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Risk factors and correlates of neonatal growth velocity in extremely low gestational age newborns: the ELGAN Study
Julie Bartholomew1, Camilia R Martin, Elizabeth Allred
1Division of Newborn Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Mass., USA.
Insights
Severe pulmonary disease, not caloric intake, is linked to reduced growth velocity in extremely premature infants. Ventilator dependence and pulmonary dysfunction are key risk factors for slower growth in the first 28 days.
Area of Science:
- Neonatology
- Pediatric Growth and Development
- Critical Care Medicine
Background:
- Extremely premature infants face significant challenges in achieving optimal growth.
- Reduced growth velocity (GV) in the neonatal period can have long-term implications for health outcomes.
- Identifying factors associated with impaired growth is crucial for improving care.
Purpose of the Study:
- To determine maternal and infant characteristics linked to diminished growth velocity in extremely premature newborns.
- To investigate the relationship between caloric intake and growth velocity in this vulnerable population.
Main Methods:
- A cohort of 1,187 infants born between 23 and 27 weeks' gestation was analyzed.
- Data were collected from 14 institutions between 2002 and 2004.
- Infants surviving until day 28 were assessed for growth velocity and caloric intake, with lowest quartiles identified.
Main Results:
- Infants with intrauterine growth restriction or high SNAP-II scores received fewer calories but were not at higher risk for lowest GV.
- Bacteremia, patent ductus arteriosus, severe retinopathy of prematurity, or pulmonary illness were associated with lower caloric intake.
- Ventilator dependence on day 7, early persistent pulmonary dysfunction, and postnatal dexamethasone exposure were independently associated with increased risk of lowest GV.
Conclusions:
- Severe pulmonary disease indicators are more predictive of reduced growth velocity in the first 28 postnatal days than low caloric intake.
- Early identification and management of pulmonary issues may be critical for promoting growth in extremely premature infants.
Objectives:
To identify maternal and infant characteristics associated with reduced growth velocity (GV) in extremely premature newborns.
Methods:
We evaluated 1,187 infants born between 23 and 27 weeks' gestation at 14 institutions between 2002 and 2004 who survived until day 28 to identify the maternal and infant characteristics associated with a GV and caloric intake in the lowest quartile.
Results:
Newborns in the lowest gestational age and low birth weight categories, as well as those with intrauterine growth restriction, or high SNAP-II received relatively fewer kcal/kg/day than their peers without these risk factors, but were not at increased risk of being in the lowest GV quartile. Newborns with bacteremia, patent ductus arteriosus, retinopathy of prematurity stage 3-5, or pulmonary illness received fewer calories, as did those who received medications or blood transfusions. However, in a multivariable model adjusting for confounders, only ventilator dependence on day 7 (OR 2.2, 95% CI 1.5-3.2), early persistent pulmonary dysfunction (OR 1.8, 95% CI 1.3-2.5), and postnatal exposure to dexamethasone (OR 2.8, 95% CI 1.2-6.5) were associated with an increased risk of being in the lowest GV quartile. In this model, low caloric intake was not associated with low GV (OR 1.3, 95% CI 0.9-1.9).
Conclusion:
Variables associated with severe pulmonary disease convey more information about the risk of reduced GV during the first 28 postnatal days than does low caloric intake.
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