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Extrauterine growth restriction(EUGR), caused by perinatal diseases, neonatal morbidities and inadequate nutrition, refers to preterm growth failure in which an anthropometric measure is below the target according to growth charts at a certain point of time after birth.EUGR is prevalent among very preterm and very low birth weight infants, potentially causing the impairment on physical growth, neurodevelopment and cardiometabolic system.Nowadays, many researchers challenge the definition of EUGR and raise arguments about the optimal growth pattern, the growth assessment tools and nutrition strategies of preterm newborns.This article reviews the research progress on extrauterine growth restriction in preterm infants.
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Objective:To monitor and investigate the long-term growth trend and nutritional status of very preterm infants (VPIs, born at gestational age between [28~31 +] weeks) with extrauterine growth restriction (EUGR) from birth to preschool period. Methods:VPIs who met with the following criteria were enrolled: infants born in Huai'an Maternity and Child Heath Care Hospital from January 1 to December 31, 2015; infants admitted to the Neonatal Medical Center and discharged alive; infants who received multi-disciplinary treatment in Child Care Division from discharge to preschool period. All of the VPIs were divided into the EUGR group and the non-EUGR group according to whether the weight at hospital discharge was below the 10 th percentile for corrected age in body weight. The weight for age Z score (WAZ), height for age Z score (HAZ), and head circumference for age Z score (HCZ) were calculated at each specified time point (at 40 weeks of age; at 1, 2, 3, 4, 5, 6 and 24 months of corrected age; and at 48 months of age). The growth trend and the nutritional status at 48 months of age were compared between the two groups. Results:1. A total of 53 VPIs were enrolled, among whom 35 cases were boys and 20 cases were with EUGR. The differences in the gestational age, birth weight, incidence of very low birth weight infants, neonatal respiratory distress syndrome (NRDS) and bronchopulmonary dysplasia (BPD) were all statistically significant between the EUGR group and the control group ( x 2= 2.306, 3.543, 10.852, 9.515, 0.001, respectively; all P<0.05). 2. The WAZ and HAZ of the EUGR group were lower at each time point. The WAZ at 40 weeks of age and the HAZ at 3 months of corrected age were significantly different between the two groups. From 40 weeks of age to 2 months of corrected age and from 6 months to 24 months of corrected age, the WAZ, HAZ and HCZ in both groups showed an increasing trend. However, the WAZ in the EUGR group and the WAZ, HAZ and HCZ in the non-EUGR group showed a declining trend from 24 months of corrected age to 48 months of age. 3. There was no significant differences in growth restriction incidence at each time point between the EUGR group and the control group. 4. The nutritional status showed no significant difference between the two groups, either ( P>0.05). Conclusions:Low gestational age, low birth weight, NRDS and BPD are the risk factors of EUGR. The growth trend of the EUGR VPIs shows an overall upward trend from hospital discharge to 24 months of corrected age but declined thereafter, while the nutritional status is good at 48 months of age. Thus, in addition to the integrated management, continuous monitoring of long-term growth and nutrient input after 24 months of age is required for VPIs.
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Extremely low birth weight infants with nutrition deficiency always suffer complication of extrauterine growth restriction(EUGR).EUGR is a risk factor for growth of the nervous system,cardiovascular system,lung,gastrointestinal tract and other organs.At present,there are still some difficulties in the clinical management,such as how to balance the contradiction between parenteral nutrition and metabolic syndrom,and how to provide the essential nutrients.Great efforts are still needed to establish appropriate nutrition management.
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Extrauterine growth restriction (EUGR) in premature infant is a common problem in the world. The reasons for high EUGR rate, such as declining gestational age and birth weight, getting more medical treatment and examination or interruption of nutritional support, had been profoundly studied. However, there are few reports about the limited ability of intakes of energy and various nutrients and the updating of the growth standard curve . Research suggested that the average time taken to reach the recommended fat intake in preterm infants is proximately day 6 after birth, protein day 4 after birth, carbohydrate one-week after birth. Vitamins and trace elements are usually not able to or take a long time to reach the recommended nutrient intake. Without enough intake of energy and nutrients to maintain the need of intrauterine growth rate and catch-up growth in preterm infants, EUGR cannot be improved. In this paper, the EUGR and the intake of important nutrients, such as energy, fat, protein, vitamins and minerals, etc., during hospitalization were reviewed in hope to achieve more rational and standardized management for preterm infant,and provide more reasonable advise to control EUGR.
