Elsevier

Early Human Development

Volume 83, Issue 10, October 2007, Pages 643-651
Early Human Development

Growth curves for preterm infants

https://doi.org/10.1016/j.earlhumdev.2007.07.008Get rights and content

Abstract

The commonly used growth curves for preterm infants are four decades old and may not be suitable for the current population. Uncertainty exists regarding the most suitable curves for monitoring the growth of preterm infants. While intrauterine growth rate appears to be the ideal growth that needs to be attained by the preterm infants, it may not be feasible given the limitations set by the morbidities of prematurity. Babson and Benda’s chart has been updated using recent data from large samples of preterm infants making it useful for monitoring growth of infants in the preterm period. Once a corrected age of 40 weeks is reached, the recently released WHO growth curves can be used to monitor their ongoing growth. While aiming for achieving intrauterine growth velocities in postnatal life, one should not lose sight of the potential short term adverse effects of aggressive nutrition and long term adverse effects of excessive catch up growth.

Section snippets

Growth curves for preterm infants

Growth assessment using growth curves is a useful tool for defining health and nutritional status in children [1]. Growth monitoring helps to improve nutrition, educate the care givers and enables early detection of growth disorders. Proper growth monitoring consists of serial assessments of various physical parameters like weight, length/height, head circumference etc over time [2].

Growth monitoring is especially important in preterm infants because several studies have shown that postnatal

Summary and conclusions

There is lot of uncertainty regarding the ideal growth curves for preterm infants. Due to improvements in management of sick preterm infants, the growth of these infants in 1990 and 2000s is different from those of previous years. Hence it is preferable to use the growth curves developed based on preterm infants born after 1990. Intrauterine growth curves represent ideal growth, but may not be feasible given the limitations imposed by the immature gut and other morbidities of prematurity.

Key guidelines

  • 1.

    Updated Babson and Benda’s charts have incorporated the growth parameters from three recent large population samples and appear suitable for monitoring growth of preterm infants until they reach term gestation.

  • 2.

    Once the preterm infants reach term gestation, the recently released WHO growth curves appear appropriate to monitor their ongoing growth.

  • 3.

    While aiming to achieve intrauterine growth rate in postnatal life, one should not lose sight of the adverse effects of overly aggressive nutrition and

In the short term

  • 1.

    A meta-analysis of all the published intrauterine growth curves from preterm infants born from the year 1990 onwards using appropriate statistical methods to provide a pooled estimate of the intrauterine growth and hence the ideal prescriptive postnatal growth.

  • 2.

    Meta-analysis of all the published postnatal growth curves of preterm infants from 1990 onwards using appropriate statistical methods to arrive at the ‘actually feasible’ growth and the minimum standard required to be achieved.

In the long term

Further

References (57)

  • R.A. Ehrenkranz et al.

    Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants

    Pediatrics

    (2006)
  • Use of growth charts for assessing and monitoring growth in Canadian infants and children

    Paediatr Child Health

    (2004)
  • Use and interpretation of anthropometric indicators of nutritional status

    Bull World Health Organ

    (1986)
  • C.M. Wright et al.

    Growth reference charts for use in the United Kingdom

    Arch Dis Child

    (2002)
  • American Academy of Pediatrics Committee on Nutrition: nutritional needs of low-birth-weight infants

    Pediatrics

    (1985)
  • Nutrient needs and feeding of premature infants

    CMAJ

    (1995)
  • P. Karna et al.

    Anthropometric measurements for neonates, 23 to 29 weeks gestation, in the 1990s

    Paediatr Perinat Epidemiol

    (2005)
  • T.R. Fenton

    A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format

    BMC Pediatr

    (2003)
  • R.L. Guaran et al.

    Update of growth percentiles for infants born in an Australian population

    Aust N Z J Obstet Gynaecol

    (1994)
  • S.W. Wen et al.

    Secular trends of fetal growth in Canada, 1981 to 1997

    Paediatr Perinat Epidemiol

    (2003)
  • J.M. Thompson et al.

    Sex specific birth weight percentiles by gestational age for New Zealand

    N Z Med J

    (1994)
  • M.S. Kramer et al.

    Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age

    Pediatrics

    (2001)
  • P. Thomas et al.

    A new look at intrauterine growth and the impact of race, altitude, and gender

    Pediatrics

    (2000)
  • G.R. Alexander et al.

    1994–1996 U.S. singleton birth weight percentiles for gestational age by race, Hispanic origin, and gender

    Matern Child Health J

    (1999)
  • A. Niklasson et al.

    An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977–1981)

    Acta Paediatr Scand

    (1991)
  • P.J. Beeby et al.

    New South Wales population-based birthweight percentile charts

    J Paediatr Child Health

    (1996)
  • E. Bertino et al.

    Neonatal anthropometric charts: what they are, what they are not

    Arch Dis Child Fetal Neonatal Ed

    (2007)
  • W. Zaw et al.

    The risks of adverse neonatal outcome among preterm small for gestational age infants according to neonatal versus fetal growth standards

    Pediatrics

    (2003)
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