Defining postnatal growth failure among preterm infants in Indonesia

Abstract

BackgroundPostnatal growth failure (PGF) frequently occurred among preterm infants with malnutrition. The decline in a weight-for-age z-score of ≥1.2 has been proposed to define PGF. It was unknown whether this indicator would be useful among Indonesian preterm infants.MethodsInfants of <37 weeks of gestational age born between 2020 and 2021, both stable and unstable, were recruited for a prospective cohort study during hospitalization in the level III neonatal intensive care unit at the Cipto Mangunkusumo General Hospital, Jakarta, Indonesia. The prevalence of PGF as defined by a weight-for-age z-score of <−1.28 (<10th percentile) at discharge, a weight-for-age z-score of <−1.5 (<7th percentile) at discharge, or a decline in a weight-for-age z-score of ≥1.2 from birth till discharge was compared. The association between those PGF indicators with the preterm subcategory and weight gain was assessed. The association between the decline in a weight-for-age z-score of ≥1.2 with the duration to achieve full oral feeding and the time spent for total parenteral nutrition was analyzed.ResultsData were collected from 650 preterm infants who survived and were discharged from the hospital. The weight-for-age z-score of <−1.28 or <−1.5 was found in 307 (47.2%) and 270 (41.5%) subjects with PGF, respectively. However, both indicators did not identify any issue of weight gain among subjects with PGF, questioning their reliability in identifying malnourished preterm infants. By contrast, the decline in a weight-for-age z-score of ≥1.2 was found in 51 (7.8%) subjects with PGF, in which this indicator revealed that subjects with PGF had an issue of weight gain. Next, a history of invasive ventilation was identified as a risk factor for preterm infants to contract PGF. Finally, the decline in a weight-for-age z-score of ≥1.2 confirmed that preterm infants with PGF took a longer time to be fully orally fed and a longer duration for total parenteral nutrition than the ones without PGF.ConclusionThe decline in a weight-for-age z-score of ≥1.2 was useful to identify preterm infants with PGF within our cohort. This could reassure pediatricians in Indonesia to use this new indicator.

Contemporary Definitions of Infant Growth Failure and Neurodevelopmental and Behavioral Outcomes in Extremely Premature Infants at Two Years of Age

“…One study examining ELBW and very preterm infants utilizing these definitions did not find differences in neurodevelopmental outcomes on the BSID-II at 12 months ( 1 ). In contrast, one study found a decline in weight z-score > 1.2 to be associated with increased days to oral feeding ( 21 ), a known strong predictor of neurodevelopmental outcomes, and another found a weight z-score change > 1 to be associated with BSID-III scores ( 22 ). Other studies are similar to ours, identifying poor linear growth as detrimental to cognitive and language outcomes ( 8 , 15 , 23 ).…”

Contemporary definitions of infant growth failure and neurodevelopmental and behavioral outcomes in extremely premature infants at two years of age

“…Brinkis et al examining ELBW and very preterm infants utilizing these definitions did not find differences in neurodevelopmental outcomes on the BSID-II at 12 months [ 1 ]. In contrast, Rohsiswatmo et al found a decline in weight z-score >1.2 to be associated with increased days to oral feeding [ 24 ], a known strong predictor of neurodevelopmental outcomes, and Yitayew et al found a weight z-score change >1 to be associated with lower BSID-III scores [ 25 ]. Other studies identify poor linear growth as detrimental to cognitive and language outcomes [ 8 , 15 , 17 , 26 ].…”

Risk Factors Contributing to Extrauterine Growth Restriction in Very Low Birth Weight Infants

“…In this study, the incidence of EUGR was 71.6% (237/331) based on the definition of EUGR as a decline in weight z-score >1.2 from birth to discharge, using the Fenton growth chart 16,17) . The incidence of EUGR was higher than previous studies involving VLBW infants 2,8) , and similar to a study involving extremely preterm infants 9) .…”

“…To quantify postnatal growth, the difference in z-scores between birth and discharge was calculated. EUGR was defined as a decline in the weight-for-age z-score >1.2 from birth to discharge, using the Fenton growth chart 16,17) . The enrolled infants were categorized into an EUGR group or a non-EUGR group.…”