Misclassification of newborns due to systematic error in plotting birth weight percentile values

Equally Good Neurological, Growth, and Health Outcomes up to 6 Years of Age in Moderately Preterm Infants Who Received Exclusive vs. Fortified Breast Milk-A Longitudinal Cohort Study

Moderately preterm infants (32-36 weeks of gestational age) have an increased risk of worse health and developmental outcomes compared to infants born at term. Optimal nutrition may alter this risk. The aim of this study was to investigate the neurological, growth, and health outcomes up to six years of age in children born moderately preterm who receive either exclusive or fortified breast milk and/or formula in the neonatal unit. In this longitudinal cohort study, data were collected for 142 children. Data were collected up to six years of age via several questionnaires containing questions about demographics, growth, child health status, health care visits, and the Five to Fifteen Questionnaire. Data on the intake of breast milk, human milk fortification, formula, and growth during hospitalization were collected from the children's medical records. No statistically significant differences in neurological outcomes, growth, or health at six years of age were found between the two groups (exclusive breast milk, n = 43 vs. fortified breast milk and/or formula, n = 99). There is a need for research in larger populations to further assess potential effects on health and developmental outcomes when comparing the use of exclusive versus fortified breast milk for moderately preterm infants during neonatal hospitalization.

Evaluation of a Simple Weight-Based Screening Tool for Asymptomatic Neonatal Hypoglycemia

The objective of this study was to determine if the use of weight-based criteria to screen for asymptomatic hypoglycemia is consistent with using percentile curves to determine small and large for gestational age status. A retrospective chart review of 892 term infants in the normal nursery was performed. The degree of agreement in screening recommendations between weight-based criteria and the Lubchenco, Oken, and Olsen percentile curves was determined using Cohen's κ and McNemar's test. Agreement was lower between Lubchenco and Olsen or Oken (0.470, 0.509, respectively) than with weight-based criteria (Lubchenko = 0.532; Oken = 0.566; and Olsen = 0.582). Weight-based criteria recommended screening 12% and 7% fewer patients than Lubchenko and Oken, respectively (P < .001), but was equally likely to screen infants as Olsen (P = .579). Simple weight-based criteria for asymptomatic hypoglycemia screening can identify infants at risk for hypoglycemia in a manner consistent with current guidelines.

Improving the Accuracy of Newborn Weight Classification

PURPOSE

The purpose of this project was to improve the accuracy of newborn weight classification using a regional newborn growth reference (Olsen), an evidence-based method, to determine SGA, AGA and LGA in term infants compared to the current growth reference (Lubchenco).

DESIGN

Quality improvement methods using Lewin's Change Theory guided the process.

SETTING/LOCAL PROBLEM

At an academic medical center term infants were evaluated for weight-for-gestational age using the Lubchenco growth reference as well as other growth references based on provider preference.

PATIENTS

All term newborns (N = 314) admitted to the newborn nursery during one month following a 3-months implementation of the practice change.

INTERVENTION/MEASUREMENTS

Newborn nursery nursing staff and provider staff were provided education and training on using and interpreting the new growth reference.

RESULTS

Use of the Olsen regional growth reference identified more infants as small and fewer infants as large for gestational age. Post hoc analysis with a more global growth reference (Fenton) also identified more infants as small and fewer infants as large for gestational age. There was no statistically significant difference between the Olsen or Fenton growth references.

CONCLUSION

Use of either of these two updated growth references more accurately classifies infant weight for gestational age compared to the Lubchenco growth reference, potentially decreasing newborn health risks such as hypoglycemia.

Physiological adjustment to postnatal growth trajectories in healthy preterm infants

BACKGROUND

International guidelines suggest that growth of preterm infants should match intrauterine rates. However, the trajectory for extrauterine growth may deviate from the birth percentile due to an irreversible, physiological loss of extracellular fluid during postnatal adaptation to extrauterine conditions. To which "new" physiological growth trajectory preterm infants should adjust to after completed postnatal adaptation is unknown. This study analyzes the postnatal growth trajectories of healthy preterm infants using prospective criteria defining minimal support, as a model for physiological adaptation.

METHODS

International, multi-center, longitudinal, observational study at five neonatal intensive care units (NICUs). Daily weights until day of life (DoL) 21 of infants with undisturbed postnatal adaptation were analyzed (gestational ages: (i) 25-29 wk, (ii) 30-34 wk).

RESULTS

981 out of 3,703 admitted infants included. Maximum weight loss was 11% (i) and 7% (ii) by DoL 5, birth weight regained by DoL 15 (i) and 13 (ii). Infants transitioned to growth trajectories parallel to Fenton chart percentiles, 0.8 z-scores below their birth percentiles. The new trajectory after completed postnatal adaptation could be predicted for DoL 21 with R(2) = 0.96.

CONCLUSION

This study provides a robust estimate for physiological growth trajectories of infants after undisturbed postnatal adaptation. In the future, the concept of a target postnatal trajectory during NICU care may be useful.

Assessment of neonatal growth in prematurely born infants

The concept that adequate nutritional status and normal growth are important is well-accepted. How to assess the adequacy of nutrition and how to define appropriate growth remains an area of active debate. Our goal is to review how growth is assessed at birth and during the hospital stay of prematurely born infants, and to offer a standardized approach.