Growth of preterm very low birth weight infants discharged with weight of less than 1500grams

Early discharge of preterm very low birth weight (VLBW) infants is at times inevitable in low resource settings. The implication of such practice on the growth of this high-risk population is not known. We conducted a retrospective chart review to describe the growth of preterm VLBW infants discharged with a weight of less than 1500g.ObjectivesTo describe the growth of discharged preterm VLBW infants over the first 12weeks.MethodBetween June 2013 and January 2014; 164 discharged preterm VLBW infants were followed up for 3months. Among the survivors (132), we identified 111 infant records for this study. Relevant data was entered in STATA for analysis. Growth percentiles were determined at approximately 4weeks, 8weeks, and 12weeks post-discharge using the intergrowth 21st growth charts. Growth velocities were computed using the 2-point average weight model. Regression analysis was used to identify factors associated with growth failure. Growth failure was defined as occipital frontal circumference (OFC), weight, and length<10th centile by 12weeks post-discharge. P-value of <0.05 was considered significant at a 95% confidence interval.ResultsAmong the study infants the median gestational age and weight at birth were 32weeks (range 28-35weeks) and 1250g(range 850-1500g) respectively; 60/111(54%) were Small for Gestational Age (SGA). The median discharge postmenstrual age (PMA) was 34weeks (range 30-38weeks) and weight was 1140g (range 830-1490g). The majority 88.2% had not recovered birth weight at discharge of whom 59.1% recovered by 2weeks and 40.9% recovered between 2 and 4weeks after discharge. By 12weeks post-discharge the median PMA and weight were 46weeks (range 37-51weeks),and 3110g (range 1750-5000g) respectively, 38.7% of the infants had growth failure and 36.9% had OFC <3rd centile. Growth velocity<15g/kg/d in the first 4weeks (OR 3.8, p 0.010) and subsequent 4weeks (OR 2.5, p 0.049) post-discharge were independently associated with growth failure.ConclusionSlow birth weight recovery was observed and growth failure was prevalent by 12weeks post-discharge with more than a third having severe microcephaly. Poor post-discharge growth velocity was associated with subsequent growth failure.RecommendationsGrowth velocity monitoring among preterm VLBW infants should be emphasized. The implication and interventions of this early growth failure needs to be explored.