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Updated: Nov 10, 2025
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Comparison of Postnatal Growth Charts of Singleton Preterm and Term Infants Using World Health Organization Standards
Li Zhang1, Jian-Gong Lin2, Shuang Liang3
1Department of Developmental Pediatrics and Child Health Care, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Jinan, China.
Insights
Growth charts for preterm infants show higher length and weight than WHO standards, necessitating local charts for Chinese infants. These charts are crucial for accurate monitoring during the first two years of life.
Area of Science:
- Pediatrics
- Growth and Development
- Public Health
Background:
- Controversy exists on using World Health Organization (WHO) growth charts for preterm infants.
- Evaluating postnatal growth of preterm infants requires specific considerations.
Purpose of the Study:
- Compare postnatal growth charts of singleton preterm and term infants using WHO standards.
- Assess the applicability of current WHO standards for preterm infant growth.
- Determine the necessity of local growth charts for Chinese preterm infants.
Main Methods:
- Retrospective cohort study in Jinan, China.
- Longitudinal measurements (length/height, weight, head circumference, BMI) from birth to 160 weeks postmenstrual age (PMA).
- Generalized Additive Models for Location, Scale, and Shape (GAMLSS) used for chart construction; Z-scores calculated with WHO Anthro software.
Main Results:
- Preterm infants showed increased length/height and weight compared to WHO standards.
- Preterm infants' length, weight, and BMI were higher than term infants at 40 weeks PMA, but surpassed by term infants at 52-64 weeks PMA.
- Head circumference in preterm infants remained consistent with both term controls and WHO standards throughout the observed period.
- Z-scores for length, weight, and BMI in preterm infants decreased over time relative to WHO standards.
- Preterm infants exhibited higher growth trajectories than WHO standards and similar, yet not identical, trajectories to term infants in the first two years.
Conclusions:
- WHO growth charts may not fully capture the growth patterns of preterm infants.
- Preterm infants demonstrate distinct growth trajectories compared to term infants and WHO standards.
- Developing localized growth charts for Chinese preterm infants is essential for accurate growth assessment and monitoring.
Abstract:
There remains controversy regarding whether the growth charts constructed from data of term infants, such as those produced by the World Health Organization (WHO) standards, can appropriately evaluate the postnatal growth of preterm infants. This retrospective cohort study, conducted in the First Affiliated Hospital of Shandong First Medical University in Jinan China, aimed to compare the postnatal growth charts of singleton preterm and term infants using WHO standards at 40-160 weeks postmenstrual age (PMA). A total of 5,459 and 15,185 sets of longitudinal measurements [length/height, weight, head circumference (HC), and body mass index (BMI)] from birth to 160 weeks PMA were used to construct growth charts for 559 singleton preterm (mean PMA at birth, 33.84 weeks) and 1,596 singleton term infants (born at 40 weeks PMA), respectively, using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Z-scores (prematurity corrected) were calculated using WHO Anthro software. Compared to WHO standards, all parameters of preterm infants were increased, especially in terms of length/height and weight; the gap between the two almost spanned two adjacent centile curves. Compared to term controls, the length/height, weight, and BMI of preterm infants were higher at 40 weeks PMA, surpassed by term infants at 52-64 weeks PMA, and quite consistent thereafter. The HC of preterm infants at 40-160 weeks PMA was quite consistent with both term controls and the WHO standards. The Z-scores for length/height, weight, and BMI of preterm infants relative to the WHO standards gradually decreased from 1.20, 1.13, and 0.74 at 40-44 weeks PMA to 0.67, 0.42, and 0.03 at 132-160 weeks PMA, respectively; Z-scores for HC of preterm infants rapidly decreased from 0.73 to 0.29 at 40-50 weeks PMA, and then fluctuated in the range of 0.08-0.23 at 50-160 weeks PMA. Preterm infants had higher growth trajectories than the WHO standards and similar but not identical trajectories to term infants during the first 2 years of life. These findings reemphasize the necessity of constructing local growth charts for Chinese singleton preterm infants.
