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Published on: June 29, 2013
Extrauterine growth restriction in very preterm infant: etiology, diagnosis, and 2-year follow-up
Josep Figueras-Aloy1, Clara Palet-Trujols2, Isabel Matas-Barceló2
1Neonatology Service, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, BCNatal (Centre de Medicina Maternofetal i Neonatologia de Barcelona), Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), Universitat de Barcelona, Barcelona, Catalonia, Spain. jfiguer@clinic.cat.
Insights
Extrauterine growth restriction (EUGR) affects 15% of very preterm infants by age 2.5 years. This "true-EUGR" in non-small-for-gestational-age infants is linked to factors like low birth weight and male sex.
Area of Science:
- Neonatology
- Pediatric Growth and Development
- Perinatal Medicine
Background:
- Extrauterine growth restriction (EUGR) is commonly assessed in preterm infants, but its definition and impact, particularly in small-for-gestational-age (SGA) infants, require clarification.
- Current growth monitoring relies on various charts, potentially leading to inconsistent EUGR diagnosis and management strategies.
Purpose of the Study:
- To differentiate true EUGR in non-SGA infants from the postnatal growth patterns of SGA infants.
- To identify fetal, maternal, and neonatal factors associated with EUGR in both SGA and non-SGA very-preterm infants.
Main Methods:
- A cohort of 479 very-preterm infants (<32 weeks) was studied using INTERGROWTH-21st and WHO growth standards.
- EUGR was defined as weight <10th percentile at 36-34 weeks postmenstrual age; catch-up growth and anthropometric deficits were assessed at 2-2.5 years.
- Logistic regression analyzed risk factors associated with EUGR, stratified by SGA status at birth.
Main Results:
- Overall EUGR was observed in 51% at discharge and 21% at 2-2.5 years.
- In non-SGA infants, "true-EUGR" rates were 43% at discharge and 15% at 2-2.5 years.
- Factors associated with "true-EUGR" included low birth weight, hyaline membrane disease, bronchopulmonary dysplasia, and male sex.
Conclusions:
- A significant proportion (15%) of very-preterm infants experience "true-EUGR" by 2-2.5 years of age.
- SGA infants show a postnatal evolution of fetal growth restriction rather than true EUGR, with head circumference normalizing over time.
- Preeclampsia, low gestational age, severe neonatal morbidity, and male sex are independent risk factors for "true-EUGR" in non-SGA infants.
Abstract:
In very-preterm small-for-gestational-age (SGA) infants, long-term postnatal growth is confused with extrauterine growth restriction (EUGR). We aimed to document EUGR in SGA infants and in non-SGA infants ("true-EUGR") and its relationship with fetal, maternal, and neonatal etiological factors. Four hundred seventy-nine very-preterm infants (< 32 weeks) born between 2003 and 2014 and attending the follow-up clinic were included. INTERGROWTH-21st preterm postnatal growth standards in conjunction with WHO Child Growth Standards were used to judge the postnatal growth patterns. EUGR was defined as weight < 10th percentile according to the sex at 36-34 weeks postmenstrual age, usually at discharge. Catch-up was evaluated at 2-2.5 years. Low-weight-for-age (wasting), low-length-for-age (stunting), and low-head-circumference-for-age were diagnosed if the z-scores were below - 2 SD. Logistic regression analysis estimated the association between the risk factors and EUGR, according to the SGA status at birth. Overall, EUGR occurred in 51% at 36-34 postmenstrual weeks and 21% at 2-2.5 years. However, among 411 non-SGA infants, "true-EUGR" rates were 43% and 15%, respectively.Conclusion: By 2-2.5 years of age, a "true-EUGR" of 15% can be expected and only the head circumference normalizes in SGA infants. Low birth weight, hyaline membrane disease, bronchopulmonary dysplasia, and male sex were associated with "true-EUGR." What is Known: • Fetal, neonatal, or postnatal charts have been considered to monitor the postnatal growth of preterm infants. • This selection influences the diagnosis of "extrauterine growth restriction" (EUGR) and the clinical strategies used. What is New: • Extrauterine growth restriction (EUGR) in small-for-gestational-age (SGA) infants can not be considered a true EUGR but a postnatal evolution of fetal growth restriction. • Preeclampsia, low gestational age, severe neonatal morbidity and male sex are independently associated with EUGR in non-SGA infants (named "true-EUGR"), which can be expected in 15% of very preterm infants by 2-2.5 years of age.
