II DIAN J-OUI NAL OF PED1ATi' ICS Vol. 46

july, 1979

No. 378

" B I R T H W~-IGHr TO BIRTH W E I G H T " P O S T N A T A L W E I G H T P A T T E R N OF P R E T E R M INFANTS SUNIT S1NGHI AND MEItARBAN SINGH* JCtw Delhi

The importance of normal weight curve for assessment of growth of newborn infants cannot he over-emphasized. Accurate weighing of low birth weight babies during !lf6"iteonatal period is a very sensitive tool t0~csess the adequacy of feeding regimen ~ind weUbeing of the infants. All infants after birth show an initial weight loss, followed by stabilization and then an uninterrupted gain in weight. However, no information on these immediate postnatal weight changes in Indian preterm babies is available. I n the present study, an attempt is made to provide information on these changes in healthy appropriatefor.gestatlonal age (AGA) preterm infants. The effect o f two major variables, gestational age and caloric intake, on the postnatal growth pattern was also evaluated. Materials and Methods

Ninty-nine preterm infants ( 110

Overall

28-31 wk (n-15)

13.34-5.0 (n-7)

10.44-4-7 (n-4)

9.94-7.8 (n-4)

10.64- 5.6

$1-32 wk

11.04-4.0

7.34-3.9

7.7-]=3.7

(n.31)

(n-7)

(n-14)

(n-lo)

8.44-4.1

34-36 wk (n.53)

9.9 4- 4.7 (n-t5)

8.04-5.2 (n-24)

7.04- 4.5 (n-14)

8.34-4.9

10.74-5.0

8.04-4.8

8.04- 5.1

864-5.0

Overall

p ~ Gestation L 0.5, Caloric intake Z 0.01.

Irrespective of caloric intake, the initial weight loss was slgnificantly higher amongst lower gestational groups particularly among infants with gestat!onal age of 31 weeks or less (p < 0.05) ~Tabie 2). An intake of less than 80 cals/kg/day during the first and second week of life resulted in a significantly greater initial weight loss at each gestational age. The time taken to regain birth weight was inversely related to the gestatlonal maturity (p .~ 0.05). Babies with a gestational age of 31 weeks or less on an average T a b l e 3. Gestation

took 18.6 days to regain their birth weight as comPared t o 16.3 and 16.2 days by babies belonging to 32~33 weeks and 34-36 weeks gestation group respectively. The intake of upto 80 cals/kg/day during the first two weeks of life was associated with significant prolongation of time taken to regain birth weight when compared to ~n intake of more than 80 cals/kg/day. However, no significant difference was observed regarding time taken to regain birth weight among infants receiving 80-110 eab/kg/day, or > 110 cals]kg]day (Table 3).

Time taken to regain bbth weight (days)

Caloric intake per kg/day during I and II weeks > llO 50-80 81-110 9

=

28-31 weeks (n-15)

20.7+5.0 (n-7)

Overall

19.84.2 [ (n-4)

13.8~3.8

(n-4)

ii

186~4.2

32-33 weeks (n-31!

21.0-1-4.6 (n-7)

15.6t6,6 (n-14)

13.74-28

34-36 weeks (no53)

16.64-t-7.4 (n-15)

12.7• (no24)

14.24-5.6

14.2~6.1

Overall

18.7 4. 6.5

L4.515.8

14.14-4.0

15.6!59

p ~ Gestation L 0.05, Caloric intake L 0 0 l .

163•

C.-lo) (n-14)

226

IIqDIAN JOU,'~,NAL OF PEDIATRICS

Dtscueslon After birth, duri~g the p!izr~, of extrauterine acclimatisation and physiological adjustments, there is a transient interruption in the growth continuity of the newborn baby. After an initial weight loss, he stabilises and attempts to reestablish a postnatal growth rate which is similar to intrauterine growth velocity. The initial weight loss, which is due to loss of large amounts of extcacellular fluid, vernix, meconium and discontinuation of intrauterine" growth during the phase of extrauterine adaptation, is about 5 to 15 per cent in preterm neonates {Cross 1971, Petter 1965). An initial weight loss of 8 . 6 i 5 percent seen in our study is in keeping with other reports on preterm babies of Caucasian origin, but is much higher than the initial weight loss observed in term neonates. The duration of initial weight loss is aho considerably prolonged (6.8+-2.5 days) when compared to term neonates (3-4 days). Slower extrauterine adaptation, due to physiological immaturity and occurrence of late metabolic acidosis in preterm infants appear to be the main cause for this prolonged and higher initial weight loss (Singhi et el. 1978). Many factors, such as gestation, type and amount of feed, time of first feed (Das et el. 1975) environmental temperature and humidity (Glass r el. 1975) may effect the severity and duration of initial weight loss. The time of first feed, t$pe of feeds, environmental temperature and humidity and nursing care were similar for all infants in our study. Therefore, the effects of two variab!es, gestational age and caloric intake on the early postnatal growth pattern w.ere evaluated.