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Objective To understand variation of weight for age Z scores in premature infants with extrauterine growth restriction(EUGR).Methods Retrospective analysis was adopted with the data of very -low -gestational age (VLGA)preterm infants who met with the following criteria:admitted to Neonatal Medical Center of Huai′an Maternity and Child Healthcare Hospital from January 201 1 to December 201 3,gestational age <32 weeks,more than 4 weeks of hospital stay and survived when discharged.All VLGA premature infants were divided into non -EUGR group and EUGR group according to whether the standard weight on hospital discharge was below the 1 0th percentile of body weight at corrected age.The weight for age Z scores of preterm infants were calculated at each time point.The differences and trends between 2 groups were compared.The receiver operating characteristic (ROC)curve in diagnosing EUGR by weight for age Z scores was drawn.Results A total of 1 77 VLGA premature infants were enrolled,and among them there were was 1 04 cases of EUGR and the incidence amounted to 58.8%.The weight for age Z scores curve of EUGR group was under that of all preterm infants,and the curve of non -EUGR group was above that of all preterm infants. The weight for age Z scores of all preterm infants and EUGR group showed overall downward trend along with prolonged hospitalization.However,the weight for age Z scores of non -EUGR group did not change significantly at each week point except for the first week.The weight for age Z scores of EUGR group was lower than that of non -EUGR group at birth (-0.84 ±0.39 vs -0.31 ±0.41 ),the first week after birth (-1 .1 9 ±0.36 vs -0.74 ±0.40),the second week after birth (-1 .1 7 ±0.36 vs -0.68 ±0.40),the third week after birth (-1 .23 ±0.34 vs -0.64 ±0.39),the fourth week after birth (-1 .35 ±0.41 vs -0.65 ±0.42),the fifth week after birth (-1 .45 ±0.41 vs -0.56 ± 0.38),the sixth week (-1 .54 ±0.49 vs -0.70 ±0.36)and on discharge time (-1 .72 ±0.38 vs -0.67 ±0.42). The difference at each week point was statistically significant (all P =0.000).The weight for age Z scores on discharge were negatively correlated with start time of enteral feeding in preterm infants (r =-0.271 ,P <0.05),time of paren-teral nutrition up to 41 8 kJ/(kg·d)(r =-0.388,P <0.05),time of full enteral feeding (r =-0.332,P <0.05),a-mino cumulative dose (r =-0.298,P <0.05)and fat milk cumulative dose (r =-2.221 ,P <0.05).Area under the curve at each week point of the weight for age Z scores predicting the EUGR gradually increased along with prolonged hospitalization.There was a statistical significance in the weight for age Z scores value at each week point on the diagno-sis of EUGR(P =0.000).There was a high sensitivity and specificity at each week point.Conclusions Dynamic mo-nitoring weight of age Z scores of the premature infants can show the nutrition and growth trend,and may be a risk warning of the preterm infants suffering from EUGR.
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PURPOSE: To identify the effects of modified parenteral nutrition (PN) and enteral nutrition (EN) regimens on the growth of very low birth weight (VLBW) infants. METHODS: The study included VLBW infants weighing <1,500 g, admitted to Chungnam National University Hospital between October 2010 and April 2014, who were alive at the time of discharge. Subjects were divided according to 3 periods: period 1 (n=37); prior to the PN and EN regimen being modified, period 2 (n=50); following the PN-only regimen modification, period 3 (n=37); following both PN and EN regimen modification. The modified PN regimen provided 3 g/kg/day of protein and 1 g/kg/day of lipid on the first day of life. The modified EN regimen provided 3.5-4.5 g/kg/day of protein and 150 kcal/kg/day of energy. We investigated growth rate, anthropometric measurements at 40 weeks postconceptional age (PCA) and the incidence of extrauterine growth restriction (EUGR) at 40 weeks PCA. RESULTS: Across the 3 periods, clinical characteristics, including gestational age, anthropometric measurements at birth, multiple births, sex, Apgar score, surfactant use and PDA treatment, were similar. Growth rates for weight and height, from time of full enteral feeding to 40 weeks PCA, were higher in period 3. Anthropometric measurements at 40 weeks PCA were greatest in period 3. Incidence of weight, height and head circumference EUGR at 40 weeks PCA decreased in period 3. CONCLUSION: Beginning PN earlier, with a greater supply of protein and energy during PN and EN, is advantageous for postnatal growth in VLBW infants.
Subject(s)
Humans , Infant , Apgar Score , Enteral Nutrition , Gestational Age , Head , Incidence , Infant, Very Low Birth Weight , Multiple Birth Offspring , Parenteral Nutrition , Parturition , Passive Cutaneous AnaphylaxisABSTRACT
Objective To observe changes of the nitrogen balance in premature infants with extrauterine growth restriction (EUGR) during hospitalization.Methods We selected a total of 64 very preterm (VP) infants admitted to Neonatal Medical Center of Huai'an Maternity and Child Healthcare Hospital affiliated to School of Medicine, Yangzhou University within 24 hours after birth and with gestational age ＜ 32 weeks from May to October 2014, and divided them into EUGR group (n =18) and non-EUGR group (n =46) according to the diagnostic criteria of EUGR.All of the infants' urea nitrogen levels were detected by Kjeldahl method on the 1st, 7th, 14th, and 28th days after birth, and nitrogen balance scores were calculated and compared between the EUGR and non-EUGR groups.Results Nitrogen balance scores of the two groups were all negative on the 1 st, 7th, 14th, and 28th days after birth, with a tendency rising with days.A significant difference was showed in the intra-group comparison in EUGR group on the 1st, 7th, 14th, and 28th days after birth (-492.66 ±204.39,-290.79 ± 173.78,-205.96 ± 180.59, and-145.14 ± 140.15, respectively, F =53.086, P =0.000), so was in the non-EUGR group (-383.41 ± 130.57,-278.91 ±225.80,-182.00 ± 144.70, and-61.08 ±49.71, respectively, F =41.745, P =0.000).At each observation time point after death, the nitrogen balance score in the EUGR group was lower than in the non-EUGR group, and the differences on the 1st and 28th days were statistically significant (both P ＜ 0.05);while those on the other time points were not statistically significant (both P ＞ 0.05).Conclusion The VP infants are at a negative nitrogen balance during hospitalization, among whom the EUGR premature infants may be more serious.
