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Continuous growth reference from 24th week of gestation to 24 months by gender
Aimon Niklasson1, Kerstin Albertsson-Wikland
1Göteborg Pediatric Growth Research Centre, Department of Pediatrics, the Institute for Clinical Sciences at the Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden. aimon.niklasson@vgregion.se
Insights
A new continuous growth chart provides a unified standard for assessing child growth from birth to two years. This tool improves the detection of growth deviations, aiding in early intervention for various health conditions.
Area of Science:
- Pediatrics
- Child Health
- Growth Monitoring
Background:
- Child growth assessment relies on growth charts, crucial for global child health.
- Updated, continuous growth standards are needed to bridge birth size and postnatal growth for better screening.
Purpose of the Study:
- To develop a novel, continuous growth standard for infants from birth to two years.
- To improve the accuracy and ease of child growth screening and monitoring.
Main Methods:
- Constructed a continuous growth chart using Swedish Medical Birth Registry data (n=810,393) for size at birth and postnatal growth data from 3,650 children.
- Utilized logarithmic transformations for weight and time axes to magnify early growth stages.
- Smoothed standard deviation estimates using empirical curve-fitting for gestational weeks and gender.
Main Results:
- Presents the first continuous, gender-specific growth chart for weight, length, and head circumference from birth to two years.
- Compared to previous references, birth weight at 40 weeks increased by ~100g and length by 1mm.
- The new chart exhibits a less S-shaped curve with more constant variation than previous or international charts.
Conclusions:
- The updated growth chart aids in detecting deviations from unrestricted growth patterns.
- Facilitates age-corrected growth evaluation, especially for preterm infants, by comparing with estimated intrauterine growth.
- Valuable for population screening, research, and evaluating growth-promoting interventions in pediatric care.
Background:
Growth charts and child growth assessment have become prime global instruments in child health practice over the 30 years. An updated, continuous growth standard that bridges size at birth values with postnatal growth values can improve child growth screening and monitoring.
Methods:
This novel growth chart was constructed from two sources of information. Size at birth (weight, length and head circumference) reference values were updated based on information of normal deliveries (i.e. singleton live births without severe congenital malformation, with healthy mothers and born vaginally) from the Swedish Medical Birth Registry, 1990-1999 (n = 810393). Weight was evaluated using logarithmic transformation as for postnatal weight. Standard deviations were estimated from data within the empirical mean +/- 1.0 SD for each gestational week and gender. These values were smoothed by empirical curve-fitting together with values from our recently published postnatal growth reference including 3650 longitudinally followed children from birth to final height 9. Timescale and weight axes were made logarithmic in order to magnify the early time part of the graph.
Results:
This study presents the first continuous gender specific growth chart from birth irrespective of gestational age at birth until 2 years of age for weight, length and head circumference. Birth weight at 40 weeks of gestation increased approximately 100 gram and length increased only 1 mm compared with earlier Swedish reference from 1977-81. The curve is now less S-shaped as compared with earlier curves and compared with 4 curves from other countries and with more constant variation over the whole range.
Conclusion:
Our values picture the unrestricted pattern of growth improving the detection of a deviating growth pattern, when the growth of an individual infant is plotted on the charts. Especially for very preterm infants age corrected growth can be more easily evaluated although it must be recognized that the early comparison is with what is estimated as normal growth in uterus. The reference values are useful in child health care systems for population screening, but also in research or in the clinic for evaluating various growth promoting interventions - either nutritional, surgical or therapeutic - that might affect a child in early life.
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