Factors Associated with In‐Hospital Growth Trajectories of Very Low Birth Weight (VLBW) Infants
Bibliographic record
Abstract
Background Optimal in‐hospital growth is associated with improved long‐term health and neurodevelopment in VLBW infants. Previous studies have examined many explanatory factors (e.g. birth characteristics, type of enteral feeding, nutrient intakes, and morbidity). However, few studies have systematically evaluated these factors together to examine growth rates over the entire in‐hospital course. Objective To examine associations between infant characteristics, morbidities, daily macronutrient and energy intakes, and in‐hospital weight, length, and head circumference (HC) trajectories over time. Methods 316 VLBW infants from the GTA‐DoMINO (ISRCTN35317141) trial were included. Infant characteristics, morbidities, daily nutrient intakes, and weekly anthropometrics were collected prospectively from birth to 90‐days or until hospital discharge, whichever occurred first. Repeated measures linear regression models were used to assess the relationship between explanatory factors and anthropometric measures over time. Results Mean birth weight, length, and HC were 1021 (SD, 260) g, 35.7 (3.4) cm, and 25.1 (2.3) cm, respectively. At birth, mean gestational age was 28.0 (2.5) weeks and 13% of infants were small for gestational age. All macronutrient and energy intakes were associated with weight over time. Of energy and macronutrients, energy intakes showed the greatest association with mean weight gain during postnatal days 9–29 (2.5 g/kg/d, p<.0001); however, lipid intakes showed the greatest association with weight gain during days 30–90 (3.0 g/kg/d, p<.0001). From days 1–8, all macronutrient and energy intakes were associated with length over time (p‐values: 0.003–0.0005); however, no intakes were associated with length beyond day 8. Lipid and energy intakes were associated with HC over time during days 1–8 and 9–29 (p‐values: 0.01–0.007), but not beyond the first month. Infants fed >50% donor milk showed slower weight gain between days 9–29 compared to infants fed >50% formula (−0.9 g/kg/d) or mothers' milk (−1.1 g/kg/d, p<.0001); while the HC gains of infants fed >50% donor milk and mothers' milk were similar, they were slower than the HC gains of infants fed >50% formula. Of morbidities assessed, patent ductus arteriosus showed the greatest association with weight (−2.6 g/kg/d, p<.0001) and HC (−0.21 cm/wk, p<.0001) during days 9–29, while late‐onset sepsis showed the greatest association with weight (−1.6 g/kg/d, p<.0001) and length (−0.13 cm/wk, p<.0006) during days 30–90. Conclusions Daily macronutrient and energy intakes are associated with weight gain over time, regardless of postnatal age. Early, rather than late, nutrient intakes are associated with length and HC gains over time. Morbidities and the strength of their association with growth are dependent upon the infants' postnatal age during hospitalization. Support or Funding Information Funded by CIHR (MOP#102638; FDN#143233).
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".