Prevalence and factors associated with extrauterine growth restriction in premature infants
Abstract
Background Extrauterine growth restriction (EUGR) is common in preterm infants and has been shown to affect their neurodevelopment. Significant variability exists in the criteria used to define EUGR and a standard definition has not yet been established. Several factors associated with EUGR have been identified, yet EUGR remains a problem in preterm infants. There is still much to be explored regarding risk factors associated with EUGR.
Objective To determine the prevalence and factors associated with EUGR in preterm infants.
Methods This cross-sectional study included randomly selected premature infants (<37 weeks gestational age) who were admitted to levels II and III Neonatal Ward at Prof. Dr. I.G.N.G. Ngoerah Hospital from May 2022 to August 2023.
Results Of 185 subjects, the prevalence of EUGR in preterm infants was 47% and there were significant associations between EUGR and birth weight <1500 g (PR 8.814; 95%CI: 3.943 to 19.7; P=0.000), small for gestational age/SGA (PR 28.95; 95%CI: 3.79 to 220.1; P=0.000), neonatal sepsis (PR 4.29; 95%CI: 2.21 to 8.31; P=0.000), hyaline membrane disease/HMD (PR 2.12; 95%CI: 1.16 to 3.88; P=0.021), use of respiratory support (PR 2.57; 95%CI: 1.35 to 4.92; P=0.005), initiation of enteral nutrition at >48 hours (PR 2.23; 95%CI: 1.21 to 4.09; P=0.014) and length of stay/LOS >14 days (PR 8.11; 95%CI: 4.13 to 15.9; P=0.000). Multivariate analysis revealed birth weight <1500 g (aPR 5.14; 95%CI: 1.55 to 17.06; P=0.007), SGA (aPR 24.26; 95%CI: 2.64 to 222.6; P=0.005), presence of sepsis (aPR 2.35; 95%CI: 1.00 to 5.5; P=0.049), and length of hospital stay >14 days (aPR 4.93; 95%CI: 2.15 to 11.31; P=0.000) maintained positive significant associations with EUGR.
Conclusion The prevalence of EUGR in preterm infants is 47%. Birth weight <1500 g, small for gestational age, sepsis, and length of stay >14 days are associated with EUGR in preterm infants.
References
2. Katz J, Lee ACC, Kozuki N, Lawn JE, Cousens S, Blencowe H, et al. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013;382:417–25. DOI: https://doi.org/10.1016/S0140-6736(13)60993-9
3. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics. 2003;111:986–90. DOI: https://doi.org/10.1542/peds.111.5.986
4. Ruth V. Extrauterine growth restriction: a review of the literature. Neonatal Netw. 2008;27:177–84. DOI: https://doi.org/10.1891/0730-0832.27.3.177
5. Lunde D. Extrauterine growth restriction: what is the evidence for better nutritional practices in the neonatal intensive care unit? Newborn Infant Nurs Rev. 2014;14:92–8. DOI: https://doi,org/10.1053/j.nainr.2014.06.008
6. Gidi NW, Goldenberg RL, Nigussie AK, McClure E, Mekasha A, Worku B, et al. Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia. BMJ Paediatr Open. 2020;4:e000765. DOI: https://doi.org/10.1136/bmjpo-2020-000765
7. Leksomono N, Sutomo R, Haksari EL. Predictors of early growth failure in preterm, very low birth weight infants during hospitalization. Paediatr Indones. 2019;59:44–50. DOI: https://doi.org/10.14238/pi59.1.2019.44-50
8. Ehrenkranz RA, Das A, Wrage LA, Poindexter BB, Higgins RD, Stoll BJ, et al. Early nutrition mediates the influence of severity of illness on extremely LBW infants. Pediatr Res. 2011;69:522–9. DOI: https://doi.org/10.1203/PDR.0b013e318217f4f1
9. Nakubulwa C, Musiime V, Namiiro FB, Tumwine JK, Hongella C, Nyonyintono J, et al. Delayed initiation of enteral feeds is associated with postnatal growth failure among preterm infants managed at a rural hospital in Uganda. BMC Pediatr. 2020;20:86. DOI: https://doi.org/10.1186/s12887-020-1986-5
10. Lee SM, Kim N, Namgung R, Park M, Park K, Jeon J. Prediction of postnatal growth failure among very low birth weight infants. Sci Rep. 2018;8:3729. DOI: https://doi.org/10.1038/s41598-018-21647-9
11. Starc M, Giangreco M, Centomo G, Travan L, Bua J. Extrauterine growth restriction in very low birth weight infants according to different growth charts: a retrospective 10 years observational study. PLoS One. 2023;18:e0283367. DOI: https://doi.org/10.1371/journal.pone.0283367
12. Mauer AM, Dweck HS, Finberg L. Nutritional needs of low-birth-weight infants. Pediatrics. 1985;75(5):976–86. DOI: https://doi.org/10.1542/peds.75.5.976
13. de Sousa JCS, de Carvalho AVD, Monte de Prada L de C, Marinho AP, de Lima KF, Macedo SK de O, et al. Nutritional factors associated with late-onset sepsis in very low birth weight newborns. Nutrients. 2021;14:196. DOI: https://doi.org/10.3390/nu14010196
14. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292:2357–63. DOI: https://doi.org/10.1001/jama.292.19.2357
15. Hibbert JE, Currie A, Strunk T. Sepsis-induced immunosuppression in neonates. Front Pediatr. 2018;6:357. DOI: https://doi.org/10.3389/fped.2018.00357
16. Flannery DD, Jensen EA, Tomlinson LA, Yu Y, Ying G-S, Binenbaum G. Poor postnatal weight growth is a late finding after sepsis in very preterm infants. Arch Dis Child Fetal Neonatal Ed. 2021;106:298–304. DOI: https://doi.org/10.1136/archdischild-2020-320221
17. Lan S, Fu H, Zhang R, Zhong G, Pan L, Bei F, Hong L. Extrauterine growth restriction in preterm infants: Postnatal growth pattern and physical development outcomes at age 3-6 years. Front Pediatr. 2022;10:945422. DOI: https://doi.org/10.3389/fped.2022.945422
18. Wright CM, Parkinson KN. Postnatal weight loss in term infants: what is normal and do growth charts allow for it? Arch Dis Child Fetal Neonatal Ed. 2004;89:F254-7. DOI: https://doi.org/10.1136/adc.2003.026906
19. Ziegler EE. Meeting the nutritional needs of the low-birth-weight infant. Ann Nutr Metab. 2011;58 Suppl 1:8–18. DOI: https://doi.org/10.1159/000323381
20. Khasawneh W, Khassawneh M, Mazin M, Al-Theiabat M, Alquraan T. Clinical and nutritional determinants of extrauterine growth restriction among very low birth weight infants. Int J Gen Med. 2020;13:1193–200. DOI: https://doi.org/10.2147/IJGM.S284943
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Accepted 2024-10-14
Published 2024-10-14
