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Longitudinal BMI Growth Curves for Surviving Preterm NICU Infants Based on a Large US Sample
Adrienne L Williamson1,2, Josip Derado1,3, Bradley J Barney1,4
1Departments of Statistics and Analytical Sciences and.
Insights
New longitudinal Body Mass Index (BMI) growth charts for preterm infants (24-36 weeks gestational age) reveal actual growth patterns over time, differing from existing cross-sectional data.
Area of Science:
- Neonatalogy
- Pediatric Growth Monitoring
- Biostatistics
Background:
- Existing growth curves for preterm infants lack longitudinal Body Mass Index (BMI) data.
- Current BMI curves rely on cross-sectional data from different infant cohorts at each gestational age (GA).
Purpose of the Study:
- To develop longitudinal BMI growth curves for preterm infants.
- To provide a more accurate representation of infant body proportionality changes over time.
Main Methods:
- Calculated BMI for 68,693 preterm infants (24-36 weeks GA).
- Created longitudinal median curves stratified by sex, GA, and birth BMI quintiles.
- Validated curves for fit, classification, and normality of z-scores.
Main Results:
- Developed two sets of longitudinal BMI growth charts.
- Longitudinal curves accurately reflect growth patterns, showing differences from cross-sectional data, especially post-nadir.
- Observed variations in growth by GA and sex.
Conclusions:
- New longitudinal BMI curves offer insights into preterm infant body proportionality.
- These charts provide clinicians with data on dynamic growth changes in premature infants.
Background:
Longitudinal growth curves, based on repeated measurements from the same group of infants, exist for preterm infant weight and length but not for BMI. Our existing BMI (weight divided by length squared) curves are based on cross-sectional birth data obtained from a different group of infants at each gestational age (GA).
Methods:
We calculated BMI over time for 68 693 preterm infants between 24 and 36 weeks GA. Stratifying infants by sex, GA at birth, and quintiles based on birth BMI, we created longitudinal median curves using R and validated the resulting curves for empirical fit, proper classification, and normality of z scores.
Results:
We created 2 sets of BMI growth charts. The first set displays fitted median curves for all 5 percentile groups in each GA group by sex. The second set displays fitted median curves with their corresponding third and 97th percentiles by percentile group, GA, and sex. In the validation analysis, percentage of daily observations below the median curve approximated the expected 50th percentile after the initial 3 days. Unlike the cross-sectional curves, the longitudinal curves reveal the pattern of change corresponding to nadir; postnadir, these curves remained consistently below the cross-sectional curves and varied by GA and sex as expected. The percentage of observations falling below the 50th percentile for cross-sectional curves (revealing optimal growth) was generally much higher than for longitudinal curves (revealing actual growth).
Conclusions:
These new longitudinal curves provide clinicians data on how premature infants' body proportionality changes over time.
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