Abstract
Postnatal steroids, often used to prevent and treat bronchopulmonary dysplasia, may influence the growth of preterm infants, although data are scarce in the literature. This is a multicenter cohort study including surviving preterm infants <32 weeks at birth (n = 17,621) from the Spanish Neonatal Network SEN1500 database, without major congenital malformations. Linear regression models were adjusted for postnatal steroids, respiratory severity course (invasive mechanical ventilation at 28 days), progression to moderate–severe bronchopulmonary dysplasia (O2 at 36 weeks), length of stay, sex, gestational age and z-scores at birth. A subgroup analysis depending on the timing of administration, ventilation status at 28 days and moderate–severe BPD diagnosis was also performed. Overall, systemic postnatal steroids were not independently associated with poorer weight gain (0.1; 95% CI: −0.05 to 0.2 g/kg/day), linear growth (0; 95% CI: −0.03 to 0.01 cm/week) or head circumference growth (−0.01; 95% CI: −0.02 to 0 cm/week). Patients who received steroids after 28 days or who were not O2 dependent at 36 weeks after having received steroids gained more weight (0.22; 95% CI: 0.04 to 0.4 and 0.2; 95% CI: 0.004 to 0.5 g/kg/day, respectively). Globally, systemic postnatal steroids had no significant adjusted effect on postnatal growth.
Highlights
Postnatal growth restriction is one of the most common complications of prematurity and is associated with worse neurodevelopment [1]
Data on 17,621 preterm infants
The main epidemiological, growth and respiratory data on the analyzed patients are summarized in Overall, after adjustment by sex, gestational age, moderate–severe bronchopulmonary dysplasia (BPD), invasive mechanical ventilation at 28 days of life, length of stay and z-scores at birth, systemic postnatal steroids had no significant adjusted effect on postnatal weight gain (0.1; 95% CI: −0.05 to 0.2 g/kg/day), linear growth
Summary
Postnatal growth restriction is one of the most common complications of prematurity and is associated with worse neurodevelopment [1]. Postnatal growth restriction is the result of a combination of different factors, leading to insufficient nutrient delivery, absorption or accretion to match the protein-caloric requirements of a rapidly growing neonate, who faces a number of organ and systemic complications. Postnatal growth restriction may occur even when current nutritional recommendations are followed [2]. Other factors independent of nutrient delivery, sex and illness may affect postnatal growth. Medical and surgical treatments can interfere with growth too. Better knowledge of the interactions between treatments, disease, metabolism, and growth may increase our understanding of the etiology of postnatal growth restriction and, eventually, lead to the design of better strategies to prevent it
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