Influence Of Birth Weight Discordance And Adequate Enteral Nutrition During Hospitalization On Discharge EUGR Of Twins

ObjectiveTo study the weight changes of live born twins with inconsistent birth weight during hospitalization,analyze the influence of inconsistent birth weight and adequate enteral nutrition during hospitalization on EUGR of twins at discharge,and compare the sensitivity and applicability of adequate enteral nutrition standards in predicting the occurrence of EUGR at discharge.MethodsTo collect and retrospectively analyze the data of 1080 live twin births born in the Third Affiliated Hospital of Guangzhou Medical University between January 2011 and December 2020 in the neonatal intensive care unit(NICU).The twins were divided into the birthweight discordant twins(BWDT)and the birthweight concordant twins(BWCT)with the standard of birthweight discordance> 20%.The twins were divided into heavy infants and light infants according to their weight.The weight changes and adequate enteral nutrition of the BWDT group and the BWCT group,the heavy infants and the light infants were compared by Chi-square test,independent T-test or rank sum test.The independent risk factors of extrauterine growth retardation(EUGR)were investigated by logistic regression analysis,and the sensitivity and applicability of different adequate enteral nutrition criteria in predicting EUGR of twins at discharge from hospital were evaluated.ResultsStudy 1: A total of 204 BWDT pairs and 876 BWCT pairs were included in this study.The general data of the pregnant woman were comparable between the two groups(P > 0.05).The proportion of boys(49.5% vs.40.7%)and the birth weight(1868.22±394.14 vs.1520.81±379.38)(g)of the light infants in the BWDT group are significantly lower than those in the BWCT group.The incidence of small for gestational age(SGA)(18.5% vs.61.8%),milk opening time(h)(17 vs.21),adequate feeding time(d)(13 vs.18.5),the incidence of bronchopuldysplasia(BPD)(8.9%vs.13.7%),hospital days(d)(18 vs.28)and the incidence of EUGR(68.9% vs.95.8%)of the light infants in the BWDT group are significantly higher than those in the BWCT group(P < 0.05),and the differences were statistically significant(all P <0.05).BWDT had a faster rate of body weight gain(g/kg/d)(13.33±12.76 vs.21.42±47.38),but the difference was not statistically significant(P = 0.062).The birth weight(g)(2048.68±429.54 vs.2150.35±455.62),milk opening time(h)(17vs.21),the recovery days of birth weight(9 vs.11)of the heavy infants in the BWDT group are significantly higher than those in the BWCT group,and the differences were statistically significant(all P < 0.05).SGA(OR=122.97,95%CI17.059-886.414),BWDT(OR=1.582,95%CI 0.981-2.551),delayed adequate enteral nutrition time(OR=1.063,95%CI 1.041～1.086)were the risk factors for EUGR of twins at discharge.Study 2: In the BWDT or BWCT group,total fluid intake(ml/kg/d)and total caloric calorie intake(kcal/kg/d)were divided,respectively.General data of the two groups’ pregnant woman were comparable between groups(P > 0.1).In the BWDT or BWCT group,there were significant differences in feeding days,caloric calories and fluid volume of heavy or light infants under different feeding standards,and the differences were statistically significant(P < 0.05).With the enteral nutrition standards of adequate fluid levels,EUGR was associated with lower birth weight(OR=0.867,95%CI 0.828-0.907),delayed enteral feeding time with adequate fluid volume(OR=1.052,95%CI 1.012-1.094),and prevalence of BPD(OR=5.510,95%CI1.226～24.760).With the enteral nutrition standards of caloric fluid levels,EUGR was associated with lower birth weight(OR=0.873,95%CI 0.837-0.910)and delayed caloric feeding time(OR=1.109,95%CI 1.037-1.186).Conclusions1.BWDT and the delay of adequate enteral feeding time are the high risks factors for the occurrence of EUGR of twins at discharge.For BWDT population,the physical indexes should be closely monitored early to achieve adequate enteral nutrition as soon as possible.2.Taking calorie level as the standard of adequate enteral nutrition has a higher sensitivity to predict the occurrence of EUGR of twins at discharge,and it is recommended to use this standard to evaluate and analyze the growth and development status of diseases treated with fluid restriction.