Growth of Infants with Intestinal Failure or Feeding Intolerance Does Not Follow Standard Growth Curves.

Danielle L Morton,Keli M Hawthorne,Carolyn E Moore

doi:10.1155/2017/8052606

Abstract

Objective. Infants with intestinal failure or feeding intolerance are nutritionally compromised and are at risk for extrauterine growth restriction. The aim of the study was to evaluate growth velocities of infants with intestinal failure and feeding intolerance for the first three months of age and to determine growth percentiles at birth and at 40-week postmenstrual age (PMA). Methods. A chart review of infants followed by the Texas Children's Hospital Intestinal Rehabilitation Team was conducted from April 2012 to October 2014. Weekly weight, length, and head circumference growth velocities were calculated. Growth data were compared to Olsen growth curves to determine exact percentiles. Results. Data from infants (n = 164) revealed that average growth velocities of 3-month-old infants (weight gain, 19.97 g/d; length, 0.81 cm/week; head circumference, 0.52 cm/week) fluctuated and all were below expected norms. At discharge or death, average growth velocities had further decreased (length, 0.69 cm/week; head circumference, 0.45 cm/week) except for weight, which showed a slight increase (weight, 20.56 g/d). Weight, length, and head circumference percentiles significantly decreased from birth to 40-week PMA (P < 0.001). Conclusions. Growth of infants with intestinal failure or feeding intolerance did not follow standard growth curves.

Highlights

In the Neonatal Intensive Care Unit (NICU), intrauterine growth curves are the standard method used for assessing weight, length, and head circumference of preterm infants [1]
Prior to the publication of the Olsen curves, many infants were inaccurately classified as appropriate for gestational age (AGA) when they were small for gestational age (SGA) or large for gestational age (LGA) [1]
Subjects in this study experienced a wide range of feeding intolerance complications including gastric residual volume of more than 50% of the previous feeding volume, emesis, abdominal distension, or both of these symptoms and a decrease, delay, or discontinuation of enteral feedings

Summary

Introduction

In the Neonatal Intensive Care Unit (NICU), intrauterine growth curves are the standard method used for assessing weight, length, and head circumference of preterm infants [1]. Intrauterine curves are based on cross-sectional birth data from a diverse population and illustrate ideal fetal growth. They differ from longitudinal postnatal curves which reflect actual growth of preterm infants over time. High-risk infants are commonly classified as small for gestational age (SGA) or large for gestational age (LGA) in the NICU. Large for gestational age infants are at risk for early hypoglycemia [2] and are more likely to develop metabolic syndrome later in life [3]. Prior to the publication of the Olsen curves, many infants were inaccurately classified as appropriate for gestational age (AGA) when they were SGA or LGA [1]. It is possible that some of these infants may not have been evaluated properly for future health risks

Methods

Results

Discussion

Conclusion