Extrauterine growth restriction: Universal problem among premature infants
Keywords:
Growth and development, Infant, premature, MalnutritionAbstract
Objective
To analyze the growth rate of premature infants in the first weeks of life and factors associated with extrauterine growth restriction.
Methods
This is a cross-sectional study of 254 premature infants in a neonatal intensive care unit conducted from January 1, 2008 to December 31, 2010. Infants who died or had malformations incompatible with life were excluded. Median weight curves according to gestational age were constructed for the first four weeks of life. The Fenton growth chart calculations provided the weight Z-scores. Extrauterine growth restriction was defined as corrected weight-for-age Z-score ≤-2. Perinatal, morbidity, and health care variables were analyzed. The Poisson regression model yielded the prevalence ratios. Associations between extrauterine growth restriction and the perinatal, morbidity, and care variables were investigated. Poisson regression controlled possible
confounding factors.
Results
The frequency of extrauterine growth restriction was 24.0%. Most (85.0%) small-for-gestational-age infants developed extrauterine growth restriction; 55.3% of extrauterine growth restriction cases involved small-forgestational-age infants. Premature infants with gestational age >32 weeks did not recover the median birth weight until the third week of life and had a higher frequency of small-for-gestational-age. The Z-scores ofnon-small-for-gestational-age infants decreased more after birth than those of small-for-gestational-age infants. extrauterine growth restriction was associated with small-for-gestational-age (PR=6.14; 95%CI=3.33-11.33;
p<0.001) and time without enteral diet (PR=1.08; 95%CI=1.04-1.13; p=0.010).
Conclusion
Extrauterine growth restriction occurs in premature infants of all gestational age. The participation of small-forgestational-age and nutritional practices in its genesis is noteworthy. We suggest prospective studies of all premature infants. The implementation of best care practices, individualized for small-for-gestational-age infants, to improve nutrient supply can minimize the problem.
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Copyright (c) 2023 Brunnella Alcantara Chagas de FREITAS, Silvia Eloiza PRIORE, Luciana Moreira LIMA, Sylvia do Carmo Castro FRANCESCHINI
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