Anthropometric and Neurodevelopmental Trajectories of High-risk SNCU Graduates in the First Year of Life: A Longitudinal Cohort Study

Introduction: While neonatal intensive care expansion has improved survival, high-risk neonates face significant Extrauterine Growth Restriction (EUGR) and neurodevelopmental morbidity. Longitudinal data on both these trajectories remains scarce in resource constrained hilly areas in North India. Aim: To evaluate the longitudinal anthropometric and neurodevelopmental catch-up growth of high-risk Sick Newborn Care Unit (SNCU) graduates over their first year and also to identify independent perinatal predictors of developmental delay. Materials and Methods: A longitudinal cohort study evaluated 170 high-risk neonates discharged from SNCU at Indira Gandhi Medical College Shimla, Himachal Pradesh, India, from July 2024 till December 2025. Anthropometric parameters {World Health Organisation (WHO)/Intergrowth-21st Z-scores} were assessed at three, six, nine, and 12 months of corrected age. Neurodevelopment was evaluated at six and 12 months using the Developmental Assessment Scale for Indian Infants (DASII). Multivariate logistic regression was utilised to determine independent risk factors for motor and mental delay with statistical significance set at p<0.05. Results: The cohort (64.7% preterm; mean birth weight 2191±734 g) experienced profound early EUGR. By 12 months, somatic weight completely normalised (mean Z-score -0.30±0.86), but severe linear stunting persisted in 41.23% of infants. Multivariate analysis at 12 months identified prematurity (Motor aOR 19.86; Mental aOR 8.31), birth asphyxia (Motor aOR 6.15; Mental aOR 5.27), and neonatal sepsis (Mental aOR 4.05) as independent predictors of delay. Conclusion: Despite robust weight catch-up, linear stunting and neurodevelopmental delay persist. Individualised early intervention must aggressively target infants surviving sepsis and asphyxia alongside extreme preterm and prolonged SNCU stay as trigger for early enrollment.