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Multicenter Study
. 2023 Aug 31;23(1):437.
doi: 10.1186/s12887-023-04245-1.

Real-world evidence regarding the growth of very premature infants with small for gestational age after birth: a multicenter survey in China

Xue-Rong Huang #  1   2 , Wei Shen #  1   2 , Fan Wu  3 , Jian Mao  4 , Ling Liu  5 , Yan-Mei Chang  6 , Rong Zhang  7 , Xiu-Zhen Ye  8 , Yin-Ping Qiu  9 , Li Ma  10 , Rui Cheng  11 , Hui Wu  12 , Dong-Mei Chen  13 , Ling Chen  14 , Ping Xu  15 , Hua Mei  16 , San-Nan Wang  17 , Fa-Lin Xu  18 , Rong Ju  19 , Zhi Zheng  1   2 , Xin-Zhu Lin  20   21 , Xiao-Mei Tong  22 ; Chinese Multicenter EUGR Collaborative Group
Collaborators, Affiliations
Multicenter Study

Real-world evidence regarding the growth of very premature infants with small for gestational age after birth: a multicenter survey in China

Xue-Rong Huang et al. BMC Pediatr. .

Abstract

Background: To analyze the real-world growth pattern of very premature infants (VPI) with small for gestational age (SGA) after birth by using the ΔZ value of weight at discharge.

Methods: The clinical data were collected from 28 hospitals in China from September 2019 to December 2020. They were divided into the EUGR(Extrauterine Growth Restriction) and the non-EUGR group according to the criterion of ΔZ value of weight at discharge < -1.28.

Results: This study included 133 eligible VPI with SGA. Following the criterion of ΔZ value, the incidence of EUGR was 36.84% (49/133). The birth weight, the 5-min Apgar score, and the proportion of male infants in the EUGR group were lower (P < 0.05). The average invasive ventilation time, cumulative duration of the administration of antibiotics, blood transfusion time, blood transfusion ratio, and total days of hospitalization were significantly higher in the EUGR group (P < 0.05). In the EUGR group, several factors exhibited higher values (P < 0.05), including the initiation of enteral feeding, the volume of milk supplemented with human milk fortifier (HMF), the duration to achieve complete fortification, the cumulative duration of fasting, the duration to achieve full enteral feeding, the length of parenteral nutrition (PN), the number of days required to attain the desired total calorie intake and oral calorie intake, as well as the age at which birth weight was regained. The average weight growth velocity (GV) was significantly lower in the EUGR group (P < 0.001). The incidences of patent ductus arteriosus with hemodynamic changes (hsPDA), neonatal necrotizing enterocolitis (NEC) stage≥ 2, late-onset sepsis (LOS), and feeding intolerance (FI) in the EUGR group were higher (P < 0.05). Multivariate logistic regression analysis showed that birth weight, male, and GV were the protective factors, while a long time to achieve full-dose fortification, slow recovery of birth weight, and NEC stage ≥2 were the independent risk factors.

Conclusion: SGA in VPI can reflect the occurrence of EUGR more accurately by using the ΔZ value of weight at discharge. Enhancing enteral nutrition support, achieving prompt and complete fortification of breast milk, promoting greater GV, reducing the duration of birth weight recovery, and minimizing the risk of NEC can contribute to a decreased occurrence of EUGR.

Trial registration: CHICTR, ChiCTR1900023418. Registered 26/05/2019, http://www.chictr.org.cn .

Keywords: Extrauterine growth retardation; Extremely premature infants; GV; Nutrition; Small for gestational age; Z score.

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Conflict of interest statement

The authors declare that they have no competing interests.

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