Cuestas Eduardo, Rizzotti Alina
Department of Pediatrics and Neonatology, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
Clin Exp Pediatr. 2025 Apr;68(4):287-297. doi: 10.3345/cep.2024.01354. Epub 2024 Dec 23.
Very preterm infants (VPIs) often experience extrauterine growth failure. Therefore, aggressive nutritional management of VPIs is recommended with the goal of achieving the postnatal growth of an equivalent fetus. However, VPIs frequently present postnatal length growth restriction at term-corrected age that remains lower than the standard weight and have greater fat mass and lower lean and bone mass than term-born infants. This condition differs from the classic pattern of infant undernutrition defined as a significantly lower weight for a given length. Moreover, it suggests that nonnutritional factors play a key role in length growth restriction. While weight faltering has been extensively studied, the significance of length growth failure in VPIs has only recently emerged. The nonnutritional factors underlying poor length growth in VPIs are currently not fully understood. In this review, we address recent advances in our understanding of the pathophysiology of length growth restriction, which has been identified as a major predictor of adverse neurodevelopmental and cognitive outcomes in VPIs. First, we review the shortand long-term consequences of poor length growth in VPIs; next, we highlight the effects of nonnutritional factors on postnatal length growth with focus on sustained neonatal inflammation; and finally, we discuss hypothesis and future lines of research attempting to understand the complex inflammatory-endocrine interactions and pathophysiological changes during early postnatal life, appropriately guide and apply clinical strategies aimed at optimizing length growth of VPIs, and identify evidence of the associations between sustained neonatal inflammation, stunting, and long-term health risks and the potential implications thereof.
极早产儿（VPI）常出现宫外生长发育迟缓。因此，建议对极早产儿进行积极的营养管理，目标是实现与足月胎儿相当的出生后生长。然而，极早产儿在足月校正年龄时经常出现出生后身长生长受限，其身长仍低于标准体重，且与足月儿相比，脂肪量更多，瘦体重和骨量更低。这种情况不同于经典的婴儿营养不良模式，即身长既定情况下体重显著降低。此外，这表明非营养因素在身长生长受限中起关键作用。虽然体重增长缓慢已得到广泛研究，但极早产儿身长增长失败的重要性直到最近才显现出来。目前尚未完全了解极早产儿身长增长不佳的非营养因素。在本综述中，我们阐述了在理解身长生长受限病理生理学方面的最新进展，身长生长受限已被确定为极早产儿不良神经发育和认知结局的主要预测因素。首先，我们回顾极早产儿身长增长不佳的短期和长期后果；其次，我们重点强调非营养因素对出生后身长生长的影响，尤其关注持续性新生儿炎症；最后，我们讨论一些假说和未来的研究方向，旨在理解出生后早期复杂的炎症 - 内分泌相互作用和病理生理变化，适当地指导和应用旨在优化极早产儿身长生长的临床策略，并确定持续性新生儿炎症、发育迟缓与长期健康风险之间关联的证据及其潜在影响。
