{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T19:50:54Z","timestamp":1792180254855,"version":"4.4.0"},"reference-count":42,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Postnatal growth failure in very preterm infants remains a major concern in neonatal care and clinical management is complicated by the lack of a standardized definition. This study aims to identify risk factors for growth faltering (GF) and undernutrition (UN) at hospital discharge, defined according to the latest consensus definitions established by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). Methods: We conducted a retrospective observational study of 416 preterm infants (gestational age &lt; 32 weeks and\/or birth weight &lt; 1500 g). Growth was monitored using the Intergrowth 21st standards. In line with ESPGHAN criteria, GF was defined longitudinally as a weight for age (WFA) z-score decline \u2265 1 SD from birth, while UN was defined cross-sectionally as a WFA or length for age z-score &lt; \u22122 SD at discharge. Logistic regression models were used to determine independent predictors for both growth phenotypes. Results: At discharge, the prevalence of GF and UN was 45.3% and 33.1%, respectively. In infants born without growth restriction (GR), UN was almost entirely driven by GF (89.7%). In contrast, 85.5% of infants born with GR remained undernourished at discharge. Multivariate analysis identified bronchopulmonary dysplasia and higher maximal postnatal weight loss as major independent risk factors for GF, while female sex and human milk feeding at discharge were associated with a lower risk of GF. For infants born with adequate weight, maternal hypertension, extremely low birth weight, and the co-occurrence of GF were the strongest predictors of UN. Conclusions: Nearly half of very preterm infants experience significant growth impairment before discharge. By assessing the dynamic process of GF and the static endpoint of UN, we identified distinct clinical trajectories. Standardized ESPGHAN criteria allow for the identification of high-risk \u201cphenotypes\u201d\u2014particularly those with GR at birth or severe neonatal morbidity\u2014enabling more targeted and intensive nutritional management during the critical developmental window.<\/jats:p>","DOI":"10.3390\/nu18020286","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T11:39:37Z","timestamp":1768563577000},"page":"286","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Risk Factors for Postnatal Growth Faltering and Undernutrition at Discharge in Very Preterm Infants: A Retrospective Study Applying the ESPGHAN Consensus Definitions"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4819-1830","authenticated-orcid":false,"given":"Isadora","family":"Beghetti","sequence":"first","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"},{"name":"Neonatal Intensive Care Unit, S. Orsola Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalila","family":"Magno","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ettore","family":"Benvenuti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9274-985X","authenticated-orcid":false,"given":"Arianna","family":"Aceti","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"},{"name":"Neonatal Intensive Care Unit, S. Orsola Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8119-7743","authenticated-orcid":false,"given":"Luigi Tommaso","family":"Corvaglia","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy"},{"name":"Neonatal Intensive Care Unit, S. Orsola Hospital, IRCCS Azienda Ospedaliero Universitaria di Bologna, 40138 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1002\/jpn3.70054","article-title":"Assessment of Growth Status and Nutritional Management of Prematurely Born Infants After Hospital Discharge: A Position Paper of the ESPGHAN Nutrition Committee","volume":"81","author":"Haiden","year":"2025","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Peila, C., Spada, E., Giuliani, F., Maiocco, G., Raia, M., Cresi, F., Coscia, A., and Bertino, E. (2020). Extrauterine Growth Restriction: Definitions and Predictability of Outcomes in a Cohort of Very Low Birth Weight Infants or Preterm Neonates. Nutrients, 12.","DOI":"10.3390\/nu12051224"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Gonz\u00e1lez-L\u00f3pez, C., Sol\u00eds-S\u00e1nchez, G., Lareu-Vidal, S., Fern\u00e1ndez-Sarmiento, J.M., Gonz\u00e1lez-Caballero, D., Blanco-Rodr\u00edguez, A., L\u00f3pez-Ramos, M.G., and Reyes-Dom\u00ednguez, A. (2024). Variability in Definitions and Criteria of Extrauterine Growth Restriction and Its Association With Neurodevelopmental Outcomes in Preterm Infants: A Narrative Review. Nutrients, 16.","DOI":"10.3390\/nu16070968"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ejpn.2021.06.004","article-title":"Extra-Uterine Growth Restriction in Preterm Infants: Neurodevelopmental Outcomes According to Different Definitions","volume":"33","author":"Cota","year":"2021","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Kakatsaki, I., Papanikolaou, S., Roumeliotaki, T., Koropouli, M., and Hatzidaki, E. (2023). The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction Among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association With Clinical and Nutritional Factors. Nutrients, 15.","DOI":"10.3390\/nu15153290"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Starc, M., Giangreco, M., Centomo, G., Travan, L., and Bua, J. (2023). Extrauterine Growth Restriction in Very Low Birth Weight Infants According to Different Growth Charts: A Retrospective 10 Years Observational Study. