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      Extrauterine Growth Restriction: Need for an Accurate Definition

      research-article
      Author(s): 1 , 2 , 3 , 4 , 5 , 6 , 7
      Publication date (Electronic):
      Journal: Newborn (Clarksville, Md.)
      Keywords: Body fat mass, Cohort of Indonesian PreTerm infants for long-term Outcomes study, Corrected gestational age, Delta-Z, Demographic factors, Extra-uterine growth restriction, Failure to thrive, Fenton growth chart, Genetic make-up, growth charts, Infant growth, Intra-uterine growth restriction, Intergrowth 21st charts, Infant feeding, Linear growth velocity, Maternal metabolism, Maternal and paternal anthropometrics, Medications, Newborn, Neonate, Neurodevelopmental outcomes, Neonatal morbidities, Placental health, Postnatal growth restriction, Postnatal malnutrition, Pre-conceptional nutritional status, Postnatal morbidities, Postnatal growth, Small for gestation, Term corrected age, Total caloric intake, Total metabolic activity, Weight gain velocity, Z-scores

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          Abstract

          Neonates show considerable variation in growth that can be recognized through serial measurements of basic variables such as weight, length, and head circumference. If possible, measurement of subcutaneous and total body fat mass can also be useful. These biometric measurements at birth may be influenced by demographics, maternal and paternal anthropometrics, maternal metabolism, preconceptional nutritional status, and placental health. Subsequent growth may depend on optimal feeding, total caloric intake, total metabolic activity, genetic makeup, postnatal morbidities, medications, and environmental conditions. For premature infants, these factors become even more important; poor in utero growth can be an important reason for spontaneous or induced preterm delivery. Later, many infants who have had intrauterine growth restriction (IUGR) and are born small for gestational age (SGA) continue to show suboptimal growth below the 10th percentile, a condition that has been defined as extrauterine growth restriction (EUGR) or postnatal growth restriction (PNGR). More importantly, a subset of these growth-restricted infants may also be at high risk of abnormal neurodevelopmental outcomes. There is a need for well-defined criteria to recognize EUGR/PNGR, so that correctional steps can be instituted in a timely fashion.

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          A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

          Tanis R Fenton, Jae Kim (2013)
          Background The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring. Methods Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated. Results Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks. Conclusions The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.
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            Effect of DHA supplementation during pregnancy on maternal depression and neurodevelopment of young children: a randomized controlled trial.

            Maria Makrides, Robert A. Gibson, Andrew J. Mcphee … (2010)
            Uncertainty about the benefits of dietary docosahexaenoic acid (DHA) for pregnant women and their children exists, despite international recommendations that pregnant women increase their DHA intakes. To determine whether increasing DHA during the last half of pregnancy will result in fewer women with high levels of depressive symptoms and enhance the neurodevelopmental outcome of their children. A double-blind, multicenter, randomized controlled trial (DHA to Optimize Mother Infant Outcome [DOMInO] trial) in 5 Australian maternity hospitals of 2399 women who were less than 21 weeks' gestation with singleton pregnancies and who were recruited between October 31, 2005, and January 11, 2008. Follow-up of children (n = 726) was completed December 16, 2009. Docosahexaenoic acid-rich fish oil capsules (providing 800 mg/d of DHA) or matched vegetable oil capsules without DHA from study entry to birth. High levels of depressive symptoms in mothers as indicated by a score of more than 12 on the Edinburgh Postnatal Depression Scale at 6 weeks or 6 months postpartum. Cognitive and language development in children as assessed by the Bayley Scales of Infant and Toddler Development, Third Edition, at 18 months. Of 2399 women enrolled, 96.7% completed the trial. The percentage of women with high levels of depressive symptoms during the first 6 months postpartum did not differ between the DHA and control groups (9.67% vs 11.19%; adjusted relative risk, 0.85; 95% confidence interval [CI], 0.70-1.02; P = .09). Mean cognitive composite scores (adjusted mean difference, 0.01; 95% CI, -1.36 to 1.37; P = .99) and mean language composite scores (adjusted mean difference, -1.42; 95% CI, -3.07 to 0.22; P = .09) of children in the DHA group did not differ from children in the control group. The use of DHA-rich fish oil capsules compared with vegetable oil capsules during pregnancy did not result in lower levels of postpartum depression in mothers or improved cognitive and language development in their offspring during early childhood. anzctr.org.au Identifier: ACTRN12605000569606.
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              Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants.

