Updates on Assessment and Monitoring of the Postnatal Growth of Preterm Infants

Cordova, Erika G.; Belfort, Mandy B.

doi:10.1542/neo.21-2-e98

Cited by 26 publications

(30 citation statements)

References 53 publications

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“…When looking at growth of preterm children in general, there can be big challenges for optimizing infant growth. 8,42 In childhood, even moderately preterm children continue to be smaller (both in height and weight), 4 but in puberty there seem not to be notable problems according to our findings. For teenagers themselves, developing normally and at the same time as others can have a large psychological lift.…”

Section: Discussionsupporting

confidence: 64%

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

et al. 2021

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Background We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. Methods In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34–<37 weeks, 94/106), and term (≥37 weeks, 131/151), resulting in median 9 measurements at ≥6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately). Results Age at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: −0.2 to 0.4) years/0.2 (−0.1 to 0.4) for very or moderately/late preterm born men and −0.0 (−0.3 to 0.3)/−0.0 (−0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups. Conclusions Timing of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term. Impact Pubertal growth and pubertal timing were similar in preterm and term participants in a relatively large cohort with a wide range of gestational ages. Previous literature indicates that small for gestational age is a risk for early puberty in term born children. This was not shown in preterm children. While our study had limited power for children born very preterm, all children born preterm were not at increased risk for early puberty.

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Section: Discussionsupporting

confidence: 64%

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

et al. 2021

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“…Regardless of the definition used, PGF and moderate to severe malnutrition among extremely preterm infants were consistently associated with growth rates below 13 g/kg/day. Our finding that growth rates are strongly correlated with declines in weight z scores indicates that analyzing changes in weight z scores (i.e., malnutrition) instead of analyzing single-time weight z scores (i.e., PGF) ( 19 ) or calculating growth rates ( 21 ) could be justified. Without using the term “malnutrition”, other studies have analyzed the association between changes in weight z scores from birth to 36 weeks PMA and neurodevelopment ( 22 , 23 ).…”

Section: Discussionmentioning

confidence: 91%

“…Many support the use of the INTEGROWTH-21 st growth curves because they were developed using longitudinal data from mother-infant dyads of geographically diverse backgrounds who had reliable gestational ages, proper nutrition, and good medical care ( 14 ). Others question the validity of these curves for assessing infants less than 30 weeks because the number of preterm infants that contributed to the development of the INTERGROWTH-21 st growth curves was limited ( 19 ). Our comparative analysis showed that the INTERGROWTH-21 st growth curves were more predictive of cognitive outcomes than the Fenton growth curves.…”

Section: Discussionmentioning

confidence: 99%

“…Cognitive outcomes at 2 years of age have some limitations ( 26 ), but overall they are good predictors of cognitive function in early adulthood ( 30 ). To increase the external validity of our study, we chose the INTERGROWTH-21st growth curves to assess the postnatal growth of extremely preterm infants ( 15 ) and we included analysis of declines in z scores in view of recent evidence ( 12 , 15 , 19 ).…”

Section: Discussionmentioning

confidence: 99%

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Postnatal growth of preterm infants 24 to 26 weeks of gestation and cognitive outcomes at 2 years of age

2020

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Background: Weight z scores at 36 weeks of postmenstrual age (PMA) define postnatal growth failure (PGF) and malnutrition. This study aimed to determine weight z scores at 36 weeks PMA that are associated with adverse cognitive outcomes at 2 years of age. Methods: In this retrospective cohort study, 350 infants 24 to 26 weeks of gestation born between 2006 and 2014 and followed at 2 years were included. Weight z scores at birth and at 36 weeks PMA were calculated using the INTERGROWTH-21st growth curves. The primary outcome was cognitive delay at 2 years of age (Bayley-III cognitive score < 85). Results: Neither the traditional definition of PGF (z score below −1.3) nor the recently proposed definition of malnutrition (z score decline of 1.2 or greater) was associated with cognitive delay. Both a weight z score below −1.0 at 36 weeks PMA (RR: 1.65; 95% CI: 1.10 - 2.49; p <0.05) and a decline below −1.0 in weight z score from birth to 36 weeks PMA (RR: 1.40; 95% CI: 1.00 – 1.94; p <0.05) were associated with a higher risk of cognitive delay. Conclusion: With optimal cutoffs, INTERGROWTH-21st weight z scores can predict the risk of cognitive delay.

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“…10 , 11 This evidence suggests that any nutritional intervention that reduces the risk of postnatal growth faltering should ideally improve the quantitative (i.e., weight, length, and head circumference) and qualitative (i.e., body composition) outcomes of growth. 12 , 13 Body composition measurements are not part of routine clinical care, but reference values for preterm infants have been recently defined. 14 …”

Section: Introductionmentioning

confidence: 99%

Body composition of extremely preterm infants fed protein-enriched, fortified milk: a randomized trial

et al. 2021

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Background Critically ill extremely preterm infants fed human milk are often underrepresented in neonatal nutrition trials aimed to determine the effects of enteral protein supplementation on body composition outcomes. Methods Masked randomized trial in which 56 extremely preterm infants 25–28 weeks of gestation were randomized to receive either fortified milk enriched with a fixed amount of extensively hydrolyzed protein (high protein group) or fortified milk without additional protein (standard protein group). Results Baseline characteristics were similar between groups. In a longitudinal analysis, the mean percent body fat (%BF) at 30–32 weeks of postmenstrual age (PMA), 36 weeks PMA, and 3 months of corrected age (CA) did not differ between groups (17 ± 3 vs. 15 ± 4; p = 0.09). The high protein group had higher weight (−0.1 ± 1.2 vs. −0.8 ± 1.3; p = 0.03) and length (−0.8 ± 1.3 vs. −1.5 ± 1.3; p = 0.02) z scores from birth to 3 months CA. The high protein group also had higher fat-free mass (FFM) z scores at 36 weeks PMA (−0.9 ± 1.1 vs. −1.5 ± 1.1; p = 0.04). Conclusions Increased enteral intake of protein increased FFM accretion, weight, and length in extremely preterm infants receiving protein-enriched, fortified human milk. Impact Extremely preterm infants are at high risk of developing postnatal growth failure, particularly when they have low fat-free mass gains. Protein supplementation increases fat-free mass accretion in infants, but several neonatal nutrition trials aimed to determine the effects of enteral protein supplementation on body composition outcomes have systematically excluded critically ill extremely preterm infants fed human milk exclusively. In extremely preterm infants fed fortified human milk, higher enteral protein intake increases fat-free mass accretion and promotes growth without causing excessive body fat accretion.

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Updates on Assessment and Monitoring of the Postnatal Growth of Preterm Infants

Cited by 26 publications

References 53 publications

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

Postnatal growth of preterm infants 24 to 26 weeks of gestation and cognitive outcomes at 2 years of age

Body composition of extremely preterm infants fed protein-enriched, fortified milk: a randomized trial

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