Logo of archdischfnArchives of Disease in Childhood - Fetal & NeonatalVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Arch Dis Child Fetal Neonatal Ed. 2003 Nov; 88(6): F492–F500.
PMCID: PMC1763245

The EPICure study: growth and associated problems in children born at 25 weeks of gestational age or less


Aim: To define growth outcomes of a geographically defined population of extremely preterm babies.

Population: The EPICure study identified all surviving children in the United Kingdom and Ireland born at ⩽ 25 weeks 6 days gestation between March and December 1995. Of 308 survivors, 283 (92%) were evaluated at 30 months of age corrected for prematurity.

Methods: Growth was measured as part of a medical and full neurodevelopmental assessment. Growth parameters were evaluated in relation to other 30 month outcomes and perinatal variables.

Results: The children were smaller in each of the five growth measures compared with published population norms: mean (SD) standard deviation scores were -1.19 (1.32) for weight, -1.40 (1.37) for head circumference, -0.70 (1.19) for height, -1.00 (1.38) for body mass index, and -0.75 (0.95) for mid-upper arm circumference. Despite being of average size at birth, children were significantly lighter with smaller head circumferences at the expected date of delivery, compared with population norms, and only weight showed later catch up, by 0.5 SD. Poorer growth was found in children whose parents reported feeding problems and with longer duration of oxygen dependency, as a marker for neonatal respiratory illness. Although severe motor disability was associated with smaller head circumference, overall there was no relation between Bayley scores and head growth.

Conclusions: Poor growth in early childhood is common in extremely preterm children, particularly when prolonged courses of systemic steroids have been given for chronic lung disease. Improving early growth must be a priority for clinical care.

Full Text

The Full Text of this article is available as a PDF (458K).

Supplementary Material

[Web-only Appendix]

