Growth and Neurodevelopment Outcome Among Preterm and Very Low Birth Weight Neonates Given Early Aggressive Amino Acid Therapy Admitted in the NICU of a Tertiary Hospital
Ana Kristina GarciaSobrevega, Wilfredo R. Santos
Apr 2022 DOI 10.35460/25461621.20200046
Introduction
There has been an improvement in the survival of preterm infants due to advancements in neonatal care. Preterm birth is defined as being born before 37 weeks of gestation associated with major morbidities which include abnormal neurodevelopment outcome related to inadequate nutrition during the early postnatal period. Therefore, timely nutritional care is important in optimizing neurodevelopment outcome among preterm infants.[1]
Aside from prematurity, postnatal growth failure is extremely common among the very low birth weight (VLBW) infants  birth weight of less than 1500 g and related with higher risk of poor neurodevelopment outcome.[2] VLBW infants at times demonstrate difficulties across a wide range of domains: cognitive, language, motor, and behavioral functioning.[1]
The goal of nutritional therapy for both preterm and VLBW infants is the achievement of postnatal growth at a rate that approximates the intrauterine growth in the normal fetus. This goal is best achieved with effective enteral feeding. However, early enteral feeding is commonly limited among this population due to the immaturity of gastrointestinal motor function.[3] Also, even if enteral feeding is being done, the oral feedings given often do not provide the adequate nutrition until full feeds were achieved which might take 7 to 10 days. To address these limitations, early parenteral therapy is initiated soon after birth. Of the major nutritional components, proteins are essential for normal growth and development. Preterm and VLBW infants given intravenous amino acids showed evidence of enhanced growth in the part of the brain responsible for cognition, as proven by an increase in head circumference and brain size.[4] Multiple studies have been done regarding the dose of amino acid therapy to be given to VLBW and preterm infants. With this, the current standard of nutritional therapy is early amino acid therapy, defined as initiating 3.0 g/kg/day of amino acids within the first 24 hours of life. One of the major limitations of the systematic review is the lack of studies that pertain to the longterm effect of nutritional therapy by giving amino acids, particularly the neurodevelopment outcome of preterm and VLBW infants.[5]
Methodology
This was a prospective cohort study conducted at the High Risk Clinic of the Outpatient Department of a tertiary hospital which included preterm and very low birth weight newborns admitted at the neonatal intensive care unit (NICU). In this study, we want to determine the growth and neurodevelopment outcome of preterm and very low birth weight infants admitted in the NICU who were given early amino acid therapy. Newborns with major congenital or metabolic abnormalities and asphyxiated infants were not included in the study.
All newborn infants who met the inclusion criteria admitted at the NICU were included in the study provided that the informed consent was signed by the parent/caregiver. All subjects were started on parenteral nutrition containing amino acid (6% Aminosteril) at 3 g/kg/day within 24 hours of life, in accordance with the standards of nutritional therapy. Enteral feeding was initiated as soon as possible and tapering down of amino acids was started once the patient could tolerate 70 ml/kg/day of enteral feeds. The subject’s weight and length as well as head circumference was measured until upon discharge and plotted against the Fenton Chart. Once discharged, subjects were followed up at the 6th, 9th, and 12th month of corrected age and assessed by the investigator using the Bayley Scales of Infant and Toddler Development – Third Edition (BSID–III) Screening Tool, neurodevelopment parameters were assessed: cognitive, language, motor, socialemotional and adaptive behavior scales while taking note of weight, length and head circumference and plotted against the WHO growth charts. The results gathered underwent statistical analysis and if determined to have neurodevelopment delay, an immediate referral to a specialist was done.
The sample size was calculated using a formula devised by Krejcie and Morgan and yielded a result of 34 participants.
Results
A total of 34 participants were included in the study, but only 29 participants completed the study. The five patients who dropped out were admitted in our institution, but were unable to followup. To maintain prognostic balance generated from the original random treatment allocation, the data was canned by using the intentiontotreat (ITT) procedure. Perprotocol population is defined as a subset of the ITT population who completed the study without any major protocol violations, to provide information about the potential effects of treatment policy rather than on the potential effects of specific treatment.
Table 1: Demographic profile of the respondents included in the study
Profile 
Frequency (n = 34) 
Percentage (%) 
Mean±SD 
Gender Male Female 
17 17 
50.0 50.0 

Age of Gestation Moderate Preterm Very Preterm Extremely Preterm 
12 17 5 
35.29 50.00 14.71 

Birth Weight (kg) Low birth weight Very low birth weight Extremely low birth weight 
12 20 2 
35.29 58.82 5.88 
1.35±0.35 
Birth Length (cm) 33  35 36  38 39  41 42  44 45 and above 
2 5 6 7 14 
5.88 14.71 17.65 20.59 41.18 
40.60±3.72 
Head Circumference (cm) 23  25 26  28 29  31 32 and above 
2 7 12 13 
5.88 20.59 35.29 38.24

