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Early Postnatal Weight Loss and Its Association with Outcomes in Very Preterm Neonates: A Systematic Review and
Sreeja Kothapally1, Chandra Rath2,3,4, Bhanu B Gowda4,5,6
1Paediatrics, Perth Children's Hospital, Nedlands, Washington, Australia.
Neonatology
|March 6, 2025
Summary
Excessive or inadequate early postnatal weight loss in very preterm infants may increase risks for mortality and morbidity. Further research is needed to understand contributing factors and refine care for these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric critical care
- Perinatal medicine
Background:
- The optimal range for early postnatal weight loss (PWL) in preterm infants is not well-established.
- Understanding the association between early PWL and adverse outcomes is crucial for improving care in very premature infants (<32 weeks gestation).
Purpose of the Study:
- To systematically review and meta-analyze the association between early postnatal weight loss patterns and mortality and morbidity in very premature infants.
Main Methods:
- Systematic review and meta-analysis of observational studies identified through a comprehensive search of multiple databases (PubMed, Medline, EMBASE, Cochrane Library, EMCARE, MedNar) in April 2024.
- Outcomes included mortality and morbidities: intraventricular hemorrhage (IVH), chronic lung disease (CLD), necrotizing enterocolitis (NEC), and neurodevelopmental outcomes.
- Data were pooled using random-effects models, with separate analyses for cohort and case-control studies, and for excess weight loss (EWL; >15%) and inadequate weight loss (IWL; <5%) groups.
Main Results:
- Eighteen studies involving 25,158 infants were analyzed.
- Excessive weight loss (EWL) in cohort studies was significantly associated with increased odds of mortality (OR 1.39), severe IVH (OR 1.37), NEC (OR 2.05), and combined mortality or IVH (OR 1.40).
- EWL was linked to CLD, and IWL to mortality or CLD in case-control studies. The certainty of evidence was rated as 'Low' or 'Very-low'.
Conclusions:
- Both excessive and inadequate early postnatal weight loss in very preterm infants may be associated with higher risks of mortality and morbidity.
- The study highlights the need for careful monitoring of weight changes in this population.
- Limitations include the inability to assess confounding factors such as disease severity, nutritional support, and treatment variations.
