Erin Landau-Crangle1, Niels Rochow1, Tanis R Fenton2, Kai Liu3, Anaam Ali1, Hon Yiu So3, Gerhard Fusch1, Michael L Marrin1, Christoph Fusch1,4. 1. Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. 2. Alberta Children's Hospital Research Institute, Department of Community Health Sciences, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada. 3. Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada. 4. Department of Pediatrics, Paracelsus Medical School, General Hospital of Nuremberg, Nuremberg, Germany.
Abstract
BACKGROUND: Growth of preterm infants is monitored using fetal charts despite individual trajectories being downshifted postnatally by adaptational processes. The study aims to compare different approaches to create individualized postnatal trajectories. METHODS: Three approaches to achieve growth similar to healthy term infants at 42+0/7 weeks postmenstrual age (PMA) on World Health Organization growth standards (WHOGS) (target weight) were tested by comparing trajectories obtained by: 1) following birth percentiles (Birth-Weight-Percentile Approach); 2) following percentiles achieved at day of life 21 (Postnatal-Percentile Approach); 3) using day-specific fetal median growth velocities starting at day of life 21 (Fetal-Median-Growth Approach [FMGA]). The primary outcome was delta weight (ΔW), defined as difference between target weight (WHOGS) at 42+0/7 weeks and weight predicted by trajectories. The secondary outcome was ΔW vs %fat mass in a cohort of 20 disease-free surviving very low-birth-weight infants. RESULTS: Birth-Weight-Percentile and Postnatal-Percentile Approach showed high ΔW; FMGA alone reduced ΔW. Introducing a factor to FMGA to reflect the transition to extrauterine conditions (Growth-Velocity Approach [GVA]) minimized ΔW. GVA merged with target and best normalized for body composition related to ΔW. CONCLUSIONS: GVA provides an evidence-based approach for individualized growth trajectories. GVA is based on physiologic data and that healthy preterm infants adjust their postnatal trajectory below their birth percentile. GVA may reflect a biologic principle because it matches consistently with WHOGS at 42+0/7 weeks for all preterm infants from 24 to 34 weeks. This concept could become a bedside tool to aid clinicians in monitoring growth, guiding nutrition, and minimizing chronic adult disease risks as a consequence of unguided, inappropriate growth.
BACKGROUND: Growth of preterm infants is monitored using fetal charts despite individual trajectories being downshifted postnatally by adaptational processes. The study aims to compare different approaches to create individualized postnatal trajectories. METHODS: Three approaches to achieve growth similar to healthy term infants at 42+0/7 weeks postmenstrual age (PMA) on World Health Organization growth standards (WHOGS) (target weight) were tested by comparing trajectories obtained by: 1) following birth percentiles (Birth-Weight-Percentile Approach); 2) following percentiles achieved at day of life 21 (Postnatal-Percentile Approach); 3) using day-specific fetal median growth velocities starting at day of life 21 (Fetal-Median-Growth Approach [FMGA]). The primary outcome was delta weight (ΔW), defined as difference between target weight (WHOGS) at 42+0/7 weeks and weight predicted by trajectories. The secondary outcome was ΔW vs %fat mass in a cohort of 20 disease-free surviving very low-birth-weight infants. RESULTS: Birth-Weight-Percentile and Postnatal-Percentile Approach showed high ΔW; FMGA alone reduced ΔW. Introducing a factor to FMGA to reflect the transition to extrauterine conditions (Growth-Velocity Approach [GVA]) minimized ΔW. GVA merged with target and best normalized for body composition related to ΔW. CONCLUSIONS:GVA provides an evidence-based approach for individualized growth trajectories. GVA is based on physiologic data and that healthy preterm infants adjust their postnatal trajectory below their birth percentile. GVA may reflect a biologic principle because it matches consistently with WHOGS at 42+0/7 weeks for all preterm infants from 24 to 34 weeks. This concept could become a bedside tool to aid clinicians in monitoring growth, guiding nutrition, and minimizing chronic adult disease risks as a consequence of unguided, inappropriate growth.
Authors: Nathan J Stevenson; Lisa Oberdorfer; Maria-Luisa Tataranno; Michael Breakspear; Paul B Colditz; Linda S de Vries; Manon J N L Benders; Katrin Klebermass-Schrehof; Sampsa Vanhatalo; James A Roberts Journal: Ann Clin Transl Neurol Date: 2020-05-05 Impact factor: 4.511
Authors: Niels Rochow; Erin Landau-Crangle; Hon Yiu So; Anna Pelc; Gerhard Fusch; Jan Däbritz; Wolfgang Göpel; Christoph Fusch Journal: PLoS One Date: 2019-05-07 Impact factor: 3.240
Authors: Victoria A A Beunders; Jorine A Roelants; Jessie M Hulst; Dimitris Rizopoulos; Anita C S Hokken-Koelega; Esther G Neelis; Kirsten S de Fluiter; Vincent W V Jaddoe; Irwin K M Reiss; Koen F M Joosten; Marijn J Vermeulen Journal: Pediatr Obes Date: 2020-11-17 Impact factor: 4.000