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Growth patterns of extremely low-birth-weight hospitalized preterm infants
Deborah K Steward1, Karen F Pridham
1The Ohio State University College of Nursing, Columbus 43210, USA. steward.20@osu.edu
Insights
Extremely low-birth-weight (ELBW) infants experience a worsening growth deficit during hospitalization, with most discharged below the 10th percentile. This necessitates catch-up growth at home.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
Background:
- Extremely low-birth-weight (ELBW) infants face significant challenges in achieving adequate growth during hospitalization.
- Understanding growth patterns in ELBW infants is crucial for optimizing their long-term health outcomes.
Purpose of the Study:
- To characterize the hospitalization growth patterns of extremely low-birth-weight (ELBW) infants.
- To assess weight gain, growth velocity, and relative weight change in ELBW infants.
Main Methods:
- Retrospective, descriptive study involving 35 ELBW infants (<1000g birth weight) from two US neonatal intensive-care units.
- Chart review to collect clinical and nutritional data.
- Analysis included z-score comparisons of birth and discharge weights, comparison to intrauterine growth references, and calculation of growth velocity (g/day).
Main Results:
- ELBW infants showed a significant decrease in weight-for-age z scores from birth to discharge.
- By discharge, 89% of infants weighed below the 10th percentile, with mean discharge weight significantly lower than fetal medians.
- The time to regain birth weight was a significant factor influencing growth outcomes.
Conclusions:
- ELBW infants develop and exacerbate a growth deficit during hospitalization, often persisting post-discharge.
- Current medical and nutritional management strategies may contribute to this growth deficit.
- Post-discharge catch-up growth at home is essential for ELBW infants.
Objective:
To characterize the growth of extremely low-birth-weight (ELBW) infants during hospitalization in terms of weight gain, growth velocity, and relative change in weight.
Design:
Retrospective, descriptive design.
Setting:
Two neonatal intensive-care units located in the midwestern United States.
Patients:
Thirty-five ELBW infants with a birth weight less than 1,000 g and appropriate for gestational age.
Main Outcome Measures:
Clinical data related to the infant's growth and nutrition were obtained from a chart review. Birth weight and discharge weight were compared following conversion of the weights to z scores. The discharge weight was compared to the median weight of a fetus of comparable gestational age based on an intrauterine growth reference. Growth velocity was determined (grams/day).
Results:
Weight-for-age z scores decreased significantly between birth and discharge. By discharge, 89% of the infants had discharge weights less than the 10th percentile. The mean discharge weight was significantly less than the median weight of a fetus of comparable gestational age. Days to regain birth weight significantly affected growth outcomes.
Conclusion:
ELBW infants develop a growth deficit during the first few weeks of life that not only persists but also worsens during hospitalization. Potential causes of this growth deficit include the medical and nutritional management that are part of the usual care of ELBW infants. Because these infants are discharged with this growth deficit, catch-up growth will have to occur at home.