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Postnatal Transitional Weight Loss and Adverse Outcomes in Extremely Premature Neonates
Rita P Verma1, Syed Shibli2, Eugene Komaroff3
1Department of Pediatrics, Nassau University Medical Center, East Meadow, NY.
Insights
Early postnatal weight loss (EPWL) in extremely low birth weight (ELBW) infants is not linked to adverse outcomes when adjusted for gestational age. Maternal hypertension may influence EPWL in these vulnerable infants.
Area of Science:
- Neonatology
- Perinatal Medicine
- Infant Health
Background:
- Early postnatal weight loss (EPWL) in extremely low birth weight (ELBW) infants (<1000 g) exhibits significant variability.
- Previous studies suggest EPWL is unassociated with adverse outcomes within a 3-21% range, potentially due to this wide variation.
Purpose of the Study:
- To investigate the impact of graded maximum EPWL (low, moderate, high) on clinical outcomes in ELBW infants.
- To determine if EPWL is an independent predictor of adverse outcomes in ELBW infants.
Main Methods:
- Retrospective cohort observational study of ELBW infants.
- Maximum weight loss (MWL) from birth weight was calculated and categorized into low (5-12%), moderate (12-18%), and high (18-25%) groups.
- Clinical course and complications were compared across MWL groups, with adjustments for gestational age (GA).
Main Results:
- Infants in the low MWL group had higher GA and required less surfactant and respiratory support.
- While initial comparisons showed differences in oxygen dependency and fluid balance, these became non-significant after controlling for GA.
- Maternal pregnancy-associated hypertension was more prevalent in mothers of infants with low MWL (38%) compared to the high MWL group (0%).
Conclusions:
- Maximum postnatal weight loss in ELBW infants is not independently associated with adverse clinical outcomes when gestational age is considered.
- Maternal hypertension appears to be a factor that decreases EPWL in ELBW infants.
Abstract:
The early postnatal weight loss (EPWL) is highly variable in the extremely low birth weight infants (birth weight <1000 g, ELBW). It is reported to be unassociated with adverse outcomes within a range of 3-21% of birth weight. Its wide range might have contributed to this lack of association. The aim of our paper is to study the effects of maximum EPWL, graded as low, medium and large on clinical outcomes in ELBW infants. In a retrospective cohort observational study EPWL was measured as maximum weight loss from birth weight (MWL) in ELBW infants and grouped as low (5-12%) moderate (18.1-12%) and high (18-25%). The clinical course and complications of infants were compared between the groups. Gestational age (GA) was highest and surfactant administration, peak inspiratory pressure requirement, fluid intake, urinary output, oxygen dependent days and the number of oxygen dependent infants at age 28 days were lower in the low MWL compared to the high MWL group. However, all these significant P-values declined after controlling for GA. Diabetes mellitus and pregnancy associated hypertension were not noted in mothers in high MWL group, whereas 38% of mothers in low MWL group suffered from the latter (P=0.05). Maximum postnatal transitional weight loss, assessed in the range of low, moderate and high, is not associated with adverse outcomes independent of gestational age in ELBW infants. Maternal hypertension decreases EPWL in them.
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