Growth of preterm very low birth weight infants discharged with weight of less than 1500grams

Abstract

Early discharge of preterm very low birth weight (VLBW) infants is at times inevitable in low resource settings. The implication of such practice on the growth of this high-risk population is not known. We conducted a retrospective chart review to describe the growth of preterm VLBW infants discharged with a weight of less than 1500 g. Objectives To describe the growth of discharged preterm VLBW infants over the first 12 weeks. Method Between June 2013 and January 2014; 164 discharged preterm VLBW infants were followed up for 3 months. Among the survivors (132), we identified 111 infant records for this study. Relevant data was entered in STATA for analysis. Growth percentiles were determined at approximately 4 weeks, 8 weeks, and 12 weeks post-discharge using the intergrowth 21st growth charts. Growth velocities were computed using the 2-point average weight model. Regression analysis was used to identify factors associated with growth failure. Growth failure was defined as occipital frontal circumference (OFC), weight, and length < 10th centile by 12 weeks post-discharge. P-value of < 0.05 was considered significant at a 95% confidence interval. Results Among the study infants the median gestational age and weight at birth were 32 weeks (range 28-35 weeks) and 1250 g(range 850-1500 g) respectively; 60/111(54%) were Small for Gestational Age (SGA). The median discharge postmenstrual age (PMA) was 34 weeks (range 30-38 weeks) and weight was 1140 g (range 830-1490 g). The majority 88.2% had not recovered birth weight at discharge of whom 59.1% recovered by 2 weeks and 40.9% recovered between 2 and 4 weeks after discharge. By 12 weeks post-discharge the median PMA and weight were 46 weeks (range 37-51 weeks),and 3110 g (range 1750-5000 g) respectively, 38.7% of the infants had growth failure and 36.9% had OFC <3rd centile. Growth velocity < 15 g/kg/d in the first 4 weeks (OR 3.8, p 0.010) and subsequent 4 weeks (OR 2.5, p 0.049) post-discharge were independently associated with growth failure. Conclusion Slow birth weight recovery was observed and growth failure was prevalent by 12 weeks post-discharge with more than a third having severe microcephaly. Poor post-discharge growth velocity was associated with subsequent growth failure. Recommendations Growth velocity monitoring among preterm VLBW infants should be emphasized. The implication and interventions of this early growth failure needs to be explored.

Growth of a cohort of very low birth weight and preterm infants born at a single tertiary health care center in South Africa

“…Weeks of failure of adequate growth is followed by a recovery of weight-for-age, length-for-age, and head circumferences by latest 12 months of corrected age. Similar to other studies, catch-up growth was most rapid for growth of head circumference, followed by weight, while length recovery lagged behind and remained lowest for all infants and both gender ( 5 , 7 , 40 , 51 ). This trend is seen at birth already, with the head circumference for corrected age starting off with the values close to normal, while the weight for age z-scores were well below −2SD, and length-for-age below −3SD.…”

“…Our study could further confirm the findings that many preterm and VLBW infants struggle to gain weight and height appropriately, especially in their first year of life ( 5 , 7 , 11 , 26 , 31 , 37 ). Weeks of failure of adequate growth is followed by a recovery of weight-for-age, length-for-age, and head circumferences by latest 12 months of corrected age.…”

“…In the last few decades, the survival rate of preterm and very low birth weight (VLBW) infants has increased worldwide (1)(2)(3). However, while improved survival is a global trend, low-and middle-income countries (LMICs) are still lagging behind, as also shown in one of our previous studies of this cohort (3)(4)(5)(6). Furthermore, post-discharge mortality of babies born with VLBW can be considerable in those countries (4,7).…”

Growth Pattern With Morbidities From Birth to 5 Years of Age in Very Low Birth Weight Infants: Comparison of the Korean National Network and National Health Insurance Service

“…Poor growth is related to poor neurodevelopmental outcomes; hence, the importance of comprehensive follow-up of VLBW infants is important to improve various long-term outcomes. 25 26 However, in Korea, low rates of follow-up and limitation of detailed outcomes remain challenging issues. By indirectly integrating the sporadic clinical data of VLBW obtained in the NHIS and KNN, we identified disparities in the follow-up rate and incidence of morbidities of VLBW infants.…”

Postnatal Growth Faltering: Growth and Height Improvement at Two Years in Children with Very Low Birth Weight between 2002–2017

“…Similar results have been reported in other series, as described by Stoll et al with preterm infants born between 2005 and 2012 [ 33 ]. A lower daily weight gain was also observed in the first 4 weeks in the first quinquennium, a parameter related to growth restriction [ 22 , 34 ]. We observed that the lower daily weight gain in the first 4 weeks was related to the risks of short stature at 2 years.…”