European Journal of Pediatrics

, 168:1055 | Cite as

Extrauterine growth retardation in premature infants in Shanghai: a multicenter retrospective review

  • Hong Mei Shan
  • Wei Cai
  • Yun Cao
  • Bing Hua Fang
  • Yi Feng
Original Paper


Intrauterine growth retardation (IUGR) represents the degree of body growth and development decided by genes and by placental function. Extrauterine growth retardation/restriction (EUGR) refers to severe nutritional deficits during the first weeks of life that result in growth that is less than expected based on intrauterine growth rates (growth values ≤10th percentile of intrauterine growth expected in accordance with the estimated gestational age). The deficits affect not only weight but also head circumference and height. As is well known, a nutrition support team (NST) is a multidisciplinary team comprised of physicians, nurses, dietitians, pharmacists, social workers, and medical technologists who provide nutritional management. In this study, we review 2,015 premature infants (1,209 boys and 806 girls) from four hospitals in the Shanghai area from January 1, 2003 to December 31, 2006, two of which had NSTs. The overall incidence of EUGR was 56.8% assessed by weight, while the incidence of IUGR was 26.1%. Higher incidence of EUGR was associated with lower birth weight, but higher gestational age. There was a significant relationship between EUGR incidence and NST availability (χ2 = 60.630, p < 0.001), though there was no similar finding for IUGR incidence. The incidence of EUGR was 44% in NST hospitals and 62.6% in non-NST hospitals. According to logistic regression, the following five factors were related to EUGR: male gender, gestational age at birth, birth weight, length of hospital stay, and NST availability. NSTs reduced the risk of EUGR by a magnitude of 0.47. EUGR remains a serious problem in premature infants in Shanghai, but NSTs can reduce EUGR incidence.


Extrauterine growth retardation Premature infants Nutrition support team 


  1. 1.
    Beck AM, Balknăs UN, Camilo ME et al (2002) Practices in relation to nutritional care and support: report from the Council of Europe. Clin Nutr 21(4):351–354. doi:10.1054/clnu.2002.0555 PubMedCrossRefGoogle Scholar
  2. 2.
    Clark RH, Thomas P, Peabody J (2003) Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 111(5):986–990. doi:10.1542/peds.111.5.986 PubMedCrossRefGoogle Scholar
  3. 3.
    Clark RH, Wagner CL, Merritt RJ et al (2003) Nutrition in the neonatal intensive care unit: how do we reduce the incidence of extrauterine growth restriction? J Perinatol 23(4):337–344. doi:10.1038/ PubMedCrossRefGoogle Scholar
  4. 4.
    Donovan R, Puppala B, Angst D et al (2006) Outcomes of early nutrition support in extremely low-birth-weight infants. Nutr Clin Pract 21(4):395–400. doi:10.1177/0115426506021004395 PubMedCrossRefGoogle Scholar
  5. 5.
    Ehrenkranz RA (2007) Early, aggressive nutritional management for very low birth weight infants: what is the evidence? Semin Perinatol 31(2):48–55. doi:10.1053/j.semperi.2007.02.001 PubMedCrossRefGoogle Scholar
  6. 6.
    Embleton NE, Pang N, Cooke RJ (2001) Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 107(2):270–273. doi:10.1542/peds.107.2.270 PubMedCrossRefGoogle Scholar
  7. 7.
    Gianini NM, Viera AA, Moreira ME (2005) Evaluation of the nutritional status at 40 weeks corrected gestational age in a cohort of very low birth weight infants. J Pediatr (Rio J) 81(1):34–40Google Scholar
  8. 8.
    Jin HZ, Huang DM, Guan XJ (2003) Textbook of practical neonatology, 3rd edn. Public Health, BeijingGoogle Scholar
  9. 9.
    Jonkers CF, Prins F, Van Kempen A et al (2001) Towards implementation of optimum nutrition and better clinical nutrition support. Clin Nutr 20(4):361–366. doi:10.1054/clnu.2001.0470 PubMedCrossRefGoogle Scholar
  10. 10.
    Kuzma-O’Reilly B, Duenas ML, Greecher C et al (2003) Evaluation, development, and implementation of potentially better practices in neonatal intensive care unit. Pediatrics 111:e461–e470. doi:10.1542/peds.111.3.461 PubMedCrossRefGoogle Scholar
  11. 11.
    Ochoa JB, Magnuson B, Swintosky M (2000) Long-term reduction in the cost of nutritional intervention achieved by a nutrition support service. Nutr Clin Pract 15:174–180CrossRefGoogle Scholar
  12. 12.
    Planas M, Camilo ME (2002) Artificial nutrition: dilemmas in decision-making. Clin Nutr 21(4):355–361. doi:10.1054/clnu.2002.0549 PubMedCrossRefGoogle Scholar
  13. 13.
    Radmacher PG, Looney SW, Rafail ST et al (2003) Prediction of extrauterine growth retardation (EUGR) in VVLBW infants. J Perinatol 23(5):392–395. doi:10.1038/ PubMedCrossRefGoogle Scholar
  14. 14.
    Regenstein M (1991) Nutritional support teams—alive, well, and still growing. Nutr Clin Pract 7(6):296–301. doi:10.1177/0115426592007006296 CrossRefGoogle Scholar
  15. 15.
    Taeusch HW, Ballard RA (1999) Avery’s diseases of the newborn, 7th edn. Saunders, PhiladephiaGoogle Scholar
  16. 16.
    Thureen PJ, William W, Hay J (2001) Early aggressive nutrition in preterm infants. Semin Neonatol 6(5):403–415. doi:10.1053/siny.2001.0061 PubMedCrossRefGoogle Scholar
  17. 17.
    Usha R, Lynnette MN. Recent Advances in Nutrition and Intrauterine Growth. Nestle Nutrition Workshop Series Pediatric Program Volume 47Google Scholar
  18. 18.
    Wu SM, Peng XM, Cai W (2003) Textbook of neonatal nutrition, 1st edn. Public Health, BeijingGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • Hong Mei Shan
    • 1
  • Wei Cai
    • 2
  • Yun Cao
    • 3
  • Bing Hua Fang
    • 4
  • Yi Feng
    • 1
  1. 1.Shanghai Children’s Medical CenterShanghai Jiao Tong University School of MedicineShanghaiChina
  2. 2.Xin Hua HospitalShanghai Jiao Tong University School of MedicineShanghaiChina
  3. 3.Children’s Hospital of Fudan UniversityShanghaiChina
  4. 4.Children’s Hospital Affiliated to Shanghai Jiao Tong UniversityShanghaiChina

Personalised recommendations