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0283367"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"817","DOI":"10.1007\/s00431-020-03796-0","article-title":"Extrauterine Growth Restriction in Extremely Preterm Infants Based on the Intergrowth-21st Project Preterm Postnatal Follow-Up Study Growth Charts and the Fenton Growth Charts","volume":"180","author":"Kim","year":"2021","journal-title":"Eur. J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Consales, A., Porro, M., Gangi, S., Leonardi, S., Gagliano, V., Gardon, L., Rossi, S., Giann\u00ec, M.L., Roggero, P., and Mosca, F. (2023). In-hospital growth and long-term neurodevelopmental outcomes of very low birth weight infants. Front. Pediatr., 11.","DOI":"10.3389\/fped.2023.1180068"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Massirio, P., Battaglini, M., Bonato, I., Arnaudo, P., Schiaffino, G., Mancardi, M.M., Severino, M., Traggiai, C., and Ramenghi, L.A. (2024). Early Extra-Uterine Growth Restriction in Very-Low-Birth-Weight Neonates with Normal or Mildly Abnormal Brain MRI: Effects on a 2\u20133-Year Neurodevelopmental Outcome. Nutrients, 16.","DOI":"10.20944\/preprints202401.0369.v1"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1007\/s00431-020-03613-8","article-title":"Comorbidities in Childhood Associated with Extrauterine Growth Restriction in Preterm Infants: A Scoping Review","volume":"179","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1007\/s00431-020-03628-1","article-title":"Extrauterine Growth Restriction in Very Preterm Infant: Etiology, Diagnosis, and 2-Year Follow-Up","volume":"179","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1025","DOI":"10.1038\/s41372-021-00948-4","article-title":"Antenatal and Neonatal Factors Contributing to Extra Uterine Growth Failure (EUGR) Among Preterm Infants in Boston Birth Cohort (BBC)","volume":"41","author":"Makker","year":"2021","journal-title":"J. Perinatol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Wang, L., Lin, X.Z., Shen, W., Chen, H.L., Zhang, H., Guo, X.H., Liu, X.M., Xia, S.W., and Li, S. (2022). Risk Factors of Extrauterine Growth Restriction in Very Preterm Infants With Bronchopulmonary Dysplasia: A Multi-Center Study in China. BMC Pediatr., 22.","DOI":"10.1186\/s12887-022-03405-z"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Bozzetti, V., Dui, L.G., Zannin, E., Tagliabue, P.E., and Ventura, M.L. (2025). AI to Predict Extrauterine Growth Restriction During Transitional Nutrition of Preterm Infants: A Retrospective Study. J. Perinatol., epub ahead of print.","DOI":"10.1038\/s41372-025-02445-4"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1002\/uog.15884","article-title":"Consensus definition of fetal growth restriction: A Delphi procedure","volume":"48","author":"Gordijn","year":"2016","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_16","unstructured":"Vermont Oxford Network (2025, December 16). Vermont Oxford Network Manual 2025. Available online: https:\/\/vtoxford.zendesk.com\/hc\/en-us\/categories\/360000861394-Manuals-and-Forms."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1164\/rccm.201812-2348OC","article-title":"The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach","volume":"200","author":"Jensen","year":"2019","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e681","DOI":"10.1016\/S2214-109X(15)00163-1","article-title":"Postnatal growth standards for preterm infants: The Preterm Postnatal Follow-up Study of the INTERGROWTH-21st Project","volume":"3","author":"Villar","year":"2015","journal-title":"Lancet Glob. Health"},{"key":"ref_19","unstructured":"Italian Society of Neonatology (2025, December 16). Preterm Infant Follow-Up. The First Six Years of Life; Task force on Preterm Infant Follow-Up: 2022; iDeaCpa Editore: Rome, Italy, 2022; ISBN 978-88-946318-7-6. Available online: https:\/\/blog.sin-neonatologia.it\/wp-content\/uploads\/2023\/04\/Manuale-follow-up_sin22_06.04.2023.pdf."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jpeds.2017.12.059","article-title":"Consensus based definition of growth restriction In the newborn","volume":"196","author":"Beune","year":"2018","journal-title":"J. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Fenton, T.R., and Kim, J.H. (2013). A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr., 13.","DOI":"10.1186\/1471-2431-13-59"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1097\/MPG.0000000000003642","article-title":"Enteral Nutrition in Preterm Infants (2022): A Position Paper From the ESPGHAN Committee on Nutrition and Invited Experts","volume":"76","author":"Embleton","year":"2023","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1136\/archdischild-2020-320816","article-title":"Bronchopulmonary dysplasia and postnatal growth following extremely preterm birth","volume":"106","author":"Dassios","year":"2021","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e27388","DOI":"10.1002\/ppul.27388","article-title":"Post-Discharge Growth Among Extremely Preterm Infants With or Without Bronchopulmonary Dysplasia","volume":"60","author":"Kimoto","year":"2025","journal-title":"Pediatr. Pulmonol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1159\/000538527","article-title":"Severe