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Postnatal growth of preterm infants: which reference charts?
1SCDUNeonatologia, Dipartimento di Scienze Pediatriche, Università degli Studi di Torino, Italy.
Insights
Evaluating preterm infant growth is crucial, but current charts are inadequate. New international standards are needed, with Italian INeS charts recommended for initial assessment until a global solution is available.
Area of Science:
- Neonatalogy
- Pediatric Growth Monitoring
- Public Health
Background:
- Improved neonatal care has increased preterm infant survival, making them a majority in NICUs.
- Accurate postnatal growth evaluation for preterm infants is a growing concern, yet optimal patterns and monitoring strategies remain debated.
- Current growth charts (fetal, neonatal anthropometric, term postnatal) are unsuitable for preterm infants.
Purpose of the Study:
- To address the lack of appropriate growth charts for preterm infants.
- To highlight the limitations of existing growth monitoring tools for this population.
- To propose interim solutions for preterm infant growth assessment in clinical practice.
Main Methods:
- Review of current practices and limitations in preterm infant growth monitoring.
- Identification of the need for a dedicated international prescriptive standard for preterm infant growth.
- Proposal of a tiered approach using existing charts as a temporary measure.
Main Results:
- No single existing chart accurately assesses preterm infant postnatal growth.
- An international project is underway to develop a new standard for preterm infant growth evaluation.
- Current Italian clinical practice suggests a stepwise chart usage: INeS charts up to term, WHO/CDC charts from term to two years, and SIEDP charts from two to 20 years.
Conclusions:
- Existing growth charts are insufficient for preterm infants.
- A new international standard for preterm infant growth is essential and forthcoming.
- A pragmatic approach using specific chart sequences is recommended in Italy pending the new standard.
Abstract:
Preterm Infants' survival has greatly increased in the last few decades thanks to the improvement in obstetrical and neonatal care. These neonates constitute the large majority of the population in neonatal intensive care units. The correct evaluation of postnatal growth of these babies is nowadays of primary concern, although the definition of their optimal postnatal growth pattern is still controversial. Concerns have also been raised about the strategies to monitor their growth,specifically in relation to the charts used. At present the available charts in clinical practice are fetal growth charts, neonatal anthropometric charts and postnatal growth charts for term infants. None of these, for different reasons, is suitable to correctly evaluate preterm infant growth. An international multicentric project has recently started a study aiming at building a prescriptive standard for the evaluation of postnatal growth of preterm infants and it will be available in the next years. At present, while an international longitudinal standard for evaluating preterm infant postnatal growth is lacking, in Italy the best compromise in clinical practice is likely to be as follows: new Italian INeS (Italian Neonatal Study) charts up to term; International longitudinal charts WHO 2006 or CDC 2002 from term to two years; finally, the Italian Society for Pediatric Endocrinology and Diabetes (SIEDP) 2006 growth charts could be suitable for monitoring the growth of these infants from two years up to 20 years of age.