28.22±2.47 
Hospital Stay (days) 15  27 28  40 41  53 54  66 67 and above 
11 10 7 3 3 
32.35 29.41 20.59 8.32 8.32 
38.59±18.45 
The collected data on demographic profile of the respondents were tabulated and presented in frequency, percentage, and mean ± SD as shown in Table 1. Evidently, the patients were equally distributed in terms of gender. Majority of the subjects were classified as very preterm and very low birth infants with mean birth weight of 1.35 kg. The birth lengths were distributed at a range interval of 30 and above with mean birth length of 40.6 cm. The head circumferences had an average of 28.22 cm. Most of the subjects stayed 15 to 40 days in the hospital with an average of 38.59 days.
Table 2: Descriptive analysis on weight, linear growth and head circumference
Variables 
Frequency beyond normal 
Percentage 
Mean±SD 
Weight Gain Discharge Weight 6th Month Weight 9th Month Weight 12th Month Weight 
12 1 0 0 
35.20 2.94 0.0 0.0 
1.98±0.26 6.93±0.44 8.00±0.45 9.065±0.78 
Linear Growth Discharge Length 6th Month Length 9th Month Length 12th Month Length 
7 3 0 0 
20.59 8.82 0.0 0.0 
44.41±2.33 65.42±2.00 69.39±1.97 73.53±1.46 
Head Circumference Discharge Circumference 6th Month Circumference 9th Month Circumference 12th Month Circumference 
4 0 0 0 
11.76 0.0 0.0 0.0 
31.50±1.19 42.98±0.97 45.10±1.01 46.10±1.09 
Table 2 presents the descriptive analysis on weight, linear growth, and head circumference of the subjects. The results showed that there were 12 (35.2%) participants below their normal weight from the target range of 10th to 90th percentile at the time of discharge with the average weight of 1.98 kg. At the 6th month of corrected age, upon follow up, the number of participants with below normal weight decreased to 1 (2.94%) with the average weight of 6.93 kg. All participants had normal weight for age by the 9th month of corrected age. There were 7 (20.59%) participants with below normal linear length at the time of discharge with average length of 44.41 cm. By the 6th month corrected age, it decreased to 3 (2.94%) with average weight of 65.42 cm, and by the 9th month of corrected age, all participants had normal for age linear growth. As for head circumference, there were 4 (11.76%) participants with below normal head circumference at the time of discharge with average measure of 31.50 cm, and by the 6th month of corrected age, all participants had normal measurement of head circumference.
Table 3: Bayley Scales result on neurodevelopment outcome assessed on 6th, 9th, and 12th month of corrected age
Description 
Frequency 
Percentage 
Bayley Scales Result on 6th Month At Risk Emerging Risk Competent 
0 4 25 
0.0 13.8 86.2 
Bayley Scales Result on 9th Month At Risk Emerging Risk Competent 
0 2 27 
0.0 6.9 93.1 
Bayley Scales Result on 12th Month At Risk Emerging Risk Competent 
0 1 28 
0.0 3.4 96.6 
Table 3 presents the neurodevelopment outcome of the respondents assessed on the 6th, 9th, and 12th month of corrected age using the Bayley scale. The results showed that there were no subjects classified as “at risk for developing neurodevelopment delay” on the 6th, 9th, or 12th month of corrected age. There were 4 (13.8%) respondents classified as “emerging risk” while 25 (86.2%) subjects were classified as competent using the Bayley scales on the 6th month. On the 9th month of corrected age, only 2 (6.9%) were classified as “emerging risk” and it decreased to 1 (3.4%) by the 12th month of corrected age.
Table 4: Paired Ttest analysis on weight, linear growth and head circumference of the respondents from the baseline to 12th month of corrected age
Description 
tvalue 
pvalue p = 0.05 
Remarks 
Weight Gain Baseline x Discharge Weight Baseline x 6th Month Weight Baseline x 9th Month Weight Baseline x 12th Month Weight 
8.29 48.30 57.91 58.43 
0.000 0.000 0.000 0.000 
Significant Significant Significant Significant 
Linear Growth Baseline x Discharge Length Baseline x 6th Month Length Baseline x 9th Month Length Baseline x 12th Month Length 
6.13 31.62 36.59 43.31 
0.000 0.000 0.000 0.000 
Significant Significant Significant Significant 
Head Circumference Baseline x Discharge Head Circumference Baseline x 6th Month Head Circumference Baseline x 9th Month Head Circumference Baseline x 12th Month Head Circumference 
7.77 30.84 33.09 34.06 
