Department of Paediatrics and Child Health, Makerere University College of Health Sciences, P.O Box 7072, Kampala, Uganda.
Department of Paediatrics and Child Health, Mulago National Referral hospital, Kampala, Uganda.
BMC Pediatr. 2021 Mar 25;21(1):145. doi: 10.1186/s12887-021-02612-4.
Early discharge of preterm very low birth weight (VLBW) infants is at times inevitable in low resource settings. The implication of such practice on the growth of this high-risk population is not known. We conducted a retrospective chart review to describe the growth of preterm VLBW infants discharged with a weight of less than 1500 g.
To describe the growth of discharged preterm VLBW infants over the first 12 weeks.
Between June 2013 and January 2014; 164 discharged preterm VLBW infants were followed up for 3 months. Among the survivors (132), we identified 111 infant records for this study. Relevant data was entered in STATA for analysis. Growth percentiles were determined at approximately 4 weeks, 8 weeks, and 12 weeks post-discharge using the intergrowth 21st growth charts. Growth velocities were computed using the 2-point average weight model. Regression analysis was used to identify factors associated with growth failure. Growth failure was defined as occipital frontal circumference (OFC), weight, and length < 10th centile by 12 weeks post-discharge. P-value of < 0.05 was considered significant at a 95% confidence interval.
Among the study infants the median gestational age and weight at birth were 32 weeks (range 28-35 weeks) and 1250 g(range 850-1500 g) respectively; 60/111(54%) were Small for Gestational Age (SGA). The median discharge postmenstrual age (PMA) was 34 weeks (range 30-38 weeks) and weight was 1140 g (range 830-1490 g). The majority 88.2% had not recovered birth weight at discharge of whom 59.1% recovered by 2 weeks and 40.9% recovered between 2 and 4 weeks after discharge. By 12 weeks post-discharge the median PMA and weight were 46 weeks (range 37-51 weeks),and 3110 g (range 1750-5000 g) respectively, 38.7% of the infants had growth failure and 36.9% had OFC <3rd centile. Growth velocity < 15 g/kg/d in the first 4 weeks (OR 3.8, p 0.010) and subsequent 4 weeks (OR 2.5, p 0.049) post-discharge were independently associated with growth failure.
Slow birth weight recovery was observed and growth failure was prevalent by 12 weeks post-discharge with more than a third having severe microcephaly. Poor post-discharge growth velocity was associated with subsequent growth failure.
Growth velocity monitoring among preterm VLBW infants should be emphasized. The implication and interventions of this early growth failure needs to be explored.
在资源有限的环境中，早产儿极低出生体重儿（VLBW）的早期出院有时是不可避免的。这种做法对这一高危人群的生长发育的影响尚不清楚。我们进行了一项回顾性图表审查，以描述出院时体重低于 1500 克的早产儿 VLBW 婴儿的生长情况。
描述早产儿 VLBW 婴儿在出院后 12 周内的生长情况。
2013 年 6 月至 2014 年 1 月期间，对 164 名出院的早产儿 VLBW 婴儿进行了 3 个月的随访。在幸存者（132 人）中，我们确定了 111 名婴儿的记录进行本研究。将相关数据输入 STATA 进行分析。使用生长 21 世纪图表在出院后大约 4 周、8 周和 12 周时确定生长百分位数。使用两点平均体重模型计算生长速度。回归分析用于确定与生长失败相关的因素。生长失败定义为出院后 12 周时头围（OFC）、体重和长度<第 10 百分位数。置信区间为 95%时，p 值<0.05 被认为具有统计学意义。
在研究婴儿中，中位胎龄和出生体重分别为 32 周（范围 28-35 周）和 1250 克（范围 850-1500 克）；60/111（54%）为小于胎龄儿（SGA）。中位出院后校正胎龄（PMA）为 34 周（范围 30-38 周），体重为 1140 克（范围 830-1490 克）。大多数婴儿（88.2%）在出院时未恢复出生体重，其中 59.1%在 2 周内恢复，40.9%在出院后 2-4 周内恢复。出院后 12 周时，中位 PMA 和体重分别为 46 周（范围 37-51 周）和 3110 克（范围 1750-5000 克），分别有 38.7%的婴儿生长失败和 36.9%的婴儿头围<第 3 百分位数。出院后前 4 周（OR 3.8，p<0.010）和随后 4 周（OR 2.5，p<0.049）生长速度<15g/kg/d 与生长失败独立相关。
观察到体重恢复缓慢，出院后 12 周时生长失败普遍存在，超过三分之一的婴儿有严重的小头畸形。出院后生长速度不良与随后的生长失败有关。
应强调对早产儿极低出生体重儿生长速度的监测。需要探讨这种早期生长失败的意义和干预措施。
