Risk factors of extrauterine growth restriction in very preterm infants with bronchopulmonary dysplasia: a multi-center study in China

Abstract

Objective Nutritional deficiency soon after birth is a risk factor of chronic lung disease (bronchopulmonary dysplasia, BPD). Afflicted infants are further prone to inadequate growth during hospitalization (extrauterine growth restriction, EUGR). This multi-center retrospective study investigated risk factors of EUGR, specifically in very preterm infants with BPD. Method Data of infants with BPD who were born less than 32 weeks gestation (n = 1010) were collected from 7 regions of China. All infants were non-small for gestational age at birth. Infants were characterized as EUGR or non-EUGR at 36 weeks gestation or discharge, or stratified by gestational age or birthweight. Logistic regression analysis was applied. Results In 65.5% of the population, the BPD was mild. Infants with severe BPD (8.3%) had the highest rate of EUGR (72.6%, P < 0.001). Groups stratified by gestational age did not differ in rates of EUGR, but the birthweight of the EUGR group was significantly lower than that of the non-EUGR (P < 0.001). Birthweights of < 1000, 1000–1499, and ≥ 1500 g showed EUGR rates of 65.9%, 43.4%, and 23.8%, respectively (P < 0.001). Overall, the independent risk factors of EUGR were: moderate-to-severe BPD, gestational hypertension, cesarean section, cumulative fasting time, time required to achieve 110 kcal/kg/d, and hemodynamically significant patent ductus arteriosus (hsPDA). Conclusion In very preterm infants with BPD, the lower the birthweight or the more severe the BPD, the greater the risk of EUGR. In those with hsPDA, or moderate-to-severe BPD, it is especially important to prevent EUGR through perinatal management, enteral nutrition, and nutritional strategies.

Comparative effectiveness of explainable machine learning approaches for extrauterine growth restriction classification in preterm infants using longitudinal data

“…Therefore, these factors’ high SHAP values emphasize their importance in predicting growth outcomes. In the weight baseline dataset, GA displayed a positive correlation, suggesting that lower gestational age at birth, a common risk factor for EUGR, is linked with growth restriction ( 78 , 79 ). However, in the weight follow-up dataset, GA was negatively correlated.…”

Comparison of two novel diagnostic criteria for bronchopulmonary dysplasia in predicting adverse outcomes of preterm infants: a retrospective cohort study

“…Infants with BPD require increased energy to support their respiratory muscle workload, however, fluid restriction may result in inadequate energy intake leading to EUGR, which can impede lung and pulmonary vessel development and repair. The risk of EUGR is positively associated with the severity of BPD in preterm infants [ 20 ]. Our study revealed that EUGR at 36 weeks’ PMA was associated with poor long-term prognosis, emphasizing the importance of strengthening perinatal and enteral nutrition management after birth to prevent long-term adverse outcomes.…”

Bronchopulmonary dysplasia: preventive measures and therapeutic approach until discharge from the neonatal unit

“…Infants with early or developing BPD should be fed with human milk, preferably with fortified fresh maternal milk 68 . Ideally, infants with BPD should receive a fluid intake of no more than 135-150 ml/kg/day and an energy intake of 120-150 kcal/kg/day 96,97 . Providing high energy in a low volume remains a challenge and is the main cause of growth restriction in these infants.…”

“…Specialized nutritional strategies may be needed to overcome difficulties that are common in BPD infants, such as gastroesophageal reflux and poorly coordinated feeding 96 . Table 4 summarizes a practical nutritional approach to use in infants at risk of, or with, BPD 96,97 .…”

“…Enteral water-soluble vitamin A (5000 IU/day) started within 24 hours of introducing feeds and continued until 34 weeks' postmenstrual age improved plasma retinol Table 4. Nutritional approach in infants at risk of, or with, established BPD 96,97 Preventive nutritional approach in infants at high risk of BPD…”