Concerns About Growth and Development in Preterm Infants

Request for Growth Status

Hello, my daughter was born via cesarean section at 37 weeks and 3 days.
The reason for the cesarean was that she stopped growing at 1800g after 31 weeks.
An amniocentesis was performed during prenatal check-ups, and the results were normal.
She was born weighing 1790g and experienced physiological dehydration down to 1600g.
Now, at 3 months old, she weighs only 3700g and is 51cm tall.
She feeds every 3.5-4 hours with 100cc of milk.
After birth, her blood was collected for testing, and the chromosome results were also normal.
The newborn screening results were normal as well, but her growth rate does not seem ideal and is not progressing well.
Currently, her activity level seems decent; she puts her hands in her mouth and has a reflex to grasp the bottle while feeding, but she cannot lift her head when lying on her stomach and shows no willingness to do so.
How can I train her to perform this action? How can I help her catch up in height and weight? I feel that her neck lacks strength and is quite soft.
Given her situation, some people have told me that she did not grow in the womb after 31 weeks and only started growing after birth.
Does this classify her as a preterm infant? Sometimes she makes sounds while lying down and moves her mouth when she sees others talking, but she rarely cries, only when receiving vaccinations.
Is there anything I need to do for her? A brain ultrasound was performed at birth, and the normal value of the ventricular floor was increased by 0.5-1cm.
Will this affect her cognitive development? She is my only daughter, so please tell me what I should do.
Now she also does not wake up at night to feed; should I just let her sleep? (She seems to prioritize sleep over feeding.) Thank you very much! I appreciate your help.

Mama in Need of Strength, 30~39 year old female. Ask Date: 2012/02/17

Dr. Xiao Kaiwen reply Pediatrics

1.
The prognosis for newborns with intrauterine growth restriction (IUGR) largely depends on the presence of any associated abnormalities.
If there are chromosomal abnormalities, the prognosis is poor (normal chromosomal tests do not guarantee that all genes are normal; many genetic abnormalities related to congenital diseases remain undetectable with current medical technology).
However, if the IUGR is solely due to poor placental nutrition, the prognosis is generally good, and development will gradually catch up after birth (the time it takes to catch up varies by individual).
2.
How can height and weight catch up? Similarly, if the IUGR is benign, care for the newborn is no different from that of a typically developing infant.
3.
The situation regarding brain ultrasound examinations should be monitored; whether it will affect cognitive development depends on subsequent follow-up results.
4.
Likewise, the developmental status after birth will depend on the presence of any associated abnormalities.
If the IUGR is solely due to poor placental nutrition, development will catch up.
5.
If the baby is in deep sleep, there is no need to force them to wake up for feeding; they will compensate during the day.

Reply Date: 2012/02/17

More Info

Concerns about growth and development in preterm infants are common among parents, especially when the infant has experienced intrauterine growth restriction (IUGR) or has been born prematurely. In your case, your daughter was born at 37 weeks and 3 days via cesarean section, with a birth weight of 1790 grams, which classifies her as a low birth weight infant. Given that she was noted to have stopped growing in utero at 31 weeks, it is understandable that you have concerns regarding her growth and development.

Firstly, it is important to recognize that preterm infants often have different growth trajectories compared to full-term infants. They may take longer to catch up in terms of weight and height. The growth patterns of preterm infants are typically monitored using adjusted age, which means that for the first two years of life, their developmental milestones and growth should be assessed based on their due date rather than their actual birth date. For example, since your daughter was born 3 weeks early, her developmental milestones should be evaluated as if she were only 3 weeks old.

Regarding her current weight of 3700 grams and height of 51 cm at 3 months, it is essential to track her growth on a growth chart specifically designed for preterm infants. If her growth is consistently below the 10th percentile or if there is a significant drop in her growth curve, further evaluation may be warranted. Regular pediatric check-ups are crucial to monitor her growth and development closely.

You mentioned that she does not yet have the strength to lift her head while lying on her stomach. This is a common concern among parents of preterm infants, as they may take longer to develop muscle tone and strength. To encourage her to develop these skills, you can engage in tummy time, which involves placing her on her stomach while she is awake and supervised. Start with short intervals and gradually increase the duration as she becomes more comfortable. This activity helps strengthen her neck and shoulder muscles, which are essential for head control.

In terms of feeding, it is crucial to ensure that she is receiving adequate nutrition to support her growth. If she is sleeping through feedings at night, it is generally acceptable to allow her to sleep, as long as she is gaining weight appropriately during the day. However, if you have concerns about her feeding patterns or if she is not gaining weight as expected, consulting with a pediatrician or a lactation consultant may provide additional guidance.

As for the brain ultrasound results indicating that the ventricles are slightly enlarged, this finding should be monitored, but it does not necessarily indicate that there will be an impact on her cognitive development. Many infants with similar findings go on to develop normally. Regular follow-up with a pediatric neurologist may be recommended to ensure that her brain development is on track.

In summary, while it is natural to have concerns about your daughter’s growth and development, it is essential to remember that preterm infants often have unique growth patterns. Regular pediatric visits, monitoring her growth on appropriate charts, engaging in tummy time, and ensuring she receives adequate nutrition are all vital steps in supporting her development. If you have any ongoing concerns, do not hesitate to reach out to your pediatrician for further evaluation and support.

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