Disrupted Maturation of the Microbiota and Metabolome among Extremely Preterm Infants with Postnatal Growth Failure

Abstract Objectives Corticosteroids are administered to ventilator dependent infants with bronchopulmonary dysplasia (BPD) to improve respiratory function and facilitating extubation. Acutely, however, growth impairment can occur as a side effect of such therapy. We aimed to determine the effect of corticosteroids on postnatal growth during the entire neonatal intensive care unit (NICU) admission. Methods A whole population study of extremely preterm infants with BPD was undertaken. Corticosteroid therapy was classified as treatment with dexamethasone or hydrocortisone for a least five consecutive days. Growth was calculated as the difference in weight and head circumference z-score from birth to discharge. Results Six thousand, one hundred and four infants with BPD were included of whom 28.3% received postnatal corticosteroids. Infants receiving corticosteroids were less mature (GA 25.0 vs. 26.3 weeks) and of lower birthweight (0.70 vs. 0.84 kg) than those not receiving treatment. There were no significant differences between those who did and did not receive corticosteroids in weight gain (p=0.61) or head circumference growth (p=0.33) from birth to discharge. Single vs. multiple courses of postnatal corticosteroids did not result in significant differences in weight (p=0.62) or head circumference (p=0.13) growth. Conclusions Postnatal corticosteroid treatment did not affect the longer term growth of preterm infants with BPD.

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Diagnostic Accuracy of Adjusted Growth Curves to Predict Cognitive Scores at 24 Months in Extremely Preterm Infants (P11-054-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz048.p11-054-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

Anisha Bhatia ◽

Ariel Salas

Keyword(s):

Multivariate Analysis ◽

Diagnostic Accuracy ◽

Preterm Infants ◽

Growth Curves ◽

Postnatal Growth ◽

Growth Trajectories ◽

Linear Regression Models ◽

Growth Standards ◽

Extremely Preterm ◽

Extremely Preterm Infants

Abstract Objectives To compare the diagnostic accuracy of adjusted and unadjusted growth curves to define postnatal growth and predict neurodevelopment at age 2 years in extremely preterm infants. Methods We performed a retrospective cohort study assessing infant growth at 36 weeks post-menstrual age (PMA) in 350 extremely preterm infants born ≤ 26 6/7 weeks gestational age (GA) between 01/01/2006-12/31/2014 at University of Alabama at Birmingham Regional Neonatal Intensive Care Unit. Postnatal growth was defined as below, within, or above target using adjusted and unadjusted growth curves. Linear regression models were used to compare adjusted and standard growth trajectories at 36 weeks PMA. The primary outcome was Cognitive Composite Score (CCS) of the Bayley Scales of Infant Development-III (Bayley-III) at 24 months. Results Mean birthweight (BW) was 750 ± 138 g and median GA was 25 weeks (interquartile range: 24 to 26). A multivariate analysis of postnatal growth defined with adjusted curves and eight covariates (GA, BW, weight-Z-score at birth, sex, race, antenatal steroid use, singleton birth, and corrected age at follow-up assessment) predicted higher CCS-Bayley-III scores at 24 months in infants with postnatal growth within target (adjusted mean ± standard error: 89 ± 3) and lower scores in infants with postnatal growth below and above target (85 ± 3 vs. 83 ± 6, respectively) at 36 weeks PMA (P = 0.04). A multivariate analysis of postnatal growth defined with unadjusted curves and the same covariates did not predict significant differences in scores of infants with postnatal growth below (86 ± 3), within (86 ± 3), or above target (86 ± 6) at 36 weeks PMA (P = 0.99). Conclusions Adjusted growth curves identified an inverted “U-shaped” association between postnatal growth and CCS-Bayley-III scores at 24 onths. Individualized growth trajectories adjusted for physiologic weight loss may predict cognitive impairment more accurately than traditionally defined growth standards. Additional well-powered studies are needed to validate the diagnostic ability of adjusted growth curves in routine clinical practice. Funding Sources None.

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