0.000 0.000 0.000 0.000 
Significant Significant Significant Significant 
The paired ttest analysis on weight, linear growth, and head circumference of the respondents from the baseline to the 12th month of corrected age was assessed and summarized in Table 4. The tvalue between baseline and discharge weight was 8.29 with pvalue of 0.000 at a level of significance of 0.05. Thus, the result shows that there is significant weight gain of the participants from the time of birth to time of discharge. Consequently, the pvalues of comparisons of weight gain from the baseline to 12th month of corrected age was 0.000 with tvalues of 8.29, 48.30, 57.91, and 58.43, respectively. Generally, there were significant increases on respondents’ weight from baseline weight to the 12th month weight. The pvalues between birth lengths compared continuously to discharge date until follow up at the 6th, 9th, and 12th month of corrected age was 0.000 with tvalue of 6.13, 31.62, 36.59, and 43.31, respectively. Thus, the results show that there is significant gain on the linear growth of respondents started at the time of discharge and continuously acquired the same results up to the 12month period. The pvalues between head circumference at birth, compared to measurements taken upon discharge up to the 12th month of corrected age was 0.000 with tvalue of 7.77, 30.84, 33.09, and 34.06, respectively. Thus, the result showed that there was significant gain on the linear growth of respondents started at the time of discharge and continuously acquired the same results up to the 12month period.
Discussion
Major developments in neonatal care have resulted in improved survival of preterm infants.[4] Despite this, poor weight gain remains the most frequent morbidity seen in VLBW infants. Another frequently occurring morbidity seen is neurodevelopment impairment. There have been extensive studies that link neurodevelopment impairment and early undernutrition.[1] With these findings, it has been the standard of care to start very preterm and VLBW infants with early aggressive amino acid therapy, that is, giving 3 g/kg/day of amino acid as early as 24 hours of life. This accounts for the 0.3 g/kg/day to mimic intrauterine changes in the body composition, + 2.2 g/kg/day to 2.5 g/kg/day for normal growth + 1 g/kg/day for the obligatory urinary and dermal protein loss. Recent studies have shown that protein delivery of 3 g/kg/day beginning on day 1 of life is safe and associated with plasma amino acid concentrations similar to those of a second and third trimester fetus.[7]
A systematic review which compared early and late administration of amino acids among preterm infants included seven randomized controlled trials that showed safety in administering 3 g/kg/day of amino acid as evidenced by normal blood urea nitrogen levels despite positive nitrogen balance with a variable finding with regard to its effect on head circumference growth.
During the past 10 years, there has been an increasing number of screening tests available to assist physicians in identifying babies who may need further assessment. The Bayley Scales of Infant and Toddler development, Third Edition (BSID–III) Screening Tool was developed to assess the infant using different domains: cognitive, language, fine and gross motor movement among infants aged 018 months of corrected age. With minimal training, the test can be administered by the members of health care.[8]
Analysis of the study results showed that the subjects included more of very preterm and VLBW infants who stayed at the NICU for at least 1527 days as shown in Table 1. Of the 34 respondents, only 29 completed the study. Since our institution is a tertiary and referral hospital, we get patients who live far away from our area, making follow up after discharge difficult.
Of the subjects included, 35.2% had below normal weight, 20.59% had below normal length, and 11.75% had below normal measurement of head circumference upon discharge. This indicates that a majority of the patients were able to have normal anthropometrics by the time of discharge. However, current studies show that it is important for monitoring growth after NICU discharge, and going by the data gathered there is an upward trend in all areas of growth (weight, length, and head circumference) at the 6th, 9th, and 12th month of corrected age.