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Objective To assess the incidences of intrauterine growth restriction (IUGR) and extrauterine growth restriction(EUGR) in premature infants with respiratory distress syndrome (RDS) and early nutritional efficiency on EUGR.Methods Data of 70 infants with RDS admitted in neonatal intensive care unit were reviewed.According to the weight when a premature infant was discharged,all subjects were divided into EUGR group(48 cases) and non-EUGR group(22 cases).The difference of two groups in terms of basic situation,peripartum factors,nutritional support,treatment measures and complications were compared.Results Assessing by weight,the incidence of IUGR and EUGR was 12.86％ (9/70)and 60.00％ (42/70)respectively.The differences in birth weight [(1 666.10 ±440.16) g vs (2 108.20 ±552.81) g],head circumference at birth [(28.81 ± 2.65) cm vs (30.48 ± 2.39) cm],IUGR,multiple pregnancy (16 cases vs 3 cases),cesarean delivery (29 cases vs 7 cases) were considered statistically significant (P ＜ 0.05),and there were no stastitically significant difference in gestational age,nutritional support,mechanical ventilation and complications (P ＞ 0.05).Conclusion The EUGR is related with IUGR,multiple pregnancy,cesarean delivery,low birthweight,low birth head circumference.The short time nutrition interventions can't improve EUGR in RDS.
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PURPOSE: Extrauterine growth restriction (EUGR) in preterm infants is a major problem in neonatal intensive care units (NICUs) and it has been related to long-term growth deficit and neurodevelopmental issues. The aim of this study was to investigate the frequency of and risk factors for EUGR. METHODS: The study subjects consisted of very low birth weight (VLBW) infants with a gestational age < or =32 weeks that were born at the Seoul National University Children's Hospital between November 2005 and April 2009. EUGR was defined as weight for gestation, lower than the 10th percentile on discharge. RESULTS: The frequency of EUGR was 67% (n=111/166). By multiple logistic regression, the presence of small for gestational age (SGA) was the greatest predictor of EUGR, birth weight and daily weight gain during the first 28 days were independent predictors of EUGR. Risk factors for EUGR in non-SGA infants were evaluated because 56% (64/114) of non-SGA infants developed EUGR at discharge. Daily weight gain in the first 28 days was also decreased in EUGR group and independently predicted the risk of EUGR in the non-SGA group. CONCLUSION: EUGR was a common problem in the NICU. SGA was the most significant predictive factor of the EUGR. Half of the non-SGA infants also developed EUGR, revealing poor weight gain in the early days was as an important predictor. These results support the importance of early nutritional intervention for weight gain which have lagged behind other modern therapeutic interventions when the infant is clinically unstable.
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Humans , Infant , Infant, Newborn , Pregnancy , Birth Weight , Gestational Age , Infant, Premature , Infant, Very Low Birth Weight , Intensive Care Units, Neonatal , Logistic Models , Risk Factors , Weight GainABSTRACT
As the number of survivors of extremely preterm infants increases, the study of their growth and development are now becoming a priority issue of neonatal intensive care. However, maintaining water and electrolyte balance and providing the optimal nutrition for growth and development in these infants are still challenging in modern neonatal intensive care. It is essential to define the risks and benefits of current fluid/electrolyte management and early parenteral and enteral nutrition in micropremies for better outcome. Neonatal clinicians should recognize the barriers and obstacles to the implementation of these recommendations.
Subject(s)
Humans , Infant , Infant, Newborn , Enteral Nutrition , Fluid Therapy , Growth and Development , Infant, Extremely Premature , Intensive Care, Neonatal , Risk Assessment , Survivors , Water-Electrolyte BalanceABSTRACT
Objective To study the nutrition status of premature infants in the early postnatal stage.Methods According to the physical development standard,the premature neonates for treatment in our NICU from Jun.2007 to Jun.2009 were enrolled and divided into normal growth group and extrauterine growth restriction(EUGR) group.The nutrition status of these premature neonates were evaluated respectively.SPSS 13.0 software was used to analyze the data.Results Compared with EUGR group,the durations of regaining birth weight were shorter in normal growth group(t=-13.83,P0.05).Conclusions Premature neonates are prone to encounter extrauterine growth retardation.Extrauterine growth retardation had great impact on premature neonates.Premature neonates should be strengthened with nutrition supplement in order to reduce the incidence of extrauterine growth retardation.