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Factors associated with extrauterine growth restriction in very-low-birth-weight infants: A retrospective study in

Rina Matsubara1, Kaori Yonezawa2, Megumi Haruna2

  • 1Department of Midwifery and Women's Health, Division of Health Sciences and Nursing, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, Japan; Karugamo-no-ie, Saitama Medical University Welfare Association, Kamoda, Kawagoe-shi, 1930-1, Saitama, Japan.

Pediatrics and Neonatology
|November 2, 2025
PubMed

Insights

Congenital heart disease and slower enteral feeding increases the risk of extrauterine growth restriction (EUGR) in very-low-birth-weight infants (VLBWIs). This longitudinal study highlights key factors impacting growth in premature infants.

Area of Science:

  • Neonatalogy
  • Pediatric Cardiology
  • Growth and Development

Background:

  • Very-low-birth-weight infants (VLBWIs) face significant risks of extrauterine growth restriction (EUGR).
  • EUGR is linked to adverse neurodevelopmental outcomes in premature infants.
  • Understanding EUGR incidence and contributing factors is crucial for improving infant health.

Purpose of the Study:

  • To determine the incidence of longitudinal extrauterine growth restriction (EUGR) in very-low-birth-weight infants (VLBWIs).
  • To identify factors associated with the development of EUGR in this vulnerable population.
  • To utilize a longitudinal definition for a more accurate assessment of growth restriction.

Main Methods:

  • Retrospective data collection from 334 VLBWIs (<1500g) at a Tokyo university hospital.
  • Longitudinal EUGR defined as >1 standard deviation score loss in weight and head circumference from birth to 36 weeks postmenstrual age.
  • Multivariate analysis to identify significant risk factors for EUGR.

Main Results:

  • The incidence of longitudinal EUGR was 31.4% for weight and 38.3% for head circumference.
  • Congenital heart disease was identified as a significant risk factor for both weight and head circumference EUGR.
  • A longer duration to achieve 150 ml/kg/day of enteral feeding was also associated with increased risk of EUGR.

Conclusions:

  • Congenital heart disease is a key factor associated with longitudinal EUGR in VLBWIs.
  • The rate of enteral feeding advancement is critical for maintaining adequate growth in hospitalized VLBWIs.
  • This study provides novel insights into EUGR using a longitudinal definition, emphasizing the importance of cardiac health and nutritional support.
Abstract

Keywords:
Extrauterine growth restrictionGrowthNeonatal intensive carePretermVery low birth weight

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