"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants

Area of Science:

• Neonatology
• Pediatric Growth and Development
• Nutritional Science

Background:

• Extrauterine growth restriction (EUGR) and postnatal growth failure (PGF) are common concerns in preterm infants.
• Current diagnostic criteria often rely on arbitrary weight percentiles (<10th) at discharge or 36-40 weeks postmenstrual age.
• These labels are frequently applied without considering head circumference, length, proportionality, body composition, or genetic growth potential.

Purpose of the Study:

• To critically evaluate the limitations of current definitions of EUGR/PGF in preterm neonates.
• To highlight the challenges posed by arbitrary statistical cut-offs in growth assessment.
• To explore opportunities for refining the understanding of growth and nutritional requirements in this population.

Main Methods:

• Review of current diagnostic practices for EUGR/PGF.
• Analysis of the shortcomings of weight-only percentile-based assessments.
• Discussion of the implications of arbitrary cut-offs on nutritional management.

Main Results:

• EUGR/PGF diagnoses based on current criteria are not predictive of adverse outcomes.
• These diagnoses neglect crucial growth parameters like head and length growth, proportionality, and body composition.
• Assessment timing often precedes natural fetal growth deceleration, leading to potentially inaccurate classifications.
• Normal postnatal weight loss is frequently ignored in these assessments.

Conclusions:

• The current definitions of EUGR/PGF are oversimplified and lack clinical utility.
• Arbitrary growth cut-offs can lead to misclassification and potentially inappropriate nutritional interventions.
• Further research is needed to develop more comprehensive and individualized approaches to assessing preterm infant growth and nutritional needs.