postnatal growth of preterm born children ≤750g at birth.  Early Hum Dev. 2011;87(7):495-507
PubMed  |  Link to Article
Pierrat V, Marchand-Martin L, Guemas I,  et al; EPIPAGE Study Group.  Height at 2 and 5 years of age in children born very preterm: the EPIPAGE study.  Arch Dis Child Fetal Neonatal Ed. 2011;96(5):F348-F354
PubMed
Cooke RW, Foulder-Hughes L. Growth impairment in the very preterm and cognitive and motor performance at 7 years.  Arch Dis Child. 2003;88(6):482-487
PubMed
Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA. Growth failure in the preterm infant: can we catch up?  Semin Perinatol. 2003;27(4):302-310
PubMed
Gutbrod T, Wolke D, Soehne B, Ohrt B, Riegel K. Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison.  Arch Dis Child Fetal Neonatal Ed. 2000;82(3):F208-F214
PubMed
Santos IS, Matijasevich A, Domingues MR, Barros AJ, Victora CG, Barros FC. Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study.  BMC Pediatr. 2009;9:71
PubMed
Gyamfi C. Neonatal and developmental outcomes in children born in the late preterm period versus term [abstract].  Am J Obstet Gynecol. 2008;199(6):(suppl A)  S45Link to Article
Raby BA, Celedón JC, Litonjua AA,  et al.  Low-normal gestational age as a predictor of asthma at 6 years of age.  Pediatrics. 2004;114(3):e327-e332
PubMed  |  Link to Article
Goyal NK, Fiks AG, Lorch SA. Association of late-preterm birth with asthma in young children: practice-based study.  Pediatrics. 2011;128(4):e830-e838
PubMed  |  Link to Article
Davidoff MJ, Dias T, Damus K,  et al.  Changes in the gestational age distribution among US singleton births: impact on rates of late preterm birth, 1992 to 2002.  Semin Perinatol. 2006;30(1):8-15
PubMed
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008.  Natl Vital Stat Rep. 2010;59(1):1, 3-71
PubMed
Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? a review and meta-analysis.  J Child Psychol Psychiatry. 2004;45(3):641-654
PubMed
Yang S, Tilling K, Martin R, Davies N, Ben-Shlomo Y, Kramer MS. Pre-natal and post-natal growth trajectories and childhood cognitive ability and mental health.  Int J Epidemiol. 2011;40(5):1215-1226
PubMed
Casey PH, Bradley RH, Whiteside-Mansell L, Barrett K, Gossett JM, Simpson PM. Evolution of obesity in a low birth weight cohort [published online June 9, 2011].  J Perinatol
PubMed  |  Link to Article
Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study.  BMJ. 2000;320(7240):967-971
PubMed

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure. Flowchart of study sample. Boxes to the right of the main flow show the reasons infants were excluded from the study. Dark gray sections represent infants included for analysis at 6, 12, and 18 months. Light gray sections represent the sample after exclusion of infants born small for gestational age (SGA). WCC indicates well-child care.

Tables

Table Graphic Jump LocationTable 1. Clinical and Demographic Characteristics of Children With and Without WCC Visits at 6, 12, and 18 Months
Table Graphic Jump LocationTable 2. Clinical and Demographic Characteristics by Gestational Age Categorya
Table Graphic Jump LocationTable 3. Multivariable Associations of Predictors With Low Attained Weighta
Table Graphic Jump LocationTable 4. Multivariable Associations of Predictors With Low Attained Weight After Normal Birth Weighta

