Feeding intolerance as an independent risk factor for extrauterine growth restriction and neurodevelopmental impairment in small-for-gestational-age preterm infants: a retrospective cohort study

Preterm infants classified as small for gestational age (SGA) face elevated risks of extrauterine growth restriction (EUGR) and impaired neurodevelopment. Although feeding intolerance (FI) is a frequent complication in this population, its independent contribution to these adverse outcomes is not fully elucidated. In this single-center retrospective cohort analysis, 180 SGA preterm infants admitted to the NICU from January 2019 to January 2024 were enrolled. Based on ESPGHAN diagnostic criteria, infants were categorized into two groups: those with FI (n = 85) and those without (n = 95). The primary endpoints were the incidence of EUGR and neurodevelopmental impairment, defined as a Gesell Developmental Quotient (DQ) ≤ 85, assessed at 12 months of corrected age. Multivariable logistic regression analyses were performed to control for potential confounding factors. The group with FI demonstrated significantly higher incidence 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 both EUGR (adjusted odds ratio [aOR] = 5.82; 95% CI 2.75–12.31) and neurodevelopmental impairment (aOR = 3.92; 95% CI 1.84–8.35). A significant dose–response relationship was identified between the duration of FI and the likelihood of both outcomes (p < 0.001). Additionally, infants with FI experienced longer durations of hospitalization and parenteral nutrition dependence, alongside increased rates of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia (BPD), and late-onset sepsis. Feeding intolerance serves as a significant independent predictor for EUGR and poor neurodevelopmental outcomes in SGA preterm infants. Implementing strategies for the early detection and proactive management of FI may help optimize growth and neurodevelopmental trajectories in this high-risk group.