Retard de croissance postnatal du grand prématuré (27-33 SA) : fréquence et facteurs de risque: Étude rétrospective à propos de 161 cas

Abstract

The optimization of the nutrition of very low birth weight premature neonates has become a major concern given the improvement in survival for these children. The goal of the recommended nutritional intakes is to reach a quantitative and qualitative growth similar to the in utero growth. The objectives of this study were to analyze the anthropometric data at birth and near term in a cohort of premature neonates with birth weight appropriate for gestational age and to try to determine risk factors of postnatal hypotrophy. Population and methods. – We conducted a retrospective study over three years (1998-2001) in the neonatology unit of the Armand Trousseau Children’s Hospital, Paris, France. The inclusion criteria was a gestational age under 33 weeks with birth weight appropriate for gestational age. Data were collected at admission, during hospitalisation and at discharge and a standardised form was filled for each child. We defined postnatal hypotrophy (PNH) as an hypotrophy at discharge (weight < 10 th centile according to the Audipog reference curve) in neonates with birth weight appropriate for gestational age. Results. – One hundred and sixty one neonates were included. Eighty two had PNH. In univariate analysis, factors significantly associated with PNH were: birth weight, gestational age, length of hospitalisation, the occurrence of nosocomial infection, of enteropathy, preeclampsia, neonatal asphyxia and antenatal corticoid treatment. In multivariate analysis, risk factors of PNH were: low birth weight, low gestational age and the occurrence of nosocomial infection. Conclusion. – Our study shows that half of the appropriate for gestational age premature neonates were hypotrophic near term. The causes may be various: nutrition is not optimal and intercurrent factors may play a major role such as nosocomial infection.