Neurodevelopmental outcomes at 3–12 months corrected age in predominantly enteral-fed very low birth weight infants in a resource-limited South African setting

Résumé

Background: Very low birth weight infants (VLBWIs) are at risk of neurodevelopmental impairment (NDI). Evidence linking early nutrition and growth to neurodevelopment is largely derived from high-income settings where parenteral nutrition is routine. Data from resource-limited settings using predominantly enteral feeding strategies are limited. Objective: To describe neurodevelopmental outcomes and post-discharge growth trajectories up to 12 months corrected age and identify associated factors in a predominantly enteral-fed cohort of VLBWIs. Methods: A retrospective cohort study was conducted at Tygerberg Hospital, South Africa (2021-2022). VLBWIs who received predominantly enteral nutrition and attended follow-up were included. Neurodevelopment was assessed using the Hammersmith Infant Neurological Examination (HINE) at 3, 6, and 12 months corrected age (CA). NDI was defined using age-specific HINE thresholds. Associations between clinical variables and NDI were evaluated using Fisher's exact test, Wilcoxon rank-sum tests, and logistic regression. Results: Of 296 infants with follow-up data, 190 (64.2%) attended the 12-month assessment. Most infants had HINE scores within the normal range (mean ± SD: 75.2 ± 7.7), with 5/190 (2.6%) classified as abnormal. Extrauterine growth restriction was common (33.7%) but was not associated with NDI at 12 months. Late-onset sepsis and metabolic bone disease were associated with increased odds of abnormal neurodevelopmental outcome in unadjusted analyses. In multivariable analysis, these associations persisted, although estimates were imprecise. Conclusion: In this predominantly enteral-fed cohort of VLBWIs, early motor outcomes assessed using the HINE at 12 months corrected age were reassuring despite a high prevalence of EUGR at discharge. Neonatal morbidities, particularly late-onset sepsis and metabolic bone disease, appeared more strongly associated with adverse early neurological outcomes than growth parameters alone. Longer-term follow-up is needed to determine whether later-emerging neurodevelopmental impairments become apparent beyond infancy.

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