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Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Niels Rochow1, Preeya Raja1, Kai Liu2

  • 1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

Pediatric Research
|February 10, 2016
PubMed

Insights

Preterm infants establish a new physiological growth trajectory after birth, typically 0.8 z-scores below their birth percentile. This adjusted growth pattern, observed after initial fluid loss, is predictable for neonatal intensive care unit (NICU) infants.

Area of Science:

  • Neonatal physiology
  • Pediatric growth studies
  • Infant adaptation

Background:

  • International guidelines recommend matching intrauterine growth rates for preterm infants.
  • Postnatal adaptation involves physiological extracellular fluid loss, potentially altering growth trajectories.
  • The target postnatal growth trajectory for preterm infants post-adaptation remains undefined.

Purpose of the Study:

  • To analyze postnatal growth trajectories in healthy preterm infants.
  • To model physiological adaptation using minimal support criteria.
  • To identify the new growth trajectory after completed postnatal adaptation.

Main Methods:

  • Longitudinal, observational study across five NICUs.
  • Analysis of daily weights for infants with undisturbed postnatal adaptation.
  • Inclusion of infants with gestational ages 25–29 weeks and 30–34 weeks.

Main Results:

  • Maximum weight loss reached 11% (25–29 wk) and 7% (30–34 wk) by day 5.
  • Birth weight was regained by day 15 (25–29 wk) and day 13 (30–34 wk).
  • Infants adopted growth trajectories parallel to Fenton percentiles, 0.8 z-scores below birth percentiles, predictable by day 21 (R²=0.96).

Conclusions:

  • This study estimates physiological growth trajectories for preterm infants post-adaptation.
  • A predictable new growth trajectory emerges after initial fluid loss and adaptation.
  • Future NICU care may benefit from targeting these established postnatal growth trajectories.
Abstract

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