Among the participants 86.2% were deemed competent using the Bayley Scales taken at the 6th month of corrected age, with only 4 of 13.8% classified as emerging risk for delay. All patients classified as emerging risk were referred to a neurodevelopment specialist for further evaluation and early intervention. The four patients who were classified as emerging risk were extremely preterm infants who stayed at the NICU the longest and had a difficult neonatal course. On further followup at the 9th and 12th month of corrected age, we can observe a decrease in the number of infants classified as emerging risk for delay, which could indicate an improvement in the neurodevelopment aspect of these patients, and only one remained to be in the emerging risk category by the 12th month of corrected age. This patient was already started on occupational therapy as advised by the neurodevelopment specialist.
Lastly, table 4 showed the paired ttest analysis of baseline anthropometrics in comparison to measurements taken upon discharge and follow up and showed significant results.
Conclusion and Recommendations
Very preterm and VLBW infants are considered a high risk population in developing longterm complications related to prematurity such as problems in growth as well as neurodevelopment delay. Early identification of such complications is important for prompt intervention.
The results of this study clearly illustrate the longterm benefits of giving early aggressive amino acid therapy among high risk neonates, specifically in terms of growth and neurodevelopment.
However, one of the limitations of this study is the number of patients who were unable to complete the study. Also, the study, only followed up participants up to 12 months of corrected age, and it would be better if they can be followed up until 2 years of age and longer.
This research only focused on the nutritional intervention, in the form of early amino acid administration, and since neurodevelopment delay can be multifactorial, another recommendation for future studies is to include other factors that may influence the outcome of having neurodevelopment delay such as episodes of hypoglycemia, sepsis, etc.
Acknowledgment
This research would not have been possible if not for the support of the Department of Medical Education and Research, Research Ethics Committee, as well as the Section of Newborn Medicine of the University of Santo Tomas Hospital. The author would also like to acknowledge Mr. Noel Potenciano for the assistance in doing statistical analysis of this study.
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 Ihab AN. Impact of early and high doses of amino acid supplement on the growth and development of preterm and low birth weight neonates. Clinical Pediatrics. 2016 April.1(3: 1.
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 Velaphi S. Nutritional requirements and parenteral nutrition in preterm infants. South African Journal of Clinical Nutrition [Internet]. 2011 Jan;24(sup3):27–31. Available from: http://dx.doi.org/10.1080/16070658.2011.11734377
 Trivedi A, Sinn J.Early versus late administration of amino acids in preterm infants receiving parenteral nutrition. Cochrane Database of Systematic Reviews 2013. [cited 2019 August 3]. Available from: https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008771.pub2/abstract. DOI: https://doi.org/10.1002/14651858.CD008771.pub2
 Kamarudin A, Manan M, Zulkifly H, Neoh C, Ali S, Ming L. Amino acid dosing in parenteral nutrition for very low birth weight preterm neonates: an outcome assessment. Asia Pacific Journal of Clinical Nutrition. 2016. [cited 2019 August 3];25(1):5361. Available from: https://search.informit.org/doi/10.3316/ielapa.908268313931029
 Valentine CJ, Fernandez S, Rogers L, Gulati P, Hayes J, Lore P, et al. Early amino acid administration improves preterm infant weight. Journal of Perinatology. 2009 May. [cited 2019 August 3];29:428432. Available from: https://www.nature.com/articles/jp200951
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APPENDIX A: PATIENT DATA SHEET
PATIENT DATA CHARACTERISTICS UPON BIRTH AND DISCHARGE
CODE 
SEX 
AOG 
BIRTH WEIGHT 
BIRTH LENGTH 
HEAD CIRCUMFERENCE 
DISCHARGE WEIGHT 
% 
DISCHARGE LENGTH 
% 
DISCHARGE HEAD CIRCUMFERENCE 
% 
TOTAL HOSPITAL DAYS 
001 
F 
3132 wks 
1.66 kg 
40.5 cm 
