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Individualized Postnatal Growth Trajectories for Preterm Infants

Erin Landau-Crangle1, Niels Rochow1, Tanis R Fenton2

  • 1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

JPEN. Journal of Parenteral and Enteral Nutrition
|February 9, 2018
PubMed

Insights

Individualized growth trajectories for preterm infants are best achieved using the Growth-Velocity Approach (GVA), which accounts for extrauterine adaptation. This method minimizes weight discrepancies compared to fetal charts, aiding clinical monitoring and nutrition guidance.

Area of Science:

  • Neonatalogy
  • Pediatric Growth Monitoring
  • Nutritional Science

Background:

  • Preterm infant growth is typically monitored using fetal growth charts, which do not account for postnatal adaptive changes.
  • Individual growth trajectories in preterm infants often shift downwards after birth due to adaptation to extrauterine life.

Purpose of the Study:

  • To compare different methods for creating individualized postnatal growth trajectories for preterm infants.
  • To identify an optimal approach that aligns with healthy term infant growth standards.

Main Methods:

  • Three approaches were evaluated: Birth-Weight-Percentile, Postnatal-Percentile, and Fetal-Median-Growth Approach (FMGA).
  • The Growth-Velocity Approach (GVA), an adaptation of FMGA, was introduced to incorporate extrauterine transition factors.
  • Primary outcome was delta weight (ΔW) difference between target weight and predicted weight; secondary outcome assessed ΔW against body fat mass in very low-birth-weight infants.

Main Results:

  • The Birth-Weight-Percentile and Postnatal-Percentile approaches resulted in significant weight discrepancies (high ΔW).
  • The Fetal-Median-Growth Approach (FMGA) alone reduced ΔW, but the Growth-Velocity Approach (GVA) further minimized it.
  • GVA demonstrated optimal normalization for weight and body composition, aligning closely with target growth standards.

Conclusions:

  • The Growth-Velocity Approach (GVA) offers an evidence-based method for individualized preterm infant growth trajectories.
  • GVA aligns with physiological data, reflecting that preterm infants naturally adjust their postnatal growth below birth percentiles.
  • This approach can serve as a bedside tool for clinicians to optimize growth monitoring, nutritional support, and reduce risks of chronic adult diseases.
Abstract

Keywords:
calculatorgrowthgrowth standardnutritionnutrition assessmentnutrition support practicepostnatalpreterm infanttrajectoryweight loss

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