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Defining growth faltering and malnutrition among very preterm infants in a neonatal intensive care unit

Rachel R Rickman1, Anthony Rudine2,3, Steven A Abrams1,4

  • 1Department of Nutritional Sciences, The University of Texas at Austin, Austin, TX, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|February 11, 2026
PubMed

Insights

Weight-for-age percentile cut-offs misclassify malnutrition in very preterm infants. Z-score changes provide a more accurate assessment of growth concerns for extremely low birthweight and very low birthweight infants.

Area of Science:

  • Neonatalogy
  • Pediatric Nutrition
  • Growth Monitoring

Background:

  • Preterm infants, especially those born extremely low birthweight (ELBW) or very low birthweight (VLBW), are at high risk for growth abnormalities.
  • Current growth assessment methods at 36 weeks postmenstrual age may not accurately identify all infants experiencing malnutrition.

Purpose of the Study:

  • To compare the accuracy of weight-for-age ≤10th percentile (10%ile) versus z-score changes in identifying malnutrition among very preterm infants at 36 weeks.
  • To identify predictors of malnutrition in this vulnerable population.

Main Methods:

  • Retrospective analysis of ELBW (n=699) and VLBW (n=878) infants born ≤32 weeks gestation.
  • Infants classified using weight-for-age ≤10%ile and by malnutrition categories based on z-score changes.
  • Multiple logistic regression used to determine predictors of malnutrition.

Main Results:

  • 13% of ELBW and 15% of VLBW infants were classified as moderately/severely malnourished using z-score losses, exceeding the 10%ile threshold.
  • Chronic lung disease and ventilator use were associated with increased risk of moderate/severe malnutrition.
  • A loss of ≤0.8 z-scores was not linked to postnatal clinical risk factors.

Conclusions:

  • Using weight-for-age ≤10%ile as a sole indicator for growth concerns at 36 weeks postmenstrual age leads to misclassification in many preterm infants.
  • Z-score changes offer a more sensitive method for diagnosing malnutrition in very preterm infants.
  • Further research may be needed to understand growth patterns associated with smaller z-score losses.
Abstract

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