Extra uterine growth restriction and its related factors in extremely and very low birth weight babies including 1500 grams admitted to Jammhoria hospital in Benghazi.
DOI:
https://doi.org/10.37376/benunivmedj.v2i2.7496Keywords:
Benghazi, extra-uterine growth restriction, extremely low birth weight, very low birth weight, premature infants.Abstract
Abstract
Background:Extra-uterine growth restriction (EUGR) in premature infants remains a major challenge for neonatologists worldwide. In the neonatal intensive care unit (NICU), suboptimal nutrition and the fear of advancing feeds are key contributors. Updated feeding protocols that support rapid but safe feeding advancement, breast milk fortification, and close monitoring of growth parameters are essential to achieving optimal nutritional outcomes and preventing long-term neurodevelopmental impairment.
Objective: To determine the frequency of extra-uterine growth restriction (EUGR) among premature infants in Benghazi and identify associated risk factors.
Method: This cross-sectional study was conducted in Benghazi. Medical records of 107 premature infants were obtained from the neonatal clinic. All preterm infants born at <34 weeks’ gestation and weighing ≤1500 grams were included. Growth measurements at birth, discharge, and 40 weeks corrected age were plotted on Fenton growth charts. Weight <10th percentile was classified as EUGR. A p-value <0.05 was considered statistically significant.
Results: EUGR was identified in 85 infants (79%) at discharge and in 63 infants (58.8%) at 40 weeks corrected age. Significant risk factors for EUGR at discharge and at 40 weeks included lower birth weight (p = 0.01; p = 0.005), longer hospital stay (p = 0.007; p = 0.01), small for gestational age (SGA) (p = 0.000; p = 0.02), and sepsis (p = 0.03; p = 0.001). Additionally, gestational age 33–34 weeks (p = 0.001) and multiple births (p = 0.03) were significant risk factors for EUGR at discharge only.
Conclusion: Extra-uterine growth restriction is highly prevalent among Libyan premature infants. Lower birth weight, prolonged hospitalization, SGA status, gestational age of 33–34 weeks, and multiple births were significant associated risk factors.
Recommendations: Implementation of updated feeding protocols for premature infants in Libya—including rapid but safe advancement of enteral feeds, breast milk fortification, and close monitoring of growth parameters—is essential to improving nutritional outcomes and reducing the risk of EUGR.
References
(1) Fanaroff AA, Hack M, Walsh MC. The NICHD neonatal research network: Changes in practice and outcome during the first15 years.Semin Perinatol 2003;27:281-7 .
(12) Patel RM, Kandefer S, Walsh MC, Bell,EF., Carlo, WA., Laptook, AR., Sanches,PJ., Shankaran, S., Merus, KP., Ball, MB., Hale,EC., Newman,NS., Das,A., Haggins,RD., Stoll, BJ . Causes and timing of death inextremely premature infants from 2000 through 2011. N Engl J Med2015; 372:331–40.
(3) Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003;111:986–90.
(4) Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2001;107: 270e3.
(5) Lin HY, Huang FK, Lin MH, Chiu HY, Lin HC, Su BH. Extrauterine
growth restriction in very preterm infants. Annual Meeting of Taiwan Pediatric Association 2012;53:196.
(6) Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF,Wright LL, Katsikiotis, V., Tyson, JE., Oh,W., Shankaran, S., Bauer, CR., Korones, SB., Stoll, BJ., Stevenson,DK., Papile, LA. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics. 1999;104:280---9
(7) Shan HM, Cai W, Cao Y, Fang BH, Feng Y. Extra-uterine growth retardation in premature infants in Shanghai: a multicenter retrospective review. Eur J Pediatr. 2009;168:1055---9.
(8) Ehrenkranz RA. Early aggressive nutritional management for very low birth weight infants: what is the evidence? Semin Perinatol.2007;31:48-55
(9) McCallie KR, Lee HC, Mayer O, Cohen RS, Hintz SR, Rhine WD. Improved outcomes with a standardized feeding protocol for very low birth weight infants. J Perinatol.2011;31:S61-7
(10) Ehrenkranz RA. Periviable Birth Workshop: obstetrical & neonatal considertions. Ongoing NICU issues:nutrition, prevention of bronchopulmonary dysplasia& nosocomial infection . Semin perinatal. 2013: in press
(11) Dinerstein A, Nieto RM, Solana CL, Perez GP, Otherguy LE, Larguia AM. Early and aggressive nutritional strategy(parenteral and enteral) decreases postnatal growth failure in very low birth weight infants. J Perinatol.2006;26:436-42
(12) Patole SK, De Klerk N. Impact of standardized feeding regimens on incidence of neonatal necrotizing enterocolitis: a systematic review and meta-analysis of observational studies .Arch Dis Child Fetal Neonatal Ed.2005;90:F147-51.
