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Risk Factors for Postnatal Growth Faltering and Undernutrition at Discharge in Very Preterm Infants: A Retrospective
Isadora Beghetti1,2, Dalila Magno1, Ettore Benvenuti1
1Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy.
Insights
Nearly half of very preterm infants experience growth issues before hospital discharge. Identifying risk factors like bronchopulmonary dysplasia and birth growth restriction is key for targeted infant nutrition.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth Monitoring
Background:
- Postnatal growth failure (GF) and undernutrition (UN) in very preterm infants are significant concerns.
- Lack of standardized definitions complicates clinical management.
- This study applies European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria for GF and UN.
Purpose of the Study:
- To identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge in very preterm infants.
- To apply standardized ESPGHAN criteria for defining GF and UN.
- To understand distinct clinical trajectories of growth impairment.
Main Methods:
- Retrospective observational study of 416 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g).
- Growth monitored using Intergrowth 21st standards.
- GF defined as ≥ 1 SD weight-for-age z-score decline; UN as z-score < -2 at discharge.
- Logistic regression used to identify independent predictors.
Main Results:
- Prevalence of GF was 45.3% and UN was 33.1% at discharge.
- Bronchopulmonary dysplasia and maximal postnatal weight loss were key risk factors for GF.
- Female sex and human milk feeding were associated with lower GF risk.
- Maternal hypertension, extremely low birth weight, and GF predicted UN in infants with adequate birth weight.
Conclusions:
- Almost half of very preterm infants exhibit significant growth impairment before discharge.
- Assessing both GF dynamics and UN endpoints reveals distinct patient trajectories.
- Standardized ESPGHAN criteria aid in identifying high-risk infants for targeted nutritional support.
Background:
Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge, defined according to the latest consensus definitions established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN).
Methods:
We conducted a retrospective observational study of 416 preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g). Growth was monitored using the Intergrowth 21st standards. In line with ESPGHAN criteria, GF was defined longitudinally as a weight for age (WFA) z-score decline ≥ 1 SD from birth, while UN was defined cross-sectionally as a WFA or length for age z-score < -2 SD at discharge. Logistic regression models were used to determine independent predictors for both growth phenotypes.
Results:
At discharge, the prevalence of GF and UN was 45.3% and 33.1%, respectively. In infants born without growth restriction (GR), UN was almost entirely driven by GF (89.7%). In contrast, 85.5% of infants born with GR remained undernourished at discharge. Multivariate analysis identified bronchopulmonary dysplasia and higher maximal postnatal weight loss as major independent risk factors for GF, while female sex and human milk feeding at discharge were associated with a lower risk of GF. For infants born with adequate weight, maternal hypertension, extremely low birth weight, and the co-occurrence of GF were the strongest predictors of UN.
Conclusions:
Nearly half of very preterm infants experience significant growth impairment before discharge. By assessing the dynamic process of GF and the static endpoint of UN, we identified distinct clinical trajectories. Standardized ESPGHAN criteria allow for the identification of high-risk "phenotypes"-particularly those with GR at birth or severe neonatal morbidity-enabling more targeted and intensive nutritional management during the critical developmental window.
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