Extrauterine growth restriction in very low birth weight premature infants in the NEOCOSUR neonatal network

Abstract

Postnatal growth in preterm infants is a fundamental part of medical care, as it determines better brain growth and, consequently, better neurocognitive development. Given postnatal morbidity and different nutritional practices, it is not possible to maintain normal intrauterine growth levels. Postnatal nutritional impairment has been described as extrauterine growth restriction (EUGR).

Objective: To describe the prevalence of EUGR in very low birth weight (VLBW) preterm infants from a multicenter neonatal network (NEOCOSUR) and to identify the factors associated with its occurrence.

Patients and Method: Retrospective study of data recorded between 2006 and 2016. EUGR was defined as a birth weight below the 10th percentile on the Intergrowth-21 curves at discharge. Variables associated with EUGR were analyzed. A general mixed regression model was used to evaluate independent factors associated with EUGR.

Results: A total of 8,690 preterm infants were included, with a gestational age of 29 weeks (IQR 28-31) and a birth weight of 1,177 g (IQR 984-1,344 g) from 27 neonatal centers. The prevalence of EUGR was 49.0% (range 22.4-89.4% depending on the center). Variables independently associated with EUGR were greater gestational age, small for gestational age, bronchopulmonary dysplasia, late-onset sepsis, delayed initiation and achievement of 100 mL/kg/day of enteral intake, period of birth, and postnatal use of corticosteroids.

Conclusion: A high and highly variable prevalence of EUGR was identified, along with some of the identified independent factors, offering an opportunity for intervention to improve nutritional outcomes.