Is intrauterine growth appropriate to monitor postnatal growth of preterm neonates?

Pereira‐da‐Silva, Luís; Virella, Daniel

doi:10.1186/1471-2431-14-14

Cited by 21 publications

(13 citation statements)

References 20 publications

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“…The resulting growth pattern will therefore not reflect the true potential of postnatal growth for healthy preterm infants. Two factors cause postnatal trajectories to deviate further from the ones in utero; (i) postnatal adaptation to extrauterine life initiates a one-time, irreversible contraction of extracellular water space during the first days of life (11)(12)(13)(14)(15)(16). This physiological contraction and subsequent weight loss makes it reasonable to assume that there will be a permanent offset of postnatal growth trajectories when compared to intrauterine trajectories.…”

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confidence: 99%

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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Background: International guidelines suggest that growth of preterm infants should match intrauterine rates. However, the trajectory for extrauterine growth may deviate from the birth percentile due to an irreversible, physiological loss of extracellular fluid during postnatal adaptation to extrauterine conditions. To which "new" physiological growth trajectory preterm infants should adjust to after completed postnatal adaptation is unknown. This study analyzes the postnatal growth trajectories of healthy preterm infants using prospective criteria defining minimal support, as a model for physiological adaptation. Methods: International, multi-center, longitudinal, observational study at five neonatal intensive care units (NICUs). Daily weights until day of life (DoL) 21 of infants with undisturbed postnatal adaptation were analyzed (gestational ages: (i) 25-29 wk, (ii) 30-34 wk). results: 981 out of 3,703 admitted infants included. Maximum weight loss was 11% (i) and 7% (ii) by DoL 5, birth weight regained by DoL 15 (i) and 13 (ii). Infants transitioned to growth trajectories parallel to Fenton chart percentiles, 0.8 z-scores below their birth percentiles. The new trajectory after completed postnatal adaptation could be predicted for DoL 21 with R 2 = 0.96. conclusion: This study provides a robust estimate for physiological growth trajectories of infants after undisturbed postnatal adaptation. In the future, the concept of a target postnatal trajectory during NICU care may be useful. i mproved survival rates of very-low-birth-weight (<1,500 g birth weight) infants have shifted the focus of neonatal care onto improving postnatal growth and nutrition, aiming to achieve growth rates that optimize later health outcomes (1). Pediatric societies in North America and Europe have recommended that postnatal growth of preterm infants match the in utero growth rates of fetuses that remain in utero until full-term (2-4). These recommendations gain importance in light of the Developmental Origins of Health and Disease (DOHaD) hypothesis (5). The DOHaD concept suggests that suboptimal growth of a fetus or a newborn infant can impact the early onset of adult metabolic and cardiovascular diseases. In utero, the growth rate of an individual fetus is determined by its genetic potential and modified by "environmental" factors such as maternal nutrition, body composition, pathologies, or altitude above sea level. After birth, growth patterns of preterm infants are under external control by neonatal staff who modify the infants' nutrient intake. Figure 1 shows three hypothetical postnatal trajectories for a given preterm infant (27 wk of gestation, birth weight 1,000 g). It is of interest to note that these trajectories have similar slopes and hence not dramatically different growth rates. However, postnatal adjustment to different percentiles during the phase of stable growth will lead to different body compositions-potentially affecting later health outcomes.The current evidence for optimal postnatal growth trajectories is scarce....

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confidence: 99%

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

et al. 2016

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“…This allows adequate protein synthesis to support body growth, including bone, using the intrauterine rate as a reference. However, body weight reflects body mass, which includes fat mass and a high proportion of water, especially in preterm neonates (2).…”

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confidence: 99%

Parenteral phosphate and amino acids supply effect on the growth of extremely preterm infants: accurate measurements and optimized statistical analysis are important

2015

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“…At least 25 reference charts of this type are available (15). One of their disadvantages is the fact that the preterm infant usually is smaller than the healthy reference not exposed to the extrauterine environment (16,17,18). Furthermore, after preterm birth, weight gain and longitudinal growth are more intense close to term (37-40 weeks), whereas weight and length gain are already decreasing at the end of a normal full-term gestation (19).…”

Section: Preterm Growth Chartsmentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Growth and growth hormone therapy in short children born preterm

Boguszewski

Cardoso-Demartini

2017

European Journal of Endocrinology

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Approximately 15 million babies are born preterm across the world every year, with less than 37 completed weeks of gestation. Survival rates increased during the last decades with the improvement of neonatal care. With premature birth, babies are deprived of the intense intrauterine growth phase, and postnatal growth failure might occur. Some children born prematurely will remain short at later ages and adult life. The risk of short stature increases if the child is also born small for gestational age. In this review, the effects of being born preterm on childhood growth and adult height and the hormonal abnormalities possibly associated with growth restriction are discussed, followed by a review of current information on growth hormone treatment for those who remain with short stature during infancy and childhood.

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Is intrauterine growth appropriate to monitor postnatal growth of preterm neonates?

Cited by 21 publications

References 20 publications

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

Parenteral phosphate and amino acids supply effect on the growth of extremely preterm infants: accurate measurements and optimized statistical analysis are important

MANAGEMENT OF ENDOCRINE DISEASE: Growth and growth hormone therapy in short children born preterm

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