Abstract :
on behalf of Keywords Postnatal growth failure; Preterm infants; Risk factors; Incidence; Small for gestational age Highlights * The incidence of postnatal growth restriction in very preterm infants in Chinese NICU is 19.9%. * About 25.5% of small-for-gestational-age infants had postnatal growth restriction. * Growth outcomes in very preterm infants reflect suboptimal nutrition status. * Earlier start of enteral feeds and earlier achievement to full enteral feeds can improve postnatal growth. * Necrotizing enterocolitis is most associated with poorer postnatal growth. Abstract Background Postnatal growth restriction (PGR) is common in very preterm infants (VPIs) and is associated with adverse short and long-term developmental outcomes. Postnatal growth status for VPIs in middle- or low-income countries remains unclear. Aims To evaluate PGR in VPIs and identify maternal and neonatal factors, clinical practice, and major neonatal morbidities associated with PGR in China. Study design Prospective cohort study. Subjects We included 6085 infants born at Outcome measures Birth and discharge weights were converted to age-specific Z-scores. PGR was defined as a decrease in weight z-score from birth to discharge 2. Results The overall incidence of PGR was 19.9 %. The mean (standard deviation [SD]) weight Z-score was 0.12 (0.78) at birth and decreased to -1.36 (0.98) at discharge. About 4.0 % of VPIs were small for gestational age (SGA) at birth and 25.5 % of SGA infants had PGR. The incidence of PGR increased with decreasing gestational age except in the SGA subgroup. Each 1-unit increase in birthweight Z-score was associated with a 1.49-fold increased risk for PGR. Late initiation of enteral feeds and late achievement of full enteral feeds were positively associated with PGR. The common morbidities that influenced PGR were necrotizing enterocolitis [greater than or equal to] stage II, patent ductus arteriosus requiring medical or surgical treatment, sepsis, bronchopulmonary dysplasia, and respiratory distress syndrome requiring surfactants. Conclusion Nearly one fifth of VPIs were PGR, and one fourth of SGA had PGR, which warranted further study to investigate underlying causes by which to improve postnatal growth in very preterm infants in future. Abbreviations PGR, postnatal growth restriction; VPIs, very preterm infants; VLBW, very low birth weight; NICU, neonatal intensive care unit; CHNN, Chinese Neonatal Network; PN, parenteral nutrition; RDS, respiratory distress syndrome; PDA, patent ductus arteriosus; NEC, necrotizing enterocolitis; IVH, intraventricular hemorrhage; ROP, retinopathy of prematurity; BPD, bronchopulmonary dysplasia; HMF, human milk fortifier; GA, gestational age; SGA, small for gestational age; SD, standard deviation; IQR, interquartile range; OR, odds ratio; CI, confidence interval Author Affiliation: (a) Department of Neonatology, Children's Hospital of Capital Institute of Pediatrics, Beijing, China (b) Experiment Center, Capital Institute of Pediatrics, Beijing, China (c) NHC Key Laboratory of Neonatal Diseases, Fudan University, Children's Hospital of Fudan University, Shanghai, China (d) Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China (e) Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada (f) Department of Pediatrics, University of Toronto, Toronto, ON, Canada (g) Division of Neonatology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China * Corresponding author at: Department of Neonatology, Children's Hospital of Fudan University, 399 Wanyuan Road, Minhang District, Shanghai 201102, China. Article History: Received 29 April 2022; Revised 28 August 2022; Accepted 29 August 2022 Byline: Yanyu Lyu (a,b), Dongzhe Zhu (a), Yanchen Wang (c), Siyuan Jiang (c,d), Shoo K. Lee (e,f), Jianhua Sun (g), Li Li (a), Yun Cao [yuncao@fudan.edu.cn] (c,d,*)