Postnatal Growth Restriction in Preterm Infants: A Major Impact of Nutritional Practices and Methods of Assessment

Background: Nutritional management of preterm infants represents a significant challenge for most practitioners caring for sick and/or premature babies. Despite aggressive parenteral and enteral alimentation, a considerable number of preterm infants continue to fall far short of expected growth trajectories that match infants of similar gestation in-utero. Postnatal growth failure may be associated with future neurodevelopmental and cognitive impairments. Objective: The aim of the research is to investigate the incidence of postnatal growth restriction (PNGR) and characteristics of nutritional practices and growth parameters in a cohort of preterm infants born <32 weeks’ gestational age (GA) in a single neonatal intensive care unit (NICU). Methodology: This prospective study included 130 preterm infants born <32 weeks’ GA and admitted to the NICU between February 2018 and January 2020. The infants were divided into two groups: A (GA 23–26+6 weeks [n=50]) and B (27–31+6 weeks [n=80]). The association between PNGR and predicting risk factors was evaluated using logistic regression models. Results: PNGR was found in 62 (47%) infants at 28 days of life and increased to 73% of infants at 36 weeks’ postmenstrual age. Low birth weight and GA were independent factors predicting growth failure. PNGR was significantly correlated with birth weight (p < 0.01), length (p < 0.002), and GA (p < 0.03) at birth; however, HC was not a predictor of PNGR at 28 days. At 36 weeks’ PMA or discharge, PNGR was more pronounced in length, with a mean Z-score of -3.0, followed by weight, with a mean Z-score of -2.1, and an HC Z-score of -1.4. Conclusion : PNGR was significantly high in preterm infants <32 weeks’ gestation. A significant nutritional gap still exists between the recommended and actual caloric and protein supplementation, especially in the first few days after birth. Delayed optimization of caloric intake may be insufficient to promote growth trajectories, especially in preterm infants with significant morbidities.

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Impact of size at birth and postnatal growth on metabolic and neurocognitive outcomes in prematurely born school-age children

Scientific Reports ◽

10.1038/s41598-021-86292-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Yoo Jinie Kim ◽

Seung Han Shin ◽

Eun Sun Lee ◽

Young Hwa Jung ◽

Young Ah Lee ◽

...

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Growth Velocity ◽

Postnatal Growth ◽

School Age ◽

Z Score ◽

Neurodevelopmental Outcomes ◽

Neurocognitive Outcomes ◽

Size At Birth

AbstractPrematurity, size at birth, and postnatal growth are important factors that determine cardiometabolic and neurodevelopmental outcomes later in life. In the present study, we aimed to investigate the associations between the size at birth and growth velocity after birth with cardiometabolic and neurodevelopmental outcomes in preterm infants. Fifty-six preterm infants born at < 32 weeks of gestation or having a birth weight of < 1500 g were enrolled and categorized into small for gestational age (SGA) and appropriate for gestational age (AGA) groups. Anthropometric and cardiometabolic parameters were assessed at school-age, and the Korean Wechsler Intelligence Scale for Children, fourth edition (K-WISC-IV) was used for assessing the intellectual abilities. The growth velocity was calculated by changes in the weight z-score at each time period. Multivariate analysis was conducted to investigate the associations of growth velocity at different periods with cardiometabolic and neurodevelopmental outcomes. Forty-two (75%) were classified as AGA and 25% as SGA. At school-age, despite the SGA children showing significantly lower body weight, lean mass index, and body mass index, there were no differences in the cardiometabolic parameters between SGA and AGA groups. After adjusting for gestational age, birth weight z-score, weight z-score change from birth to discharge and sex, change in weight z-score beyond 12 months were associated with a higher systolic blood pressure, waist circumference, and insulin resistance. Full-scale intelligent quotient (β = 0.314, p = 0.036) and perceptional reasoning index (β = 0.456, p = 0.003) of K-WISC-IV were positively correlated with postnatal weight gain in the neonatal intensive care unit. Although cardiometabolic outcomes were comparable in preterm SGA and AGA infants, the growth velocity at different time periods resulted in different cardiometabolic and neurocognitive outcomes. Thus, ensuring an optimal growth velocity at early neonatal period could promote good neurocognitive outcomes, while adequate growth after 1 year could prevent adverse cardiometabolic outcomes in preterm infants.

