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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.
Insights
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.
Introduction:
Ideal early postnatal weight loss (PWL) and its association with mortality and morbidity in preterm infants are not well known. This review explored the association between early PWL and outcomes in very premature infants (<32 weeks).
Methods:
This is a systematic review and meta-analyses of the observational studies. PubMed, Medline, EMBASE, Cochrane Library, EMCARE, and MedNar databases were searched in April 2024. Outcomes of interest were mortality and morbidities such as intraventricular haemorrhage (IVH), chronic lung disease (CLD), patent ductus arteriosus, necrotising enterocolitis (NEC), retinopathy of prematurity, and long-term neurodevelopmental outcomes. Data were pooled separately for adjusted and unadjusted odds ratios (ORs) using random-effects model. Separate analyses were conducted for case-control and cohort studies. Data were pooled separately for the excess weight loss (EWL) group (>15% from birth weight) and inadequate weight loss (IWL) group (<5% from birth weight).
Results:
Eighteen studies (25,158 infants) were included. Pooling of adjusted ORs in EWL group from cohort studies found significant association with mortality (OR 1.39 confidence interval [CI; 1.10-1.75]), severe IVH (OR 1.37 CI [1.18-1.59]), NEC (OR 2.05 CI [1.05-4.03]), and "Mortality or IVH" (OR 1.40 CI [1.10-1.78]). Pooling adjusted ORs from case-control studies showed a significant association between EWL and CLD and between IWL and mortality or CLD. Certainty of evidence was "Low" or "Very-low."
Conclusion:
EWL or IWL in very preterm infants may be associated with higher odds of mortality and morbidity. However, cofactors of severity of associated disease, insufficient nutrition, and treatments could not be assessed.