29 cm 
2.2 kg 
10TH percentile 
41.5 cm 
<10th percentile 
30.5cm 
10TH percentile 
35 days 
002 
F 
3233 wks 
1.15 kg 
40.5 cm 
29 cm 
1.84 kg 
<10th percentile 
42 cm 
<10th percentile 
31 cm 
<10th percentile 
34 days 
003 
F 
32 wks 
1.76 kg 
44 cm 
30.5 cm 
2 kg 
50th percentile 
44 cm 
50th percentile 
31.5 cm 
50TH percentile 
19 days 
004 
M 
2627 wks 
0.88 kg 
35 cm 
24.5 cm 
2.1 kg 
10th percentile 
44 cm 
10th percentile 
32 cm 
50th percentile 
65 days 
005 
F 
2728 wks 
0.85 kg 
35 cm 
26 cm 
1.75 kg 
10th percentile 
42 cm 
50th percentile 
32 cm 
50th percentile 
58 days 
006 
F 
3031 wks 
1.39 kg 
39 cm 
27 cm 
2.4 kg 
10TH percentile 
46.5 cm 
10th percentile 
32 cm 
10th percentile 
49 days 
007 
M 
3132 wks 
1.43 kg 
41.5 cm 
29.5 cm 
2 kg 
<10th percentile 
44 cm 
10th percentile 
31 cm 
10th percentile 
37 days 
008 
M 
3233 wks 
1.89 kg 
45 cm 
31 cm 
2.09 kg 
10th percentile 
46 cm 
10th percentile 
32.5 cm 
50th percentile 
17 days 
009 
M 
2627 wks 
0.73 kg 
33 cm 
22.5 cm 
2.2 kg 
<10th percentile 
48 cm 
10th percentile 
33 cm 
50th percentile 
80 days 
010 
M 
3031 wks 
1.57 kg 
43 cm 
29 cm 
1.97 kg 
<10th percentile 
45 cm 
10th percentile 
32 cm 
50th percentile 
35 days 
011 
F 
2930 wks 
1.0 kg 
45 cm 
30 cm 
2.18 kg 
10th percentile 
46 cm 
10th percentile 
32.5 cm 
50TH percentile 
50 days 
012 
M 
3031 wks 
1.2 kg 
40 cm 
27 cm 
2.54 kg 
10th percentile 
46 cm 
10th percentile 
33 cm 
50th percentile 
43 days 
013 
M 
2930 wks 
1.25 kg 
38 cm 
25.5 cm 
2.11 kg 
<10th percentile 
47 cm 
10th percentile 
31 cm 
<10th percentile 
65 days 
014 
F 
3334 wks 
1.43 kg 
45 cm 
30 cm 
2.12 kg 
<10th percentile 
47 cm 
50TH percentile 
32 cm 
10th percentile 
22 days 
015 
M 
3132 wks 
1.8 kg 
45 cm 
30 cm 
2 kg 
10th percentile 
44 cm 
10th percentile 
32 cm 
50th percentile 
22 days 
016 
F 
3435 wks 
1.5 kg 
40 cm 
29.5 cm 
1.75kg 
<10th percentile 
43 cm 
<10th percentile 
30.5 cm 
10th percentile 
19 days 
017 
M 
2829 wks 
1.07 kg 
38 cm 
27 cm 
2.06 kg 
10th percentile 
43 cm 
<10th percentile 
31 cm 
10th percentile 
47 days 
018 
F 
3031 wks 
1.61 kg 
43 cm 
29 cm 
2.14 kg 
10th percentile 
46 cm 
50TH percentile 
32 cm 
50TH percentile 
36 days 
019 
M 
3233 wks 
1.66 kg 
43 cm 
30 cm 
1.91 kg 
<10th percentile 
45 cm 
10th percentile 
33 cm 
50th percentile 
27 days 
020 
M 
26 wks 
0.93 kg 
37 cm 
26 cm 
2.10 kg 
<10th percentile 
43.5 cm 
<10th percentile 
31.5 cm 
10th percentile 
82 days 
021 
M 
3233 wks 
1.79 kg 
43 cm 
30.5 cm 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
022 
M 
32 wks 
1.8 kg 
44 cm 
29 cm 
2.29 kg 
50th percentile 
45 cm 
50th percentile 
30.5 cm 
50th percentile 
18 days 
023 
M 
32 wks 
1.56 kg 
44cm 
31cm 
1.93 kg 
10th percentile 
46 cm 
50th percentile 
32 cm 
50th percentile 
22 days 
024 
M 
3334 wks 
1.45kg 
42 cm 
30 cm 
1.64 kg 
<10th percentile 
45 cm 
10th percentile 
33 cm 
50th percentile 
16 days 
025 
F 
2930 wks 
1.06 kg 
35 cm 
25.5 cm 
1.79 kg 
10th percentile 
39.5 cm 
<10th percentile 
29 cm 
10th percentile 
43 days 
026 
M 
3233 wks 
1.45 kg 
43 cm 
32 cm 
1.99 kg 
<10th percentile 
46 cm 
50th percentile 
32 cm 
50th percentile 
35 days 
027 
F 
2829 wks 
980 g 
34.5 cm 
25 cm 
1.88 kg 
10th percentile 
42 cm 
10TH percentile 
30 cm 
10th percentile 
53 days 
028 
F 
3132 wks 
1.75kg 
45 cm 
30 cm 
1.87 kg 
10TH percentile 
47 cm 
10th percentile 
31.5 cm 
50th percentile 
32 days 
029 
F 
3334 wks 
1.48 kg 
43 cm 
31.5 cm 
1.83kg 
10th percentile 
45 cm 
50th percentile 
32.5 cm 
50th percentile 
18 days 
030 
M 
3233 wks 
2 kg 
45.5 cm 
31.5 cm 
2.22 kg 
10th percentile 
46 cm 
10th percentile 
33 cm 
50th percentile 
21 days 
031 
F 
2627 wks 
0.92 kG 
35 cm 
24 cm 
1.82 
10th percentile 
38 cm 
<10th percentile 
28 cm 
<10th percentile 
50 days 
032 
F 
3132 wks 
1.8KG 
44cm 
29 cm 
1.94 kg 
50th percentile 
46 cm 
50th percentile 
31 cm 
50th percentile 
15 days 
033 
F 
3132 wks 
1.17 KG 
40 cm 
27 cm 
2.1 kg 
<10th percentile 
44 cm 
<10th percentile 
30 cm 
<10th percentile 
46 days 
034 
F 
2829 wks 
1.19 KG 
38 cm 
27 cm 
1.89 kg 
<10th percentile 
42 cm 
10th percentile 
31.5 cm 
50th percentile 
42 days 
GROWTH AND NEURODEVELOPMENTAL SCORES AT 6TH MONTH CORRECTED AGE
CODE 
AOG 
WEIGHT 
Z SCORE 
LENGTH 
Z SCORE 
HEAD CIRCUMFERENCE 
Z SCORE 
BSID SCORE 
REMARKS 