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“Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants

Journal of Perinatology ◽

10.1038/s41372-020-0658-5 ◽

2020 ◽

Vol 40 (5) ◽

pp. 704-714 ◽

Cited By ~ 10

Author(s):

Tanis R. Fenton ◽

Barbara Cormack ◽

Dena Goldberg ◽

Roseann Nasser ◽

Belal Alshaikh ◽

...

Keyword(s):

Preterm Infants ◽

Growth Failure ◽

Postnatal Growth ◽

Growth Restriction ◽

Extrauterine Growth Restriction ◽

Postnatal Growth Failure

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Extrauterine Growth Restriction in Low Birth Weight Infants

Neonatal Network The Journal of Neonatal Nursing ◽

10.1891/0730-0832.38.1.27 ◽

2019 ◽

Vol 38 (1) ◽

pp. 27-33 ◽

Cited By ~ 3

Author(s):

Kari Bonnar ◽

Debbie Fraser

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Very Low Birth Weight ◽

Neurodevelopmental Outcome ◽

Growth Failure ◽

Postnatal Growth ◽

Growth Restriction ◽

Low Birth Weight Infants ◽

Extrauterine Growth Restriction ◽

Postnatal Growth Failure

Extrauterine growth restriction (EUGR) affects a significant number of very low birth weight (VLBW) infants and has the potential to impact neurodevelopmental outcome as well as other aspects of long-term health. More aggressive nutritional approaches have reduced the incidence of postnatal growth failure but many questions remain about the expected rate of growth for very preterm infants, the best ways to measure growth velocity, and the optimal approaches to supporting growth. This article examines some of the outstanding issues regarding postnatal growth failure and summarizes current practice recommendations.

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Poor postnatal weight growth is a late finding after sepsis in very preterm infants

Archives of Disease in Childhood - Fetal and Neonatal Edition ◽

10.1136/archdischild-2020-320221 ◽

2020 ◽

Vol 106 (3) ◽

pp. 298-304

Author(s):

Dustin D Flannery ◽

Erik A Jensen ◽

Lauren A Tomlinson ◽

Yinxi Yu ◽

Gui-Shuang Ying ◽

...

Keyword(s):

Growth Failure ◽

Postnatal Growth ◽

Mean Difference ◽

Growth Trajectories ◽

Z Score ◽

Very Preterm Infants ◽

Weight Growth ◽

Significant Difference ◽

The Usa ◽

Z Scores

ObjectiveTo characterise the association between sepsis and postnatal weight growth when accounting for the degree of growth restriction present at birth.DesignRetrospective matched cohort study using data from the Postnatal Growth and Retinopathy of Prematurity study. Participants were born with birth weights of <1500 g or gestational ages of <32 weeks between 2006 and 2011 at 29 neonatal centres in the USA and Canada. Sepsis was defined as a culture-confirmed bacterial or fungal infection of the blood or cerebrospinal fluid before 36 weeks’ postmenstrual age (PMA). Growth was assessed as the change in weight z-score between birth and 36 weeks’ PMA.ResultsOf 4785 eligible infants, 813 (17%) developed sepsis and 693 (85%) were matched 1:1 to controls. Sepsis was associated with a greater decline in weight z-score (mean difference −0.09, 95% CI −0.14 to −0.03). Postnatal weight growth failure (decline in weight z- score>1) was present in 237 (34%) infants with sepsis and 179 (26%) controls (adjusted OR 1.49, 95% CI 1.12 to 1.97). Longitudinal growth trajectories showed similar initial changes in weight z-scores between infants with and without sepsis. By 3 weeks after sepsis onset, there was a greater decline in weight z-scores relative to birth values in those with sepsis than without sepsis (delta z-score −0.89 vs −0.77; mean difference −0.12, 95% CI −0.18 to −0.05). This significant difference persisted until 36 weeks or discharge.ConclusionInfants with sepsis had similar early weight growth trajectories as infants without sepsis but developed significant deficits in weight that were not apparent until several weeks after the onset of sepsis.

