Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study
SHEN Wei, ZHENG Zhi, LIN Xin-Zhu, WU Fan, TIAN Qian-Xin, CUI Qi-Liang, YUAN Yuan, REN Ling, MAO Jian, SHI Bi-Zhen, WANG Yu-Mei, LIU Ling, ZHANG Jing-Hui, CHANG Yan-Mei, TONG Xiao-Mei, ZHU Yan, ZHANG Rong, YE Xiu-Zhen, ZOU Jing-Jing, LI Huai-Yu, ZHAO Bao-Yin, QIU Yin-Ping, LIU Shu-Hua, MA Li, XU Ying, CHENG Rui, ZHOU Wen-Li, WU Hui, LIU Zhi-Yong, CHEN Dong-Mei, GAO Jin-Zhi, LIU Jing, CHEN Ling, LI Cong, YANG Chun-Yan, XU Ping, ZHANG Ya-Yu, HU Si-Le, MEI Hua, YANG Zu-Ming, FENG Zong-Tai, WANG San-Nan, MENG Er-Yan, SHANG Li-Hong, XU Fa-Lin, OU Shao-Ping, JU Rong
Department of Neonatology, Women's and Children's Hospital Affiliated to Xiamen University/Xiamen Maternal and Child Health Hospital, Xiamen, Fujian 361003, China
Abstract：Objective To investigate the incidence of extrauterine growth retardation (EUGR) and its risk factors in very preterm infants (VPIs) during hospitalization in China. Methods A prospective multicenter study was performed on the medical data of 2 514 VPIs who were hospitalized in the department of neonatology in 28 hospitals from 7 areas of China between September 2019 and December 2020. According to the presence or absence of EUGR based on the evaluation of body weight at the corrected gestational age of 36 weeks or at discharge, the VPIs were classified to two groups: EUGR group (n=1 189) and non-EUGR (n=1 325). The clinical features were compared between the two groups, and the incidence of EUGR and risk factors for EUGR were examined. Results The incidence of EUGR was 47.30% (1 189/2 514) evaluated by weight. The multivariate logistic regression analysis showed that higher weight growth velocity after regaining birth weight and higher cumulative calorie intake during the first week of hospitalization were protective factors against EUGR (P<0.05), while small-for-gestational-age birth, prolonged time to the initiation of total enteral feeding, prolonged cumulative fasting time, lower breast milk intake before starting human milk fortifiers, prolonged time to the initiation of full fortified feeding, and moderate-to-severe bronchopulmonary dysplasia were risk factors for EUGR (P<0.05). Conclusions It is crucial to reduce the incidence of EUGR by achieving total enteral feeding as early as possible, strengthening breastfeeding, increasing calorie intake in the first week after birth, improving the velocity of weight gain, and preventing moderate-severe bronchopulmonary dysplasia in VPIs.
SHEN Wei,ZHENG Zhi,LIN Xin-Zhu et al. Incidence of extrauterine growth retardation and its risk factors in very preterm infants during hospitalization: a multicenter prospective study[J]. CJCP, 2022, 24(2): 132-140.
Izquierdo Renau M, Aldecoa-Bilbao V, Balcells Esponera C, et al. Applying methods for postnatal growth assessment in the clinical setting: evaluation in a longitudinal cohort of very preterm infants[J]. Nutrients, 2019, 11(11): 2772. PMID: 31739632. PMCID: PMC6893690. DOI: 10.3390/nu11112772.
Backstr?m MC, Kouri T, Kuusela AL, et al. Bone isoenzyme of serum alkaline phosphatase and serum inorganic phosphate in metabolic bone disease of prematurity[J]. Acta Paediatr, 2000, 89(7): 867-873. PMID: 10943972. DOI: 10.1111/j.1651-2227.2000.tb00395.x.
Patel AL, Engstrom JL, Meier PP, et al. Accuracy of methods for calculating postnatal growth velocity for extremely low birth weight infants[J]. Pediatrics, 2005, 116(6): 1466-1473. PMID: 16322172. DOI: 10.1542/peds.2004-1699.
Chien HC, Chen CH, Wang TM, et al. Neurodevelopmental outcomes of infants with very low birth weights are associated with the severity of their extra-uterine growth retardation[J]. Pediatr Neonatol, 2018, 59(2): 168-175. PMID: 28866004. DOI: 10.1016/j.pedneo.2017.08.003.
Makker K, Ji Y, Hong X, et al. Antenatal and neonatal factors contributing to extra uterine growth failure (EUGR) among preterm infants in Boston birth cohort (BBC)[J]. J Perinatol, 2021, 41(5): 1025-1032. PMID: 33589730. PMCID: PMC7883994. DOI: 10.1038/s41372-021-00948-4.
Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates[J]. Pediatrics, 2003, 111(5 Pt 1): 986-990. PMID: 12728076. DOI: 10.1542/peds.111.5.986.
Griffin IJ, Tancredi DJ, Bertino E, et al. Postnatal growth failure in very low birthweight infants born between 2005 and 2012[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(1): F50-F55. PMID: 26201534. DOI: 10.1136/archdischild-2014-308095.
Klevebro S, Westin V, Stoltz Sj?str?m E, et al. Early energy and protein intakes and associations with growth, BPD, and ROP in extremely preterm infants[J]. Clin Nutr, 2019, 38(3): 1289-1295. PMID: 29885776. DOI: 10.1016/j.clnu.2018.05.012.
Baillat M, Pauly V, Dagau G, et al. Association of first-week nutrient intake and extrauterine growth restriction in moderately preterm infants: a regional population-based study[J]. Nutrients, 2021, 13(1): 227. PMID: 33466801. PMCID: PMC7830065. DOI: 10.3390/nu13010227.
Bartholomew J, Martin CR, Allred E, et al. Risk factors and correlates of neonatal growth velocity in extremely low gestational age newborns: the ELGAN study[J]. Neonatology, 2013, 104(4): 298-304. PMID: 24192897. PMCID: PMC3929951. DOI: 10.1159/000351020.
