Extrauterine growth restriction in very low birth weight infants according to different growth charts: A retrospective 10 years observational study

Abstract

Background Extrauterine growth restriction (EUGR) is common among very low birth weight (VLBW) infants and associated with poor neurodevelopmental outcomes. There are two types of EUGR definitions (cross-sectional and longitudinal) and many growth charts for monitoring postnatal growth. Aims of our study were 1) to compare the rate of small for gestational rate (SGA) and EUGR in a population of VLBW infants, both according to different growth charts (Fenton, INeS charts and Intergrowth-21) and different definitions; 2) to identify risk factors for EUGR. Methods This is a single centre retrospective observational study, including all VLBW infants born between January 2009 and December 2018. Anthropometric measures were obtained at birth and at discharge and presented as z-scores according to three growth charts (Fenton, INeS charts, Intergrowth-21). Maternal, clinical and nutritional data were retrieved from clinical records. Results 228 VLBW were included. Percentage of SGA did not change significantly according to the three different growth charts (Fenton 22.4%, INeS charts 22.8%, Intergrowth 28.2%, p 0.27). Prevalence of EUGR was significantly higher when INeS and Fenton charts were used, compared to Intergrowth charts regardless of EUGR-definition (cross sectional-EUGR: Fenton 33.5%, INeS charts 40.9%, Intergrowth-21 23.8%, p 0.001; longitudinal-EUGR (loss of 1SDS): Fenton 15%, INeS charts 20.4%, Intergrowth 4%, p <0.001). In our population a longer time to reach 100 ml/kg/day of enteral feeding increased of 18% the risk of longitudinal EUGR. Late onset sepsis and retinopathy of prematurity were associated with an increased risk of longitudinal EUGR, although not significantly, while having a preeclamptic mother was associated with a reduced risk. Conclusions We confirmed a wide variability of EUGR rates when using different charts and definitions, highlighting that Intergrowth-21 charts identify less EUGR when compared to INeS and Fenton charts. Standardized criteria for defining EUGR are warranted in order to facilitate comparisons between studies and to improve the nutritional management of VLBW infants.

The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association with Clinical and Nutritional Factors

“…Our study revealed that extremely and very preterm neonates had a higher prevalence of EUGR at discharge concerning weight, according to Fenton2013 charts compared to INTERGROWTH-21st charts. This is in accordance with other studies [46][47][48], and particularly, a recent study by Starc et al reported a decreased prevalence of EUGR of weight when INTERGROWTH-21st charts were used in comparison to Fenton. The differences in outcomes between these two growth charts were expected and can be attributed to the fundamental disparities in the way they were created.…”

Risk Factors Contributing to Extrauterine Growth Restriction in Very Low Birth Weight Infants

“…This study explored the incidence and risk factors for EUGR in VLBW infants at a single center. The incidence of EUGR varies from 21.7% to 77.2% depending on the definitions employed [1][2][3][4][5][6][7][8][9] .…”

“…Extrauterine growth restriction (EUGR) is prevalent in preterm and very low birth weight (VLBW) infants. The incidence of EUGR varies from 21.7% to 77.2% depending on the definitions employed [1][2][3][4][5][6][7][8][9] . EUGR is generally defined as an anthropometric measure (mainly weight) below a cut-off value, often the 10th percentile, based on the postmenstrual age (PMA) of the preterm infant.…”

“…Factors known to influence EUGR include gestational age (GA), birth weight, male sex, small for gestational age (SGA), periods of inadequate nutrition, and morbidities associated with preterm birth, such as respiratory distress syndrome (RDS), patent ductus arteriosus (PDA), necrotizing enterocolitis (NEC), gastrointestinal (GI) perforation, retinopathy of prematurity (ROP), sepsis, and bronchopulmonary dysplasia (BPD) 1,5,[7][8][9][10]13) .…”

“…(1) Cross-sectional: weight at a given time below the 10th percentile, regardless of birth weight, or (2) Longitudinal: weight loss between birth and a given time with various standard deviation thresholds 5) . Zozaya et al 14) reported that a decrease in the weight z-score from birth to 36 weeks is a more rational definition of EUGR and can predict neurodevelopment.…”