Weight Gain Goals and Factors Associated With Readmission for Faltering Weight in Infants

Infants hospitalized for faltering weight are a vulnerable population with limited evidence guiding inpatient management and weight gain targets. We examined associations of patient factors and weight gain target attainment with faltering weight-specific readmission and sought to identify an optimal weight gain threshold associated with reduced readmission.

This retrospective study examined infants aged 1 to 12 months admitted to hospital medicine for faltering weight at a quaternary children's hospital from 2018 to 2022. In-hospital average weight gain was classified as meeting or not meeting World Health Organization (WHO) standards and registered dietitian (RD) recommendations. Associations between readmission and weight gain attainment, demographics, chronic conditions, social factors, and feeding status were assessed using Fisher exact tests, Wilcoxon rank-sum tests, and odds ratios (ORs) with 95% CIs. Logistic regression evaluated readmission in relation to percent average daily weight gain above WHO standards.

Among 273 infants, 36 (13.2%) were readmitted for faltering weight within 2 years. Preexisting tube feeds on admission were associated with increased readmission (P = .02; OR 5.80; 95% CI, 1.48-22.73). Infants who met RD goals, especially goals that exceeded the WHO standard, had lower readmission (P = .01; OR 0.30; 95% CI, 0.12-0.73). No percent average daily weight gain above the WHO threshold showed predictive ability or reduced readmission.

Individualized, expert-guided nutrition strategies improve outcomes for infants with faltering weight when weight gain goals exceed the WHO standard. Larger, multicenter studies are needed to improve generalizability and statistical power to detect smaller effects.