Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda.
BMC Pediatr. 2024 Nov 6;24(1):706. doi: 10.1186/s12887-024-05172-5.
Postnatal growth failure (PGF), a multifactorial condition is common in preterm infants and infants born weighing <1500 g and is associated with impaired neurodevelopmental and growth outcomes. In low-resource settings, like Uganda, parenteral nutrition and breastmilk fortifier are often unavailable, and preterm infants rely solely on their mother's expressed breastmilk, which can be inadequate. This retrospective cohort study, conducted in a level II neonatal unit in eastern Uganda, aimed to evaluate the incidence of and risk factors for postnatal growth failure among infants <1500 g.
The study included infants with birthweight <1500 g, admitted within 24 h of birth, and who spent 7 or more days in the neonatal unit. Major congenital malformations or a diagnosis of hypoxic ischemic encephalopathy were exclusion criteria. PGF was defined as a decrease in weight Z score between birth and discharge of more than - 1.28. Data on feeding, anthropometry, co-morbidities, and clinical measures were extracted from medical records. Statistical analyses were performed using Stata 17.0 with crude and adjusted relative risks (RR) were reported.
One hundred and four infants were recruited, including 47 (45.2%) male and 57 (54.8%) female, with a mean birth weight of 1182 g (SD 18 g, 95% CI: 1140, 1210). Almost half were small for gestational age, most were singletons (66.3%), and most were born by spontaneous vaginal delivery (82.7%). PGF was observed at discharge in 75.9% (N = 79). Clinical risk factors for PGF included: small for gestational age (cRR 1.25, 95% CI: 1.01, 1.53), respiratory distress syndrome (aRR 1.30 95% CI: 1.01, 1.67), duration of bubble continuous positive airway pressure use (aRR 1.35, 95% CI: 1.10, 1.66), sepsis requiring second line (aRR 1.58, 95% CI: 1.22, 2.04) and third line treatment (aRR 1.46, 95% CI: 1.20, 1.77), prolonged time to achieve full feeds (aRR 1.30, 95% CI: 1.01, 1.66) and prolonged hospitalisation (aRR 1.85, 95% CI: 1.31, 2.61).
PGF was common among infants <1500 g in this hospitalised cohort who were primarily fed on their mother's own milk. Urgent action is needed to enhance postnatal growth in this vulnerable patient group. Future research should focus on exploring multidisciplinary interventions that can improve growth outcomes in this population and understanding the long-term implications and need for care for these infants.
产后生长迟缓（PGF）是一种多因素疾病，在早产儿和出生体重<1500 克的婴儿中很常见，与神经发育和生长结局受损有关。在资源匮乏的环境中，例如乌干达，肠外营养和母乳强化剂往往无法获得，早产儿只能依靠母亲的母乳，但这可能是不足的。本回顾性队列研究在乌干达东部的二级新生儿单位进行，旨在评估<1500 克婴儿的产后生长迟缓发生率和危险因素。
该研究纳入了出生体重<1500 克、出生后 24 小时内入院且在新生儿病房中住院 7 天以上的婴儿。主要先天性畸形或缺氧缺血性脑病的诊断为排除标准。PGF 定义为出生至出院时体重 Z 评分下降超过-1.28。从病历中提取喂养、人体测量学、合并症和临床指标的数据。使用 Stata 17.0 进行统计分析，报告了粗相对风险（RR）和调整后相对风险（RR）。
共纳入 104 名婴儿，包括 47 名（45.2%）男性和 57 名（54.8%）女性，平均出生体重为 1182 克（标准差 18 克，95%置信区间：1140，1210）。近一半的婴儿为小于胎龄儿，大多数为单胎（66.3%），大多数为自然阴道分娩（82.7%）。75.9%（N=79）的婴儿在出院时出现 PGF。PGF 的临床危险因素包括：小于胎龄儿（cRR 1.25，95%CI：1.01，1.53）、呼吸窘迫综合征（aRR 1.30，95%CI：1.01，1.67）、使用气泡持续气道正压通气的时间（aRR 1.35，95%CI：1.10，1.66）、需要二线（aRR 1.58，95%CI：1.22，2.04）和三线治疗（aRR 1.46，95%CI：1.20，1.77）的败血症，以及达到全量喂养的时间延长（aRR 1.30，95%CI：1.01，1.66）和住院时间延长（aRR 1.85，95%CI：1.31，2.61）。
在该住院队列中，<1500 克的婴儿中 PGF 很常见，他们主要以母亲的母乳喂养。迫切需要采取行动来促进这个脆弱患者群体的产后生长。未来的研究应侧重于探索可以改善该人群生长结局的多学科干预措施，并了解这些婴儿的长期影响和护理需求。
