Variables associated with extra uterine growth restriction in very low birth weight infants

Lima, Paola Azara Tabicas; de Carvalho, Manoel; Costa, Ana Carolina Carioca da; Moreira, Maria Elisabeth Lopes

doi:10.1016/j.jpedp.2013.05.007

Article information

Abstract

Objectives

To determine the rate of extrauterine growth restriction in very low birth weight infants and to evaluate the influence of perinatal variables, clinical practices, and neonatal morbidities on this outcome.

Methods

A longitudinal study was performed in four neonatal units in the city of Rio de Janeiro. 570 very low birth weight infants were analyzed. The study included perinatal variables, variables related to clinical practices, and incident morbidities in these preterm infants. Extrauterine growth restriction was defined using z-scores for weight or head circumference ≤ −2 for cor-rected age. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) and R software.

Results

This study comprised 570 infants, of which 49% were males, and 33% were small for gestational age (SGA). The mean weight and head circumference at birth were 1,113± 267g and 27 ± 2cm, respectively. The mean z-scores of birth weight and weight at discharge were −0.96± 0.78 and −1.54 ± 0.75, respectively; for head circumference, the mean z-scores at birth and at discharge were −0.63 ± 1.18 and −0.45 ± 0.94, respectively. The rate of extrauterine growth restriction considering the weight was 26% (149/570) and considering the head circumference, 5% (29/570). SGA was the variable with the greatest impact on both growth restriction for weight (PR = 4.33) and for head circumference (PR = 2.11) in adjusted analyses.

Conclusion

Extrauterine growth restriction was high in the population, especially for SGA newborns and those with neonatal morbidities

Keywords:

Premature

Growth

Malnutrition

Resumo

Objetivos: Determinar a frequência da restrição de crescimento extrauterino em recém- nascidos prétermos de muito baixo peso e avaliar o impacto de variáveis perinatais, práticas clínicas e morbidades neonatais nesta morbidade.

Materiais e métodos: Foi realizado um estudo longitudinal em 4 unidades neonatais do Rio de Janeiro. Foram analisados 570 recém-nascidos pré-termos de muito baixo peso. Foram incluídas no estudo variáveis perinatais, variáveis relacionadas às práticas clínicas e morbidades incidentes nestes recém-nascidos. A restrição de crescimento extrauterino foi definida pelos escores z de peso ou perímetro cefálico ≤ −2 para idade corrigida. Na análise estatística foram utilizados o software SPSS e o software R.

Resultados: Foram analisados 570 recém-nascidos dos quais 49% eram do sexo masculino e 33% nasceram pequenos para idade gestacional. A média do peso e perímetro cefálico ao nascimento foi respectivamente 1113 ± 267g e 27 ± 2cm. As médias de escore z do peso ao nascimento e na alta foram respectivamente, −0,96 ± 0,78 e −1,54 ± 0,75 e as do perímetro cefálico foram −0,63± 1,18 e −0,45 ± 0,94. A frequência de restrição de crescimento extrauterino considerando o peso foi 26% do perímetro cefálico foi de 5%. Nascer pequeno para idade gestacional foi a variável de maior impacto na restrição de crescimento tanto para o peso (RP 4,33) quanto parao perímetro cefálico (RP 2,11) nas analises ajustadas.

Conclusão: A restrição de crescimento extrauterino foi alta na população, especialmente para os recém-nascidos PIG e com morbidades neonatais.

Palavras-chave:

Pematuro

Crescimento

Desnutrição

Full text is only aviable in PDF

Referências

[1]

R.S. Procianoy, R. Guinsburg.

Avanços no manejo do recém- nascido prematuro extremo.

J Pediatr (Rio J)., 81 (2005), pp. S1-S2

[2]

American Academy of Pediatrics Committee on Nutrition: nutritional needs of low-birth-weight infants. Pediatrics. 1985;75:976-86.

[3]

Freitas BA, Sant’Ana SE, Barros JF, Fraceschini SC. Crescimento do prematuro: revisão sobre as curvas de referência. Revista de Pediatria SOPERJ.;1; 2012;13:4-15.

[4]

L. Sices, D. Wilson-Costello, N. Minich, H. Friedman, M. Hack.

Postdischarge growth failure among extremely low birth weight infants: correlates and consequences.

Paediatr Child Health., 12 (2007), pp. 22-28

Medline

[5]

R.H. Clark, P. Thomas, J. Peabody.

Extrauterine growth restriction remains a serious problem in prematurely born neonates.

Pediatrics., 11 (2003), pp. 986-990

[6]

A.M. Dusick, B.B. Poindexter, R.A. Ehrenkranz, J.A. Lemons.

Growth failure in the preterm infant: can we catch up?.

Semin Perinatol., 27 (2003), pp. 302-310

Medline

[7]

D.J. Barker, P.D. Winter, C. Osmod, B. Margetts, S.J. Simmonds.

Weight in infancy and death from ischaemic heart disease.

Lancet., 2 (1989), pp. 577-580

Medline

[8]

A. Lucas.

Role of nutritional programming in determining adult morbidity.

Arch Dis Child., 71 (1994), pp. 288-290

Medline

[9]

A. Lucas.

Long-term programming effects of early nutrition – implications for the preterm infant.

J Perinatol., 25 (2005), pp. S2-S6

http://dx.doi.org/10.1038/sj.jp.7211308 | Medline

[10]

R.J. Cooke, S.B. Ainsworth, A.C. Fenton.

