National Institute for Health Research Imperial Biomedical Research Centre, Institute for Translational Medicine and Therapeutics Data Science Group, Imperial College London, London, UK.
School of Public Health, Faculty of Medicine, Imperial College London, London, UK; Section of Neonatal Medicine, Chelsea and Westminster Hospital, London, UK.
Lancet Child Adolesc Health. 2021 Oct;5(10):719-728. doi: 10.1016/S2352-4642(21)00232-7. Epub 2021 Aug 25.
Intrauterine and postnatal weight are widely regarded as biomarkers of fetal and neonatal wellbeing, but optimal weight gain following preterm birth is unknown. We aimed to describe changes over time in birthweight and postnatal weight gain in very and extremely preterm babies, in relation to major morbidity and healthy survival.
In this cohort study, we used whole-population data from the UK National Neonatal Research Database for infants below 32 weeks gestation admitted to neonatal units in England and Wales between Jan 1, 2008, and Dec 31, 2019. We used non-linear Gaussian process to estimate monthly trends, and Bayesian multilevel regression to estimate unadjusted and adjusted coefficients. We evaluated birthweight; weight change from birth to 14 days; weight at 36 weeks postmenstrual age; associated Z scores; and longitudinal weights for babies surviving to 36 weeks postmenstrual age with and without major morbidities. We adjusted birthweight for antenatal, perinatal, and demographic variables. We additionally adjusted change in weight at 14 days and weight at 36 weeks postmenstrual age, and their Z scores, for postnatal variables.
The cohort comprised 90 817 infants. Over the 12-year period, mean differences adjusted for antenatal, perinatal, demographic, and postnatal variables were 0 g (95% compatibility interval -7 to 7) for birthweight (-0·01 [-0·05 to 0·03] for change in associated Z score); 39 g (26 to 51) for change in weight from birth to 14 days (0·14 [0·08 to 0·19] for change in associated Z score); and 105 g (81 to 128) for weight at 36 weeks postmenstrual age (0·27 [0·21 to 0·33] for change in associated Z score). Greater weight at 36 weeks postmenstrual age was robust to additional adjustment for enteral nutritional intake. In babies surviving without major morbidity, weight velocity in all gestational age groups stabilised at around 34 weeks postmenstrual age at 16-25 g per day along parallel percentile lines.
The birthweight of very and extremely preterm babies has remained stable over 12 years. Early postnatal weight loss has decreased, and subsequent weight gain has increased, but weight at 36 weeks postmenstrual age is consistently below birth percentile. In babies without major morbidity, weight velocity follows a consistent trajectory, offering opportunity to construct novel preterm growth curves despite lack of knowledge of optimal postnatal weight gain.
UK Medical Research Council.
宫内和产后体重被广泛认为是胎儿和新生儿健康的生物标志物，但早产儿的最佳产后体重增加情况尚不清楚。本研究旨在描述极低和极早产儿的出生体重和产后体重增加随时间的变化，以及与主要发病率和健康存活的关系。
在这项整群队列研究中，我们使用了英国国家新生儿研究数据库的全人群数据，该数据库包括 2008 年 1 月 1 日至 2019 年 12 月 31 日期间在英格兰和威尔士新生儿病房住院的妊娠 32 周以下的婴儿。我们使用非线性高斯过程来估计每月趋势，并使用贝叶斯多层次回归来估计未调整和调整后的系数。我们评估了存活至 36 周胎龄的婴儿的出生体重、出生至 14 天的体重变化、36 周胎龄时的体重、相关 Z 评分以及纵向体重，同时评估了有和无主要合并症的婴儿的情况。我们根据产前、围产期和人口统计学变量调整了出生体重。我们还根据出生后变量调整了 14 天时的体重变化和 36 周胎龄时的体重及其 Z 评分。
该队列共纳入了 90817 名婴儿。在 12 年期间，经过产前、围产期、人口统计学和产后变量调整后，出生体重的平均差异为 0g（95%置信区间 -7 至 7）（相关 Z 评分的变化为 -0.01 [-0.05 至 0.03]）；出生至 14 天的体重变化为 39g（26 至 51）（相关 Z 评分的变化为 0.14 [0.08 至 0.19]）；36 周胎龄时的体重为 105g（81 至 128）（相关 Z 评分的变化为 0.27 [0.21 至 0.33]）。在没有主要合并症的存活婴儿中，36 周胎龄时的体重增加较为稳定，在所有胎龄组中，体重增加速度在 34 周胎龄时稳定在 16-25g/天，并沿着平行的百分位数线增加。
极低和极早产儿的出生体重在 12 年内保持稳定。早期的产后体重减轻减少了，随后的体重增加增加了，但 36 周胎龄时的体重始终低于出生时的百分位数。在没有主要合并症的婴儿中，体重增加速度遵循一致的轨迹，尽管不知道最佳的产后体重增加情况，但为构建新的早产儿生长曲线提供了机会。
英国医学研究理事会。
