Does feeding intolerance identify small preterm infants at greater risk of growth and developmental difficulties?

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Preterm infants who are small for gestational age (SGA) face elevated risks of extrauterine growth restriction (EUGR) and impaired neurodevelopment. Feeding intolerance (FI) is common in these infants, but its independent contribution to these outcomes is not fully understood.

This single-center retrospective cohort analysis enrolled 180 SGA preterm infants admitted to a neonatal intensive care unit (NICU) from January 2019 to January 2024. Using ESPGHAN diagnostic criteria, the researchers classified 85 infants as having FI and 95 as not having FI. The primary endpoints were the incidence of EUGR and neurodevelopmental impairment, with impairment defined as a Gesell Developmental Quotient (DQ) ≤ 85, assessed at 12 months of corrected age. Multivariable logistic regression analyses were used to control for potential confounding factors.

Compared with infants without FI, those with FI had higher rates of EUGR (85.9% vs. 49.5%; p < 0.001) and neurodevelopmental impairment (43.6% vs. 19.5%; p < 0.001). After adjustment for confounders, FI remained independently associated with EUGR (adjusted odds ratio [aOR] = 5.82; 95% confidence interval [CI] 2.75–12.31) and neurodevelopmental impairment (aOR = 3.92; 95% CI 1.84–8.35). Longer FI duration was associated with a higher likelihood of both outcomes, showing a significant dose–response relationship (p < 0.001).

Infants with FI also had longer hospital stays and longer dependence on parenteral nutrition, as well as higher rates of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and late-onset sepsis.

The researchers concluded that FI is a significant independent predictor of EUGR and poor neurodevelopmental outcomes in SGA preterm infants. They suggested that early detection and proactive management of FI may help optimize growth and neurodevelopmental trajectories in this high-risk group.