Comparison of Fenton and Intergrowth-21st For Postnatal Growth Assessment and Prediction of Neurodevelopment In Preterm Infants

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ESPR126
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Background: Preterm infants are at a higher risk for mortality and morbidity compared to infants born at term. Although the survival rate of preterm infants has improved over the years, impaired neurodevelopment remains a significant morbidity in this population. Suboptimal neurodevelopmental outcomes alone affect 20-45% of preterm infants. Early nutrition has been shown to play an important role in helping infants achieve adequate postnatal growth and optimal neurodevelopment. Optimizing nutrition is a promising avenue to mitigate the adverse neurodevelopmental consequences of preterm infants. Currently, there is no consensus regarding which growth assessment tools are suitable for monitoring postnatal growth of preterm infants and this poses a major challenge in the effort to optimize nutritional guidelines for this population. Fenton growth chart is one of the commonly used tools to identify infants who are small for gestational age (SGA) and to monitor postnatal growth. Intergrowth-21st(IG-21st) is a recently developed tool in effort to improve accuracy of growth assessment in the preterm population.

Objective: Determine the difference of two different growth assessment tools in identification of growth abnormalities and prediction of adverse neurodevelopmental outcomes.

Methods: We conducted a retrospective cohort study on a sample of 424 preterm infants born at 23-32 weeks gestation in Children's Hospital of Richmond (CHOR) over 5 years. Data on maternal and infant demographics and clinical characteristics including growth parameters were collected. Bayley III neurodevelopmental assessment scores at 1 & 2 years after birth were collected from our follow-up clinics. Descriptive analyses, Chi-square and spearman's correlation were used to analyze data.

Results: A total of 424 preterm infants who survived to discharge were included. The average gestational age was 29 ± 2.7weeks and 56% were male. 30% were white and 56% were black. The average birth weight was 1304 ± 465 grams. Of the total sample population those who followed up after NICU discharge for standardized neurodevelopmental testing were 33% and 23% at1 and 2 years respectively. Identification of SGA at birth was equivalent for Fenton and IG-21st tools. However, there was a significant difference in identification of postnatal growth failure by the two growth assessment tools with more infants identified as failure to grow at discharge per Fenton. There was no significant association between growth failure as identified by Fenton and poor neurodevelopmental outcomes at 1 or 2 years of age. However, growth failure as per IG-21st was significantly associated with poor motor and cognitive development at 2 years of age. None of the 60 infants identified as failure to grow by Fenton only had any neurodevelopmental abnormality.

Conclusion: Intergrowth-21st tool may be superior in identifying postnatal growth failure associated with poor neurodevelopmental outcomes in preterm infants.

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Children's Hospital of Richmond at Virginia Commonwealth University
Children's Hospital of Richmond
Children's Hospital of Richmond
Children's Hospital of Richmond

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