References

Escobar GJ, Greene JD, Hulac P,  et al.  Rehospitalisation after birth hospitalisation: patterns among infants of all gestations.  Arch Dis Child. 2005;90(2):125-131
PubMed   |  Link to Article
Hibbard JU, Wilkins I, Sun L,  et al.  Respiratory morbidity in late preterm births.  JAMA. 2010;304(4):419-425
PubMed
Khashu M, Narayanan M, Bhargava S, Osiovich H. Perinatal outcomes associated with preterm birth at 33 to 36 weeks' gestation: a population-based cohort study.  Pediatrics. 2009;123(1):109-113
PubMed
Tomashek KM, Shapiro-Mendoza CK, Weiss J,  et al.  Early discharge among late preterm and term newborns and risk of neonatal morbidity.  Semin Perinatol. 2006;30(2):61-68
PubMed
Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants.  Pediatrics. 2004;114(2):372-376
PubMed
Martin JA, Kirmeyer S, Osterman M, Shepherd RA. Born a bit too early: recent trends in late preterm births.  NCHS Data Brief. 2009;(24):1-8
PubMed
Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR. Differences in mortality between late-preterm and term singleton infants in the United States, 1995-2002.  J Pediatr. 2007;151(5):450-456, 456e1
PubMed  |  Link to Article
Young PC, Glasgow TS, Li X, Guest-Warnick G, Stoddard G. Mortality of late-preterm (near-term) newborns in Utah.  Pediatrics. 2007;119(3):e659-e665
PubMed  |  Link to Article
McGowan JE, Alderdice FA, Holmes VA, Johnston L. Early childhood development of late-preterm infants: a systematic review.  Pediatrics. 2011;127(6):1111-1124
PubMed
Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R.Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System.  The contribution of mild and moderate preterm birth to infant mortality.  JAMA. 2000;284(7):843-849
PubMed
Morse SB, Zheng H, Tang Y, Roth J. Early school-age outcomes of late preterm infants.  Pediatrics. 2009;123(4):e622-e629
PubMed  |  Link to Article
Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year.  Pediatrics. 2010;126(2):e311-e319
PubMed  |  Link to Article
Chyi LJ, Lee HC, Hintz SR, Gould JB, Sutcliffe TL. School outcomes of late preterm infants: special needs and challenges for infants born at 32 to 36 weeks gestation.  J Pediatr. 2008;153(1):25-31
PubMed
McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life.  Pediatrics. 2009;123(2):653-659
PubMed
Petrini JR, Dias T, McCormick MC, Massolo ML, Green NS, Escobar GJ. Increased risk of adverse neurological development for late preterm infants.  J Pediatr. 2009;154(2):169-176
PubMed
Talge NM, Holzman C, Wang J, Lucia V, Gardiner J, Breslau N. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age.  Pediatrics. 2010;126(6):1124-1131
PubMed
Pulver LS, Guest-Warnick G, Stoddard GJ, Byington CL, Young PC. Weight for gestational age affects the mortality of late preterm infants.  Pediatrics. 2009;123(6):e1072-e1077
PubMed  |  Link to Article
Carreno CA, Costantine MM, Holland MG, Ramin SM, Saade GR, Blackwell SC. Approximately one-third of medically indicated late preterm births are complicated by fetal growth restriction.  Am J Obstet Gynecol. 2011;204(3):263.e1-263.e4
PubMed  |  Link to Article
Ortigosa Rocha C, Bittar RE, Zugaib M. Neonatal outcomes of late-preterm birth associated or not with intrauterine growth restriction  Obstet Gynecol Int. 2010;2010:231842
PubMed  |  Link to Article
Zanardo V, Gambina I, Begley C,  et al.  Psychological distress and early lactation performance in mothers of late preterm infants.  Early Hum Dev. 2011;87(4):321-323
PubMed
Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy,” late preterm newborns.  Semin Perinatol. 2006;30(2):54-60
