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Defining postnatal growth failure among preterm infants in Indonesia
Rinawati Rohsiswatmo1, Risma Kerina Kaban1, Muhamad Azharry Rully Sjahrulla1
1Division of Perinatology, Department of Child Health, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Insights
A decline in weight-for-age z-score of ≥1.2 effectively identifies postnatal growth failure (PGF) in Indonesian preterm infants. This indicator also correlates with delayed oral feeding and longer parenteral nutrition duration in these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth Monitoring
Background:
- Postnatal growth failure (PGF) is common in preterm infants with malnutrition.
- A decline in weight-for-age z-score of ≥1.2 is a proposed indicator for PGF.
- The utility of this indicator in Indonesian preterm infants was previously unknown.
Purpose of the Study:
- To evaluate the usefulness of a decline in weight-for-age z-score of ≥1.2 for identifying PGF in Indonesian preterm infants.
- To compare the prevalence of PGF using different z-score criteria.
- To assess the association of PGF indicators with weight gain, feeding outcomes, and parenteral nutrition duration.
Main Methods:
- A prospective cohort study included 650 preterm infants (<37 weeks gestation) at a tertiary neonatal intensive care unit in Jakarta, Indonesia.
- PGF was defined by weight-for-age z-scores: <-1.28, <-1.5 at discharge, or a decline of ≥1.2 from birth to discharge.
- Associations between PGF indicators, weight gain, full oral feeding time, and total parenteral nutrition duration were analyzed.
Main Results:
- A decline in weight-for-age z-score of ≥1.2 identified PGF in 7.8% of infants and was associated with weight gain issues.
- Other z-score criteria (<-1.28 or <-1.5) identified PGF in 47.2% and 41.5% but did not reliably indicate weight gain problems.
- Invasive ventilation was a risk factor for PGF. The ≥1.2 decline indicator showed longer time to full oral feeding and longer total parenteral nutrition duration.
Conclusions:
- A decline in weight-for-age z-score of ≥1.2 is a reliable indicator for identifying PGF in Indonesian preterm infants.
- This indicator is associated with poorer feeding outcomes, including delayed oral feeding and increased need for parenteral nutrition.
- Pediatricians in Indonesia can be reassured to use the decline in weight-for-age z-score of ≥1.2 for PGF assessment.
Background:
Postnatal growth failure (PGF) frequently occurred among preterm infants with malnutrition. The decline in a weight-for-age z-score of ≥1.2 has been proposed to define PGF. It was unknown whether this indicator would be useful among Indonesian preterm infants.
Methods:
Infants of <37 weeks of gestational age born between 2020 and 2021, both stable and unstable, were recruited for a prospective cohort study during hospitalization in the level III neonatal intensive care unit at the Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The prevalence of PGF as defined by a weight-for-age z-score of <-1.28 (<10th percentile) at discharge, a weight-for-age z-score of <-1.5 (<7th percentile) at discharge, or a decline in a weight-for-age z-score of ≥1.2 from birth till discharge was compared. The association between those PGF indicators with the preterm subcategory and weight gain was assessed. The association between the decline in a weight-for-age z-score of ≥1.2 with the duration to achieve full oral feeding and the time spent for total parenteral nutrition was analyzed.
Results:
Data were collected from 650 preterm infants who survived and were discharged from the hospital. The weight-for-age z-score of <-1.28 or <-1.5 was found in 307 (47.2%) and 270 (41.5%) subjects with PGF, respectively. However, both indicators did not identify any issue of weight gain among subjects with PGF, questioning their reliability in identifying malnourished preterm infants. By contrast, the decline in a weight-for-age z-score of ≥1.2 was found in 51 (7.8%) subjects with PGF, in which this indicator revealed that subjects with PGF had an issue of weight gain. Next, a history of invasive ventilation was identified as a risk factor for preterm infants to contract PGF. Finally, the decline in a weight-for-age z-score of ≥1.2 confirmed that preterm infants with PGF took a longer time to be fully orally fed and a longer duration for total parenteral nutrition than the ones without PGF.
Conclusion:
The decline in a weight-for-age z-score of ≥1.2 was useful to identify preterm infants with PGF within our cohort. This could reassure pediatricians in Indonesia to use this new indicator.
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