Analysis of "true extrauterine growth retardation" and related factors in very preterm infants-A multicenter prospective study in China

Wei Shen; Fan Wu; Jian Mao; Ling Liu; Yan-Mei Chang; Rong Zhang; Zhi Zheng; Xiu-Zhen Ye; Yin-Ping Qiu; Li Ma; Rui Cheng; Hui Wu; Dong-Mei Chen; Ling Chen; Ping Xu; Hua Mei; San-Nan Wang; Fa-Lin Xu; Rong Ju; Chao Chen; Xiao-Mei Tong; Xin-Zhu Lin

doi:10.3389/fped.2022.876310

Analysis of "true extrauterine growth retardation" and related factors in very preterm infants-A multicenter prospective study in China

Front Pediatr. 2022 Sep 15:10:876310. doi: 10.3389/fped.2022.876310. eCollection 2022.

Authors

Wei Shen^{1

2}, Fan Wu³, Jian Mao⁴, Ling Liu⁵, Yan-Mei Chang⁶, Rong Zhang¹, Zhi Zheng², Xiu-Zhen Ye⁷, Yin-Ping Qiu⁸, Li Ma⁹, Rui Cheng¹⁰, Hui Wu¹¹, Dong-Mei Chen¹², Ling Chen¹³, Ping Xu¹⁴, Hua Mei¹⁵, San-Nan Wang¹⁶, Fa-Lin Xu¹⁷, Rong Ju¹⁸, Chao Chen¹, Xiao-Mei Tong⁶, Xin-Zhu Lin^{2

19}

Affiliations

¹ Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China.
² Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, Fujian, China.
³ Department of Neonatology, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
⁴ Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China.
⁵ Department of Neonatology, Guiyang Maternal and Child Health Hospital (Guiyang Children's Hospital), Guiyang, Guizhou, China.
⁶ Department of Pediatrics, Peking University Third Hospital, Beijing, China.
⁷ Department of Neonatology, Guangdong Province Maternal and Children's Hospital, Guangzhou, Guangdong, China.
⁸ Department of Neonatology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, China.
⁹ Department of Neonatology, Children's Hospital of Hebei Province, Shijiazhuang, Hebei, China.
¹⁰ Department of Neonatology, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
¹¹ Department of Neonatology, The First Hospital of Jilin University, Changchun, Jilin, China.
¹² Department of Neonatology, Quanzhou Maternity and Children's Hospital, Quanzhou, Fujian, China.
¹³ Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
¹⁴ Department of Neonatology, Liaocheng People's Hospital, Liaocheng, Shandong, China.
¹⁵ Department of Neonatology, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia, China.
¹⁶ Department of Neonatology, Suzhou Municipal Hospital, Suzhou, Jiangsu, China.
¹⁷ Department of Neonatology, The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China.
¹⁸ Department of Neonatology, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China.
¹⁹ Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian, China.

Abstract

Objective: To investigate the incidence and related factors of extrauterine growth retardation (EUGR) and "true EUGR" in very preterm infants (VPI) from different regions of China.

Materials and methods: Clinical data of VPI were prospectively collected from 28 hospitals in seven different regions of China from September 2019 to December 2020. The infants were divided into a small for gestational age (SGA) group or non-SGA group at birth, with non-SGA infants at 36 weeks of gestation or at discharge being further divided into a EUGR group or a non-EUGR group. Infants in the EUGR and non-SGA group were defined as "true EUGR." The general information of VPI, such as maternal complications during pregnancy, use of enteral nutrition and parenteral nutrition, and complications during hospitalization were compared between the groups.

Results: Among the 2,514 VPI included in this study, 47.3, 41.5, and 33.3% of VPI were below the 10th percentile, and 22.6, 22.4, and 16.0% of VPI were below the 3rd percentile for weight, height, and head circumference at 36 weeks of gestation or at discharge, respectively, by the percentile on the 2013 Fenton curve. The incidences of EUGR and "true EUGR" evaluated by weight were 47.3 and 44.5%, respectively. Univariate analysis showed that there were statistically significant differences in the aspects of perinatal and nutritional characteristics, treatment, and complications between the groups. Multivariate analysis showed that in non-SGA infants, the cumulative caloric intake during the first week was a protective factor for "true EUGR," while days to reach total enteral nutrition, late initiation of human milk fortifier, and moderate to severe bronchopulmonary dysplasia were independent risk factors for "true EUGR."

Conclusion: More attention should be paid to the nutritional management of VPI to prevent "true EUGR." Cumulative caloric intake should be ensured and increased during the first week, total enteral nutrition should be achieved as early as possible, human milk fortifier should be added early, and moderate to severe bronchopulmonary dysplasia should be prevented. These strategies are very important for reducing the incidence of "true EUGR" in VPI.

Keywords: extrauterine growth retardation; nutrition; risk factor; very preterm infants; “true EUGR”.