Applying Methods for Postnatal Growth Assessment in the Clinical Setting: Evaluation in a Longitudinal Cohort of Very Preterm Infants.

Izquierdo Renau Izquierdo Renau,Mendoza Mendoza,Iglesias-Platas Iglesias-Platas,Aldecoa-Bilbao Aldecoa-Bilbao,Esponera Esponera,Sanz Sanz

doi:10.3390/nu11112772

Izquierdo Renau Izquierdo Renau, Mendoza Mendoza + Show 4 more

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https://doi.org/10.3390/nu11112772

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Abstract

Aim: To analyze different methods to assess postnatal growth in a cohort of very premature infants (VPI) in a clinical setting and identify potential early markers of growth failure. Methods: Study of growth determinants in VPI (≤32 weeks) during hospital stay. Nutritional intakes and clinical evolution were recorded. Growth velocity (GV: g/kg/day), extrauterine growth restriction (%) (EUGR: weight < 10th centile, z-score < −1.28) and postnatal growth failure (PGF: fall in z-score > 1.34) at 36 weeks postmenstrual age (PMA) were calculated. Associations between growth and clinical or nutritional variables were explored (linear and logistic regression). Results: Sample: 197 VPI. GV in IUGR patients was higher than in non-IUGRs (28 days of life and discharge). At 36 weeks PMA 66.0% of VPIs, including all but one of the IUGR patients, were EUGR. Prevalence of PGF at the same time was 67.4% (IUGR patients: 48.1%; non-IUGRs: 70.5% (p = 0.022)). Variables related to PGF at 36 weeks PMA were initial weight loss (%), need for oxygen and lower parenteral lipids in the first week. Conclusions: The analysis of z-scores was better suited to identify postnatal growth faltering. PGF could be reduced by minimising initial weight loss and assuring adequate nutrition in patients at risk.

Highlights

Growth of preterm infants lacks a standardized approach among neonatologists [1,2] and a multitude of methods have been described to report growth trajectories in these patients
The aims of this study were: (1) to describe the applicability of the most currently used methods for the assessment of postnatal growth in clinical practice using an actual cohort of very premature infants (VPI), (2) to pinpoint early markers that can help detect which children, conditions and macronutrient provision profiles associate the highest risk of postnatal growth failure in order to provide some room for timely intervention
We have looked at factors related to postnatal growth failure (PGF) at 36 weeks postmenstrual age (PMA), finding that besides gestational age (GA), a greater maximum percentage of initial weight loss, the need of oxygen supply during admission and a lower provision of lipids during the first week of life were additional independent risk factors

Summary

Introduction

Growth of preterm infants lacks a standardized approach among neonatologists [1,2] and a multitude of methods have been described to report growth trajectories in these patients. Calculating growth velocity (GV) as g/kg/day [3,4] is one of the most widely used, followed by differences in z-score between two points in time [5]. A recent review and meta-analysis [6] examined the variability of growth assessment regarding calculations, time frames, and denominators, as well as how extrauterine growth restriction (EUGR) was defined. It concluded that the most frequent method to calculate GV was g/kg/d, followed by g/d and change in z-score relative to an intrauterine or postnatal growth chart. Some authors have explored theoretical mathematical models to individually approach

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