Abstract
Although the survival rate of preterm infants has improved over the years, growth failure and associated impaired neurodevelopmental outcome remains a significant morbidity. Optimal nutrition plays an important role in achieving adequate postnatal growth. Accurate growth monitoring of preterm infants is critical in guiding nutritional protocols. Currently, there is no consensus regarding which growth assessment tool is suitable for monitoring postnatal growth of preterm infants to foster optimal neurodevelopmental outcomes while avoiding future consequences of aggressive nutritional approaches including increased risk for cardiovascular disease and metabolic syndrome. A retrospective single center cohort study was conducted to compare the performance of two growth-assessment tools, Fenton and Intergrowth-21st (IG-21st) in the classification of size at birth, identification of impaired growth and predicting neurodevelopment. A total of 340 infants with mean gestational age of 30 weeks were included. Proportion of agreement between the two tools for identification of small for gestational age (SGA) was high 0.94 (0.87, 0.1) however, agreement for classification of postnatal growth failure at discharge was moderate 0.6 (0.52, 0.69). Growth failure at discharge was less prevalent using IG-21st. There was significant association between weight-based growth failure and poor neurodevelopmental outcomes at 12 and 24 months of age.
Highlights
Published: 18 August 2021 the survival rate of the greater than 15 million preterm infants born annually has improved, they have higher morbidity with 20–45% having suboptimal neurodevelopment compared to infants born at term, further challenging clinicians in optimizing care to improve long-term outcomes [1,2,3,4]
In this study we aim to compare the performance of IG-21st versus Fenton growth reference in identifying small for gestational Age (SGA) preterm infants, growth failure at discharge and its ability to predict impaired neurodevelopmental outcomes at 12 and 24 months of age in preterm infants
Growth charts based on cross-sectional size-at-birth measurements by gestational age should be used cautiously to monitor postnatal growth as intrauterine and extrauterine growth is not comparable owing to the different biological processes, environmental and nutritional approaches that preterm infants are subjected to after birth [18]
Summary
The survival rate of the greater than 15 million preterm infants born annually has improved, they have higher morbidity with 20–45% having suboptimal neurodevelopment compared to infants born at term, further challenging clinicians in optimizing care to improve long-term outcomes [1,2,3,4]. Guidance, adequate nutrition for the preterm infant is ideally designed to provide nutrients to approximate the rate of growth and composition of weight gain for a normal fetus of the same post-menstrual age [8]. This goal has proved challenging as extrauterine growth restriction remains a universal problem.
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