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The Impact of Neonatal Morbidities on Child Growth and Developmental Outcome in Very Low Birth Weight Infants: Nationwide Cohort Study

10.21203/rs.3.rs-168031/v1 ◽

2021 ◽

Author(s):

Jung Ho Han ◽

So Jin Yoon ◽

Joo Hee Lim ◽

Jeong Eun Shin ◽

Ho Seon Eun ◽

...

Keyword(s):

Birth Weight ◽

Preterm Infants ◽

Head Circumference ◽

Growth Parameters ◽

Periventricular Leukomalacia ◽

Normal Growth ◽

Child Growth ◽

Growth Restriction ◽

Neurodevelopmental Outcomes ◽

The Impact

Abstract IntroductionGrowth in preterm infants has long-term implications for neurodevelopmental outcomes. We aimed to estimate the nationwide growth outcomes from birth to 5 years in infants born under 1,500 g and to analyze the effects of major morbidities of preterm infants on growth.MethodsTotal 2,961 children with birth weight under 1,500 g who were born in 2013 and examined the Infant Health Check-up between 2013 and 2018 from the National Health Insurance Service database were included. Check-ups were at 4-6, 9-12, 18-24, 30-36, 42-48, and 54-60 months of age. Information was obtained by the International Classification of Diseases-10 codes or by the questionnaire in the check-up program.ResultsAt 60 months of age, mean percentiles of weight, height, and head circumference showed only 30 – 40th percentile of normal growth for their ages. About 30% had growth parameters below the 10th percentile and showed worse neurodevelopmental outcomes. Using multiple logistic regression, infants with bronchopulmonary dysplasia showed significantly higher incidence of growth restriction in all three categories, weight (odds ratio [OR] 1.50), height (OR 1.33), and head circumference (OR 1.36) at 60 months. Sepsis was associated with growth restriction in weight (OR 1.43) and head circumference (OR 1.33). Periventricular leukomalacia infants had relatively small head circumferences (OR 1.91) and poor developmental screening results (OR 2.89).ConclusionCatch-up growth remains a major issue in infants born under 1,500 g, especially those with some morbidities of preterm birth. Regular check-ups to monitor and early intervention for their normal growth is essential.

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Neuropsychological Development and New Criteria for Extrauterine Growth Restriction in Very Low-Birth-Weight Children

Children ◽

10.3390/children8110955 ◽

2021 ◽

Vol 8 (11) ◽

pp. 955

Author(s):

Leticia Alcántara ◽

Cristina Fernández-Baizán ◽

Lara González-García ◽

Enrique García-López ◽

Clara González-López ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Neuropsychological Tests ◽

Very Low Birth Weight ◽

Growth Parameters ◽

Growth Restriction ◽

Z Score ◽

Neuropsychological Development ◽

Neonatal Growth ◽

Extrauterine Growth Restriction

Background: Controversy between short-term neonatal growth of very low birth-weight preterm (VLBW) and neurodevelopment may be affected by criteria changes of extrauterine growth restriction (EUGR). Objective: to determine if new EUGR criteria imply modifications in the relationship between old criteria and results of neuropsychological tests in preterm children. Patients and methods: 87 VLBW at 5–7 years of age were studied. Neuropsychological assessment included RIST test (Reynolds Intellectual Sctreening Test) and NEPSY-II (NE neuro, PSY psycolgy assessment) tests. The relationships between these tests and the different growth parameters were analyzed. Results: RIST index was correlated with z-score Fenton’s weight (p = 0.004) and length (p = 0.003) and with z-score IGW-21’s (INTERGRWTH-21 Project) weight (p = 0.004) and length (p = 0.003) at neonatal discharge, but not with z-score difference between birth and neonatal discharge in weight, length, and HC for both. We did not find a statistically significant correlation between Fenton or IGW-21 z-scores and scalar data of NEPSY-II subtasks. Conclusion: In our series, neonatal growth influence on neuropsychological tests at the beginning of primary school does not seem robust, except for RIST test. New EUGR criteria do not improve the predictive ability of the old ones.

