Neurodevelopmental outcomes at 3–12 months corrected age in predominantly enteral-fed very low birth weight infants in a resource-limited South African setting

Background Very low birth weight infants (VLBWIs) are at risk of neurodevelopmental impairment (NDI). Evidence linking early nutrition and growth to neurodevelopment is largely derived from high-income settings where parenteral nutrition is routine. Data from resource-limited settings using predominantly enteral feeding strategies are limited. Objective To describe neurodevelopmental outcomes and post-discharge growth trajectories up to 12 months corrected age and identify associated factors in a predominantly enteral-fed cohort of VLBWIs. Methods A retrospective cohort study was conducted at Tygerberg Hospital, South Africa (2021–2022). VLBWIs who received predominantly enteral nutrition and attended follow-up were included. Neurodevelopment was assessed using the Hammersmith Infant Neurological Examination (HINE) at 3, 6, and 12 months corrected age (CA). NDI was defined using age-specific HINE thresholds. Associations between clinical variables and NDI were evaluated using Fisher's exact test, Wilcoxon rank-sum tests, and logistic regression. Results Of 296 infants with follow-up data, 190 (64.2%) attended the 12-month assessment. Most infants had HINE scores within the normal range (mean ± SD: 75.2 ± 7.7), with 5/190 (2.6%) classified as abnormal. Extrauterine growth restriction was common (33.7%) but was not associated with NDI at 12 months. Late-onset sepsis and metabolic bone disease were associated with increased odds of abnormal neurodevelopmental outcome in unadjusted analyses. In multivariable analysis, these associations persisted, although estimates were imprecise. Conclusion In this predominantly enteral-fed cohort of VLBWIs, early motor outcomes assessed using the HINE at 12 months corrected age were reassuring despite a high prevalence of EUGR at discharge. Neonatal morbidities, particularly late-onset sepsis and metabolic bone disease, appeared more strongly associated with adverse early neurological outcomes than growth parameters alone. Longer-term follow-up is needed to determine whether later-emerging neurodevelopmental impairments become apparent beyond infancy.