Neonatology Service, Institut Clínic de Ginecologia, Obstetricia i Neonatologia, BCNatal (Centre de Medicina Maternofetal i Neonatologia de Barcelona), Hospital Clínic, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi I Sunyer), Universitat de Barcelona, Barcelona, Catalonia, Spain.
Eur J Pediatr. 2020 Sep;179(9):1469-1479. doi: 10.1007/s00431-020-03628-1. Epub 2020 Mar 19.
In very-preterm small-for-gestational-age (SGA) infants, long-term postnatal growth is confused with extrauterine growth restriction (EUGR). We aimed to document EUGR in SGA infants and in non-SGA infants ("true-EUGR") and its relationship with fetal, maternal, and neonatal etiological factors. Four hundred seventy-nine very-preterm infants (< 32 weeks) born between 2003 and 2014 and attending the follow-up clinic were included. INTERGROWTH-21st preterm postnatal growth standards in conjunction with WHO Child Growth Standards were used to judge the postnatal growth patterns. EUGR was defined as weight < 10th percentile according to the sex at 36-34 weeks postmenstrual age, usually at discharge. Catch-up was evaluated at 2-2.5 years. Low-weight-for-age (wasting), low-length-for-age (stunting), and low-head-circumference-for-age were diagnosed if the z-scores were below - 2 SD. Logistic regression analysis estimated the association between the risk factors and EUGR, according to the SGA status at birth. Overall, EUGR occurred in 51% at 36-34 postmenstrual weeks and 21% at 2-2.5 years. However, among 411 non-SGA infants, "true-EUGR" rates were 43% and 15%, respectively.Conclusion: By 2-2.5 years of age, a "true-EUGR" of 15% can be expected and only the head circumference normalizes in SGA infants. Low birth weight, hyaline membrane disease, bronchopulmonary dysplasia, and male sex were associated with "true-EUGR." What is Known: • Fetal, neonatal, or postnatal charts have been considered to monitor the postnatal growth of preterm infants. • This selection influences the diagnosis of "extrauterine growth restriction" (EUGR) and the clinical strategies used. What is New: • Extrauterine growth restriction (EUGR) in small-for-gestational-age (SGA) infants can not be considered a true EUGR but a postnatal evolution of fetal growth restriction. • Preeclampsia, low gestational age, severe neonatal morbidity and male sex are independently associated with EUGR in non-SGA infants (named "true-EUGR"), which can be expected in 15% of very preterm infants by 2-2.5 years of age.
在极早产儿中，小胎龄儿（SGA）的长期产后生长与宫外生长受限（EUGR）相混淆。我们旨在记录 SGA 婴儿和非 SGA 婴儿（“真正的 EUGR”）的 EUGR，并研究其与胎儿、母体和新生儿病因因素的关系。我们纳入了 2003 年至 2014 年间出生的 479 名极早产儿（<32 周），并在随访门诊接受治疗。我们使用 INTERGROWTH-21 孕晚期生长标准和世界卫生组织儿童生长标准来判断产后生长模式。EUGR 定义为根据胎龄在 36-34 周时的性别，体重<第 10 百分位，通常在出院时。在 2-2.5 岁时评估追赶生长情况。如果 z 分数低于-2 SD，则诊断为低体重（消瘦）、低身长（发育迟缓）和低头围（小头畸形）。根据出生时的 SGA 状态，Logistic 回归分析估计了危险因素与 EUGR 之间的关联。总体而言，在 36-34 周的胎龄时，51%的婴儿出现 EUGR，在 2-2.5 岁时，21%的婴儿出现 EUGR。然而，在 411 名非 SGA 婴儿中，分别有 43%和 15%的婴儿出现“真正的 EUGR”。结论：在 2-2.5 岁时，预计会有 15%的“真正的 EUGR”，只有 SGA 婴儿的头围会恢复正常。低出生体重、透明膜病、支气管肺发育不良和男性与“真正的 EUGR”相关。已知内容：• 胎儿、新生儿或产后图表被认为可以监测早产儿的产后生长情况。• 这种选择会影响“宫外生长受限”（EUGR）的诊断和使用的临床策略。新内容：• SGA 婴儿的宫外生长受限（EUGR）不能被视为真正的 EUGR，而是胎儿生长受限的产后演变。• 子痫前期、低胎龄、严重新生儿并发症和男性是与非 SGA 婴儿（称为“真正的 EUGR”）的 EUGR 相关的独立因素，在 2-2.5 岁时，预计会有 15%的非常早产儿出现 EUGR。