Cognitive 
Receptive Communication 
Expressive Communication 
Fine Motor 
Gross Motor 

001 
3132 wks 
6.9 kg 
Z = 0 
66cm 
Z = 0 
43.5 cm 
Z = 0 
8 
6 
7 
8 
9 
COMPETENT 
002 
3233 wks 
6.8 kg 
Z = 0 
69 cm 
Z = 0 
43 cm 
Z = 0 
11 
6 
7 
7 
10 
COMPETENT 
003 
32 wks 
6.4 kg 
Z = 0 
67 cm 
Z = 0 
42.5 cm 
Z = 0 
8 
6 
7 
8 
8 
COMPETENT 
004 
2627 wks 
7.2 kg 
Z = 0 
64.5 cm 
Z = 0 
42 cm 
Z = 0 
9 
7 
6 
7 
8 
COMPETENT 
005 
2728 wks 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
006 
3031 wks 
6.5 kg 
Z = 0 
65 cm 
Z = 0 
41.5 cm 
Z = 0 
9 
6 
6 
7 
8 
COMPETENT 
007 
3132 wks 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
008 
3233 wks 
7 kg 
Z = 0 
63.8 cm 
Z = 0 
41.5 cm 
Z = 0 
7 
7 
5 
7 
7 
COMPETENT 
009 
2627 wks 
7.3 kg 
Z = 0 
64 cm 
Z = 0 
43 cm 
Z = 0 
8 
7 
8 
6 
9 
EMERGING RISK 
010 
3031 wks 
7.83 kg 
Z = 0 
67 cm 
Z = 0 
44.5 cm 
Z = 0 
9 
6 
8 
7 
9 
COMPETENT 
011 
2930 wks 
7.31 kg 
Z = 0 
64 cm 
Z = 0 
42 cm 
Z = 0 
8 
7 
7 
8 
9 
COMPETENT 
012 
3031 wks 
6.87kg 
Z = 0 
67 cm 
Z = 0 
43.8 cm 
Z = 0 
9 
5 
6 
7 
9 
EMERGING RISK 
013 
2930 wks 
8 kg 
Z = 0 
66 cm 
Z = 0 
44.6 cm 
Z = 0 
10 
8 
7 
9 
13 
COMPETENT 
014 
3334 wks 
7.5 
Z = 0 
67 cm 
Z = 0 
43 cm 
Z = 0 
10 
7 
7 
8 
11 
COMPETENT 
015 
3132 wks 
6.6 kg 
Z = 0 
66 cm 
Z = 0 
42 cm 
Z = 0 
11 
7 
8 
9 
9 
COMPETENT 
016 
3435 wks 
6.1 kg 
Z = 0 
68 cm 
Z = 0 
43 cm 
Z = 0 
8 
7 
6 
9 
10 
COMPETENT 
017 
2829 wks 
6.8 kg 
Z = 0 
68.8 cm 
Z = 0 
44 cm 
Z = 0 
8 
6 
6 
7 
9 
COMPETENT 
018 
3031 wks 
6.4 kg 
Z = 0 
65 cm 
Z = 0 
43.5 cm 
Z = 0 
7 
6 
6 
7 
9 
COMPETENT 
019 
3233 wks 
6.2 kg 
Z <2 
66 cm 
Z = 0 
42 cm 
Z = 0 
7 
6 
8 
7 
8 
COMPETENT 
020 
26 wks 
7.4 kg 
Z = 0 
67 cm 
Z = 0 
43 cm 
Z = 0 
8 
8 
7 
8 
8 
COMPETENT 
021 
3233 wks 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
022 
32 wks 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
023 
32 wks 
6.8 kg 
Z = 0 
64 cm 
Z = 0 
44 cm 
Z = 0 
7 
8 
8 
9 
8 
COMPETENT 
024 
3334 wks 
7.2 kg 
Z = 0 
65 cm 
Z = 0 
45 cm 
Z = 0 
8 
7 
6 
8 
8 
COMPETENT 
025 
2930 wks 
7 kg 
Z = 0 
62 cm 
z<2 
42 cm 
Z = 0 
8 
7 
8 
8 
10 
COMPETENT 
026 
3233 wks 
6.8 kg 
Z = 0 
63 cm 
Z<2 
42 cm 
Z = 0 
7 
8 
7 
8 
9 
COMPETENT 
027 
2829 wks 
7.1 kg 
Z = 0 
66 cm 
Z = 0 
43 cm 
Z = 0 
7 
8 
8 
7 
9 
COMPETENT 
028 
3132 wks 
7 kg 
Z = 0 
64 cm 
Z = 0 
44 cm 
Z = 0 
8 
8 
7 
8 
8 
COMPETENT 
029 
3334 wks 
7.2 kg 
Z = 0 
66 cm 
Z = 0 
44 cm 
Z = 0 
8 
8 
7 
9 
9 
COMPETENT 
030 
3233 wks 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
031 
2627 wks 
6.6 kg 
Z = 0 
68 cm 
Z = 0 
42 cm 
Z = 0 
8 
7 
5 
8 
9 
COMPETENT 
032 
3132 WKS 
7.2 kg 
Z = 0 
65 cm 
Z = 0 
43 cm 
Z = 0 
7 
8 
6 
8 
11 
COMPETENT 
033 
3132 WKS 
7.2 kg 
Z = 0 
62 cm 
Z = 0 
43 cm 
Z = 0 
8 
7 
6 
7 
7 
COMPETENT 
034 
2829 WKS 
6.3 kg 
Z = 0 
61 cm 
Z<2 
42 cm 
Z = 0 
8 
8 
7 
7 
8 
COMPETENT 
GROWTH AND NEURODEVELOPMENT SCORES AT 9TH MONTH CORRECTED AGE
CODE 
WEIGHT 
Z SCORE 
LENGTH 
Z SCORE