VoL, 46, No.~ Gestation does not seem to have significant effect on the period of ' weight loss. Possibly the time taken extrauterine physiological adaptation is,~ lated to the adequacy of extrauteri environment ra:her than gestational m:" rity. However, infants with gross immatur (28-31 weeks) showed significantly grea[;" initial weight loss. This may partly ~ due to proportionately higher extracellul fluid volume and higher incidence of l metabolic acidosis among very preter infants (Singhi et el. 1978, ganlov Siggaard Andersen 1972). Severity and duration of initial weig~ loss and time taken to regain birth weig~ was 3ign~ficantly prolonged 'among infa~: receiving < 80 cals/kg/day. Infants receivifi 80-110 cals/kg/day or > 110 eals/kg/cfa~ had identical early postnatal grow~ curves. Our findings suggest that an intak~ between 80-110 cals/kg/day during the fit~" and second week of life is optimal. TI~ increased incidence and severity of ,a~rmetabolic acidosis on higher protein intake (Swenningsen and Lindquist 1973, Sing~. e t a ' . 1978) may ezplain the tailure achieve further improvement in weight parameters at an enhanced caloric (and hence protein) intake exceeding 1t4 cals/kg/day.

Summary Ninty-nine healthy appropriate-for-~ gestational age preterm ( < 37 weeks neonates weighing less than 2000g. admitted to the Special Care Neonatal unit of All-India Institute of Medical Sciences Hospital were studied for immediate post~ natal weight pattern. Duration of initia weight loss, severity of ,initial weight lost and time taken to regain birth weight were

227

SiI~OH: A~D SIN(~H--BIRTH WEIOH'r TO BIRTH WE,IOHT

calculated. The overall mean (4.SD) initial weight loss was B.O (+-5.0) per cent. It was lost over a mean period of 0.8 (+_2.5) days, The birth weight was regained by 15.6 (4-5,9). The effect of two major variables, gestational age and calorie intake, were ~valuated and analysed statistically by twoway analysis of variance. An intake of less ~l/an 80 cals/kg/day during the first week of fig was associated with a significantly prolonged period of weight loss as compared to infants receiving 81-110 cals/kg/day (p .~ 0.01). Tim period of weight loss was unhffected by gestational maturity o f the Infant. Irrespective of caloric "intake, iniiial weight loss was significantly more in infants belonging to the lowest gestationai group ( i l . 6 % ) as compared to the higher gestational group (8.3%) (p < 0.05). An intake of less than 80 cals/kg/day during the first and second week of life resulted in a Significantly higher weight loss of 10.6 per cent, as compared to 8 4 per cent and 8.3 per cent in infants receiving 81-110 cals/kg, and ;> 110 cals/kg/day respectively. The time taken to regain birth weight was fig~ificantly prolonged in infants with lower gestational age and poor caloric intake during the first and second week of life. At caloric intakes o f 80-110 and :> 110 calslkg/day during the first and second week, there was no significant difference between m a x i m u m initial weight loss and

time taken to regain birth weight suggesting thereby that an intake beyond 110 cals/kg/day may :tot be useful. This may be explained on the basis of development of late metabolic acidosis in preterm infants receiving higher caloric and therefore higher protein intake. Refertqmcea Crou, V.M. (1971). The Preterrn Baby, Churchill Liolngstonr London, leventh Edition. Das, S.J., Devarajan, L.V., Rao, P.S.5, Jadhav, M. (1~77L Postnatal weight loss in first "/2 hours. Indian Pediatr, 14, 41. Glass, L., Lala, K., Jalswal, V., Nigam, S.K. (1975). Effect of thermal environment and ot|orir intake on head growth of low blrth, welght infan.ta during late neonatal period. Arch.Dir, GMlh. 50: 571. Petrov, S. (1065). Physiological weight loss. in premature infants. Afresh Greek (Sofia), 4, 464.

Ranlov, P., O, Siggaard, Andersen (1972). Late metabolic acidosis in oremature infants, prevalanee and significance. Acta Pediatr. (Upps tata)54, 531. Siogh, M., Giri, S.K., RamcharJdran, K. (1974). Intrauterine growth curVesof live-born babies. Indian Pediatr, 1l, 475. Singh, M., Ghai, O.P. (1970). In Care of the Newborn, Sagar Pt,bllcatlons, New Delhi. Singhi, S., Marwah, R.K., Singh, M. (1978). Late metabolic acidosis in preterm infants. Clinical profile and response to oral sodium bicarbonate therapy. Indian "/. Med. Res. {In Press). Swenningsen, N.W., Lindquist, P. (1073). Incidence of metabolic acidosis in term, preterm and small.for.gestatlonai age infants in relation to dietary protein intake. Acta Ptdiar. Second, 62, I.

"Birth weight to birth weight"--postnatal weight pattern of preterm infants.

II DIAN J-OUI NAL OF PED1ATi' ICS Vol. 46 july, 1979 No. 378 " B I R T H W~-IGHr TO BIRTH W E I G H T " P O S T N A T A L W E I G H T P A T T E R N...
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