Extrauterine growth restriction: Universal problem among premature infants

Abstract

Objective: To analyze the growth rate of premature infants in the first weeks of life and factors associated with extrauterine growth restriction. Methods: This is a cross-sectional study of 254 premature infants in a neonatal intensive care unit conducted from January 1, 2008 to December 31, 2010. Infants who died or had malformations incompatible with life were excluded. Median weight curves according to gestational age were constructed for the first four weeks of life. The Fenton growth chart calculations provided the weight Z-scores. Extrauterine growth restriction was defined as corrected weight-for-age Z-score ≤-2. Perinatal, morbidity, and health care variables were analyzed. The Poisson regression model yielded the prevalenceratios . Associations between extrauterine growth restriction and the perinatal, morbidity, and care variables were investigated. Poisson regression controlled possible confounding factors. Results: The frequency of extrauterine growth restriction was 24.0%. Most (85.0%) small-for-gestational-age infants developed extrauterine growth restriction; 55.3% of extrauterine growth restriction cases involved small-for-gestational-age infants. Premature infants with gestational age >32 weeks did not recover the median birth weight until the third week of life and had a higher frequency of small-for-gestational-age. The Z-scores of non-small-for-gestational-age infants decreased more after birth than those of small-for-gestational-age infants. extrauterine growth restriction was associated with small-for-gestational-age (PR=6.14; 95%CI=3.33-11.33;p <0.001) and time without enteral diet (PR=1.08; 95%CI=1.04-1.13; p =0.010). Conclusion: Extrauterine growth restriction occurs in premature infants of all gestational age. The participation of small-for-gestational-age and nutritional practices in its genesis is noteworthy. We suggest prospective studies of all premature infants. The implementation of best care practices, individualized for small-for-gestational-age infants, to improve nutrient supply can minimize the problem.

Delayed initiation of enteral feeds is associated with postnatal growth failure among preterm infants managed at a rural hospital in Uganda

“…2), the incidence was highest in moderate to late preterms compared to extremely preterm infants (79% Vs 71.4%) at univariate level. Shan et al [20] and Freitas et al [21] associated PGF with increasing gestational age which is consistent with our findings. These studies like ours included all preterms less than 37 weeks but earlier studies focused on preterm infants less than 34 weeks and could have missed the growth dynamics in older preterms.…”

Risk factors for extrauterine growth restriction in preterm neonates: a prospective analytical cohort study

“…16 A study by Lima et al observed that 54.2% of the SGA infants had EUGR at discharge considering weight and 7.4% considering HC, while only 12.3% of the AGA infants had EUGR at discharge considering weight and 4% considering HC. 22 In our study, NEC developed in 8.6% of babies in EUGR group. Incidence of NEC as per weight of baby was found to be is 3% in 500-750 grams, 3% in 750-1000 grams, 3% in 1000-1250 grams and 2% in 1250-1500 grams.…”

Safety of aggressive nutrition bundle-aggressive parenteral nutrition, standardized feeding policy, human milk fortification and probiotics in babies born less than 34 weeks of gestation: a prospective analytical cohort study

“…15 A Nigerian study found that babies with gestational age <32 weeks accounted for 34.2% mortalities. 16 [17][18][19] Earlier time to achieve full enteral feeds in present study may be because of strict adherence to SFR and different gestational age groups. Shukla et al, showed that by adopting the new nutritional practice guidelines there was a significant reducing trend in time to full feeds.…”