66.03 Impact of Growth and Nutrition on Risk of Acquired Diseases of Prematurity and Perinatal Mortality

T. J. Sinclair^1,2, C. Ye⁵, F. Salimi Jazi², J. Taylor², K. Bianco⁴, G. Shaw³, D. K. Stevenson³, R. Clark⁶, K. G. Sylvester^{2  1}Stanford University School Of Medicine,Department Of General Surgery,Stanford, CA, USA ²Stanford University School Of Medicine,Division Of Pediatric Surgery,Stanford, CA, USA ³Stanford University School Of Medicine,Department Of Pediatrics,Stanford, CA, USA ⁴Stanford University School Of Medicine,Department Of Obstetrics & Gynecology,Stanford, CA, USA ⁵Hangzhou Normal University,School Of Medicine,Hangzhou, ZHEJIANG, China ⁶Pediatrix-Obstetrix Center For Research, Education And Quality,Sunrise, FL, USA

Introduction:

Birth weight and gestational age are the predominant clinical factors used to risk stratify infants for acquired diseases of prematurity including necrotizing enterocolitis (NEC), chronic lung disease (CLD), and retinopathy of prematurity (ROP). We sought to further elucidate the relative impact of size (birth weight, BW), prematurity (gestational age, GA), pre- and postnatal growth, and postnatal nutrition on the risk of perinatal mortality and development of acquired diseases of prematurity. 

Methods:

We performed a retrospective longitudinal cohort study by querying a multicenter, longitudinal database that included 995 preterm infants (<32 weeks gestation). Detailed clinical and nutritional data were collected on subjects for the first 6 weeks of life. Comparator groups were generated based on the following variables: BW (top vs. bottom quartiles), GA (23-26 vs. 29-32 weeks), fetal growth restriction (small for gestational age (SGA defined as <10^th percentile BW for GA) vs. appropriate for gestational age (AGA, BW 10-90^th percentile for GA)), growth velocity (top vs. bottom quartile of change in weight z-score from birth to day of life 42), and total calories (<100 vs >120 kcal/kg/day averaged from day of life 2-42). Cases of NEC, CLD (need for supplemental oxygen at day of life 42), [DS1] and ROP were identified. Odds Ratios (OR) with 95% confidence intervals (CI) were calculated using the defined comparator groups for the outcomes of NEC, CLD, ROP, mortality (during the study period), and a composite of the disease and mortality outcomes. Statistical significance was defined as p-value < 0.05. Mortality outcome was excluded from the growth velocity and total calorie analyses given the longitudinal nature of the variable definitions.

Results:

Infants in the top quartile for BW or born at 29-32 weeks gestation were found to be at a significantly reduced risk for all disease outcomes, mortality, and the composite outcome. However, when fetal growth restriction was present there was an increased risk of ROP and mortality, but not for NEC[DS1] , CLD, or the composite outcome. Similarly, being in the bottom quartile for post-natal growth velocity was associated with an increased risk of developing ROP, but not for the other outcomes. Finally, receiving greater than 120 kcal/kg/day on average was associated with a decreased risk for all outcomes, except for NEC which approached but did not reach statistical significance. See Table 1.

Conclusion:

These results suggest that postnatal caloric delivery is a significant modifier of premature newborns’ risk of acquired major perinatal disease and mortality. These findings may be of particular importance given that postnatal caloric delivery may be modifiable.