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Postdischarge growth assessment in very low birth weight infants
Joon-Sik Park1, Jungho Han1, Jeong Eun Shin1
1Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Insights
Many very-low-birth-weight (VLBW) infants experience growth failure post-discharge, particularly those who are small-for-gestational-age (SGA) or extremely low birth weight (ELBW). Aggressive interventions are crucial for these vulnerable infants.
Area of Science:
- Neonatal nutrition and growth
- Pediatric endocrinology
- Public health and epidemiology
Background:
- Optimal nutritional support aims to replicate *in utero* growth rates for very-low-birth-weight (VLBW) infants.
- Achieving *in utero* growth rates remains a significant challenge in neonatal intensive care.
- Post-discharge growth patterns are critical for long-term health outcomes in VLBW infants.
Purpose of the Study:
- To evaluate post-discharge growth trajectories and identify growth failure in Korean VLBW infants.
- To compare growth patterns using Korean, WHO, and CDC standards.
- To analyze growth failure rates in subgroups, including small-for-gestational-age (SGA) and extremely low birth weight (ELBW) infants.
Main Methods:
- Retrospective study of 81 Korean VLBW infants.
- Serial measurements of weight and height until 24 months post-discharge, with growth failure defined as <10th percentile.
- Subgroup analysis for SGA and ELBW infants; comparison of growth patterns against Korean, WHO, and CDC standards.
Main Results:
- Significant growth failure observed at 40 weeks postconception age (PCA) (58% weight, 55% height) and 24 months PCA (24% weight, 18% height).
- Higher growth failure rates in SGA and ELBW infants compared to appropriate-weight-for-gestational-age and non-ELBW infants, respectively.
- Significant differences in growth pattern comparisons across Korean, WHO, and CDC standards (P<0.001).
Conclusions:
- Despite advances in neonatal care, catch-up growth in VLBW infants remains insufficient.
- SGA and ELBW infants are at higher risk for persistent growth failure.
- Close monitoring and proactive, aggressive interventions are essential for optimizing growth in high-risk VLBW populations.
Purpose:
The goal of nutritional support for very-low-birth-weight (VLBW) infants from birth to term is to match the in utero growth rates; however, this is rarely achieved.
Methods:
We evaluated postdischarge growth patterns and growth failure in 81 Korean VLBW infants through a retrospective study. Weight and height were measured and calculated based on age percentile distribution every 3 months until age 24 months. Growth failure was defined as weight and height below the 10th percentile at 24 months. For the subgroup analysis, small-for-gestational age (SGA) and extremely low birth weight (ELBW) infants were evaluated. The growth patterns based on the Korean, World Health Organization (WHO), or Centers for Disease Control and Prevention (CDC) standard were serially compared over time.
Results:
At postconception age (PCA) 40 weeks, 47 (58%) and 45 infants (55%) showed growth failure in terms of weight and height, respectively. At PCA 24 months, 20 infants (24%) showed growth failure for weight and 14 (18%) for height. Growth failure rates were higher for the SGA infants than for the appropriate-weight-for-gestational age infants at PCA 24 months (P=0.045 for weight and P=0.038 for height). Growth failure rates were higher for the ELBW infants than for the non-ELBW infants at PCA 24 months (P<0.001 for weight and P=0.003 for height). Significant differences were found among the WHO, CDC, and Korean standards (P<0.001).
Conclusion:
Advancements in neonatal care have improved the catch-up growth of VLBW infants, but this is insufficient. Careful observation and aggressive interventions, especially in SGA and ELBW infants, are needed.