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Growth outcome trends after necrotizing enterocolitis in preterm infants across changes in nutritional practices

Lan-Wan Wang^1,2,3, Chi-Hsiang Chu⁴, Yung-Chieh Lin⁵

¹Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan.

Pediatric Research

|December 17, 2025

Abstract

Background:

To investigated trends in postnatal and after-discharge growth outcomes during changes in nutritional practices over time in extremely preterm infants with necrotizing enterocolitis (NEC).

Methods:

This multicenter cohort study enrolled 3046 infants born at <28 weeks' gestation between 2006 and 2019. Growth trajectories by z-scores of body weight (zBW) and head circumference (zHC) from neonatal-intensive-care-unit discharge to corrected age 24 months were analyzed across NEC severity (no/stage-I NEC, stage-II, stage-III) and epochs (1: 2006-2009; 2: 2010-2014; 3: 2015-2019) after propensity-score-matching (PSM).

Results:

The PSM cohort included the stage-II (n = 221), stage-III (n = 103), and no/stage-I NEC (n = 972) groups. The stage-II/III NEC groups had significantly lower zBW and zHC compared to the no/stage-I NEC group at discharge during Epochs 2 and 3. After discharge, the stage-II NEC group achieved comparable zBW and zHC to the no/stage-I NEC group by 6-24 months in all epochs. In contrast, the stage-III NEC group displayed zBW improvement between 12 and 24 months in Epochs 2 and 3, but continued to have lower zHC from discharge to 24 months throughout all epochs.

Conclusions:

As the general nutritional practices advanced, preterm infants with stage-III NEC consistently exhibited head growth deficits through 24 months of age.

Impact:

For infants born extremely preterm in the three epochs of evolution in nutritional practices: By discharge, infants with stage-II or stage-III NEC had significantly lower mean z-scores of body weight and head circumference compared to those with no/stage-I NEC. By age 6 to 24 months, infants with stage-II NEC caught up in weight and head growth with the no/stage-I NEC group. Infants with stage-III NEC caught up in weight growth with the no/stage-I NEC group between age 12 and 24 months, but persistently lagged behind in head growth up to 24 months throughout all epochs.

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