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[Postnatal growth at hospital discharge in extremely premature newborns in Spain]
Fermín García-Muñoz Rodrigo1, Josep Figueras Aloy2, Pedro Saavedra Santana3
1Servicio de Neonatología, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, España.
Insights
Extremely premature infants (EPI) experience slow weight gain and universal growth restriction, particularly in length and weight, impacting neurodevelopment. Monitoring length and head circumference alongside weight is crucial for assessing nutritional status and identifying at-risk infants.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Nutritional Science
Background:
- Postnatal growth restriction is a significant concern in extremely premature infants (EPI).
- Suboptimal growth in EPI is linked to potential neurodevelopmental delays.
- Understanding growth patterns is vital for infant well-being.
Purpose of the Study:
- To document weight gain patterns in EPI.
- To assess changes in length and head circumference (HC) at hospital discharge.
- To identify growth deficiencies in survivors.
Main Methods:
- Analysis of 4,520 Caucasian EPI from the Spanish SEN1500 network (2002-2011).
- Weight, length, and head circumference measurements taken at birth, various post-menstrual ages, and discharge.
- Utilized an exponential method for calculating weight gain rates.
Main Results:
- Weight gain rates varied across early postnatal periods.
- At discharge, significant postnatal growth restriction was observed, most pronounced in length (z-scores -1.78 to -2.42), followed by weight (z-scores -1.67 to -1.79), and HC (z-scores -0.69 to -0.81).
- Growth restriction severity depended on gestational age (GA).
Conclusions:
- EPI exhibit slow initial weight gain and widespread postnatal growth restriction, affecting length and weight significantly.
- Close monitoring of longitudinal growth and head circumference, in addition to weight, is essential.
- These assessments aid in nutritional evaluation and early detection of infants at risk for poor growth and neurodevelopmental outcomes post-discharge.
Introduction:
Postnatal growth restriction is considered a universal problem in extremely premature infants (EPI), and causes great concern due to the possible relationship between nutrition, sub-optimal postnatal growth, and neurodevelopment delay.
Objectives:
To describe the weight gain in EPI and to determine the changes in the length and head circumference (HC) at hospital discharge in survivors.
Patients And Methods:
The study included 4,520 Caucasian EPI from single pregnancies and without severe malformations, born in the centres participating in the Spanish SEN1500 network (2002-2011). The weight was recorded at birth, 28 days, 36 weeks post-menstrual age (PMA), and at discharge. The length and HC were measured at birth and at discharge.
Results:
The rate of weight gain (exponential method) was 8.0g/kg/d (birth - 28 days); 14.3g/kg/d (28 days - 36 weeks); and 11.7g/kg/d (36 weeks - discharge). At discharge, postnatal growth restriction was greater for length (z-score between -1.78 and -2.42, depending on GA), followed by weight (-1.67 to -1.79), and HC (-0.69 to -0.81).
Conclusions:
Weight gain in the first weeks after birth is slow in EPI, and they exhibit an almost universal postnatal growth restriction that involves mainly length and weight. In addition to weight, a close control of longitudinal growth and HC are essential for nutritional assessment and detection of patients at risk for poor growth and neurodevelopment after hospital discharge.
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