DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20220510
Published: 2022-02-25

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

Reashma Roshan, Suhail A. Naik, Mubashir H. Shah

Abstract


Background: Objective of the study was to determine the incidence and risk factors for extrauterine growth restriction (EUGR) at discharge in preterm neonates.

Methods: This prospective analytical cohort study included 107 preterm neonates between 30-35 weeks of gestational age who were admitted to a tertiary neonatal intensive care unit from January 2016 to December 2016. These preterm neonates were classified into EUGR group (n=93) and non-EUGR group (n=14) based on the body weight at discharge. The risk factors for EUGR were analyzed statistically.

Results: The incidence of EUGR at discharge was 87.4% in the cohort. Delay in initiation of parenteral nutrition (p=0.04), longer time to reach full enteral feeds (p=0.03), very low birth weight (p=0.01), small for gestational age (p=0.01), intrauterine growth restriction (p=0.01), necrotizing enterocolitis (p=0.03), late-onset sepsis (p=0.03) and bronchopulmonary dysplasia (p=0.04) were significant risk factors for extra-uterine growth restriction at discharge in preterm neonates.

Conclusions: The incidence of EUGR can be decreased by improving perinatal care, minimizing preterm deliveries, early initiation of parenteral nutrition and enteral feeding and reducing immediate postnatal complications.


Keywords


Extrauterine growth restriction, Preterm, Incidence, Risk factors, Feeding, Sepsis

Full Text:

PDF

References


Ordonez-Diaz MD, Perez-Navero JL, Flores-Rojas K, Olza-Meneses J, Munoz-Villanueva MC, Aguilera-Garcia CM, Gil-Campos M. Prematurity With Extrauterine Growth Restriction Increases the Risk of Higher Levels of Glucose, Low-Grade of Inflammation and Hypertension in Prepubertal Children. Front Pediatr. 2020;8:180.

Martinez-Jimenez MD, Gomez-Garcia FJ, Gil-Campos M, Perez-Navero JL. Comorbidities in childhood associated with extrauterine growth restriction in preterm infants: a scoping review. Eur J Pediatr. 2020;179:1255-65.

Fenton TR, Chan HT, Madhu A, Griffin IJ, Hoyos A, Ziegler EE, et al. Preterm infant growth velocity calculations: a systematic review. Pediatrics. 2017;139.

Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, et al. Extrauterine growth restriction’ and ‘postnatal growth failure’ are misnomers for preterm infants. J Perinatol. 2020.

Larroque B, Bertrais S, Czernichow P, Leger J. School difficulties in 20-year-olds who were born small for gestational age at term in a regional cohort study. Pediatrics. 2001;108:111-5.

Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A. Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metab. 2007;92:804-10.

Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253-61.

Wahlig TM, Georgieff MK. The effects of illness on neonatal metabolism and nutritional management. Clin Perinatol. 1995;22(1):77-96.

Wahlig TM, Gatto CW, Boros SJ, Mammel MC, Mills MM, Georgieff MK. Metabolic response of preterm infants to variable degrees of respiratory illness. J Paediatr. 1994;124(2):283-8.

Stockman JA, Clark DA. Weight gain:a response to transfusion in selected preterm infants. Am J Dis Child. 1984;138:828-30.

Bose CL, Laughon MM, Allred EN, O’Shea TM, Marter LJV, Ehrenkranz RA, et al. Systemic inflammation associated with mechanical ventilation among extremely preterm infants. Cytokine. 2013;61(1):315-22.

Radmacher PG, Looney SW, Rafail ST, Adamkin DH. Prediction of extrauterine growth retardation (EUGR) in VVLBW infants. J Perinatol. 2003;23(5):392-5.

Patole S. Nutrition for the Preterm Neonate. Dordrecht: Springer. 2013.

Kumar M, Tripathi S, Agrawal N, Singh SN. Growth of premature neonates admitted in a level III neonatal unit. Clin Epidemiol Glob Health. 2014;2(2):56-60.

Anna M Dusick, Brenda B Poindexter, Richard A Ehrenkranz JAL. Growth failure in the preterm infant: can we catch up? Semin Perinatol. 2003;27(4):302-10.

Ehrenkranz RA. Extrauterine growth restriction: Is it preventable? J Pediatr. 2014;90(1):1-3.

Kim ES, Sohn JA, Lee EH, Choi EJ, Lee HJ, Lee JA, et al. Extrauterine Growth Restriction in Very Low Birth Weight Infants. J Korean Soc Neonatol. 2010;17:53-63.

Shan HM, Cai W, Sun JH, Cao Y, Shi YY, Fang BH. Extrauterine growth retardation and correlated factors in premature neonates. Chinese J Pediatrics. 2007;45(3):183-8.

Wang DH. Research Group for the Nutrition of Premature Infants. Multicenter study of the nutritional status of premature infants in neonatal intensive care unit in China: report of 974 cases. Chinese J Pediatrics. 2009;47(1):12-7.

Sakurai M, Itabashi K, Sato Y, Hibino S, Mizuno K. Extrauterine growth restriction in preterm infants of gestational age ≤32 weeks. Pediatr Int. 2008;50(1):70-5.

Ru XF, Feng Q, Wang Y, Zhang X, Li X, Meng JW, et al. Dynamic evaluation on body weight gain in premature infants and its significance. Chinese J Pediatrics. 2010;48(9):661-7.

Freitas BAC, Priore SE, Lima L, Franceschini SCC. Extrauterine growth restriction: Universal problem among premature infants. Rev Nutr. 2016;29(1):53-64.

Eichenwald EC, Stark AR. Management and Outcomes of Very Low Birth Weight. N Engl J Med. 2008;358(16):1700-11.