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Postnatal growth of etiologically characterized preterm newborns according to gestational age at birth
Paola Roggero1, Irina Ryumina2, Robert B Gunier3
1Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Insights
Preterm birth causes vary, impacting infant growth differently. Postnatal growth is partly independent of fetal growth, especially in late preterm infants.
Area of Science:
- Neonatalogy
- Pediatric Growth and Development
- Perinatal Medicine
Background:
- Preterm birth is a leading cause of infant mortality and morbidity.
- Infants born preterm face risks of suboptimal growth, developmental issues, and impaired neurodevelopment.
- Preterm birth is a heterogeneous condition with diverse etiologies and outcomes.
Purpose of the Study:
- To investigate the relationship between specific etiologies of preterm birth and early postnatal growth.
- To analyze postnatal growth trajectories across different gestational age categories (very, moderate, late preterm).
- To determine if postnatal growth is influenced by fetal growth (birth size) in various preterm sub-groups.
Main Methods:
- Prospective, multinational cohort study across 15 hospitals.
- Inclusion of 2320 singletons and 1180 twins.
- Serial anthropometric measurements using INTERGROWTH-21st preterm postnatal growth standards (z-scores).
Main Results:
- Infants in 'perinatal sepsis', 'suspected IUGR', and 'fetal distress' sub-groups showed lower postnatal growth compared to the 'no main condition' reference group.
- This growth pattern difference persisted in late preterm infants even after adjusting for birth weight z-score.
- Postnatal growth was found to be partially independent of fetal growth, particularly in late preterm infants.
Conclusions:
- The contribution of etiologically-defined preterm birth sub-groups and their growth patterns differ across preterm categories.
- Postnatal growth trajectories are influenced by the underlying cause of preterm birth.
- A significant portion of preterm infants, especially late preterms, exhibit postnatal growth that is not solely determined by their size at birth.
Objective:
To examine the relationship between etiologically-based preterm birth sub-groups and early postnatal growth according to gestational age at birth.
Methods:
Prospective, multinational, cohort study involving 15 hospitals that monitored preterm newborns to hospital discharge. Measures/exposures: maternal demographics; etiologically-based preterm birth sub-groups; very, moderate and late preterm categories, and feeding.
Primary Outcomes:
serial anthropometric measures expressed as z-scores of the INTERGROWTH-21st preterm postnatal growth standards.
Results:
We included 2320 singletons and 1180 twins: very=24.4% (n = 856, including 178 < 28 weeks' gestation); moderate=16.9% (n = 592) and late preterm=58.6% (n = 2052). The median (interquartile range) postmenstrual age at the last measure was 37 (36-38) weeks. The 'no main condition' sub-group percentage increased from early to late preterm; the 'perinatal sepsis' sub-group percentage decreased. 'Perinatal sepsis', 'suspected IUGR' and 'fetal distress' very and late preterm infants had lower postnatal growth patterns than the 'no main condition' reference sub-group. This pattern persisted in late but not very preterm infants when postnatal growth was corrected for weight z-score at birth.
Conclusion:
The proportional contribution of etiologically-based preterm sub-groups and their postnatal growth trajectories vary by preterm category. Postnatal growth is partially independent of fetal growth in the majority of preterm infants (i.e., those born late preterm).
Impact:
Preterm birth, the leading cause of under-5 mortality, is a highly heterogenous syndrome, with surviving infants at risk of suboptimal growth, morbidity, and impaired neurodevelopment. Both the proportional contribution of etiologically-based sub-groups and their postnatal growth trajectories vary by preterm category (very/moderate/late). The 'perinatal sepsis', 'suspected IUGR' and 'fetal distress' sub-groups amongst very and late preterm infants had lower postnatal growth than the 'no main condition' preterm infants. The pattern persisted after adjusting for birth size only in the late preterms. Postnatal growth is partially independent of fetal growth in the majority of preterm infants (i.e., those born late preterm).
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