Peer-reviewed article
Postnatal growth trajectories and extrauterine growth restriction in very low birth weight infants managed without routine parenteral nutrition in a resource-limited south African neonatal unit.
Muneerah Satardien, Evette Van Niekerk, Mirjam van Weissenbruch, Lizelle Van Wyk ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined growth outcomes in very low birth weight infants in a South African neonatal unit that managed nutrition primarily through breast milk and enteral feeding, without routine parenteral nutrition. Among 511 infants, about one-third experienced extrauterine growth restriction (failure to grow adequately after birth), with median discharge weight declining from birth. The research found that achieving enteral feeding volumes alone was insufficient to prevent poor growth, and highlighted the need for better protein and energy optimization.
Key points
- 32.4% of infants met the definition of extrauterine growth restriction (EUGR) by discharge or transfer
- Mean weight growth velocity was 13.4 g/kg/day, below optimal levels
- Discharge weight Z-scores showed median decline from birth (-0.2 to -0.7)
- EUGR was associated with lower birth weight, intrauterine growth restriction, late-onset sepsis, and delayed recovery of birth weight
- Enteral feeding advancement alone was insufficient to prevent growth restriction
Limitations
The study is retrospective and observational, so cannot determine causation or account for unmeasured confounding factors. The findings describe only what happened in one South African tertiary unit and may not generalize to other resource-limited settings or neonatal care approaches.
Abstract
BACKGROUND: Optimal nutritional management of very low birth weight infants (VLBWIs) remains challenging in resource-limited settings where parenteral nutrition is often unavailable. Data describing growth outcomes among infants managed with predominantly enteral strategies are limited. OBJECTIVE: To evaluate nutritional intake, postnatal growth trajectories, and extrauterine growth restriction (EUGR) in VLBWIs managed with predominantly enteral feeding in a tertiary neonatal unit in South Africa. METHODS: A retrospective cohort study was conducted at a tertiary unit between January 2021 and December 2022. Nutritional practices prioritised mothers' own milk. Anthropometric measurements were assessed using the Intergrowth-21st (IG-21ST) standards. EUGR was defined as a decline in weight Z-score > 1.28 from birth to discharge. Receiver operating characteristic (ROC) analysis was used to assess the predictive value of early feeding variables for EUGR. RESULTS: Of 1235 VLBWIs admitted, 511 (41.3%) met inclusion criteria. Mean gestational age was 28.6 ± 1.7 weeks, and mean birth weight was 1061.2 ± 204.3 g. Median birth weight Z-score was -0.2 (IQR -0.9 to 0.5). Mean weight growth velocity (WGV) was 13.4 ± 6.6 g/kg/d. Median discharge weight Z-score was -0.7 (IQR -2.0 to 1.9). At discharge or transfer, 166 infants (32.4%) met the ΔZ > 1.28 definition of EUGR, while 196 infants (38.4%) had a discharge/transfer weight Z-score below -1.28. EUGR was associated with lower birth weight, IUGR, late-onset sepsis, and longer time to regain birth weight. CONCLUSIONS: Despite successful early advancement of enteral feeding, suboptimal growth and declining Z-scores remained common. Achieving enteral feed volumes alone was insufficient to prevent EUGR, highlighting the importance of early protein and energy optimisation, timely advancement to full fortification, and routine growth monitoring in resource-limited settings.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Management with predominantly enteral feeding (prioritizing mothers' own milk) without routine parenteral nutrition
- Population
- 511 very low birth weight infants (mean gestational age 28.6 weeks, mean birth weight 1061.2 g) admitted to a tertiary neonatal unit in South Africa between January 2021 and December 2022
Key finding
32.4% of infants met definition of EUGR (weight Z-score decline >1.28 from birth to discharge)
Satardien et al. · PubMed (US National Library of Medicine) · 1 Jun 2026