Catch-up growth in the first two years of life in Extremely Low Birth Weight (ELBW) infants is associated with lower body fat in young adolescence

Aim To investigate growth patterns and anthropometrics in former extremely low birth weight (ELBW, <1000 g) children and link these outcomes to neurocognition and body composition in childhood. Methods ELBW children were examined at birth (n = 140), at 9 and 24 months (n >= 96) and at approximately 11 years within the framework of the PREMATCH (PREMATurity as predictor children's of Cardiovascular and renal Health) case control (n = 93-87) study. Regional growth charts were used to convert anthropometrics into Z scores. Catch up growth in the first two years of life was qualified as present if Delta Z score >0.67 SDS. At 11 years, anthropometrics, neurocognitive performance, body composition, grip strength and puberty scores were assessed. Results ELBW neonates displayed extra uterine growth restriction with mean Z scores for height, weight and head circumference of 0.77, 0.93 and 0.46 at birth, 1.61, 1.67 and 0.72 at 9 months, 1.22, 1.61 and 0.84 at 24 months, and 0.42, 0.49 and 1.09 at 11 years. ELBW children performed consistently worse on neurocognitive testing with an average intelligence quotient equivalent at 11 years of 92.5 (SD 13.1). Catch up growth was not associated with neurocognitive performance. Compared to controls, ELBW cases had lower grip strength (13.6 vs. 15.9 kg) and percentage lean body weight (75.1 vs. 80.5%), but higher body fat (24.6 vs. 19.2%) and advanced puberty scores at 11 years (all P<0.025). Catch-up growth for weight and height in the first two years of life in cases was associated with a lower percentage body fat compared to cases without catch-up growth (16.8% catchup growth for weight vs. 25.7%, P<0.001; 20.9% catch-up for height vs. 25.8%, P= 0.049). Conclusions In young adolescence, former ELBW children still have difficulties to reach their target height. Compared to normal birth weight controls, ELBW adolescents show lower neurocognitive performance and grip strength and a higher percentage body fat, a potential risk factor for adverse health outcomes in adulthood. Our key finding is that catch-up growth in ELBW children in the first two years of life is associated with a lower percentage body fat and is therefore likely to be beneficial.