HEAD CIRCUMFERENCE 
Z SCORE 
BSID SCORE 
REMARKS 

Cognitive 
Receptive Communication 
Expressive Communication 
Fine Motor 
Gross Motor 

001 
7.3 kg 
Z = 0 
73 CM 
Z = 0 
45 cm 
Z = 0 
10 
6 
6 
9 
10 
EMERGING RISK 
002 
8 kg 
Z = 0 
70 CM 
Z = 0 
46 cm 
Z = 0 
12 
8 
7 
9 
12 
COMPETENT 
003 
7.5 kg 
Z = 0 
66 cm 
Z = 0 
46 cm 
Z = 0 
11 
8 
6 
9 
12 
COMPETENT 
004 
8 kg 
Z = 0 
68.5 cm 
Z = 0 
45 cm 
Z = 0 
10 
7 
7 
8 
10 
COMPETENT 
005 
NA 
N A 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
006 
7.8 kg 
Z = 0 
70 cm 
Z = 0 
45 cm 
Z = 0 
12 
8 
7 
9 
10 
COMPETENT 
007 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
008 
7.6 kg 
Z = 0 
70 cm 
Z = 0 
44 cm 
Z = 0 
11 
9 
8 
8 
12 
COMPETENT 
009 
8.2 kg 
Z = 0 
69 cm 
Z = 0 
45 cm 
Z = 0 
14 
9 
9 
7 
12 
EMERGING RISK 
010 
8.6 kg 
Z = 0 
72cm 
Z = 0 
46cm 
Z = 0 
14 
8 
9 
9 
12 
COMPETENT 
011 
7.6 kg 
Z = 0 
70 cm 
Z = 0 
44 cm 
Z = 0 
11 
9 
9 
8 
11 
COMPETENT 
012 
7.4 kg 
Z = 0 
68 cm 
Z = 0 
45 cm 
Z = 0 
11 
12 
9 
13 
13 
COMPETENT 
013 
8 kg 
Z = 0 
72 cm 
Z = 0 
45.5 cm 
Z = 0 
15 
10 
10 
12 
14 
COMPETENT 
014 
8.1 kg 
Z = 0 
67 cm 
Z = 0 
43 cm 
Z = 0 
14 
9 
8 
11 
13 
COMPETENT 
015 
8.2 kg 
Z = 0 
69 cm 
Z = 0 
46 cm 
Z = 0 
11 
8 
11 
10 
13 
COMPETENT 
016 
7.45 kg 
Z = 0 
70 cm 
Z = 0 
45 cm 
Z = 0 
15 
8 
8 
12 
11 
COMPETENT 
017 
7.8 kg 
Z = 0 
72 cm 
Z = 0 
47 cm 
Z = 0 
12 
10 
12 
13 
12 
COMPETENT 
018 
7kg 
Z = 0 
70 cm 
Z = 0 
45 cm 
Z = 0 
15 
10 
8 
12 
12 
COMPETENT 
019 
7.6 kg 
Z = 0 
69 cm 
Z = 0 
44.5 cm 
Z = 0 
13 
11 
9 
12 
12 
COMPETENT 
020 
9 kg 
Z = 0 
72 cm 
Z = 0 
46 cm 
Z = 0 
13 
10 
12 
11 
13 
COMPETENT 
021 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
022 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
023 
7.8 kg 
Z = 0 
69 cm 
Z = 0 
45 cm 
Z = 0 
12 
10 
11 
10 
11 
COMPETENT 
024 
8.1 kg 
Z = 0 
70 cm 
Z = 0 
47 cm 
Z = 0 
13 
11 
12 
10 
12 
COMPETENT 
025 
8.2 kg 
Z = 0 
65 cm 
Z = 0 
45 cm 
Z = 0 
14 
9 
12 
9 
12 
COMPETENT 
026 
8.2 kg 
Z = 0 
68 cm 
Z = 0 
43 cm 
Z = 0 
11 
10 
11 
9 
11 
COMPETENT 
027 
8 kg 
Z = 0 
70 cm 
Z = 0 
46 cm 
Z = 0 
15 
11 
13 
13 
13 
COMPETENT 
028 
8.6 kg 
Z = 0 
69 cm 
Z = 0 
46 cm 
Z = 0 
14 
12 
12 
13 
12 
COMPETENT 
029 
8.6 kg 
Z = 0 
70 cm 
Z = 0 
46.5 cm 
Z = 0 
13 
11 
12 
12 
11 
COMPETENT 
030 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
031 
8.4 kg 
Z = 0 
70 cm 
Z = 0 
44 cm 
Z = 0 
13 
8 
6 
8 
10 
EMERGING RISK 
032 
8.4 kg 
Z = 0 
71 cm 
Z = 0 
45 cm 
Z = 0 
14 
13 
13 
12 
12 
COMPETENT 
033 
8.3 kg 
Z = 0 
65 cm 
Z = 0 
44.5 cm 
Z = 0 
7 
8 
7 
7 
9 
EMERGING RISK 
034 
8.3 kg 
Z = 0 
68 cm 
Z = 0 
45 cm 
Z = 0 
12 
12 
11 
10 
12 
COMPETENT 
GROWTH AND NEURODEVELOPMENT SCORES AT 12TH MONTH CORRECTED AGE
CODE 
WEIGHT 
Z SCORE 
LENGTH 
Z SCORE 
HEAD CIRCUMFERENCE 
Z SCORE 
BSID SCORE 
REMARKS 

Cognitive 
Receptive Communication 
Expressive Communication 
Fine Motor 
Gross Motor 