(13) Bai-Horng Su. Optimizing nutrition in preterm infants. Pediatrics and Neonatology.2014;55:5-13
(14) Gounaris A K, Soukou R , Gounari EA, Panagiotounakou P, Grivea NJ.Extrauterine growth restriction and optimal growth of very preterm neonates: State of the Art.Nutrients.2023. https://doi.org/10.3390/nu15143231
(15) Matsubara R, Yonezawa K, Haruna M, Usui Y, Yokota S, Takahashi N,Kashima k, Ito A. Factors associated with extrauterine growth restriction in very low birth weight infants: A retrospective study in Japan. pediatric and Neonatology.2025. https://doi.org/10.1016/j.pedneo.2025.010
(16) Avila-Alvarez A, Boga AS, Bermudez-Hormigo C, Carballala, JF. Extrauterine growth restriction among neonates with birth weight less than 1,500 grams. An Pediatr(Barc) 2018;89:325-32.
(17)Pampanini V, Boiani A, Marchis CD, Giacomozzi, R , Agostino R , Dini F , Ghiri P , Cianfarani S. Preterm infants with sever extrauterine growth restriction (EUGR) are at high risk of growth impairment during childhood,Eur J Pediatr 2015; 174:33-41
(18) Bozzetti v,Dui GL, Zennin E, Ricco S, Coglinese P, Cavalleri v, Iozzi L, Ventura LM, Ferrante S.AI to predict extrauterine growth restriction during transitional nutrition of preterm infants: retrospective study.J of perinatology 2025; https://doi.org/10.1038/s41372-025-02445-4
(19)IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp; 2015.
(20) Gidi NW , Goldenberg R L , Nigussie A K, Clture E M , Mekasha A, Worku Bo, Siebeck M , Genzel-Borovieczeny O , Muhe L .Incidence and associated factors of extrauterine growth restriction in preterm infants, a cross sectional study in selected NICUS in Ethiopia. BMJ paediatrics 2020; 4:e 000765.doi:10.1136/bmjbo-2020-000765
(21) Liao W-L , Lin M-C , Wang T-M , Chen C-H .Taiwan Premature Infant follow-up Network. Risk factors for post discharge growth restriction among very-low-birth-weight: A nationwide registry study in Taiwan. Paediatric andNeonatology.2019, https://doi.org/10.1016/j.pedneo.2019.03.004
(22) Zhao X , Ding L , Chen X , Zhu X , Wang J . Characteristic and risk factors for extrauterine growth restriction in very-low-birth-weight infants.Medcine.2020; 99:47
(23) Wang Y, Shen W, Wu F, Mao J, Liu L , Chang Y-M , Zhang R , Ye X- Z , Qiu Y-P, Ma L, Cheng R, Wu H , Chen D-M , Zheng Z , Lin X-Z , Tong X-M . The national multi-center Eugr Collaborative Group. Factors influencing extrauterine growth restriction in singltone-non-small for gestational age infants in China: A prospective multi-center study. Paediatric and Neonatology.2022. Published by Elsevier Taiwan. https://doi.org/10.1016/j.pedneo.2022.04.013
(24) Makkker K, Ji Y, Hong X, Wang, X. Antenatal and neonatal factors contributing to extrauterine growth failure (EUGR) among preterm infants in Boston Birth Cohort( BBC). Journal of perinatology.2021 41:1025-1032. http://doi.org/10.1038/s41372-021-00948-4
(25) Lee SM, Kim N, Namgung R, Park M, Park K, Jeon J .Prediction of postnatal growth failure among very low birth weight infants. Scientific report.2018 8: 3729. Doi: 10.1038/s41598-018-21647-9
(26) İşcan B. Postnatal growth and extrauterine growth retardation (EUGR) in extremely low gestational age newborns(ELGANS) with 2-year follow up. Trends in pediatric.2025;(6) 1:33-39.DOI: 10.59213/TP .2025.206.
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