Risk factors of extrauterine growth restriction in very preterm infants with bronchopulmonary dysplasia: a multi-center study in China
Lian Wang, Xin-Zhu Lin, Wei Shen, Fan Wu, Jian Mao, Ling Liu, Yan-Mei Chang, Rong Zhang, Xiu-Zhen Ye, Yinping Qiu, Li Ma, Rui Cheng, Hui Wu, Dongmei Chen, Ling Chen, Ping Xu, Hua Mei, Sannan Wang, Falin Xu, Rong Ju, Zhi Zheng, Xiaomei Tong, Lian Wang, Xin-Zhu Lin, Wei Shen, Zhi Zheng, Fan Wu, Jian Mao, Ling Liu, Yan-Mei Chang, Xiaomei Tong, Rong Zhang, Xiu-Zhen Ye, Yinping Qiu, Li Ma, Rui Cheng, Hui Wu, Dongmei Chen, Ling Chen, Ping Xu, Hua Mei, Sannan Wang, Falin Xu, Rong Ju, Gui-Nan Li, Long Li, Zhe Zhang, Fei Bei, Chun Deng, Ping Su, Lingying Luo, Xiaohong Liu, Lijun Wang, Shu-Qun Yu
Abstract
OBJECTIVE: Nutritional deficiency soon after birth is a risk factor of chronic lung disease (bronchopulmonary dysplasia, BPD). Afflicted infants are further prone to inadequate growth during hospitalization (extrauterine growth restriction, EUGR). This multi-center retrospective study investigated risk factors of EUGR, specifically in very preterm infants with BPD. METHOD: Data of infants with BPD who were born less than 32 weeks gestation (n = 1010) were collected from 7 regions of China. All infants were non-small for gestational age at birth. Infants were characterized as EUGR or non-EUGR at 36 weeks gestation or discharge, or stratified by gestational age or birthweight. Logistic regression analysis was applied. RESULTS: In 65.5% of the population, the BPD was mild. Infants with severe BPD (8.3%) had the highest rate of EUGR (72.6%, P < 0.001). Groups stratified by gestational age did not differ in rates of EUGR, but the birthweight of the EUGR group was significantly lower than that of the non-EUGR (P < 0.001). Birthweights of < 1000, 1000-1499, and ≥ 1500 g showed EUGR rates of 65.9%, 43.4%, and 23.8%, respectively (P < 0.001). Overall, the independent risk factors of EUGR were: moderate-to-severe BPD, gestational hypertension, cesarean section, cumulative fasting time, time required to achieve 110 kcal/kg/d, and hemodynamically significant patent ductus arteriosus (hsPDA). CONCLUSION: In very preterm infants with BPD, the lower the birthweight or the more severe the BPD, the greater the risk of EUGR. In those with hsPDA, or moderate-to-severe BPD, it is especially important to prevent EUGR through perinatal management, enteral nutrition, and nutritional strategies.