title: Physiological adjustment to postnatal growth trajectories in healthy preterm infants.
abstract: International guidelines suggest that growth of preterm infants should match intrauterine rates. However, the trajectory for extrauterine growth may deviate from the birth percentile due to an irreversible, physiological loss of extracellular fluid during postnatal adaptation to extrauterine conditions. To which "new" physiological growth trajectory preterm infants should adjust to after completed postnatal adaptation is unknown. This study analyzes the postnatal growth trajectories of healthy preterm infants using prospective criteria defining minimal support, as a model for physiological adaptation.
  
  
  
  International, multi-center, longitudinal, observational study at five neonatal intensive care units (NICUs). Daily weights until day of life (DoL) 21 of infants with undisturbed postnatal adaptation were analyzed (gestational ages: (i) 25-29 wk, (ii) 30-34 wk).
  
  
  
  981 out of 3,703 admitted infants included. Maximum weight loss was 11% (i) and 7% (ii) by DoL 5, birth weight regained by DoL 15 (i) and 13 (ii). Infants transitioned to growth trajectories parallel to Fenton chart percentiles, 0.8 z-scores below their birth percentiles. The new trajectory after completed postnatal adaptation could be predicted for DoL 21 with R(2) = 0.96.
  
  
  
  This study provides a robust estimate for physiological growth trajectories of infants after undisturbed postnatal adaptation. In the future, the concept of a target postnatal trajectory during NICU care may be useful.
authors: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors: Niels
authors: 0000-0001-7990-3904
authors: N
authors: Rochow
authors: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors: Preeya
authors: P
authors: Raja
authors: Department of Mathematics and Statistics, McMaster University, Hamilton, Ontario, Canada.
authors: Kai
authors: K
authors: Liu
authors: Department of Community Health Sciences, Alberta Children's Hospital Research Institute, O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada.
authors: Tanis
authors: T
authors: Fenton
authors: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors: Erin
authors: E
authors: Landau-Crangle
authors: Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.
authors: Susanne
authors: S
authors: Göttler
authors: Department of Pediatrics, University of Greifswald, Greifswald, Germany.
authors: Andrea
authors: A
authors: Jahn
authors: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors: Sauyoung
authors: S
authors: Lee
authors: Department of Pediatrics, St. Joseph's Healthcare, Hamilton, Ontario, Canada.
authors: Sandra
authors: S
authors: Seigel
authors: Department of Pediatrics, St. Michael's Hospital, Toronto, Ontario, Canada.
authors: Douglas
authors: D
authors: Campbell
authors: Department of Pediatrics, University of Greifswald, Greifswald, Germany.
authors: Matthias
authors: M
authors: Heckmann
authors: Department of Pediatrics, University of Heidelberg, Heidelberg, Germany.
authors: Johannes
authors: J
authors: Pöschl
authors: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
authors: Christoph
authors: C
authors: Fusch
mesh_terms: D015415:Biomarkers / Q000378:metabolism; D001724:Birth Weight / Q000502:physiology*; D001823:Body Composition; D001835:Body Weight; D005260:Female; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature / Q000254:growth & development*; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D007391:International Cooperation; D008137:Longitudinal Studies; D008297:Male; D011446:Prospective Studies; D012044:Regression Analysis
chemical_list: D015415:Biomarkers