PubMed
Alessandrini EA, Alpern ER, Chamberlain JM, Shea JA, Gorelick MH. A new diagnosis grouping system for child emergency department visits.  Acad Emerg Med. 2010;17(2):204-213
PubMed
Olsen EM. Failure to thrive: still a problem of definition.  Clin Pediatr (Phila). 2006;45(1):1-6
PubMed
Committee on Practice and Ambulatory Medicine.  Recommendations for preventive pediatric health care.  Pediatrics. 2000;105(3):645-646
PubMed
Grummer-Strawn LM, Reinold C, Krebs NF. Use of World Health Organization and CDC growth charts for children aged 0-59 months in the United States [published correction appears in MMWR Recomm Rep. 2010;59(36):1184].  MMWR Recomm Rep. 2010;59(RR-9):1-15
PubMed
Argyle J. Approaches to detecting growth faltering in infancy and childhood.  Ann Hum Biol. 2003;30(5):499-519
PubMed
Olsen EM, Skovgaard AM, Weile B, Petersen J, Jorgensen T. Risk factors for weight faltering in infancy according to age at onset.  Paediatr Perinat Epidemiol. 2010;24(4):370-382
PubMed
Wright CM, Parkinson KN, Drewett RF. How does maternal and child feeding behavior relate to weight gain and failure to thrive? data from a prospective birth cohort.  Pediatrics. 2006;117(4):1262-1269
PubMed
Mackner LM, Black MM, Starr RH Jr. Cognitive development of children in poverty with failure to thrive: a prospective study through age 6.  J Child Psychol Psychiatry. 2003;44(5):743-751
PubMed
Alexander GR, Himes JH, Kaufman RB, Mor J, Kogan M. A United States national reference for fetal growth.  Obstet Gynecol. 1996;87(2):163-168
PubMed
Hokken-Koelega AC, De Ridder MA, Lemmen RJ, Den Hartog H, De Muinck Keizer-Schrama SM, Drop SL. Children born small for gestational age: do they catch up?  Pediatr Res. 1995;38(2):267-271
PubMed
Emond A, Drewett R, Blair P, Emmett P. Postnatal factors associated with failure to thrive in term infants in the Avon Longitudinal Study of Parents and Children.  Arch Dis Child. 2007;92(2):115-119
PubMed
Kelleher KJ, Casey PH, Bradley RH,  et al.  Risk factors and outcomes for failure to thrive in low birth weight preterm infants.  Pediatrics. 1993;91(5):941-948
PubMed
Morgan JB, Lucas A, Fewtrell MS. Does weaning influence growth and health up to 18 months?  Arch Dis Child. 2004;89(8):728-733
PubMed
Blair PS, Drewett RF, Emmett PM, Ness A, Emond AM. Family, socioeconomic and prenatal factors associated with failure to thrive in the Avon Longitudinal Study of Parents and Children (ALSPAC).  Int J Epidemiol. 2004;33(4):839-847
PubMed
Elliman A, Bryan E, Elliman A, Walker J, Harvey D. The growth of low-birth-weight children.  Acta Paediatr. 1992;81(4):311-314
PubMed
Dellert SF, Hyams JS, Treem WR, Geertsma MA. Feeding resistance and gastroesophageal reflux in infancy.  J Pediatr Gastroenterol Nutr. 1993;17(1):66-71
PubMed
Hyman PE. Gastroesophageal reflux: one reason why baby won't eat.  J Pediatr. 1994;125(6, pt 2):S103-S109
PubMed
Nelson SP, Chen EH, Syniar GM, Christoffel KK.Pediatric Practice Research Group.  One-year follow-up of symptoms of gastroesophageal reflux during infancy.  Pediatrics. 1998;102(6):e67
PubMed  |  Link to Article
Krieger N, Chen JT, Waterman PD, Soobader MJ, Subramanian SV, Carson R. Geocoding and monitoring of US socioeconomic inequalities in mortality and cancer incidence: does the choice of area-based measure and geographic level matter? the Public Health Disparities Geocoding Project.  Am J Epidemiol. 2002;156(5):471-482
PubMed
US Census Bureau.  Statistical brief: poverty areas. June 1995. http://www.census.gov/population/socdemo/statbriefs/povarea.html. Accessed August 1, 2010
