Prediction of Postnatal Growth Failure among Very Low Birth Weight Infants

Abstract

Postnatal growth failure (PGF) in preterm infants remains an important clinical issue. In this study, we analysed the incidence of PGF among very low birth weight (VLBW) infants and evaluated the risk factors for PGF based on the data of 2799 VLBW infants obtained from the Korean Neonatal Network database from 2013 to 2014. PGF was defined as a decrease in weight Z score between birth and discharge of more than −1.28 using the Fenton growth charts. Risk factors were evaluated in relation to birth weight for gestational age, namely small (SGA) or appropriate (AGA) for gestational age, using propensity score matching used for between-group differences. The overall incidence of PGF was 45.5%, with a rate of 68.9% in the SGA group and 36.2% in the AGA group. PGF was negatively correlated with gestation and birth weight; additionally, PGF was associated with a higher incidence of co-morbidities. Predictors of PGF in the SGA group were respiratory distress syndrome and days to attain 100 mL/kg of enteral feeding. The only predictor of PGF in the AGA group was days to attain 100 mL/kg of enteral feeding. Early initiation and aggressive progression of enteral nutrition may decrease the incidence of PGF.

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

“…Being ill increases the basal metabolic requirements and yet the sick preterms are in most cases fed less due to concerns of instability and ability to digest feeds. This creates protein and energy deficits consequently leading to poor growth as has been reported by Bertino et al 2006 [5,12,18].…”

“…Clark et al reported 28% PGR among preterm infants who were 23 to 34 weeks in a multi-center study in USA [3]. A more recent study in Korea found postnatal growth failureof 45.9% from a sample of 2799 VLBW preterms [5]. In Africa, a study done in South Africa also demonstrated early growth failure in a cohort of VLBW preterm infants [11].…”

“…Preterm infants experience a nutritional emergency as they are suddenly removed from a nutrient rich environment in-utero to the extrauterine life where nutrition is harder to initiate and later on maintain. Although postnatal nutrition in preterm infants is aimed at them attaining growth rates that approximate the intrauterine fetal growth rates [2] growth lags are reported among these hospitalized infants worldwide [3][4][5]. These growth deficits are not only reflected by poor weight gain but also head circumference and length.…”

Risk factors for postdischarge growth retardation among very-low-birth-weight infants: A nationwide registry study in Taiwan

“…33,34 Longer time to achieve full enteral feeding was reported to be a significant risk factor for postnatal growth failure (PGF) both in SGA and AGA VLBW infants. 35 Infants suffering from surgical NEC may have needed prolonged parenteral nutrition support, which delayed the commencement of complete enteral feeding. However, we did not have detailed parenteral nutrition data to validate this in our study.…”

“…Lee et al had reported RDS was the predictor of PGF among VLBW SGA infants. 35 Severe RDS can contribute to additional energy consumption by more requirement of respiratory work. Administration of surfactant in preterm infants with RDS can reduce mortality and decrease incidence of air leak syndrome and need for mechanical ventilation.…”