EC Paediatrics

Background: The globe receives about 15 million pre-term babies each year, and about two-third of them occur in Sub‑Saharan Africa and South Asia. However, the description of the growth pattern of preterm infants during the first infancy period is still an unmet need in several populations. As a result, this study aimed to describe the growth pattern of preterm babies in the first six months of post-delivery and identify the magnitude of poor growth and its associated factors.

Methods: Institution-based serial cross-sectional study was conducted among 251 eligible pre-term infants selected using a consecutive sampling approach at Ayder Comprehensive Specialized Hospital, Northern Ethiopia, from September 2017 to August 2019. Data were extracted using extraction format from charts of the preterm neonates, registration books and electronic records. After entering data into EpiData 4.4 and then it was exported to SPSS version 23 for analysis. Frequencies and percentages were used to describe categorical variables. Continuous variables were also described using an appropriate combination of measure of central tendency and measure of dispersion. Adjusted odds ratios, 95% confidence intervals, and P-values were computed by conducting logistic regression, to evaluate the association of predictors with poor growth. A p-value less than 0.05 were considered statistically significant.

Results: Male neonates constitute 58.2% of the study participants. Very preterm, moderate preterm, and late preterm accounted for 19.1%, 33.9%, and 47.0% of the study participants. Very low birth weight accounted for 191 (76.1%) of the preterm infants. The median length of stay in the neonatal ICU was 11 days. The mean duration of admission in neonatal ICU was 14.9 (SD = 10.0) days, while days needed to regain birth weight was 13.2 (SD = 5.4) days. The average daily weight gain velocity was 9 g/kg/day in the first month. Fifty-one percent of preterm infants had poor growth at least with one parameter (17.5% of infants by weight, 38.6% by length, 22.7% by HC, and 3.6% by weight for length) being less than -2 z-score. As birth weight increases by 1 kilogram, the odds of poor growth were found to decrease by 94% [AOR = 0.06; 95% CI: 0.02 to 0.18); p < 0.001].

Conclusion: The incidence of poor growth at six months among preterm-born infants in our study population was high. Lower birth weight was found to be a statistically significant independent risk factor for poor growth.

Keywords: Growth Pattern; Preterm; Neonate; Poor Growth; Weight; Height, Head Circumference

Abbreviations

ACHS: Ayder Comprehensive Specialized Hospital; HBsAg: Hepatitis B Surface Antigen; HC: Head Circumference; HC/A: Head Circumference for Age; ICU: Intensive Care Unit; KMC: Kangaroo Mother Care; L/A: Length for Age; PDA: Patent Ductus Arteriosus; PITC: Provider Initiated Testing and Counseling; VDRL: Venereal Disease Research Laboratory; W/A: Weight for Age; W/L: Weight for Length; WHO: World Health Organization

1. Hack Maureen., et al. “Growth of very low birth weight infants to age 20 years”. Pediatrics1 (2003): e30-e38.
2. Saigal Saroj., et al. “Growth trajectories of extremely low birth weight infants from birth to young adulthood: a longitudinal, population-based study”. Pediatric Research 6 (2006): 751-758.
3. Ohuma Eric O., et al. “National, regional, and global estimates of preterm birth in 2020, with trends from 2010: a systematic analysis”. The Lancet10409 (2023): 1261-1271.
4. Christian Parul., et al. “Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low-and middle-income countries”. International Journal of Epidemiology5 (2013): 1340-1355.
5. Sania Ayesha., et al. “The contribution of preterm birth and intrauterine growth restriction to childhood undernutrition in Tanzania”. Maternal and Child Nutrition4 (2015): 618-630.
6. Villar José., et al. “Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21^st Project”. The Lancet Global Health11 (2015): e681-e691.
7. Jasper Elizabeth A., et al. “Perinatal determinants of growth trajectories in children born preterm”. PLoS One1 (2021): e0245387.
8. Kassa Wondwossen. "College of health sciences school of graduate studies department of medical laboratory sciences”. PhD diss., school of Allied Health Science, Department of Medical Laboratory Science, Addis Ababa University (2015).
9. Villar J., et al. “Conceptual issues related to the construction of prescriptive standards for the evaluation of postnatal growth of preterm infants”. Archives of Disease in Childhood12 (2010): 1034-1038.
10. De Onis Mercedes., et al. “Worldwide implementation of the WHO child growth standards”. Public Health Nutrition9 (2012): 1603-1610.
11. Garza Cutberto and Mercedes de Onis. "Rationale for developing a new international growth reference”. Food and Nutrition Bulletin1 (2004): S5-S13.
12. USAID Press Office. 1000 Days: change a life, change the future. USAID (2014).
13. Lee Soon Min., et al. “Prediction of postnatal growth failure among very low birth weight infants”. Scientific Reports 1 (2018): 3729.
14. Clark Reese H., et al. "Extrauterine growth restriction remains a serious problem in prematurely born neonates”. Pediatrics 5 (2003): 986-990.
15. Team, R. Core. "RA language and environment for statistical computing, R Foundation for Statistical”. Computing (2020).
16. Mathew Georgie., et al. “Postnatal weight gain patterns in preterm very-low-birth-weight infants born in a tertiary Care Center in South India”. Journal of Tropical Pediatrics2 (2018): 126-131.
17. Oluwafemi Rosena Olubanke and Moses Temidayo Abiodun. "Growth patterns of preterm infants: a prospective study in an indigenous African population”. Sahel Medical Journal4 (2018): 181-188.
18. Rochow Niels., et al. “Physiological adjustment to postnatal growth trajectories in healthy preterm infants”. Pediatric Research 6 (2016): 870-879.
19. Mah Evelyn Mungyeh., et al. “Evaluation of short-term growth in very low birth weight preterm infants at a tertiary hospital in Cameroon”. Journal of Clinical Neonatology4 (2016): 247-253.
20. Saluja Satish., et al. “Growth of very low birth-weight Indian infants during hospital stay”. Indian Pediatrics10 (2010): 851-856.
21. Avila-Alvarez Alejandro., et al. “Restricción del crecimiento extrauterino en recién nacidos de menos de 1.500 gramos de peso al nacer☆”. Anales de Pediatría6 (2018): 325-332.
22. Trivedi Amit., et al. "Early versus late administration of amino acids in preterm infants receiving parenteral nutrition”. Cochrane Database of Systematic Reviews1 (2024): CD008771.
23. Ehrenkranz Richard A., et al. “Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants”. Pediatrics 4 (2006): 1253-1261.