Lesson 3: Monitoring Growth
3.1 Introduction
Postnatal growth failure is the most prevalent recognizable complication of extreme prematurity. Its incidence is inversely related to gestational age, meaning that the more premature the neonate is, the higher her chance is to develop postnatal growth faltering. As already discussed in Lesson 2.2 and 2.3 of Unit 1 of this module, nutrition is a key factor to avoiding postnatal growth failure.
The best strategy to avoid growth failure is actually to prevent it altogether. For that, it is clear that monitoring growth in the preterm infant is of the utmost importance (Poindexter 2014).
First of all, the neonatologist has to be prepared to recognize preterm infants who are at most risk of growth faltering. These risk factors have been reported by Clark and colleagues and include:
- Male gender
- Assisted ventilation necessity on the first day postpartum
- Respiratory support at 28 days
- Presence of necrotizing enterocolitis
- Administration of postnatal steroids.
(Clark et al. 2003)
Secondly, "more critically ill” neonates (defined by the use of mechanical ventilation for the first 7 days of life) were shown to receive reduced nutritional support (both parenteral and enteral) during the first 3 days post-partum in the NICU (Ehrenkranz et al. 2011). These infants receiving mechanical ventilation should also be included in the group risk for growth faltering and should be monitored to receive proper nutritional support.