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Topical Area: Maternal, Perinatal and Pediatric Nutrition

Maternal, Perinatal and Pediatric Nutrition (I) (Poster Session)

(P07-049-23) Defining Growth Failure and Malnutrition Among Very Preterm Infants in a Large NICU Cohort: A Comparison of a Commonly Used Cut Point With Longitudinal Changes in Z-Scores

Saturday, July 22, 2023

12:00 PM – 1:00 PM ET

Location: Poster Board 181

Presenting Author(s)

Rachel R. Rickman, PhD, MS, RD (she/her/hers)

Graduate
The University of Texas at Austin
Austin, Texas, United States

Co-Author(s)

Steven A. Abrams, MD

Professor of Pediatrics
Dell Medical School at the University of Texas at Austin
Austin, Texas, United States
MA

Marcela Abrego

The University of Texas at Austin
Saralyn F. Foster, MS, RDN, LD (she/her/hers)

Doctoral Candidate
The University of Texas at Austin
Austin, Texas, United States
AR

Anthony Rudine

The University of Texas at Austin
Elizabeth M. Widen, PhD, RD

Assistant Professor
The University of Texas at Austin
Austin, Texas, United States

Disclosure(s):

Rachel R. Rickman, PhD, MS, RD: No relevant financial relationship(s) with ineligible companies to disclose.

Saralyn F. Foster, MS, RDN, LD: No relevant financial relationship(s) with ineligible companies to disclose.

Objectives: There is a need for improved malnutrition and growth failure classifications for infants born very preterm (≤32 wks gestation), with very low birthweight (VLBW; ≤1500 g) or extremely low birthweight (ELBW; ≤1000 g) in a NICU setting. We compared the growth failure classifications ≤10^th%ile for Fenton weight-for-age at 36 weeks postmenstrual age to recent malnutrition guidelines using changes in Fenton weight-for-age z-scores.

Methods: Data from very preterm infants were extracted from a single healthcare system from 2012 to 2020 in Austin, Texas (ELBW n=700; VLBW n=879). We compared the commonly used definition of growth failure (≤10^th %ile for Fenton weight-for age at 36 wks) to the recommended malnutrition indicators for weight-for-age z-scores from the 2018 Academy of Nutrition and Dietetics guidelines. The criteria for no malnutrition was defined as any change in weight-for-age z-score that was not a decrease of > 0.8. Mild malnutrition was characterized by a decrease of 0.8 to 1.2 z-scores, moderate as a decrease of 1.2 to 2, and severe as a decline ≥ 2. The changes in Fenton z-scores were calculated from birth to 36 weeks postmenstrual age.

Results: The proportion of infants classified with growth failure compared to the malnutrition indicators differed between the two methods (ELBW X²= 33.3, p< 0.001; VLBW X²=40, p< 0.001). Ninety-one ELBW (13%) and 131 (14%) VLBW infants with moderate or severe malnutrition based on z-score criteria were ≥10^th %ile for weight. Many infants classified as ≤10^th%ile had no or mild malnutrition based on z-score changes (ELBW n=205; VLBW n=114).

Conclusions: Utilizing the Fenton criterion, the use of the 10^th percentile for weight-for-age as a cut-off to identify growth failure at 36 wks failed to identify a large proportion of infants with moderate and/or severe growth failure for weight when classified using changes in z-scores. Malnutrition criteria using changes in growth parameters should be considered in clinical practice and as the basis for evaluating future research examining malnutrition in very preterm infants.

Funding Sources: Academy of Nutrition and Dietetics Nutritional Epidemiology Research Grant