Bronchopulmonary Dysplasia Adversely Affects Brain Growth in Preterm Infants","volume":"121","author":"Shimotsuma","year":"2024","journal-title":"Neonatology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1008","DOI":"10.1038\/s41372-022-01369-7","article-title":"Postnatal maximal weight loss, fluid administration, and outcomes in extremely preterm newborns","volume":"42","author":"Valentine","year":"2022","journal-title":"J. Perinatol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Valentine, G.C., Brandon, O.C., Perez, K.M., Strobel, K.M., Mayock, D.E., Law, J.B., Neches, S., German, K., Kolnik, S., and Heagerty, P.J. (2025). Time to regain birthweight and in-hospital outcomes among United States-born extremely preterm newborns. Pediatr. Res., 1\u20139.","DOI":"10.1038\/s41390-025-04563-3"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Chen, W., Cai, W., Lin, Z., Ye, X., Chen, B., Mei, S., Huang, T., and Ren, Y. (2025). Third-day weight changes and bronchopulmonary dysplasia risk in preterm infants: A cohort study. Front. Pediatr., 13.","DOI":"10.3389\/fped.2025.1592069"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1007\/s00431-021-04173-1","article-title":"Association of hypertensive disorders of pregnancy with infant growth in the first 36 months of life","volume":"181","author":"Jiang","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Calek, E., Binder, J., Palmrich, P., Pateisky, P., Eppel, W., Berger, A., Werther, T., and Worda, C. (2024). Preeclampsia and Future Implications on Growth and Body Composition in Preterm Infants. Nutrients, 16.","DOI":"10.3390\/nu16213627"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Cerasani, J., Ceroni, F., De Cosmi, V., Mazzocchi, A., Syren, M.L., Roggero, P., Agostoni, C., and Giann\u00ec, M.L. (2020). Human Milk Feeding and Preterm Infants\u2019 Growth and Body Composition: A Literature Review. Nutrients, 12.","DOI":"10.3390\/nu12041155"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1016\/j.jpeds.2021.04.037","article-title":"Rates and Determinants of Mother\u2019s Own Milk Feeding in Infants Born Very Preterm","volume":"236","author":"Dharel","year":"2021","journal-title":"J. Pediatr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"151381","DOI":"10.1016\/j.semperi.2020.151381","article-title":"Maternal production of milk for infants in the neonatal intensive care unit","volume":"45","author":"Hoban","year":"2021","journal-title":"Semin. Perinatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s13668-020-00303-7","article-title":"Human Breast Milk: Bioactive Components, from Stem Cells to Health Outcomes","volume":"9","author":"Bardanzellu","year":"2020","journal-title":"Curr. Nutr. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1016\/j.jpeds.2016.03.003","article-title":"Greater Early Gains in Fat-Free Mass, but Not Fat Mass, Are Associated with Improved Neurodevelopment at 1 Year Corrected Age for Prematurity in Very Low Birth Weight Preterm Infants","volume":"173","author":"Ramel","year":"2016","journal-title":"J. Pediatr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"e899","DOI":"10.1542\/peds.2011-0282","article-title":"Infant growth before and after term: Effects on neurodevelopment in preterm infants","volume":"128","author":"Belfort","year":"2011","journal-title":"Pediatrics"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1159\/000336127","article-title":"The relationship of poor linear growth velocity with neonatal illness and two-year neurodevelopment in preterm infants","volume":"102","author":"Ramel","year":"2012","journal-title":"Neonatology"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1136\/archdischild-2021-322892","article-title":"Optimising Growth in Very Preterm Infants: Reviewing the Evidence","volume":"108","author":"Young","year":"2023","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"98","DOI":"10.3945\/ajcn.113.080945","article-title":"Determinants of Body Composition in Preterm Infants at the Time of Hospital Discharge","volume":"100","author":"Simon","year":"2014","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1159\/000521032","article-title":"Body Composition of Preterm Infants Following Rapid Transition to Enteral Feeding","volume":"119","author":"Wiechers","year":"2022","journal-title":"Neonatology"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Lafeber, A.H., de Kraker, L.C.D., van Goudoever, J.B., and de Groof, F. (2026). Nutritional Strategies and Their Influence on Growth and Body Composition in Moderate and Late Preterm Infants: A Systematic Review of Recent Literature. Curr. Opin. Clin. Nutr. Metab. Care, 29.","DOI":"10.1097\/MCO.0000000000001206"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"101636","DOI":"10.1016\/j.siny.2025.101636","article-title":"Short- and Longer-Term Growth and Development of Fat Mass in Preterm Infants","volume":"30","author":"Jain","year":"2025","journal-title":"Semin. Fetal Neonatal Med."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/2\/286\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T11:56:51Z","timestamp":1768564611000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/2\/286"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":42,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["nu18020286"],"URL":"https:\/\/doi.org\/10.3390\/nu18020286","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]}}}