5 - Current Epidemiology and Factors Contributing to Extrauterine Growth Retardation in Infants Born at Less than 32 Weeks’ Gestation in China

Poster Number: 5
Publication Number: 5.337

Yanyu Lyu, Children’s Hospital of Capital Institute of Pediatrics, Beijing, Beijing, China (People's Republic); Dongzhe Zhu, Capital Institute of Pediatrics, Beijing, Beijing, China (People's Republic); Yanchen Wang, Children‘s Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Siyuan Jiang, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic); Shoo Lee, University of Toronto Temerty Faculty of Medicine, Edmonton, AB, Canada; Jianhua Sun, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai, Shanghai, China (People's Republic); Li Li, Children’s Hospital of Capital Institute of Pediatrics, Beijing, Beijing, China (People's Republic); Yun Cao, Children's Hospital of Fudan University, Shanghai, Shanghai, China (People's Republic)

Background: Extrauterine growth restriction (EUGR) is common in very preterm infants (VPI) and is associated with adverse short and long-term health outcomes. The prevalence of EUGR among VPI in Chinese neonatal intensive care units (NICU) is not well documented.

Objective: To describe EUGR in VPIs born before 32 weeks’ gestation and to explore the maternal and neonatal factors, clinical practices and neonatal morbidities associated with EUGR in NICUs in China.

Design/Methods: We studied 6179 VPIs who were admitted to 57 neonatal intensive care units from 25 provinces in the Chinese Neonatal Network between January 1, 2019 and December 31, 2019 and hospitalized more than 7days. Birth weight and discharge weight were converted to age-specific and gender-specific Z-scores and percentiles using 2013 Fenton growth curve. The primary outcome was EUGR defined as a discharge weight less than the 10th percentile for postmenstrual age. Secondary outcomes included decrease of weight Z-score between birth and discharge>1 and weight growth velocity (g/kg/d).Multivariable analyses were carried out to evaluate associations between maternal factors, neonatal factors, NICU treatment and co-morbidities with EUGR as well as associations between these factors with secondary outcomes.

Results: 4.0% of the infants were small for gestational age (SGA) at birth and 48.4% of infants had EUGR. The proportion of decrease of weight Z-score between birth and discharge>1.0 was 74.9%. The mean (SD) Z-score of weight was 0.13 (±0.78) at birth and decrease to -1.35 (±0.99) at discharge. Weight growth velocity was 10.15 g/kg/day. Factors associated with EUGR were gestational age at birth (aOR=0.78, 95% CI: 0.71-0.85), Z-score of birth weight (aOR=0.08, 95% CI:0.06-0.09), male sex (aOR=0.75, 95% CI:0.64-0.88), Apgar score < 7 at 5 min (aOR=1.62 , 95% CI:1.14-2.29), days to start enteral feeds (aOR=1.04, 95% CI:1.01-1.06), total duration of days not fed or nil per os (NPO) during hospitalization (aOR=1.10, 95% CI:1.08-1.13), respiratory distress syndrome (RDS) requiring surfactant (aOR=1.54, 95% CI:1.30-1.83) and patent ductus arteriosus (PDA) requiring medical or surgical treatment (aOR=2.13, 95% CI:1.62-2.80). Total duration of NPO during hospitalization, RDS requiring surfactant and PDA requiring medical or surgical treatment were also associated with decrease of weight Z-score between birth and discharge>1.0 and were negatively associated with weight growth velocity.Conclusion(s): Nearly half of the very preterm infants had EUGR and three out of four of these infants had decrease of weight Z-score between birth and discharge>1.0, which may indicate suboptimal nutrition. Some risk factors of NICU treatment and neonatal morbidities have been identified, and provide insights into potential strategies to reduce EUGR.

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