Analysis of “true extrauterine growth retardation” and related factors in very preterm infants—A multicenter prospective study in China

Abstract

ObjectiveTo investigate the incidence and related factors of extrauterine growth retardation (EUGR) and “true EUGR” in very preterm infants (VPI) from different regions of China.Materials and methodsClinical data of VPI were prospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. The infants were divided into a small for gestational age (SGA) group or non-SGA group at birth, with non-SGA infants at 36 weeks of gestation or at discharge being further divided into a EUGR group or a non-EUGR group. Infants in the EUGR and non-SGA group were defined as “true EUGR.” The general information of VPI, such as maternal complications during pregnancy, use of enteral nutrition and parenteral nutrition, and complications during hospitalization were compared between the groups.ResultsAmong the 2,514 VPI included in this study, 47.3, 41.5, and 33.3% of VPI were below the 10th percentile, and 22.6, 22.4, and 16.0% of VPI were below the 3rd percentile for weight, height, and head circumference at 36 weeks of gestation or at discharge, respectively, by the percentile on the 2013 Fenton curve. The incidences of EUGR and “true EUGR” evaluated by weight were 47.3 and 44.5%, respectively. Univariate analysis showed that there were statistically significant differences in the aspects of perinatal and nutritional characteristics, treatment, and complications between the groups. Multivariate analysis showed that in non-SGA infants, the cumulative caloric intake during the first week was a protective factor for “true EUGR,” while days to reach total enteral nutrition, late initiation of human milk fortifier, and moderate to severe bronchopulmonary dysplasia were independent risk factors for “true EUGR.”ConclusionMore attention should be paid to the nutritional management of VPI to prevent “true EUGR.” Cumulative caloric intake should be ensured and increased during the first week, total enteral nutrition should be achieved as early as possible, human milk fortifier should be added early, and moderate to severe bronchopulmonary dysplasia should be prevented. These strategies are very important for reducing the incidence of “true EUGR” in VPI.

Transient hypoglycemia and biochemical differences in infants less than 1250 grams at birth fed human milk with human milk-derived fortifier versus cow’s milk-derived fortifier

“…In a study on 24,371 premature neonates born between 23 and 34 weeks' GA, Clark et al noted an incidence of 28% of EUGR that was inversely proportional to GA and BW (29). Similarly, a recent multicenter prospective study involving 2514 infants born < 32 weeks demonstrated an EUGR rate as high as 47.3% (30). It has been demonstrated that the benefits of EHM implementation in preterm infants less than 1250g at birth does not increase the risk for growth failure at discharge (31).…”

Antenatal corticosteroids is associated with better postnatal growth outcomes of very preterm infants: A national multicenter cohort study in China

“…This was a secondary analysis of the data from a multicenter prospective survey ( 8 ) aiming to investigate the incidence and related factors of EUGR in VPIs during hospitalization across China conducted by the Chinese Multicenter EUGR Collaborative Group (trial registration: chictr.org.cn, number: ChiCTR1900023418). The clinical data were prospectively collected at 28 tertiary hospitals in 7 regions of China from September 2019 to December 2020.…”

“…As steady improvements in outcomes have been reported, the quality of life for VPIs, especially their postnatal growth and nutritional status, has received increasing attention. A recent large-sample, multicenter prospective study in China (8) found that 47.3% of VPIs experience extrauterine growth restriction (EUGR), as evaluated by weight, and this incidence increased with decreasing GA, reaching 55.3% among VPIs born before GA 28 weeks, which is significantly higher than the reported EUGR incidence of 38% among VPIs in developed countries in 2012 (9). EUGR is associated with poor growth and neurodevelopment as well as with cardiometabolic alterations in childhood (10).…”

Analysis of risk factors for parenteral nutrition-associated cholestasis in preterm infants: A multicenter observational study

“…Lower gestational age at birth and birth weight of preterm infants were associated with poorer neurological development, poorer organ and tissue development, and higher incidence of EUGR [32] . In this study, a multifactorial logistic regression analysis revealed that EUGR (OR, 2.396; 95% CI, 1.255 to 4.572) was an independent risk factor for PNAC, and the PNAC group required a longer duration of invasive and non-invasive ventilation, total oxygen support, and had a higher incidence of RDS, hsPDA, and LOS (p < 0.05 for all).…”

“…In this study, a multifactorial logistic regression analysis revealed that EUGR (OR, 2.396; 95% CI, 1.255 to 4.572) was an independent risk factor for PNAC, and the PNAC group required a longer duration of invasive and non-invasive ventilation, total oxygen support, and had a higher incidence of RDS, hsPDA, and LOS (p < 0.05 for all). It is suggested that the infants in the PNAC group were severely ill, and the poor management of enteral nutrition during the early postnatal period resulted in inadequate enteral nutritional support and a longer time to reach total enteral feeding, as enteral nutrition was essential to avoid EUGR in preterm infants [33] . Moreover, the duration of PN was prolonged due to inadequate enteral nutrition support, and a longer duration of PN infusion increased the risk of developing PNAC, forming a vicious circle of EUGR and PNAC.…”