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Single-course antenatal corticosteroids is related to faster growth in very-low-birth-weight infant

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03510-w ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Jiajia Jing ◽

Yiheng Dai ◽

Yanqi Li ◽

Ping Zhou ◽

Xiaodong Li ◽

...

Keyword(s):

Birth Weight ◽

Low Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Very Low Birth Weight ◽

Postnatal Growth ◽

Weight Increase ◽

Antenatal Corticosteroids ◽

Lung Maturation ◽

Growth Outcomes

Abstract Background Antenatal corticosteroids (ACS) treatment is critical to support survival and lung maturation in preterm infants, however, its effect on feeding and growth is unclear. Prior preterm delivery, it remains uncertain whether ACS treatment should be continued if possible (repeated course ACS), until a certain gestational age is reached. We hypothesized that the association of single-course ACS with feeding competence and postnatal growth outcomes might be different from that of repeated course ACS in very-low-birth-weight preterm infants. Methods A multicenter retrospective cohort study was conducted in very-low-birth-weight preterm infants born at 23–37 weeks’ gestation in South China from 2011 to 2014. Data on growth, nutritional and clinical outcomes were collected. Repeated course ACS was defined in this study as two or more courses ACS (more than single-course). Infants were stratified by gestational age (GA), including GA < 28 weeks, 28 weeks ≤ GA < 32 weeks and 32 weeks ≤ GA < 37 weeks. Multiple linear regression and multilevel model were applied to analyze the association of ACS with feeding and growth outcomes. Results A total of 841 infants were recruited. The results, just in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation, showed both single and repeated course of ACS regimens had shorter intubated ventilation time compared to non-ACS regimen. Single-course ACS promoted the earlier application of amino acid and enteral nutrition, and higher rate of weight increase (15.71; 95%CI 5.54–25.88) than non-ACS after adjusting for potential confounding factors. No associations of repeated course ACS with feeding, mean weight and weight increase rate were observed. Conclusions Single-course ACS was positively related to feeding and growth outcomes in very-low-birth-weight preterm infants born at 28–32 weeks’ gestation. However, the similar phenomenon was not observed in the repeated course of ACS regimen.

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Aortic growth arrest after preterm birth: a lasting structural change of the vascular tree

Journal of Developmental Origins of Health and Disease ◽

10.1017/s2040174411000274 ◽

2011 ◽

Vol 2 (4) ◽

pp. 218-225 ◽

Cited By ~ 18

Author(s):

U. Schubert ◽

M. Müller ◽

A.-K. Edstedt Bonamy ◽

H. Abdul-Khaliq ◽

M. Norman

Keyword(s):

Preterm Birth ◽

Carotid Artery ◽

Preterm Infants ◽

Growth Failure ◽

Later Life ◽

Postnatal Growth ◽

Direct Result ◽

Arterial Tree ◽

Very Preterm Infants ◽

Very Preterm

Young people who are born very preterm exhibit a narrower arterial tree as compared with people born at term. We hypothesized that such arterial narrowing occurs as a direct result of premature birth. The aim of this study was to compare aortic and carotid artery growth in infants born preterm and at term. Observational and longitudinal cohort study of 50 infants (21 born very preterm, all appropriate for gestational age, 29 controls born at term) was conducted. Diameters of the upper abdominal aorta and common carotid artery were measured with ultrasonography at three months before term, at term and three months after term-equivalent age. At the first assessment, the aortic end-diastolic diameter (aEDD) was slightly larger in very preterm infants as compared with fetal dimensions. Fetal aortic EDD increased by 2.6 mm during the third trimester, whereas very preterm infants exhibited 0.9 mm increase in aEDD during the same developmental period (P < 0.001 for group difference). During the following 3-month period, aortic growth continued unchanged (+0.9 mm) in very preterm infants, whereas postnatal growth in term controls slowed down to +1.3 mm (P < 0.001 v. fetal aortic growth). At the final examination, aEDD was 22% and carotid artery EDD was 14% narrower in infants born preterm compared with controls, also after adjusting for current weight (P < 0.01). Aortic and carotid artery growth is impaired after very preterm birth, resulting in arterial narrowing. Arterial growth failure may be a generalized vascular phenomenon after preterm birth, with implications for cardiovascular morbidity in later life.

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