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Published on: December 31, 2015
A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants
1Alberta Children's Hospital Research Institute, The University of Calgary, Calgary, AB, Canada. tfenton@ucalgary.ca
Insights
Revised preterm growth charts harmonize with WHO standards, using actual age for improved infant monitoring. This supports better growth tracking from preterm birth through infancy.
Area of Science:
- Pediatric growth monitoring
- Neonatalogy
- Public health
Background:
- The 2003 Fenton Preterm Growth Chart requires revision to align with current WHO Growth Standards.
- Harmonization is needed between preterm growth data and WHO estimates, informed by the PreM Growth study.
Purpose of the Study:
- To revise the Fenton Preterm Growth Chart for better preterm infant growth monitoring.
- To harmonize preterm charts with WHO Growth Standard and smooth data transitions.
- To rescale the x-axis to actual age for enhanced growth assessment.
Main Methods:
- Systematic review and meta-analysis of population-based preterm birth size references.
- Development of sex-specific growth curves using cubic splines up to 50 weeks postmenstrual age.
- Calculation of LMS parameters (Lambda, Mu, Sigma) for growth curve modeling.
Main Results:
- Combined data from six large international surveys representing nearly 4 million births.
- Developed smooth, sex-specific growth charts for preterm infants from 22 to 50 weeks corrected age.
- Ensured close agreement with data between 24 and 36 weeks, and at 50 weeks corrected age.
Conclusions:
- Revised sex-specific actual-age growth charts align with recommended growth trajectories (fetus to term infant).
- Smoothed data transitions informed by the PreM Growth study facilitate improved monitoring.
- These charts support a better transition for preterm infants to WHO growth charts.
Background:
The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring.
Methods:
Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated.
Results:
Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks.
Conclusions:
The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.