              Betty R. Vohr, Alastair Poole, Lisa Wrage … (2006)
              The objectives of this study were to assess whether (1) in-hospital growth velocity is predictive of neurodevelopmental and growth outcomes at 18 to 22 months' corrected age among extremely low birth weight (ELBW) infants and (2) in-hospital growth velocity contributes to these outcomes after controlling for confounding demographic and clinical variables. Infants 501 to 1000 g birth weight from a multicenter cohort study were divided into quartiles of in-hospital growth velocity rates. Variables considered for the logistic-regression models included gender, race, gestational age, small for gestational age, mother's education, severe intraventricular hemorrhage, periventricular leukomalacia, age at regaining birth weight, necrotizing enterocolitis, late-onset infection, bronchopulmonary dysplasia, postnatal steroid therapy for pulmonary disease, and center. Of the 600 discharged infants, 495 (83%) were evaluated at 18 to 22 months' corrected age. As the rate of weight gain increased between quartile 1 and quartile 4, from 12.0 to 21.2 g/kg per day, the incidence of cerebral palsy, Bayley II Mental Developmental Index (MDI) <70 and Psychomotor Developmental Index (PDI) <70, abnormal neurologic examination, neurodevelopmental impairment, and need for rehospitalization fell significantly. Similar findings were observed as the rate of head circumference growth increased. The in-hospital rate of growth was associated with the likelihood of anthropometric measurements at 18 months' corrected age below the 10th percentile values of the Centers for Disease Control and Prevention 2000 growth curve. Logistic-regression analyses, controlling for potential demographic or clinical cofounders, and adjusted for center, identified a significant relationship between growth velocity and the likelihood of cerebral palsy, MDI and PDI scores of <70, and neurodevelopmental impairment. These analyses suggest that growth velocity during an ELBW infant's NICU hospitalization exerts a significant, and possibly independent, effect on neurodevelopmental and growth outcomes at 18 to 22 months' corrected age.
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                Author and article information

                Journal
                Journal ID (nlm-journal-id): 9918418384706676
                Journal ID (pubmed-jr-id): 51742
                Journal ID (nlm-ta): Newborn (Clarksville)
                Journal ID (iso-abbrev): Newborn (Clarksville)
                Title: Newborn (Clarksville, Md.)
                ISSN (Electronic): 2769-514X
                Publication date Nihms-submitted: 14 October 2023
                Publication date (Print): Jul-Sep 2023
                Publication date (Electronic): 25 September 2023
                Publication date PMC-release: 15 November 2023
                Volume: 2
                Issue: 3
                Pages: 198-202
                Affiliations
                [1 ]Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
                [2 ]Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India; Global Newborn Society, Maryland, United States of America
                [3 ]Department of Neonatology, Johns Hopkins All Children’s Maternal, Fetal, and Neonatal Institute, St. Petersburg, Florida, United States of America
                [4 ]Department of Pediatrics, Azərbaycan Tibb Universiteti, Baku, Azerbaijan; Global Newborn Society, Maryland, United States of America
                [5 ]Department of Neonatology, Institute of Child and Mother Health, Dhaka, Bangladesh
                [6 ]Paediatric Research Institute, Oslo, Norway
                [7 ]Department of Neonatology and Pediatrics, Louisiana State University Health Sciences Center – Shreveport, Louisiana, United States of America
                Author notes
                Corresponding Author: Nitasha Bagga, Department of Neonatology, Rainbow Children’s Hospital, Hyderabad, Telangana, India, Phone: +91 90007 64206, nitashabagga@ 123456gmail.com
                Author information
                http://orcid.org/0000-0003-4316-0517
                http://orcid.org/0000-0003-3613-4054
                Article
                Manuscript ID: NIHMS1935672
                DOI: 10.5005/jp-journals-11002-0072
                PMC ID: 10653204
                PubMed ID: 37974930
                SO-VID: ab4a88a6-475f-42f6-a6f2-603b862b2efa
                License:

                This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                Keywords: body fat mass,cohort of indonesian preterm infants for long-term outcomes study,corrected gestational age,delta-z,demographic factors,extra-uterine growth restriction,failure to thrive,fenton growth chart,genetic make-up,growth charts,infant growth,intra-uterine growth restriction,intergrowth 21st charts,infant feeding,linear growth velocity,maternal metabolism,maternal and paternal anthropometrics,medications,newborn,neonate,neurodevelopmental outcomes,neonatal morbidities,placental health,postnatal growth restriction,postnatal malnutrition,pre-conceptional nutritional status,postnatal morbidities,postnatal growth,small for gestation,term corrected age,total caloric intake,total metabolic activity,weight gain velocity,z-scores
                Data availability:
                Keywords: body fat mass, cohort of indonesian preterm infants for long-term outcomes study, corrected gestational age, delta-z, demographic factors, extra-uterine growth restriction, failure to thrive, fenton growth chart, genetic make-up, growth charts, infant growth, intra-uterine growth restriction, intergrowth 21st charts, infant feeding, linear growth velocity, maternal metabolism, maternal and paternal anthropometrics, medications, newborn, neonate, neurodevelopmental outcomes, neonatal morbidities, placental health, postnatal growth restriction, postnatal malnutrition, pre-conceptional nutritional status, postnatal morbidities, postnatal growth, small for gestation, term corrected age, total caloric intake, total metabolic activity, weight gain velocity, z-scores

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