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

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 long-term 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, social-emotional 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 follow-up. To maintain prognostic balance generated from the original random treatment allocation, the data was canned by using the intention-to-treat (ITT) procedure. Per-protocol 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 T-test analysis on weight, linear growth and head circumference of the respondents from the baseline to 12th month of corrected age

Description

t-value

p-value

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 t-test 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 t-value between baseline and discharge weight was 8.29 with p-value 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 p-values of comparisons of weight gain from the baseline to 12th month of corrected age was 0.000 with t-values 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 p-values 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 t-value 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 12-month period. The p-values between head circumference at birth, compared to measurements taken upon discharge up to the 12th month of corrected age was 0.000 with t-value 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 12-month 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 0-18 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 15-27 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 t-test 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 long-term 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 long-term 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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  2. 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.
  3. Chawla D, Thukral A, Agarwal R, Deorari AK, Paul VK. Parenteral nutrition. Indian J Pediatr [Internet]. 2008 Apr;75(4). Available from: http://dx.doi.org/10.1007/s12098-008-0042-5
  4. 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
  5. 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
  6. 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):53-61. Available from: https://search.informit.org/doi/10.3316/ielapa.908268313931029
  7. 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];29:428-432. Available from: https://www.nature.com/articles/jp200951
  8. Jackson BJ, Needelman H, Roberts H, Willet S, McMorris C. Bayley scales of infant development screening test-gross motor subtest. Pediatric Physical Therapy [Internet]. 2012;24(1):58–62. Available from: http://dx.doi.org/10.1097/PEP.0b013e31823d8ba0

 

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

31-32 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

32-33 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

26-27 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

27-28 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

30-31 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

31-32 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

32-33 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

26-27 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

30-31 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

29-30 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

30-31 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

29-30 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

33-34 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

31-32 wks

1.8 kg

45 cm

30 cm

2 kg

10th percentile

44 cm

10th percentile

32 cm

50th percentile

22 days

016

F

34-35 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

28-29 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

30-31 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

32-33 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

32-33 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

33-34 wks

1.45kg

42 cm

30 cm

1.64 kg

<10th percentile

45 cm

10th percentile

33 cm

50th percentile

16 days

025

F

29-30 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

32-33 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

28-29 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

31-32 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

33-34 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

32-33 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

26-27 wks

0.92 kG

35 cm

24 cm

1.82

10th percentile

38 cm

<10th percentile

28 cm

<10th percentile

50 days

032

F

31-32 wks

1.8KG

44cm

29 cm

1.94 kg

50th percentile

46 cm

50th percentile

31 cm

50th percentile

15 days

033

F

31-32 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

28-29 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

31-32 wks

6.9 kg

Z = 0

66cm

Z = 0

43.5 cm

Z = 0

8

6

7

8

9

COMPETENT

002

32-33 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

26-27 wks

7.2 kg

Z = 0

64.5 cm

Z = 0

42 cm

 Z = 0

9

7

6

7

8

COMPETENT

005

27-28 wks

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

006

30-31 wks

6.5 kg

Z = 0

65 cm

Z = 0

41.5 cm

Z = 0

9

6

6

7

8

COMPETENT

007

31-32 wks

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

008

32-33 wks

7 kg

Z = 0

63.8 cm

Z = 0

41.5 cm

Z = 0

7

7

5

7

7

COMPETENT

009

26-27 wks

7.3 kg

Z = 0

64 cm

Z = 0

43 cm

Z = 0

8

7

8

6

9

EMERGING RISK

010

30-31 wks

7.83 kg

Z = 0

67 cm

Z = 0

44.5 cm

Z = 0

9

6

8

7

9

COMPETENT

011

29-30 wks

7.31 kg

Z = 0

64  cm

Z = 0

42 cm

Z = 0

8

7

7

8

9

COMPETENT

012

30-31 wks

6.87kg

Z = 0

67 cm

Z = 0

43.8 cm

Z = 0

9

5

6

7

9

EMERGING RISK

013

29-30 wks

8 kg

Z = 0

66 cm

Z = 0

44.6 cm

Z = 0

10

8

7

9

13

COMPETENT

014

33-34 wks

7.5

Z = 0

67 cm

Z = 0

43 cm

Z = 0

10

7

7

8

11

COMPETENT

015

31-32 wks

6.6 kg

Z = 0

66 cm

Z = 0

42 cm

Z = 0

11

7

8

9

9

COMPETENT

016

34-35 wks

6.1 kg

Z = 0

68 cm

Z = 0

43 cm

Z = 0

8

7

6

9

10

COMPETENT

017

28-29 wks

6.8 kg

Z = 0

68.8 cm

Z = 0

44 cm

Z = 0

8

6

6

7

9

COMPETENT

018

30-31 wks

6.4 kg

Z = 0

65 cm

Z = 0

43.5 cm

Z = 0

7

6

6

7

9

COMPETENT

019

32-33 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

32-33 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

33-34 wks

7.2 kg

Z = 0

65 cm

Z = 0

45 cm

Z = 0

8

7

6

8

8

COMPETENT

025

29-30 wks

7 kg

Z = 0

62 cm

z<-2

42 cm

Z = 0

8

7

8

8

10

COMPETENT

026

32-33 wks

6.8 kg

Z = 0

63 cm

Z<-2

42 cm

Z = 0

7

8

7

8

9

COMPETENT

027

28-29 wks

7.1 kg

Z = 0

66 cm

Z = 0

43 cm

Z = 0

7

8

8

7

9

COMPETENT

028

31-32 wks

7 kg

Z = 0

64 cm

Z = 0

44 cm

Z = 0

8

8

7

8

8

COMPETENT

029

33-34 wks

7.2 kg

Z = 0

66 cm

Z = 0

44 cm

Z = 0

8

8

7

9

9

COMPETENT

030

32-33 wks

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

NA

031

26-27 wks

6.6 kg

Z = 0

68 cm

Z = 0

42 cm

Z = 0

8

7

5

8

9

COMPETENT

032

31-32 WKS

7.2 kg

Z = 0

65 cm

Z = 0

43 cm

Z = 0

7

8

6

8

11

COMPETENT

033

31-32 WKS

7.2 kg

Z = 0

62 cm

Z = 0

43 cm

Z = 0

8

7

6

7

7

COMPETENT

034

28-29 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

0-3

4-6

7-33

Receptive Communication

0-3

4-5

6-24

Expressive Communication

0-2

3-4

5-24

Fine Motor

0-3

4-6

7-27

Gross Motor

0-4

5-6

7-28

 

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

0-6

7-9

10-33

Receptive Communication

0-5

6-7

8-24

Expressive Communication

0-3

4-5

6-24

Fine Motor

0-6

7-8

9-27

Gross Motor

0-7

8-10

11-28

 

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

0-9

10-13

14-33

Receptive Communication

0-6

7-9

10-24

Expressive Communication

0-4

5-8

9-24

Fine Motor

0-8

9-10

11-27

Gross Motor

0-10

11-12

13-28

 

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