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The impact of growth curve changes in assessing premature infant growth

M Rabner1, J Meurling2, C Ahlberg2

  • 11] Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA [2] Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|September 21, 2013
PubMed

Insights

The choice of growth chart significantly impacts the assessment of premature infant growth. Different charts, like the WHO standard versus the Infant Health Development Program (IHDP) reference, can alter classifications of underweight status in preterm infants.

Area of Science:

  • Pediatrics
  • Neonatology
  • Growth Monitoring

Background:

  • Premature infants require specialized growth monitoring post-discharge.
  • Existing growth references may not accurately reflect preterm infant growth trajectories.
  • The World Health Organization (WHO) growth standard and the Infant Health Development Program (IHDP) reference offer different benchmarks.

Purpose of the Study:

  • To compare the impact of the WHO growth standard versus the IHDP growth reference on interpreting the growth of premature infants after hospital discharge.
  • To assess how these different growth curves affect the classification of preterm infants at the extremes of growth (e.g., <5th or ≥95th percentile).

Main Methods:

  • A retrospective cohort study of 2297 infants born at ≤35 weeks gestational age.
  • Comparison of growth classifications using WHO and IHDP growth curves via Kappa statistics.
  • Logistic regression analysis to identify factors associated with growth curve disagreement.

Main Results:

  • Moderate agreement (κ=0.40-0.52) was observed between WHO and IHDP growth curves.
  • Disagreements occurred in 8.3% for weight and 13.6% for length, with the WHO curve classifying more infants as <5th percentile.
  • The IHDP curve identified more infants below the 5th percentile for head circumference.
  • Lower gestational age (<30 weeks) was linked to growth curve disagreement for weight and length extremes.

Conclusions:

  • The selection of a growth curve significantly influences the assessment of premature infant growth and underweight classification.
  • Further longitudinal research is necessary to determine which growth assessment tool best identifies preterm infants at risk for long-term growth issues.
Abstract

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