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Published on: June 29, 2013
Fetal growth and postnatal growth failure in very-low-birthweight infants
Kyla-Anna Marks1, Brian Reichman, Ayala Lusky
1Department of Neonatal Medicine, Soroka University Medical Centre, PO Box 151, Beersheva, Israel. kamarks@bgu.ac.il
Insights
Severe postnatal growth failure (PNGF) affects 10.6% of very-low-birthweight (VLBW) infants. Both poor intrauterine growth and neonatal morbidities significantly increase the risk for PNGF in these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Perinatal Medicine
Background:
- Postnatal growth failure (PNGF) is a significant concern in very-low-birthweight (VLBW) infants.
- Understanding the factors contributing to PNGF is crucial for improving infant outcomes.
Purpose of the Study:
- To determine the incidence of PNGF in VLBW infants.
- To investigate the influence of intrauterine growth and neonatal morbidities on the risk of severe PNGF.
Main Methods:
- Analysis of the Israel Neonatal Network database for VLBW infants born 1995-2001.
- Calculation of Z-scores for birthweight (BW) and discharge weight.
- Definition of severe PNGF as a Z-score decline >2; regression analysis for risk factors.
Main Results:
- Severe PNGF occurred in 10.6% of VLBW infants.
- Decreasing BW and gestational age were associated with increased PNGF incidence.
- Neonatal morbidities including RDS, PDA, sepsis, NEC, and BPD were linked to severe PNGF.
Conclusions:
- Intrauterine growth status significantly impacts postnatal growth in VLBW infants.
- Major neonatal morbidities are key contributors to severe PNGF.
- Birth growth status is an essential consideration when assessing postnatal growth in VLBW infants.
Aim:
To determine in a cohort of very-low-birthweight (VLBW) infants the incidence of postnatal growth failure and the influence of intrauterine growth and neonatal morbidities on the risk for severe postnatal growth failure (PNGF).
Methods:
The study was based on analysis of data from the Israel Neonatal Network database on VLBW infants born between 1995 and 2001. Z-score was determined for weight at birth and discharge, and severe PNGF was defined as a decline in z-score of greater than 2. Univariate analysis and multi-linear regression determined the effect of fetal growth and neonatal morbidities on the risk for severe PNGF.
Results:
Severe PNGF occurred in 10.6% of the cohort. The mean+/-SD birthweight (BW) z-score was -0.59+/-0.74, decreasing to -1.67+/-0.77 at discharge. The incidence of severe PNGF increased significantly with decreasing BW and gestational age. Each 1-unit increase in z-score BW was associated with a 2.37-fold increased risk for severe PNGF. Severe respiratory distress syndrome, patent ductus arteriosus, sepsis, necrotizing enterocolitis, and bronchopulmonary dysplasia were associated with severe PNGF.
Conclusion:
Severe PNGF among VLBW infants was markedly influenced by intrauterine growth as well as major morbidities. In the assessment of postnatal growth among VLBW infants, growth status at birth should be considered.
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