BMC Pediatrics BioMed Central
Research article Open Access
Late preterm birth is a risk factor for growth faltering in early
childhood: a cohort study
Ina S Santos*1, Alicia Matijasevich1, Marlos R Domingues1,
Aluísio JD Barros1, Cesar G Victora1 and Fernando C Barros1,2
Address: 1Postgraduate Program in Epidemiology, Department of Social Medicine, Federal University of Pelotas, Pelotas, Brazil and 2Postgraduate
Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
Email: Ina S Santos* - [email protected]; Alicia Matijasevich - [email protected]; Marlos R Domingues - [email protected];
Aluísio JD Barros - [email protected]; Cesar G Victora - [email protected]; Fernando C Barros - [email protected]
* Corresponding author
Published: 16 November 2009 Received: 19 July 2009
Accepted: 16 November 2009
BMC Pediatrics 2009, 9:71 doi:10.1186/1471-2431-9-71
This article is available from: http://www.biomedcentral.com/1471-2431/9/71
© 2009 Santos et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background: Rates of preterm birth are increasing worldwide and this increase is mostly due to
infants born between 34 and 36 weeks of gestational age, the so-called "late preterm" births. The
aim of this study was to assess the effect of late preterm birth over growth outcomes, assessed
when children were 12 and 24 months old.
Methods: In 2004, all births taking place in Pelotas (Southern Brazil) were recruited for a cohort
study. Late preterm (34/0-36/6 weeks of gestational age) and term children (37/0-42/6 weeks) were
compared in terms of weight-for-age, length-for-age and weight-for-length z-scores. Weight-for-
age, length-for-age and weight-for-length z-scores below -2 were considered, respectively,
underweight, stunting and wasting. Singleton newborns with adequate weight for gestational age at
birth, successfully followed-up either at 12 or 24 months of age were analyzed and adjusted odds
ratios with 95% confidence intervals calculated through logistic regression.
Results: 3285 births were included, 371 of whom were late preterm births (11.3%). At 12 months,
prevalence of underweight, stunting and wasting were, respectively, 3.4, 8.7 and 1.1% among late
preterm children, against 1.0, 3.4 and 0.3% among term children. At 24 months, correspondent
values were 3.0, 7.2 and 0.8% against 0.8, 2.9 and 0.4%. Comparing with the term children, adjusted
odds of being underweighted among late preterm children was 2.57 times higher (1.27; 5.23) at 12
months and 3.36 times higher (1.56; 7.23) at 24; of being stunted, 2.35 (1.49; 3.70) and 2.30 (1.40;
3.77); and of being wasted, 3.98 (1.07; 14.85) and 1.87 (0.50; 7.01). Weight gain from birth to 12
and 24 months was similar in late preterm and term children, whereas length gain was higher in the
former group in both periods.
Conclusion: Late preterm children grow faster than children born at term, but they are at
increased risk of underweight and stunting in the first two years of life. Failure to thrive in the first
two years may put them at increased risk of future occurrences of serious morbidity in late
childhood and of chronic disease development in adult life.
Page 1 of 8
(page number not for citation purposes)
BMC Pediatrics 2009, 9:71 http://www.biomedcentral.com/1471-2431/9/71
Background In the first 24 hours after birth, children were examined by
Gestational age is among the most important aspects that trained field workers supervised by a pediatrician. Gesta-
dictate short and long-term health of a newborn. As the tional age was estimated using an algorithm proposed by
fetus needs time to grow, and to develop tissues and the National Center for Health Statistics (NCHS) 
organs, premature birth can have adverse consequences based on the last menstrual period . If the birthweight,
for the neonatal infant. Rates of preterm birth are increas- length and head circumference were inconsistent with the
ing worldwide  and there is evidence that this increase normal curves for the gestational age calculated, or if the
is mostly due to infants born between 34 and 36 weeks of date of the last menstrual period was unknown, then ges-
gestational age the so-called "late preterm" births . tational age was determined using the Dubowitz method
Although less than three weeks before term may appear to  which was performed on almost all newborns. Pre-
be a minor difference, its implications for intrauterine term birth was defined as birth at
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