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“Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants

Journal of Perinatology volume 40, pages 704–714 (2020)Cite this article

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Abstract

Preterm infants are increasingly diagnosed as having “extrauterine growth restriction” (EUGR) or “postnatal growth failure” (PGF). Usually EUGR/PGF is diagnosed when weight is <10th percentile at either discharge or 36–40 weeks postmenstrual age. The reasons why the phrases EUGR/PGF are unhelpful include, they: (i) are not predictive of adverse outcome; (ii) are based only on weight without any consideration of head or length growth, proportionality, body composition, or genetic potential; (iii) ignore normal postnatal weight loss; (iv) are usually assessed prior to growth slowing of the reference fetus, around 36–40 weeks, and (v) are usually based on an arbitrary statistical growth percentile cut-off. Focus on EUGR/PGF prevalence may benefit with better attention to nutrition but may also harm with nutrition delivery above infants’ actual needs. In this paper, we highlight challenges associated with such arbitrary cut-offs and opportunities for further refinement of understanding growth and nutritional needs of preterm neonates.

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Fig. 1: Among healthy (no neonatal morbidities, no maternal diabetes, minimal infant respiratory support and were nourished by parenteral and enteral nutrition according to protocols) preterm infants, ~25% weighed less than the 10th percentile (1st dashed line below the solid line representing the 50th percentile) after their physiological postnatal weight loss.
Fig. 2: Weight gain patterns of preterm infants relative to intrauterine weight references, showing relative catch-up by the preterm infants after 36 weeks as fetal weight gain slows.

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Acknowledgements

We thank Rhonda Clark and Jim Hawkins, the parents of 27-week twins, for their endorsement of these concepts.

Author contributions

TRF conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. BC, DG, RN, BA, ME, WWH, AH, DA, FB, IG, NE, NR, ST, TS, RJS, SE, SG-W, DA, and PSS critically reviewed and revised the manuscript for important intellectual content All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

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Authors and Affiliations

  1. Community Health Sciences, Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Tanis R. Fenton, Belal Alshaikh & Seham Elmrayed

  2. Nutrition Services, Alberta Health Services, Calgary, AB, Canada

    Tanis R. Fenton

  3. Liggins Institute, University of Auckland, Auckland, New Zealand

    Barbara Cormack & Frank Bloomfield

  4. Carilion Clinic, Roanoke, VA, USA

    Dena Goldberg

  5. Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada

    Roseann Nasser

  6. Pediatrics, University of Calgary, Calgary, AB, Canada

    Belal Alshaikh

  7. Public Health and Community Medicine, Tufts University, Boston, MA, USA

    Misha Eliasziw

  8. University of Colorado, Denver, CO, USA

    William W. Hay

  9. Clínica del Country, Universidad el Bosque, Bogotá, Colombia

    Angela Hoyos

  10. Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Diane Anderson

  11. Clinical and Translational Research, Biomedical research Institute of New Jersey, Cedar Knolls, NJ, USA

    Ian Griffin

  12. Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Nicholas Embleton

  13. Pediatrics, McMaster University, Hamilton, ON, Canada

    Niels Rochow

  14. Pediatrics, Yale School of Medicine, New Haven, CT, USA

    Sarah Taylor

  15. Neonatology, University of Liege, CHU de Liege, Liege, Belgium

    Thibault Senterre

  16. Neonatal Services, Cohen Children’s Medical Center, Northwell Health, Zucker School of Medicine at Hofstra, New York, NY, USA

    Richard J. Schanler

  17. Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA

    Sharon Groh-Wargo

  18. Pediatrics, University of Louisville, Louisville, KY, USA

    David Adamkin

  19. Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah

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  1. Tanis R. Fenton
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Fenton, T.R., Cormack, B., Goldberg, D. et al. “Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants. J Perinatol 40, 704–714 (2020). https://doi.org/10.1038/s41372-020-0658-5

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