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Growth in preterm infants until 36 weeks' postmenstrual age is close to target recommendations
Miguel Sáenz de Pipaón1, Miriam Martínez-Biarge, Izaskun Dorronsoro
1Department of Neonatology, Hospital Universitario La Paz, Madrid, Spain.
Insights
Growth in very-low-birth-weight preterm infants declined during hospitalization despite adequate nutrition. Lower gestational age, birth weight, and severe illness negatively impacted growth outcomes.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Nutritional Science
Background:
- Very-low-birth-weight (VLBW) preterm infants experience significant growth challenges during hospitalization.
- Understanding the factors influencing their growth is crucial for optimizing clinical outcomes.
Purpose of the Study:
- To identify the determinants of weight, length, and head circumference changes in VLBW preterm infants during their initial hospitalization.
- To analyze the relationship between early nutritional intake, fetal growth, illness severity, and later growth parameters.
Main Methods:
- A prospective cohort study involving 111 VLBW infants (birth weight <1,500 g, gestational age <34 weeks).
- Daily monitoring of weight z-score and percentage of target dietary intakes (TDIs) for the first 5 weeks.
- Assessment of weight, length, and head circumference at 36 weeks' postmenstrual age (PMA).
- Statistical analysis using mixed effects regression, Pearson correlations, and stepwise logistic regression.
Main Results:
- Infant weight z-score significantly decreased from birth (-0.92) to 5 weeks (-1.89) and further to -2.05 at 36 weeks' PMA.
- Weight z-score changes were influenced by birth weight z-score, energy and protein intake, and gestational age.
- Birth weight z-score strongly correlated with weight z-score at 36 weeks (R² = 0.71, p < 0.001).
- Illness severity also impacted weight z-score at 36 weeks' PMA.
Conclusions:
- VLBW infants exhibited growth rates below intrauterine expectations despite achieving near-target energy and protein intakes.
- Lower gestational age, lower birth weight, and severe illness were identified as significant negative determinants of growth.
- Optimizing nutritional strategies and managing illness severity are critical for improving growth in this vulnerable population.
Objective:
To establish the determinants of weight, length and head circumference changes during their initial hospitalization in very-low-birth-weight preterm infants.
Subjects/Methods:
A prospective cohort study was performed. Weight z-score and percentage of target dietary intakes (TDIs) were prospectively determined daily during the first 5 weeks of life in a group of preterm infants (n = 111, birth weight <1,500 g, gestational age <34 weeks). Weight, length and head circumference at 36 weeks' postmenstrual age (PMA) were recorded. A mixed effects regression model was used to evaluate changes in weight z-score during the first 5 weeks of life. Simple Pearson correlations and stepwise logistic regression were used to determine the relationship between fetal growth, illness severity, nutritional intake and growth at 36 weeks' PMA.
Results:
Weight z-score decreased significantly in all infants during the first 5 weeks of life from -0.92 ± 0.66 at birth to -1.89 ± 0.65 at 5 weeks. The variation of weight z-score during the first 5 weeks of life was influenced by weight z-score at birth, energy and protein intakes and gestational age. Mean energy and protein intakes were 95.5 and 86.4% of TDIs. Weight z-score fell to -2.05 ± 0.64 at 36 weeks' PMA. Birth weight z-score was significantly correlated with weight z-score at 36 weeks (R2 = 0.71; p < 0.001). Severity of illness influenced the weight z-score at 36 weeks.
Conclusion:
Despite achieving a protein and energy intake close to the described target intake, the rate of growth in our infants was lower than indicated by the intrauterine growth curve. Lower gestational age, lower birth weight and severe illness had a negative effect on growth.
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