Association of Weight Changes by Three Days after Birth and Mortality and/or Severe Neurological Injury in Preterm Infants < 29 Weeks Gestational Age: A Multicenter Cohort Study

Time to regain birthweight and association with neurodevelopmental outcomes among extremely preterm newborns

OBJECTIVE

Determine association between time to regain birthweight and 2-year neurodevelopment among extremely preterm (EP) newborns.

STUDY DESIGN

Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating time to regain birthweight, time from birth to weight nadir, time from nadir to regain birthweight, and cumulative weight loss with 2-year corrected Bayley Scales of Infant and Toddler Development 3rd edition.

RESULTS

Among n = 654 EP neonates, those with shorter nadir-to-regain had lower cognitive scores (≤1 day versus ≥8 days: -5.0 points, [CI -9.5, -0.6]) and lower motor scores (≤1 day versus ≥8 days: -4.6 points [CI -9.2, -0.03]) in adjusted stepwise forward regression modeling. Increasingly cumulative weight loss was associated with lower cognitive scores (≤-50 percent-days: -5.6, [CI -9.4, -1.8]), motor scores (≤-50 percent-days: -4.2, [CI -8.2, -0.2]); and language scores (≤-50 percent-days: -6.0, [CI -10.1, -1.9]).

CONCLUSION

Faster nadir-to-regain and excessive cumulative weight loss are associated with adverse 2-year neurodevelopmental outcomes.

TRIAL REGISTRATION

PENUT Trial Registration: NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273 .

CLINICAL TRIAL REGISTRATION

This study is a post-hoc secondary analysis of pre-existing data from the PENUT Trial (NCT #01378273).

Risk factors and epidemiology of spontaneous intestinal perforation among infants born at 22-24 weeks' gestational age

OBJECTIVE

To describe the epidemiology, risk factors, and timing of spontaneous intestinal perforation (SIP) among infants born at 22-24 weeks' gestational age (GA).

STUDY DESIGN

Observational cohort study among infants born at 22-24 weeks' GA in 446 neonatal intensive care units.

RESULTS

We identified 9712 infants, of whom 379 (3.9%) developed SIP. SIP incidence increased with decreasing GA (P < 0.001). Antenatal magnesium (odds ratio (OR) 1.42; 95% confidence interval (CI), 1.09-1.85), antenatal indomethacin (OR 1.40; 95% CI, 1.06-1.85), postnatal indomethacin (OR 1.61; 95% CI, 1.23-2.11), and postnatal hydrocortisone exposure (OR 2.02; 95% CI 1.50-2.73) were associated with SIP. Infants who lost 15-20% (OR 1.77; 95% CI, 1.28-2.44) or >20% (OR 2.04; 95% CI, 1.46-2.85) of birth weight had higher odds of SIP than infants with weight loss <10%.

CONCLUSIONS

Antenatal magnesium exposure, antenatal indomethacin exposure, postnatal hydrocortisone exposure, postnatal indomethacin exposure, and weight loss ≥15% were associated with SIP.

Time to Regain Birthweight and Association with Neurodevelopmental Outcomes among Extremely Preterm Newborns

Objective

Determine association between time to regain birthweight and 2-year neurodevelopment among extremely preterm (EP) newborns.

Study Design

Secondary analysis of the Preterm Erythropoietin Neuroprotection Trial evaluating time to regain birthweight, time from birth to weight nadir, time from nadir to regain birthweight, and cumulative weight loss with 2-year corrected Bayley Scales of Infant and Toddler Development 3rd edition.

Results

Among n = 654 EP neonates, those with shorter nadir-to-regain had lower cognitive scores (2-4 days versus ≥ 8 days: -3.5, [CI -7.0, 0.0]; ≤1 day versus ≥ 8 days: -5.0, [CI -10.2, 0.0]) in fully adjusted stepwise forward regression modeling. Increasingly cumulative weight loss was associated with lower cognitive scores (-50 to <-23 percent-days: -4.0, [95% CI -7.6, -0.4]) and language scores (≤-50 percent-days: -5.7, [CI -9.8, -1.6]; -50 to <-23 percent-days: -6.1, [CI -10.2, -2.0]).

Conclusion

Faster nadir-to-regain and prolonged, severe weight loss are associated with adverse 2-year neurodevelopmental outcomes.

Trial registration

PENUT Trial Registration: NCT01378273. https://clinicaltrials.gov/ct2/show/NCT01378273.

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

BACKGROUND

Nutritional support of preterm infants remains a field of debate in the literature and clinical practice varies significantly. Adequate nutrition should promote growth and aim for optimal later neurodevelopment. However, it is often impaired by prematurity-associated morbidity and the physiologic immaturity of preterm infants. This study assessed the impact of energy and macronutrient provision on growth velocity and outcome and explored differences attributed to the heterogeneity of the preterm population.

METHODS

We retrospectively collected clinical and nutritional data from neonates hospitalized in two separate Neonatal Intensive Care Units (NICUs). Estimated energy and protein balance were calculated based on the ESPGHAN guidelines and their association with the growth outcome was explored. Growth assessment was based on somatometry Delta (Δ) z-scores at discharge.

RESULTS

In total, 174 neonates were included in the study. By day 14, most preterm infants were exclusively enterally fed, whereas there were infants in the <28 and 28-31+6 subgroups fed exclusively parenterally. Energy balance was positive for all gestational age (GA) subgroups except for those born <28 weeks. Protein balance was consistently positive for extremely premature but negative for late preterms. Cumulative substrates provisions were strong predictors of a positive energy or protein balance in the <34 weeks GA preterms on days 14 (ROC analyses, p < 0.001) and 7 (p < 0.05). A higher GA (p = 0.013) and enteral nutrition (p = 0.005) were additional predictors of a positive energy balance. All GA subgroups had a negative Δ z-score of weight at discharge. In the <34 GA subcohorts, a positive protein balance on day 14 (p = 0.009) and a short time to regain birth weight (exp(B) 3.1 (p = 0.004)) were independently associated with a positive Δ z-score of weight at discharge.

CONCLUSIONS

Early achievement of a positive energy and protein balance, based on the ESPGHAN guidelines, is crucial to ensure optimal postnatal growth and prevent extrauterine growth restriction, a relatively common occurrence in preterm infants.