الفهرس 
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Abstract
Background: The nutritional status of preterm infants is crucial for their overall health and development. IGF-1 is a hormone that plays a crucial role in promoting growth and development, particularly during the neonatal period. The potential use of serum IGF-1 levels as predictors of these preterm morbidities offers the opportunity for early identification and intervention. Monitoring serum IGF-1 levels in preterm infants may help identify those at higher risk of developing various morbidities.
Aim and objectives: To assess the relevance of postnatal nutritional status of very preterm neonates ≤32 weeks’ gestation to their postnatal serum IGF-1 levels and to find out their possible correlation to the development of neonatal morbidities during the postnatal period including postnatal catch-up growth and the incidence and severity of retinopathy of prematurity (ROP), the development of intraventricular hemorrhage (IVH), necrotizing enterocolitis (NEC) or bronchopulmonary dysplasia (BPD).
Subjects and Methods: This prospective observational (follow-up) study was conducted including 53 premature neonates born with gestational ages between 28 and 32 (30.6±0.95) weeks and birth weights ranged of 1000-2040 (1373±228.8) gm based on fetal U/S and postnatal clinical assessment of gestational age. They were admitted to the NICU of Pediatric hospital, Ain Shams University within their first week of postnatal life, Maternal risk factors, perinatal circumstances and Apgar scores were recorded and nourished according to the routine protocol of feeding premature infants at the unit. Gestational age was assessed (New Ballard score). Nutritional assessment done initially on admission 28-32 weeks gestation and 4 weeks later at follow up 32-34weeks gestation by assessment anthropometric measures (weight, length, Ponderal index and OFC) and calculation of total caloric intake initially on admission and follow up. Neonates were assessed for clinical complication and their management during the early postnatal period. Labs investigation also done for IGF-1 and were repeated for survivors (n=47) after a 4-week period of their NICU stay. They were followed-up over a period of 4 weeks of NICU stay for the development of neonatal morbidities of premature including ROP, IVH, NEC and BPD of premature and reporting the mortality outcome. The duration of the study ranged from 6-12 month.
Results: Initial IGF-1 levels were positively correlated to birthweight, Ponderal index, OFC, and 1&5 min Apgar scores. Both maternal anemia and preterm premature rupture of membranes (PPROM) were significant risk factor associated with low initial IGF-1 levels. Neonatal hypoxia/ischemia, RDS severity and early-onset sepsis were all associated with significantly low initial serum IGF-1 levels. Development of ROP was the only late morbidity over 4-week NICU stay associated with significantly low initial IGF-1 levels. Sepsis was the only comorbidity that was associated with significant failure of increase in IGF-1 levels during the postnatal period
Conclusion: Low serum IGF-1 levels in very preterm, at birth, are largely linked to their intrauterine growth, and nutritional status. Serum IGF-1 level is directly related to birth weight centile, OFC, and Ponderal index. Both maternal anemia and PPROM are risk factors associated with delivery of a premature neonate with low serum IGF-1 levels. Low serum IGF-1 level at birth can serve as a risk factor for the development of early neonatal complications including hypoxia, early-onset sepsis and respiratory distress syndrome.