"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants

Tanis R Fenton^{1

2}, Barbara Cormack³, Dena Goldberg⁴, Roseann Nasser⁵, Belal Alshaikh^{6

7}, Misha Eliasziw⁸, William W Hay⁹, Angela Hoyos¹⁰, Diane Anderson¹¹, Frank Bloomfield³, Ian Griffin¹², Nicholas Embleton¹³, Niels Rochow¹⁴, Sarah Taylor¹⁵, Thibault Senterre¹⁶, Richard J Schanler¹⁷, Seham Elmrayed⁶, Sharon Groh-Wargo¹⁸, David Adamkin¹⁹, Prakesh S Shah²⁰

Affiliations

¹ Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. tfenton@ucalgary.ca.
² Nutrition Services, Alberta Health Services, Calgary, AB, Canada. tfenton@ucalgary.ca.
³ Liggins Institute, University of Auckland, Auckland, New Zealand.
⁴ Carilion Clinic, Roanoke, VA, USA.
⁵ Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada.
⁶ Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷ Pediatrics, University of Calgary, Calgary, AB, Canada.
⁸ Public Health and Community Medicine, Tufts University, Boston, MA, USA.
⁹ University of Colorado, Denver, CO, USA.
¹⁰ Clínica del Country, Universidad el Bosque, Bogotá, Colombia.
¹¹ Pediatrics, Baylor College of Medicine, Houston, TX, USA.
¹² Clinical and Translational Research, Biomedical research Institute of New Jersey, Cedar Knolls, NJ, USA.
¹³ Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
¹⁴ Pediatrics, McMaster University, Hamilton, ON, Canada.
¹⁵ Pediatrics, Yale School of Medicine, New Haven, CT, USA.
¹⁶ Neonatology, University of Liege, CHU de Liege, Liege, Belgium.
¹⁷ Neonatal Services, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra, New York, NY, USA.
¹⁸ Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA.
¹⁹ Pediatrics, University of Louisville, Louisville, KY, USA.
²⁰ Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada.

PMID: 32214217
DOI: 10.1038/s41372-020-0658-5

Review

"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants

Tanis R Fenton et al. J Perinatol. 2020 May.

. 2020 May;40(5):704-714.

doi: 10.1038/s41372-020-0658-5. Epub 2020 Mar 25.

Authors

Affiliations

¹ Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. tfenton@ucalgary.ca.
² Nutrition Services, Alberta Health Services, Calgary, AB, Canada. tfenton@ucalgary.ca.
³ Liggins Institute, University of Auckland, Auckland, New Zealand.
⁴ Carilion Clinic, Roanoke, VA, USA.
⁵ Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada.
⁶ Community Health Sciences, Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
⁷ Pediatrics, University of Calgary, Calgary, AB, Canada.
⁸ Public Health and Community Medicine, Tufts University, Boston, MA, USA.
⁹ University of Colorado, Denver, CO, USA.
¹⁰ Clínica del Country, Universidad el Bosque, Bogotá, Colombia.
¹¹ Pediatrics, Baylor College of Medicine, Houston, TX, USA.
¹² Clinical and Translational Research, Biomedical research Institute of New Jersey, Cedar Knolls, NJ, USA.
¹³ Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
¹⁴ Pediatrics, McMaster University, Hamilton, ON, Canada.
¹⁵ Pediatrics, Yale School of Medicine, New Haven, CT, USA.
¹⁶ Neonatology, University of Liege, CHU de Liege, Liege, Belgium.
¹⁷ Neonatal Services, Cohen Children's Medical Center, Northwell Health, Zucker School of Medicine at Hofstra, New York, NY, USA.
¹⁸ Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA.
¹⁹ Pediatrics, University of Louisville, Louisville, KY, USA.
²⁰ Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada.

PMID: 32214217
DOI: 10.1038/s41372-020-0658-5

Abstract

Preterm infants are increasingly diagnosed as having "extrauterine growth restriction" (EUGR) or "postnatal growth failure" (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36-40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36-40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants' actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.

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Comment in

Postnatal growth in extremely low birth weight newborns: nature or nurture?
Chou FS, Pandey V, Yeh HW. Chou FS, et al. J Perinatol. 2021 Mar;41(3):648-649. doi: 10.1038/s41372-020-0737-7. Epub 2020 Jul 17. J Perinatol. 2021. PMID: 32681065 No abstract available.
A holistic approach to infant growth assessment considers clinical, social and genetic factors rather than an assessment of weight at a set timepoint.
Fenton TR, Goldberg D, Alshaikh B, Nasser R, Hay WW, Groh-Wargo S, Shah PS, Taylor S, Senterre T, Hoyos A, Embleton N, Rochow N, Bloomfield F. Fenton TR, et al. J Perinatol. 2021 Mar;41(3):650-651. doi: 10.1038/s41372-020-00785-x. Epub 2020 Aug 13. J Perinatol. 2021. PMID: 32792632 No abstract available.

References

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"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants

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"Extrauterine growth restriction" and "postnatal growth failure" are misnomers for preterm infants

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