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Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants

Journal of Perinatology volume 27, pages 359–364 (2007)Cite this article

Abstract

Objective:

To examine the association between weight loss during the first 10 days of life and the incidence of death or bronchopulmonary dysplasia (BPD) in small for gestational age (SGA) and appropriate for gestational age (AGA) extremely low-birth-weight infants.

Design/Methods:

This is a retrospective analysis of a cohort of ELBW (birth weight <1000 g) infants from the NICHD Neonatal Research Network's database. The cohort consisted of 9461 ELBW infants with gestational age of 24–29 weeks, admitted to Network's participating centers during calendar years 1994–2002 and surviving at least 72 h after birth. The cohort was divided into two groups, 1248 SGA (with birth weight below 10th percentile for gestational age) and 8213 AGA (with birth weight between 10th and 90th percentile) infants. We identified infants with or without weight loss during the first 10 days of life, which we termed as ‘early postnatal weight loss’ (EPWL). Univariate analyses were used to predict whether EPWL was related to the primary outcome, death or BPD, within each birth weight/gestation category (SGA or AGA). BPD and death were also analyzed separately in relation to EPWL. Logistic regression analysis was done to evaluate the risk of death or BPD in SGA and AGA groups, controlling for maternal and neonatal demographic and clinical factors found to be significant by univariate analysis.

Results:

SGA ELBW infants had a lower prevalence of EPWL as compared with AGA ELBW infants (81.2 vs 93.7%, respectively, P<0.001). In AGA infants, univariate analysis showed that death or BPD rate was lower in the group of infants with EPWL compared with infants without EPWL (53.4 vs 74.3%, respectively, P<0.001). The BPD (47.2 vs 64%, P<0.001) and death (13.8 vs 32.9%, P<0.001) rate were similarly lower in the EPWL group. The risk-adjusted odds ratios (ORs) showed that EPWL was associated with lower rate of death or BPD (OR 0.47, 95% CI: 0.37–0.60). In SGA infants, on univariate analysis, a similar association between EPWL and outcomes was seen as shown in AGA infants: death or BPD (55.9 vs 75.2%, P<0.001), BPD rate (48.3 vs 62.1%, P=0.002) and rate death (19 vs 40.8%, P<0.001) for those with or without EPWL, respectively. Multiple logistic regression showed that as in AGA ELBW infants, EPWL was associated with lower risk for death or BPD (OR 0.60, 95% CI: 0.41–0.89) among SGA infants.

Conclusions:

SGA infants experienced less EPWL when compared with their AGA counterparts. EPWL was associated with a lower risk of death or BPD in both ELBW AGA and SGA infants. These data suggest that clinicians who consider the association between EPWL and risk of death or BPD should do so independent of gestation/birth weight status.

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Author information

Authors and Affiliations

  1. Department of Pediatrics, All Childrens' Hospital, St. Petersburg, FL, USA

    R Wadhawan

  2. Department of Pediatrics, Brown University, Providence, RI, USA

    W Oh

  3. NICHD Neonatal Research Network, Bethesda, MD, USA

    R Perritt

  4. Department of Pediatrics, Brown University, Providence, RI, USA

    A R Laptook

  5. NICHD Neonatal Research Network, Bethesda, MD, USA

    K Poole

  6. NICHD Neonatal Research Network, Bethesda, MD, USA

    L L Wright

  7. Department of Pediatrics, Case Western Reserve University, Cleveland, OH, USA

    A A Fanaroff

  8. Department of Pediatrics, University of Miami, Miami, FL, USA

    S Duara

  9. Department of Pediatrics, Emory University, Atlanta, GA, USA

    B J Stoll

  10. Department of Pediatrics, Duke University, Durham, NC, USA

    R Goldberg

Authors
  1. R Wadhawan
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  2. W Oh
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  3. R Perritt
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  4. A R Laptook
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  5. K Poole
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  6. L L Wright
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  7. A A Fanaroff
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  8. S Duara
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  9. B J Stoll
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  10. R Goldberg
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Corresponding author

Correspondence to R Wadhawan.

Appendix A

Appendix A

Members of the NICHD Neonatal Research Network

Alan Jobe, MD, Chairman

University of Cincinnati

Case Western Reserve University (U10 HD21364)

Michele Walsh, MD*

Avroy A Fanaroff, MB, BCh

Nancy Newman, RN

University of Cincinnati (U10 HD27853)

Edward F Donovan, MD*

Vivek Narendran MD, MRCP

Marcia Mersmann, RN

Emory University (U10 HD27851)

Barbara J Stoll, MD*

Ellen Hale, RN

Indiana University (U10 HD27856)

James A Lemons, MD*

Brenda Poindexter, MD

Diana Appel, RN

University of Miami (U10 HD21397)

Shahnaz Duara, MD*

Charles R Bauer, MD

Ruth Everett, RN

University of New Mexico (U10 HD27881)

Lu-Ann Papile, MD*

Conra Backstrom, RN

Stanford University (U10 HD27880)

David K Stevenson, MD*

Krisa Van Meurs, MD

Bethany Ball, BS

University of Tennessee at Memphis (U10 HD21415)

Sheldon B Korones, MD*

Henrietta Bada, MD

Tina Hudson, RN

University of Texas Southwestern Medical Center (U10 HD40689)

Abbot R Laptook, MD*

Walid Salhab, MD

Gay Hensley, RN

University of Texas – Houston (U10 HD21373)

Jon E Tyson, MD, MPH*

Kathleen Kennedy, MD, MPH

Susie Madison, RN

Wayne State University (U10 HD21385)

Seetha Shankaran, MD*

Ganesh Konduri, MD

Geraldine Muran, RN

Women and Infants Hospital (U10 HD27904)

William Oh, MD*

Barbara Stonestreet, MD

Angelita Hensman, RN

Yale University (U10 HD27871)

Richard A Ehrenkranz, MD*

Patricia Gettner, RN

University of Alabama at Birmingham (U10 HD34216)

Waldemar A Carlo, MD*

Namasivayam Ambalavanan, MD

Monica V Collins, RN

Harvard University (U10 HD34167)

Ann R Stark, MD*

Kerri Fournier, RN

Duke University (U10 HD40492)

Ronald N Goldberg, MD*

Michael Cotten, MD

Kathy Auten, BS

Wake Forest University (U10 HD40498)

T. Michael O'Shea, MD*

Robert Dillard, MD

Nancy Peters, RN

University of Rochester (U10 HD40521)

Dale L. Phelps, MD*

Ronnie Guillet, MD, PhD

Linda Reubens, RN

University of California at San Diego (U10 HD40461)

Neil N Finer, MD*

Maynard Rassmussen, MD

Wade Rich, BS, RRT

Research Triangle Institute (U01 HD36790)

Abhik Das, PhD*

W Kenneth Poole, PhD

Betty Hastings

Carolyn M. Petrie

National Institute of Child Health and Human Development

Rosemary Higgins, MD

Linda L Wright, MD

James Hansen, MD

*Principal Investigator

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Wadhawan, R., Oh, W., Perritt, R. et al. Association between early postnatal weight loss and death or BPD in small and appropriate for gestational age extremely low-birth-weight infants. J Perinatol 27, 359–364 (2007). https://doi.org/10.1038/sj.jp.7211751

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