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Monitoring postnatal growth of preterm infants: present and future
Francesca Giuliani1, Leila Cheikh Ismail2, Enrico Bertino1
1Department of Public Health and Pediatrics, University of Turin, Turin, Italy;
Insights
Existing growth charts for preterm infants have fair to low methodologic quality, with common shortcomings in data collection and reporting. New standards are being developed using a prospective cohort to improve preterm infant growth monitoring.
Area of Science:
- Pediatrics
- Neonatology
- Biostatistics
Background:
- There is no established consensus on the optimal growth charts for monitoring preterm infants postnatally.
- Existing charts are based on studies with varying methodologic quality.
Purpose of the Study:
- To evaluate the strategies and methodologic quality of studies developing postnatal growth charts for preterm infants.
- To identify common shortcomings in existing chart development methodologies.
Main Methods:
- A systematic review of 61 longitudinal observational studies was conducted.
- Methodologic quality was assessed using 38 items across study design, statistical methods, and reporting.
- Risk of bias was evaluated by two independent reviewers.
Main Results:
- The overall median quality score for the included studies was 47%, indicating fair to low quality.
- Significant shortcomings were identified in anthropometric measures, gestational age estimation, follow-up duration, and reporting of postnatal care.
- Only 44.3% of studies scored 50% or higher in methodologic quality.
Conclusions:
- The methodologic quality of current preterm infant growth charts is insufficient.
- The International Fetal and Newborn Growth Consortium for the 21st Century Project is developing new growth standards from a prospective cohort.
- This new approach aims to create reliable growth standards for preterm newborns without fetal growth restriction.
Background:
There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants.
Objective:
We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality.
Design:
A systematic review of observational longitudinal studies, having as their primary objective the creation of postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains ("study design," "statistical methods," and "reporting methods") were assessed in each study. Each item was scored as a "low" or "high" risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of "low risk" of bias marks/total number of items assessed) × 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included studies were computed.
Results:
Sixty-one studies met the inclusion criteria. Twenty-seven (44.3%) of the 61 studies scored ≥50%, of which 10 scored >60% and only 1 scored >66%. The median (range, IQR) quality score for the 61 included studies was 47% (26-75%, 34-56%). The scores for the domains study design, statistical methods, and reporting methods were 44% (19-67%, 33-52%), 25% (0-88%, 13-38%), and 33% (0-100%, 0-33%), respectively. The most common shortcomings were observed in items related to anthropometric measures (the main variable of interest), gestational age estimation, follow-up duration, reporting of postnatal care and morbidities, assessment of outliers, covariates, and chart presentation.
Conclusions:
The overall methodologic quality of existing longitudinal studies was fair to low. To overcome these problems, the Preterm Postnatal Follow-up Study, 1 of the 3 main components of The International Fetal and Newborn Growth Consortium for the 21st Century Project, was designed to construct preterm postnatal growth standards from a prospective cohort of "healthy" pregnancies and preterm newborns without evidence of fetal growth restriction.
