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Lucaccioni L, Iughetti L, Berardi A, Predieri B. Challenges in the growth and development of newborns with extra-uterine growth restriction. Expert Rev Endocrinol Metab 2022; 17:415-423. [PMID: 35941822 DOI: 10.1080/17446651.2022.2110468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 08/03/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Extra-uterine growth restriction (EUGR) is a condition caused by the failure of very preterm infants to reach their potential growth during the NICU hospital stay. Despite enormous improvements in nutritional support and strategies, the growth pattern of preterm infants is still far from the one expected. AREAS COVERED This review focuses on what EUGR is, highlighting controversial aspects of this topic. EUGR is still missing a univocal definition, and the international debate is also open on what is the best growth chart to use. Moreover, professionals in NICU may not be trained on how to perform anthropometric measurements, increasing the risk of over- or underestimation, especially for length assessment. EUGR has recently been described as one of the main comorbidities in NICU, influencing growth, metabolism, and neurodevelopment later in life. EXPERT OPINION There is still much to investigate about what the best growth pattern in the NICU should be. What is known so far is that the majority of preterm neonates develop EUGR, and this leads to several short- and long-term consequences. It is imperative that neonatologists and pediatric endocrinologists work together, to modulate growth in the NICU.
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Affiliation(s)
- Laura Lucaccioni
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Alberto Berardi
- Neonatology Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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Lin D, Rao J, Fan D, Huang Z, Zhou Z, Chen G, Li P, Lu X, Lu D, Zhang H, Luo C, Guo X, Liu Z. Should singleton birth weight standards be applied to identify small-for-gestational age twins?: analysis of a retrospective cohort study. BMC Pregnancy Childbirth 2021; 21:446. [PMID: 34172024 PMCID: PMC8234673 DOI: 10.1186/s12884-021-03907-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 05/24/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Twin birth weight percentiles are less popular in clinical management among twin pregnancies compared with singleton ones in China. This study aimed to compare the incidence and neonatal outcomes of small for gestational age (SGA) twins between the use of singleton and twin birth weight percentiles. METHODS This was a retrospective cohort study of 3,027 pregnancies with liveborn twin pairs at gestational age of > 28 weeks. The newborns were categorized as SGA when a birthweight was less than the 10th percentile based on the singleton and twin references derived from Chinese population. Logistic regression models with generalized estimated equation (GEE) were utilized to evaluate the association between SGA twins and neonatal outcomes including neonatal unit admission, neonatal jaundice, neonatal respiratory distress (NRDS), neonatal asphyxia, ventilator support, hypoxic ischemic encephalopathy (HIE), bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intracranial hemorrhage (ICH), culture-proven sepsis, neonatal death within 28 days after birth as well as the composite outcome. RESULTS The incidence of SGA was 33.1 % based on the singleton reference and 7.3 % based on the twin reference. Both of SGA newborns defined by the singleton and twin references were associated with increases in neonatal unit admission, neonatal jaundice and ventilator support. In addition, SGA newborns defined by the twin reference were associated with increased rates of BPD (aOR, 2.61; 95 % CI: 1.18-5.78) as well as the severe composite outcome (aOR, 1.93; 95 % CI: 1.07-3.47). CONCLUSIONS The use of singleton birth weight percentiles may result in misdiagnosed SGA newborns in twin gestations and the twin birth weight percentiles would be more useful to identify those who are at risk of adverse outcomes.
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Affiliation(s)
- Dongxin Lin
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Jiaming Rao
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Zheng Huang
- The First Affiliated Hospital of Guangdong Pharmaceutical University, 510030, Guangzhou, Guangdong, China
| | - Zixing Zhou
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Gengdong Chen
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Pengsheng Li
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Xiafen Lu
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Demei Lu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Huishan Zhang
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Caihong Luo
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Xiaoling Guo
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 11 Renminxi Road, Guangdong, 528000, Foshan, China.
- Department of Obstetrics, Southern Medical University Affiliated Maternal & Child Health Hospital of Foshan, 528000, Foshan, Guangdong, China.
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