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Gestational age correction for height in preterm children to seven years of age
A M Elliman1, E M Bryan, A D Elliman
1Queen Charlotte's and Chelsea Hospital, London, UK.
Insights
Post-conceptual age correction significantly impacts height assessments in very preterm infants up to seven years old. Continuing this correction prevents misinterpreting growth patterns in premature babies.
Area of Science:
- Neonatal Medicine
- Pediatric Growth Studies
- Developmental Pediatrics
Background:
- Accurate growth assessment is crucial for preterm infants.
- Gestational age correction methods influence growth metrics.
- Continued monitoring is vital for very preterm survivors.
Purpose of the Study:
- To evaluate the impact of gestational age correction on height standard deviation scores (SDS) in very preterm infants up to seven years of age.
- To determine the optimal duration for using post-conceptual age (PCA) instead of chronological age (real age) for growth monitoring.
- To highlight the risks associated with discontinuing PCA correction prematurely.
Main Methods:
- Analysis of height standard deviation scores (SDS) in very preterm infants.
- Comparison of growth metrics using post-conceptual age versus real age.
- Extrapolation of correction effects based on gestational age.
Main Results:
- Height SDS in very preterm infants (born at 28 weeks' gestation) increased by 0.25 SDS when PCA was used instead of real age.
- Extrapolated correction effect for a 24-week gestation infant at seven years is approximately 0.32 SDS.
- Using real age can mask suboptimal growth in some preterm children.
Conclusions:
- Gestational age correction remains important for height assessment in very preterm infants until at least seven years of age.
- Discontinuing post-conceptual age correction between two and three years risks misinterpreting growth retardation or falsely reassuring about growth.
- Continued use of PCA is essential for accurate growth monitoring and appropriate clinical management of very preterm infants.
Abstract:
Correction for gestational age continues to make a difference to the height SD score (SDS) to the age of seven years in very preterm babies. The height SDS for children born at 28 weeks' gestation increased by 0.25 SDS when postconceptual age was used instead of real age. Extrapolating from these results, the effect of correction would be an increase of approximately 0.32 SDS for a seven-year-old of 24 weeks' gestation. Unsatisfactory growth may be masked by a steady or increasing real age SDS in a few children. The risks of stopping using postconceptual age at two or three years include both false confidence in genuine cases of growth retardation and misinterpretation of a decrease in height SDS as evidence of growth retardation. As the number of very preterm babies who survive increases so does the importance of these observations.