产后生长发育不良对早产儿不良喂养相关结局的预测能力：比较 Fenton 与 INTERGROWTH-21 期早产儿生长图表的探索性研究。

Predictive ability of postnatal growth failure for adverse feeding-related outcomes in preterm infants: an exploratory study comparing Fenton with INTERGROWTH-21st preterm growth charts.

机构信息

Department of Pediatrics, Division of Neonatology, Nemours Children's Hospital, University of Central Florida College of Medicine, Orlando, FL, USA.

Department of Pediatrics, Division of Neonatology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA.

出版信息

J Matern Fetal Neonatal Med. 2022 Dec;35(25):5470-5477. doi: 10.1080/14767058.2021.1882986. Epub 2021 Feb 11.

DOI:10.1080/14767058.2021.1882986

PMID:33573451

Abstract

BACKGROUND

Postnatal growth failure (PGF) can impact the short- and long-term health outcomes in preterm infants. However, PGF rates vary according to the way it is defined and the growth chart used to monitor the postnatal growth. Fenton-2013 growth charts which suggest following intrauterine fetal growth compared to INTERGROWTH-21st, one specifically constructed for monitoring preterm extrauterine growth.

OBJECTIVE

Exploratory study to determine the PGF definition at first per oral (PO) that is most predictive of adverse oral feeding-related outcomes in preterm infants.

METHODS

Prospectively collected data of preterm infants 24-32 weeks gestation, who were started on cue-based oral feeds at ≤34 weeks gestation were reviewed. Anthropometric data at first PO (weight, length, and head circumference) were compared according to Fenton and INTERGROWTH-21st growth charts. PGF was defined either as <10th percentile, -score change (ZSC) of ≥-1.5 from birth, or ZSC of ≥-2.0. Top-quartile (Q4) of feeding-related outcomes (days from first PO to full PO, post-menstrual age at full PO, days from first PO to discharge, and length of hospital stay) was considered as adverse outcome.

RESULTS

Of the 125 infants included, the median birth gestation and weight were 29.4 weeks and 1235 g, respectively. Incidence of appropriate, small, and large for gestational age was similar at birth by both growth charts. ZSC -1.5 for weight by Fenton was significantly higher at first PO vs. INTERGROWTH-21st (=.02), while percentile <10th and ZSC -2.0 rates were similar. The PGF definition based on individual anthropometrics at first PO that has the best area under the curve (AUC) for adverse feeding-related outcomes was used to create a combined PGF definition for each growth chart. The AUC for the combined PGF for the Fenton and INTERGROWTH-21st was similar (>.05) and both have moderate sensitivity and negative predictive value, but have low specificity, positive predictive value, and positive likelihood ratio for adverse feeding-related outcomes.

CONCLUSIONS

The tested definitions of PGF at first PO have only small to moderate predictive ability for adverse feeding-related outcomes in preterm infants.

摘要

背景

出生后生长迟缓（PGF）会影响早产儿的短期和长期健康结果。然而，PGF 的发生率因定义方式和用于监测出生后生长的生长图表而有所不同。与专门用于监测早产儿宫外生长的 INTERGROWTH-21st 相比，Fenton-2013 生长图表建议遵循宫内胎儿生长。

目的

探索性研究确定首次口服（PO）时最能预测早产儿不良口服喂养相关结局的 PGF 定义。

方法

回顾性收集胎龄 24-32 周、≤34 周开始基于提示的口服喂养的早产儿的前瞻性数据。根据 Fenton 和 INTERGROWTH-21st 生长图表比较首次 PO（体重、身长和头围）时的人体测量数据。PGF 定义为<第 10 百分位数、出生后 -1.5 分位数变化（ZSC）或 ZSC≥-2.0。将喂养相关结局的四分位数（从首次 PO 到完全 PO 的天数、完全 PO 时的胎龄、从首次 PO 到出院的天数和住院天数）视为不良结局。

结果

在 125 名婴儿中，中位出生胎龄和体重分别为 29.4 周和 1235g。两种生长图表在出生时的适宜、小和大胎龄的发生率相似。Fenton 的体重 ZSC-1.5 在首次 PO 时明显高于 INTERGROWTH-21st（=0.02），而第 10 百分位数<和 ZSC-2.0 的发生率相似。首次 PO 时基于个体人体测量的 PGF 定义具有最佳的不良喂养相关结局曲线下面积（AUC），用于为每个生长图表创建联合 PGF 定义。Fenton 和 INTERGROWTH-21st 的联合 PGF 的 AUC 相似（>.05），均具有中等敏感性和阴性预测值，但特异性、阳性预测值和阳性似然比均较低不良喂养相关结局。