Postnatal weight gain in very preterm infants: are we aiming too high?

Abstract

Advances in neonatal intensive care and nutrition over the past few decades have increased disability-free survival and postnatal growth of extremely preterm infants. 1 Cheong JLY Olsen JE Lee KJ et al. Temporal trends in neurodevelopmental outcomes to 2 years after extremely preterm birth. JAMA Pediatr. 2021; (published online July 19.)https://doi.org/10.1001/jamapediatrics.2021.2052 Crossref Scopus (2) Google Scholar , 2 Horbar JD Ehrenkranz RA Badger GJ et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000–2013. Pediatrics. 2015; 136: e84-e92 Crossref PubMed Scopus (176) Google Scholar At the same time, concerns are emerging that preterm infants have less favourable cardiovascular outcomes in adulthood. 3 Cheong JLY Haikerwal A Wark JD et al. Cardiovascular Health profile at age 25 years in adults born extremely preterm or extremely low birthweight. Hypertension. 2020; 76: 1838-1846 Crossref PubMed Scopus (3) Google Scholar One potential contributor to such adverse health outcomes could be the overzealous administration of nutrients in the postnatal period in an effort to match growth velocities similar to in-utero fetuses. Hence, the focus of researchers has shifted to identifying optimal nutritional strategies and the ideal preterm growth chart, so as to achieve better neurodevelopment while minimising the risk of adverse cardiovascular outcomes. Birthweight and patterns of postnatal weight gain in very and extremely preterm babies in England and Wales, 2008–19: a cohort studyThe birthweight of very and extremely preterm babies has remained stable over 12 years. Early postnatal weight loss has decreased, and subsequent weight gain has increased, but weight at 36 weeks postmenstrual age is consistently below birth percentile. In babies without major morbidity, weight velocity follows a consistent trajectory, offering opportunity to construct novel preterm growth curves despite lack of knowledge of optimal postnatal weight gain. Full-Text PDF