Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia

BackgroundPreterm infants have high risk of developing growth restriction and long-term complications. Enteral feeding is often delayed in neonatal intensive care units (NICUs) for the fear of feeding intolerance and the associated necrotising enterocolitis, and recent advances in nutritional support are unavailable in low-income countries.ObjectiveThe aim of this study was to assess the incidence and associated factors of extrauterine growth restriction (EUGR) among preterm infants in selected NICUs in Ethiopia.MethodThis was a cross-sectional study involving a subgroup analysis of preterm infants admitted to hospitals, from a multicentre descriptive study of cause of illness and death in preterm infants in Ethiopia, conducted from 2016 to 2018. EUGR was defined as weight at discharge Z-scores <-1.29 for corrected age. Clinical profiles of the infants were analysed for associated factors. SPSS V.23 software was used for analysis with a significance level of 5% and 95% CI.ResultFrom 436 preterm infants included in the analysis, 223 (51%) were male, 224 (51.4%) very low birth weight (VLBW) and 185 (42.4%) small for gestational age (SGA). The mean (SD) of weight for corrected age Z-score at the time of discharge was -2.5 (1.1). The incidence of EUGR was 86.2%. Infants who were SGA, VLBW and longer hospital stay over 21 days had increased risk of growth restriction (p-value<0.01). SGA infants had a 15-fold higher risk of developing EUGR at the time of discharge from hospital than those who were appropriate or large for gestational age (OR (95%CI)=15.2 (4.6 to 50.1).ConclusionThe majority of the infants had EUGR at the time of discharge from the hospital, which indicates suboptimal nutrition. Revision of national guidelines for preterm infants feeding and improvement in clinical practice is highly required

Intrauterine growth and postnatal nutritional status of Ethiopian preterm infants: a prospective cohort study

Background: Severe nutritional deficit experienced in early life results in growth restriction and long term metabolic and neurodevelopmental complications. Establishing enteral feeding is often difficult in neonatal intensive care units, and recent advances in nutritional support are unavailable in low income countries. Method: This was a hospital-based multi-center descriptive study, under SIP project (Study of causes of illness and death of preterm infants in Ethiopia). Neonatal outcomes of 1336, 1:1 matched, singleton small for gestational age (SGA) and appropriate for gestational age (AGA) preterm infants were compared. The incidence and associated factors of extrauterine growth restriction (EUGR) was assessed in 436 preterm infants at the time of discharge from the hospital. Result: The SGA infants had increased risk of hypoglycemia (OR and 95% CI) 1.6 (1.2-2.0), necrotizing enterocolitis (NEC) 2.3 (1.2-4.1), polycythemia 3.0 (1.6-5.4), late onset neonatal sepsis (LOS) 3.6 (1.1-10.9)) and prolonged hospitalization 2.9 (2.0-4.2), whereas, the incidence of respiratory distress syndrome (RDS), apnea and mortality were not different in the SGA and AGA groups. Over all 86.2% of the infants had EUGR, those who were SGA, VLBW, and stayed in the hospital over 21 days had increased risk of EUGR (p-value <0.01). SGA infants had the highest risk of developing EUGR at the time of discharge compared to non-SGA (OR (95% CI) = 15.2 (4.6-50.1). Conclusion: The high incidence of EUGR observed in this study indicates that the nutritional support of the preterm infants was inadequate. SGA preterm infants are at particular risk for neonatal morbidities such as failure to thrive, hypoglycemia, NEC, LOS and polycythemia. Guidelines on preterm infants feeding in Ethiopia need to be updated and nutritional practices in the NICUs have to be improved. Further studies are needed to explore better approaches on nutritional support of sick preterm infants in low income settings