EDITORIAL Extrauterine growth restriction : is it preventable ? ,

Longstanding recommendations by the American Academy of Pediatrics,1,2 the Canadian Paediatrics Society,3 and the European Society of Paediatric Gastroenterology, Hepatology, and Nutrition4,5 state that the nutritional management of preterm infants, especially of extremely preterm (EPT) infants, should support growth at a rate that approximates the rate of intrauterine growth. However, extrauterine growth restriction (EUGR) continues to be prevalent, occurring in the majority of extremely preterm (EPT) infants.6--8 EUGR is typically defined as a growth measurement (weight, length, or head circumference) that is ≤ 10th percentile of the expected intrauterine growth for the postmenstrual age (PMA) at the time of discharge;9 36 weeks’ PMA or 40 weeks’ PMA (term-equivalent age) are often used to compare the incidence of EUGR between neonatal intensive care units. A number of factors are known to contribute to this observation. The major factor is likely the development of significant protein and energy deficits during the first several weeks of life, which prove difficult to reverse.10 Furthermore, these deficits increase as gestational age decreases. Nutritional practices common during the past 20 years, such as the mean caloric and protein intake provided, have also been shown to correlate with growth.11--13 Other factors independently associated with EUGR have included intrauterine growth restriction (IUGR or