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Astbury J, Orgill AA, Bajuk B, Yu VY. Sequelae of growth failure in appropriate for gestational age, very low-birthweight infants. Dev Med Child Neurol. 1986 Aug;28(4):472–479. [PubMed]
  • Kitchen WH, Doyle LW, Ford GW, Callanan C. Very low birth weight and growth to age 8 years. I: Weight and height. Am J Dis Child. 1992 Jan;146(1):40–45. [PubMed]
  • Daily DK, Kilbride HW, Wheeler R, Hassanein R. Growth patterns for infants weighing less than 801 grams at birth to 3 years of age. J Perinatol. 1994 Nov-Dec;14(6):454–460. [PubMed]
  • O'Callaghan MJ, Burns Y, Gray P, Harvey JM, Mohay HI, Rogers Y, Tudehope DI. Extremely low birth weight and control infants at 2 years corrected age: a comparison of intellectual abilities, motor performance, growth and health. Early Hum Dev. 1995 Jan 30;40(2):115–128. [PubMed]
  • Hirata T, Bosque E. When they grow up: the growth of extremely low birth weight (< or = 1000 gm) infants at adolescence. J Pediatr. 1998 Jun;132(6):1033–1035. [PubMed]
  • Teplin SW, Burchinal M, Johnson-Martin N, Humphry RA, Kraybill EN. Neurodevelopmental, health, and growth status at age 6 years of children with birth weights less than 1001 grams. J Pediatr. 1991 May;118(5):768–777. [PubMed]
  • Elliman A, Bryan E, Elliman A, Walker J, Harvey D. The growth of low-birth-weight children. Acta Paediatr. 1992 Apr;81(4):311–314. [PubMed]
  • Hack M, Weissman B, Borawski-Clark E. Catch-up growth during childhood among very low-birth-weight children. Arch Pediatr Adolesc Med. 1996 Nov;150(11):1122–1129. [PubMed]
  • Northway WH, Jr, Moss RB, Carlisle KB, Parker BR, Popp RL, Pitlick PT, Eichler I, Lamm RL, Brown BW., Jr Late pulmonary sequelae of bronchopulmonary dysplasia. N Engl J Med. 1990 Dec 27;323(26):1793–1799. [PubMed]
  • Vohr BR, Coll CG, Lobato D, Yunis KA, O'Dea C, Oh W. Neurodevelopmental and medical status of low-birthweight survivors of bronchopulmonary dysplasia at 10 to 12 years of age. Dev Med Child Neurol. 1991 Aug;33(8):690–697. [PubMed]
  • Vrlenich LA, Bozynski ME, Shyr Y, Schork MA, Roloff DW, McCormick MC. The effect of bronchopulmonary dysplasia on growth at school age. Pediatrics. 1995 Jun;95(6):855–859. [PubMed]
  • Arnold CC, Kramer MS, Hobbs CA, McLean FH, Usher RH. Very low birth weight: a problematic cohort for epidemiologic studies of very small or immature neonates. Am J Epidemiol. 1991 Sep 15;134(6):604–613. [PubMed]
  • Costeloe K, Hennessy E, Gibson AT, Marlow N, Wilkinson AR. The EPICure study: outcomes to discharge from hospital for infants born at the threshold of viability. Pediatrics. 2000 Oct;106(4):659–671. [PubMed]
  • Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med. 2000 Aug 10;343(6):378–384. [PubMed]
  • Hurvitz EA. Stretching soleus muscle to prevent contractures. Dev Med Child Neurol. 1989 Feb;31(1):117–118. [PubMed]
  • de Onis M, Yip R, Mei Z. The development of MUAC-for-age reference data recommended by a WHO Expert Committee. Bull World Health Organ. 1997;75(1):11–18. [PMC free article] [PubMed]
  • Finnström O, Otterblad Olausson P, Sedin G, Serenius F, Svenningsen N, Thiringer K, Tunell R, Wesström G. Neurosensory outcome and growth at three years in extremely low birthweight infants: follow-up results from the Swedish national prospective study. Acta Paediatr. 1998 Oct;87(10):1055–1060. [PubMed]
  • Hack M, Breslau N, Weissman B, Aram D, Klein N, Borawski E. Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med. 1991 Jul 25;325(4):231–237. [PubMed]
  • Kitchen WH, Doyle LW, Ford GW, Callanan C, Rickards AL, Kelly E. Very low birth weight and growth to age 8 years. II: Head dimensions and intelligence. Am J Dis Child. 1992 Jan;146(1):46–50. [PubMed]
  • Wahlig TM, Gatto CW, Boros SJ, Mammel MC, Mills MM, Georgieff MK. Metabolic response of preterm infants to variable degrees of respiratory illness. J Pediatr. 1994 Feb;124(2):283–288. [PubMed]
  • Yeh TF, McClenan DA, Ajayi OA, Pildes RS. Metabolic rate and energy balance in infants with bronchopulmonary dysplasia. J Pediatr. 1989 Mar;114(3):448–451. [PubMed]
  • Kurzner SI, Garg M, Bautista DB, Bader D, Merritt RJ, Warburton D, Keens TG. Growth failure in infants with bronchopulmonary dysplasia: nutrition and elevated resting metabolic expenditure. Pediatrics. 1988 Mar;81(3):379–384. [PubMed]
  • Gibson AT, Pearse RG, Wales JK. Growth retardation after dexamethasone administration: assessment by knemometry. Arch Dis Child. 1993 Nov;69(5 Spec No):505–509. [PMC free article] [PubMed]
  • Skinner AM, Battin M, Solimano A, Daaboul J, Kitson HF. Growth and growth factors in premature infants receiving dexamethasone for bronchopulmonary dysplasia. Am J Perinatol. 1997 Oct;14(9):539–546. [PubMed]
  • Bloomfield FH, Knight DB, Breier BH, Harding JE. Growth restriction in dexamethasone-treated preterm infants may be mediated by reduced IGF-I and IGFBP-3 plasma concentrations. Clin Endocrinol (Oxf) 2001 Feb;54(2):235–242. [PubMed]
  • Crofton PM, Shrivastava A, Wade JC, Stephen R, Kelnar CJH, Mcintosh N, Lyon AJ. Effects of dexamethasone treatment on bone and collagen turnover in preterm infants with chronic lung disease. Pediatr Res. 2000 Aug;48(2):155–162. [PubMed]
  • Weiler HA, Wang Z, Atkinson SA. Dexamethasone treatment impairs calcium regulation and reduces bone mineralization in infant pigs. Am J Clin Nutr. 1995 Apr;61(4):805–811. [PubMed]
  • Powls A, Botting N, Cooke RW, Pilling D, Marlow N. Growth impairment in very low birthweight children at 12 years: correlation with perinatal and outcome variables. Arch Dis Child Fetal Neonatal Ed. 1996 Nov;75(3):F152–F157. [PMC free article] [PubMed]
  • Rajaram S, Carlson SE, Koo WW, Rangachari A, Kelly DP. Insulin-like growth factor (IGF)-I and IGF-binding protein 3 during the first year in term and preterm infants. Pediatr Res. 1995 May;37(5):581–585. [PubMed]
  • Wollmann HA. Growth hormone and growth factors during perinatal life. Horm Res. 2000;53 (Suppl 1):50–54. [PubMed]
  • Yeung Melinda Y, Smyth John P. Hormonal factors in the morbidities associated with extreme prematurity and the potential benefits of hormonal supplement. Biol Neonate. 2002 Jan;81(1):1–15. [PubMed]

Figures and Tables

Figure 1
Raw growth data for height (A), weight (B), head circumference (C), and mid-upper arm circumference (D) plotted against age corrected for prematurity for children of 25 weeks gestational age or less.
Figure 2
Mean (95% confidence interval) for weight (A; n = 233)) and head circumference (B; n = 145) standard deviation scores at birth, expected date of delivery (EDD), and 30 months of age corrected for prematurity for babies of ⩽ 23, 24, and 25 weeks ...
Figure 3
Relation between severe disability, feeding problems, and poor growth in terms of weight (top; n = 271) and head circumference (bottom; n = 278) at 20 months of corrected age for children of 25 weeks of gestational age or less. A, severe neurodevelopmental ...

Articles from Archives of Disease in Childhood. Fetal and Neonatal Edition are provided here courtesy of BMJ Group


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...