Abstract
Preterm infant growth is a major health indicator and needs to be monitored with an appropriate growth curve to achieve the best developmental and growth potential while avoiding excessive caloric intake that is linked to metabolic syndrome and hypertension later in life. New international standards for size at birth and postnatal growth for preterm infants are available and need implementation in clinical practice. A prospective, single center observational study was conducted to evaluate the in-hospital and long-term growth of 80 preterm infants with a mean gestational age of 33.3 ± 2.2 weeks, 57% males. Size at birth and at discharge were assessed using the INTERGROWTH-21ST standards, at preschool age with World Health Organization (WHO) child growth standards. The employment of INTERGROWTH-21ST Preterm Postnatal longitudinal standards during the in-hospital follow-up significantly reduced the diagnosis of short term extrauterine growth restriction when compared to commonly used cross sectional neonatal charts, with significant lower loss of percentiles between birth and term corrected age (p < 0.0001). The implementation of a package of standards at birth, preterm postnatal growth standards and WHO child growth standards proved to be consistent, with correlation between centile at birth and at follow-up, and therefore effective in monitoring growth in a moderate and late preterm infant cohort without chronic or major morbidities. Infants identified as small for gestational age at birth showed significantly more frequently a need for auxological referral.
Highlights
International standards for size at birth and postnatal growth standards for preterm infants have been developed within the INTERGROWTH-21ST Project [7], using the same methodological approach of the World Health Organization (WHO) child growth standards, and are available for use in clinical practice
The obtained standards, specific for preterms, are the most logical charts to be used for preterm infants and are meant to provide a growth reference that is realistic and should lead to less diagnoses of the so-called “extra-uterine growth restriction”, by definition based on the concept of using fetal growth as a standard for the preterm infants. [6,8] Testing the latest statement was one of the aims of the present study, hypothesizing that extrauterine growth restriction (EUGR) is not strongly predictive of adverse later growth outcome if it is calculated using inappropriate charts such as neonatal size at birth charts, and that moderate and late preterm without short-term EUGR based on specific preterm postnatal charts will show adequate growth achievements at preschool age
The present observational study was conducted in order to (1) evaluate the in-hospital growth of a population of preterm infants and the prevalence of growth failure at discharge using preterm standards compared to widely used size-at-birth charts [11,12]; (2) assess the long-term growth of such infants and the predictivity of INTERGROWTH-21ST centiles at birth [9,10] of the centile reached in preschool age on the WHO standards [13,14]; (3) verify if being born small for gestational age on the new standards predicts an adverse outcome in a long-term follow-up
Summary
Monitoring preterm infant growth is a key point in the assessment of these children during hospitalization and after discharge from neonatal intensive care unit. [1,2]Weight gain evaluation is used in clinical practice as a guidance to individualize nutritional intakes: as a consequence, the choice of an appropriate reference growth curve is key to achieve the best developmental and growth potential while avoiding excessive caloric intake, that is linked to metabolic syndrome and hypertension later in life. [3,4]Nutrients 2020, 12, 1941; doi:10.3390/nu12071941 www.mdpi.com/journal/nutrientsIn the past, fetal growth was considered the standard of growth for the preterm neonate; [5]nowadays, it is believed that such a target of weight gain in the first weeks of life may have negative consequences and “program” the infant to later increased incidence of overweight and cardiovascular risk. [6]International standards for size at birth and postnatal growth standards for preterm infants have been developed within the INTERGROWTH-21ST Project [7], using the same methodological approach of the World Health Organization (WHO) child growth standards, and are available for use in clinical practice. The present observational study was conducted in order to (1) evaluate the in-hospital growth of a population of preterm infants and the prevalence of growth failure at discharge using preterm standards compared to widely used size-at-birth charts [11,12]; (2) assess the long-term growth of such infants and the predictivity of INTERGROWTH-21ST centiles at birth [9,10] of the centile reached in preschool age on the WHO standards [13,14]; (3) verify if being born small for gestational age on the new standards predicts an adverse outcome in a long-term follow-up The obtained standards, specific for preterms, are the most logical charts to be used for preterm infants and are meant to provide a growth reference that is realistic and should lead to less diagnoses of the so-called “extra-uterine growth restriction”, by definition based on the concept of using fetal growth as a standard for the preterm infants. [6,8] Testing the latest statement was one of the aims of the present study, hypothesizing that extrauterine growth restriction (EUGR) is not strongly predictive of adverse later growth outcome if it is calculated using inappropriate charts such as neonatal size at birth charts, and that moderate and late preterm without short-term EUGR based on specific preterm postnatal charts will show adequate growth achievements at preschool age.
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