001 
7.8 kg 
Z = 0 
75.5 cm 
Z = 0 
47 cm 
Z = 0 
14 
11 
9 
11 
14 
COMPETENT 
002 
8.1 kg 
Z = 0 
75 cm 
Z = 0 
45.5 cm 
Z = 0 
16 
12 
11 
14 
16 
COMPETENT 
003 
7.9 kg 
Z = 0 
72 cm 
Z = 0 
45 cm 
Z = 0 
17 
13 
13 
14 
16 
COMPETENT 
004 
9.6 kg 
Z = 0 
74 cm 
Z = 0 
47 cm 
Z = 0 
17 
12 
12 
13 
14 
COMPETENT 
005 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
006 
8.3 kg 
Z = 0 
73 cm 
Z = 0 
46 cm 
Z = 0 
17 
13 
14 
14 
15 
COMPETENT 
007 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
008 
8.8 kg 
Z = 0 
73 cm 
Z = 0 
46 cm 
Z = 0 
16 
12 
12 
14 
15 
COMPETENT 
009 
9 kg 
Z = 0 
74 cm 
Z = 0 
46 cm 
Z = 0 
16 
11 
13 
14 
17 
COMPETENT 
010 
9.4 kg 
Z = 0 
75 cm 
Z = 0 
45 cm 
Z = 0 
15 
12 
14 
15 
18 
COMPETENT 
011 
8.6 kg 
Z = 0 
74 cm 
Z = 0 
44 cm 
Z = 0 
15 
11 
12 
14 
14 
COMPETENT 
012 
8.2 kg 
Z = 0 
72.5 cm 
Z = 0 
48 cm 
Z = 0 
19 
13 
14 
17 
15 
COMPETENT 
013 
9.2 kg 
Z = 0 
75cm 
Z = 0 
47.8 cm 
Z = 0 
18 
14 
15 
17 
17 
COMPETENT 
014 
9.5 kg 
Z = 0 
72 cm 
Z = 0 
45 cm 
Z = 0 
17 
12 
14 
14 
18 
COMPETENT 
015 
9 kg 
Z = 0 
73.5 cm 
Z = 0 
48 cm 
Z = 0 
18 
13 
15 
16 
18 
COMPETENT 
016 
9.58 kg 
Z = 0 
73 cm 
Z = 0 
47cm 
Z = 0 
18 
14 
14 
13 
16 
COMPETENT 
017 
9kg 
Z = 0 
75 cm 
Z = 0 
48 cm 
Z = 0 
15 
12 
13 
14 
16 
COMPETENT 
018 
8.8 kg 
Z = 0 
74 cm 
Z = 0 
47 cm 
Z = 0 
17 
12 
13 
12 
15 
COMPETENT 
019 
8.6 kg 
Z = 0 
73 cm 
Z = 0 
46 cm 
Z = 0 
17 
14 
14 
16 
16 
COMPETENT 
020 
11 kg 
Z = 0 
74.5 cm 
Z = 0 
46.8 cm 
Z = 0 
17 
10 
9 
11 
13 
COMPETENT 
021 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
022 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
023 
9 kg 
Z = 0 
73.5 cm 
Z = 0 
48 cm 
Z = 0 
16 
14 
15 
14 
15 
COMPETENT 
024 
9.4 kg 
Z = 0 
74 cm 
Z = 0 
48 cm 
Z = 0 
15 
12 
12 
16 
16 
COMPETENT 
025 
9.3 kg 
Z = 0 
69 cm 
Z = 0 
47 cm 
Z = 0 
14 
11 
11 
11 
13 
COMPETENT 
026 
9.5 kg 
Z = 0 
73 cm 
Z = 0 
47 cm 
Z = 0 
18 
13 
12 
14 
15 
COMPETENT 
027 
8 kg 
Z = 0 
74 cm 
Z = 0 
48 cm 
Z = 0 
17 
11 
13 
13 
14 
COMPETENT 
028 
10 kg 
Z = 0 
74 cm 
Z = 0 
47 cm 
Z = 0 
17 
15 
15 
14 
16 
COMPETENT 
029 
9.6 kg 
Z = 0 
73 cm 
Z = 0 
46 cm 
Z = 0 
16 
15 
14 
15 
15 
COMPETENT 
030 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
NA 
031 
9.8 kg 
Z = 0 
75 cm 
Z = 0 
46 cm 
Z = 0 
15 
11 
11 
12 
13 
COMPETENT 
032 
10.8 kg 
Z = 0 
74 cm 
Z = 0 
47 cm 
Z = 0 
17 
14 
14 
13 
14 
COMPETENT 
033 
8.8 kg 
Z = 0 
70 cm 
Z = 0 
47 cm 
Z = 0 
11 
11 
12 
10 
12 
EMERGING RISK 
034 
8.3 kg 
Z = 0 
75 cm 
Z = 0 
47 cm 
Z = 0 
14 
13 
12 
13 
13 
COMPETENT 
BSID SCORES: ACCORDING TO SCALE 3 MONTHS AND 16 DAYS TO 6 MONTHS AND 15 DAYS

TOTAL RAW SCORES 

SUBTEST 
AT RISK 
EMERGING RISK 
COMPETENT 
Cognitive 
03 
46 
733 
Receptive Communication 
03 
45 
624 
Expressive Communication 
02 
34 
524 
Fine Motor 
03 
46 
727 
Gross Motor 
04 
56 
728 
BSID SCORES: ACCORDING TO SCALE 6 MONTHS AND 16 DAYS TO 9 MONTHS AND 15 DAYS

TOTAL RAW SCORES 

SUBTEST 
AT RISK 
EMERGING RISK 
COMPETENT 
Cognitive 
06 
79 
1033 
Receptive Communication 
05 
67 
824 
Expressive Communication 
03 
45 
624 
Fine Motor 
06 
78 
927 
Gross Motor 
07 
810 
1128 
BSID SCORES: ACCORDING TO SCALE 9 MONTHS AND 16 DAYS TO 12 MONTHS AND 15 DAYS

TOTAL RAW SCORES 

SUBTEST 
AT RISK 
EMERGING RISK 
COMPETENT 
Cognitive 
09 
1013 
1433 
Receptive Communication 
06 
79 
1024 
Expressive Communication 
04 
58 
924 
Fine Motor 
08 
910 
1127 
Gross Motor 
010 
1112 
1328 
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