Schisterman EF, Cole SR, Platt RW. Overadjustment bias and unnecessary adjustment in epidemiologic studies.  Epidemiology. 2009;20(4):488-495
PubMed
Rubin DB, Schenker N. Multiple imputation in health-care databases: an overview and some applications.  Stat Med. 1991;10(4):585-598
PubMed
Claas MJ, de Vries LS, Koopman C,  et al.  Postnatal growth of preterm born children ≤750g at birth.  Early Hum Dev. 2011;87(7):495-507
PubMed  |  Link to Article
Pierrat V, Marchand-Martin L, Guemas I,  et al; EPIPAGE Study Group.  Height at 2 and 5 years of age in children born very preterm: the EPIPAGE study.  Arch Dis Child Fetal Neonatal Ed. 2011;96(5):F348-F354
PubMed
Cooke RW, Foulder-Hughes L. Growth impairment in the very preterm and cognitive and motor performance at 7 years.  Arch Dis Child. 2003;88(6):482-487
PubMed
Dusick AM, Poindexter BB, Ehrenkranz RA, Lemons JA. Growth failure in the preterm infant: can we catch up?  Semin Perinatol. 2003;27(4):302-310
PubMed
Gutbrod T, Wolke D, Soehne B, Ohrt B, Riegel K. Effects of gestation and birth weight on the growth and development of very low birthweight small for gestational age infants: a matched group comparison.  Arch Dis Child Fetal Neonatal Ed. 2000;82(3):F208-F214
PubMed
Santos IS, Matijasevich A, Domingues MR, Barros AJ, Victora CG, Barros FC. Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study.  BMC Pediatr. 2009;9:71
PubMed
Gyamfi C. Neonatal and developmental outcomes in children born in the late preterm period versus term [abstract].  Am J Obstet Gynecol. 2008;199(6):(suppl A)  S45Link to Article
Raby BA, Celedón JC, Litonjua AA,  et al.  Low-normal gestational age as a predictor of asthma at 6 years of age.  Pediatrics. 2004;114(3):e327-e332
PubMed  |  Link to Article
Goyal NK, Fiks AG, Lorch SA. Association of late-preterm birth with asthma in young children: practice-based study.  Pediatrics. 2011;128(4):e830-e838
PubMed  |  Link to Article
Davidoff MJ, Dias T, Damus K,  et al.  Changes in the gestational age distribution among US singleton births: impact on rates of late preterm birth, 1992 to 2002.  Semin Perinatol. 2006;30(1):8-15
PubMed
Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Mathews TJ, Osterman MJ. Births: final data for 2008.  Natl Vital Stat Rep. 2010;59(1):1, 3-71
PubMed
Corbett SS, Drewett RF. To what extent is failure to thrive in infancy associated with poorer cognitive development? a review and meta-analysis.  J Child Psychol Psychiatry. 2004;45(3):641-654
PubMed
Yang S, Tilling K, Martin R, Davies N, Ben-Shlomo Y, Kramer MS. Pre-natal and post-natal growth trajectories and childhood cognitive ability and mental health.  Int J Epidemiol. 2011;40(5):1215-1226
PubMed
Casey PH, Bradley RH, Whiteside-Mansell L, Barrett K, Gossett JM, Simpson PM. Evolution of obesity in a low birth weight cohort [published online June 9, 2011].  J Perinatol
PubMed  |  Link to Article
Ong KK, Ahmed ML, Emmett PM, Preece MA, Dunger DB. Association between postnatal catch-up growth and obesity in childhood: prospective cohort study.  BMJ. 2000;320(7240):967-971
PubMed

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Supplemental Content

Goyal NK, Fiks AG, Lorch SA. Persistence of underweight status among late preterm infants. Arch Pediatr Adolesc Med. 2012;166(5): 424-430.

eTable. ICD-9 codes for exclusion diagnoses

Supplemental Content

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 1

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
PubMed Articles
JAMAevidence.com