Background Extrauterine growth restriction (EUGR) is common in preterm infants and may impair neurodevelopment. The absence of a standardized definition limits early identification. We evaluated agreement and factors associated with EUGR using cross-sectional and longitudinal definitions. Methods Matched case–control study in three kangaroo mother care programs. EUGR was defined cross-sectionally and longitudinally. Cases were matched by gestational age and city (1:2 cross-sectional; 1:1 longitudinal). Conditional logistic regression assessed associations with maternal, perinatal, and nutritional factors. Results We included 221 cross-sectional cases with 442 controls and 287 longitudinal cases with 287 controls. Agreement between definitions was fair (κ = 0.32). For both definitions, enrollment in workers’ health insurance and longer hospital stay were associated with higher EUGR odds, whereas any formula feeding was associated with lower odds. Among infants receiving parenteral nutrition, delayed weight recovery and longer hospitalization increased EUGR odds, while higher carbohydrate intake and exclusive formula feeding reduced it. In the longitudinal model, neonatal intensive care unit stay and patent ductus arteriosus increased odds, whereas more hours in kangaroo position reduced it. Conclusions Poor agreement between EUGR definitions and differences in associated factors underscore the need to standardize EUGR definitions to optimize and individualize enteral and parenteral nutritional support. Impact <UnorderedList Mark="Bullet"> <ItemContent> This multicenter study shows that 30–40% of Colombian preterm infants <35 weeks GA develop EUGR, with the longitudinal definition capturing earlier growth faltering and the cross-sectional one more severe and persistent failure. </ItemContent> <ItemContent> Poor concordance between cross-sectional and longitudinal EUGR definitions and differences in associated factors highlight the need for a standardized EUGR definition and for optimized, individualized enteral and parenteral nutritional support in preterm infants. </ItemContent> <ItemContent> By contrasting EUGR definitions and identifying modifiable factors, this study adds novel evidence from a middle-income setting. Its impact is to guide context-specific nutritional protocols and strengthen early growth monitoring in neonatal care. </ItemContent> </UnorderedList>

Extrauterine growth restriction definitions and associated factors among Colombian preterm infants: a case control study

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2026年7月10日

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Adriana Montealegre-Pomar,
Nathalie Charpak,
Martín Alonso Rondón Sepúlveda,
Magda Cristina Cepeda Gil

摘要

Background

Extrauterine growth restriction (EUGR) is common in preterm infants and may impair neurodevelopment. The absence of a standardized definition limits early identification. We evaluated agreement and factors associated with EUGR using cross-sectional and longitudinal definitions.

Methods

Matched case–control study in three kangaroo mother care programs. EUGR was defined cross-sectionally and longitudinally. Cases were matched by gestational age and city (1:2 cross-sectional; 1:1 longitudinal). Conditional logistic regression assessed associations with maternal, perinatal, and nutritional factors.

Results

We included 221 cross-sectional cases with 442 controls and 287 longitudinal cases with 287 controls. Agreement between definitions was fair (κ = 0.32). For both definitions, enrollment in workers’ health insurance and longer hospital stay were associated with higher EUGR odds, whereas any formula feeding was associated with lower odds. Among infants receiving parenteral nutrition, delayed weight recovery and longer hospitalization increased EUGR odds, while higher carbohydrate intake and exclusive formula feeding reduced it. In the longitudinal model, neonatal intensive care unit stay and patent ductus arteriosus increased odds, whereas more hours in kangaroo position reduced it.

Conclusions

Poor agreement between EUGR definitions and differences in associated factors underscore the need to standardize EUGR definitions to optimize and individualize enteral and parenteral nutritional support.

Impact

This multicenter study shows that 30–40% of Colombian preterm infants <35 weeks GA develop EUGR, with the longitudinal definition capturing earlier growth faltering and the cross-sectional one more severe and persistent failure.

Poor concordance between cross-sectional and longitudinal EUGR definitions and differences in associated factors highlight the need for a standardized EUGR definition and for optimized, individualized enteral and parenteral nutritional support in preterm infants.

By contrasting EUGR definitions and identifying modifiable factors, this study adds novel evidence from a middle-income setting. Its impact is to guide context-specific nutritional protocols and strengthen early growth monitoring in neonatal care.