Postnatal growth retardation: a universal problem in preterm infants.

Arch Dis Child Fetal Neonatal Ed., 89 (2004), pp. F428-F430

http://dx.doi.org/10.1136/adc.2001.004044 | Medline

[11]

Vermont Oxford Network Database [Internet]. Manual of operations for infants born in 2010. Release 14.0. November, 2009 [acessado em 3 Mar 2012]. Disponível em: http://www. vtoxford.org.

[12]

T.R. Fenton.

A new growth chart for preterm babies: Babson and Benda's chart update with recent data and a new format.

BMC Pediatr., 3 (2003), pp. 13

http://dx.doi.org/10.1186/1471-2431-3-13 | Medline

[13]

T.R. Fenton, R.S. Sauve.

Using the LMS method to calculate z-scores for the Fenton preterm infant growth chart.

Eur J Clin Nutr., 61 (2007), pp. 1380-1385

http://dx.doi.org/10.1038/sj.ejcn.1602667 | Medline

[14]

P.A. Lee, S.D. Chernausek, A.C. Hokken-Koelega, P. Czernichow.

International Small for Gestational Age Advisory Board. International Small for Gestational Age Advisory Board consensus development conference statement: management of short children born small for gestational age.

Pediatrics, 11 (April 24-October 1 2003), pp. 1253-1261

[15]

IBM Corporation Released. IBM SPSS Statistics for Windows. Amonk: IBM Corporation; 2011.

[16]

R Development Core Team [Internet]. R: A language and environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2012 [acessado em 2 Mar 2013]. Disponível em: http://www.R-project.org.

[17]

N.M. Gianni, A.A. Vieira, M.E. Moreira.

Avaliação dos fatores associa- dos ao estado nutricional na idade corrigida de termo em recém- nascidos de muito baixo peso.

J Pediatr (Rio J)., 81 (2005), pp. 34-40

[18]

A.L. Goulart, M.B. Morais, B.I. Kopelman.

Impact of perinatal factors on growth deficits of preterm infants.

Rev Assoc Med Bras., 57 (2011), pp. 269-275

Medline

[19]

H.M. Shan, W. Cai, Y. Cao, B.H. Fang, Y. Feng.

Extrauterine growth retardation in premature infants in Shanghai: a multicenter retrospective review.

Eur J Pediatr., 168 (2009), pp. 1055-1059

http://dx.doi.org/10.1007/s00431-008-0885-9 | Medline

[20]

Moreira ME. Avaliação do crescimento e da composição corpo- ral de recém-nascidos pré-termos [tese]. São Paulo, SP: Uni- versidade de São Paulo; 1997.

[21]

L.M. Anchieta, C.C. Xavier, E.A. Colosimo.

Velocidade de crescimento de recém-nascido pré-termo adequados para idade gestacional.

J Pediatr (Rio J)., 80 (2004), pp. 417-424

[22]

L.M. Anchieta, C.C. Xavier, E.A. Colosimo.

Crescimento de recém- nascidos pré-termo nas primeiras 12 semanas de vida.

J Pediatr (Rio J)., 80 (2004), pp. 267-276

[23]

R.A. Ehrenkranz, N. Younes, J.A. Lemos, A.A. Fanaroff, E.F. Donovan, L.L. Wright, et al.

Longitudinal growth of hospitalized very low birth weight infants.

Pediatrics., 104 (1999), pp. 280-289

Medline

[24]

M. Hack.

Follow-up for high-risk neonates. In: Fanaroff AA, Martin RJ, eds. Neonatal-Perinatal Medicine..

6th ed., Mosby, (1997), pp. 952-957

[25]

R. Cooke.

Postnatal growth in preterm infants: have we got it right?.

J Perinatol., 25 (2005), pp. S12-S14

http://dx.doi.org/10.1038/sj.jp.7211310 | Medline

[26]

S.L. Ornelas, C.C. Xavier, E.A. Colosimo.

Crescimento de recém- nascido pré-termo pequenos para idade gestacional.

J Pediatr (Rio J)., 78 (2002), pp. 230-236

[27]

N.E. Embleton, N. Pang, R.J. Cooke.

Postnatal malnutrition and growth retardation: an inevitable consequence of current re- commendations in preterm infants?.

Pediatrics., 107 (2001), pp. 270-273

Medline

[28]

I. Claudet, P. De Montis, C. Debuisson, C. Maréchal, R. Honorat, E. Grouteau.

Analysis of neonate admissions to the pediatric emergency department.

Arch Pediatr., 19 (2012), pp. 900-906

http://dx.doi.org/10.1016/j.arcped.2012.06.016 | Medline

[29]

S. Kurtoğlu, N. Hatipoğlu, M.M. Mazıcıoğlu, M.A. Akın, D. Çoban, S. Gökoğlu, et al.

Body weight, length and head circumference at birth in a cohort of Turkish newborns.

J Clin Res Pediatr Endocrinol., 4 (2012), pp. 132-139

http://dx.doi.org/10.4274/jcrpe.693 | Medline

☆

Como citar este artigo: Lima PA, de Carvalho M, da Costa AC, Moreira ME. Variables associated with extra uterine growth restriction in very low birth weight infants. J Pediatr (Rio J). 2014;90:22-7.

Indexed in:

Follow us:

Indexed in:

Follow us:

Subscribe to our newsletter