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Integrated growth assessment in the first 1000 d of life: an interdisciplinary conceptual framework
Sanja Nel1,2,3, Robert C Pattinson2,3,4, Valerie Vannevel2,3,4
1Department of Human Nutrition, University of Pretoria, Pretoria0002, South Africa.
Insights
Improving prenatal and postnatal healthcare communication is crucial for infant growth. An integrated framework enhances continuity of care for the first 1000 days of life.
Area of Science:
- Perinatal and pediatric health
- Global health and development
- Interdisciplinary medical research
Background:
- Prenatal growth significantly impacts infant health, but communication between prenatal and postnatal care teams is often limited.
- This gap can lead to suboptimal health and developmental outcomes for infants.
- Continuity of care across the first 1000 days of life is essential for addressing these challenges.
Purpose of the Study:
- To develop an integrated, interdisciplinary framework for fetal and infant growth assessment.
- To enhance continuity of care from prenatal through postnatal periods.
- To identify growth assessment practices suitable for low- and middle-income countries (LMICs).
Main Methods:
- A multidisciplinary think-tank comprising obstetricians, pediatricians, dietitians/nutritionists, and a statistician convened over several months.
- Discussions involved sharing and debating personal practices and research experiences.
- Published research was used to verify and supplement participants' knowledge.
Main Results:
- An interdisciplinary framework integrating fetal, neonatal, and infant measurements was developed.
- Key practices for LMICs identified include antenatal Doppler screening, accurate birth anthropometry, placenta weighing, and routine use of length-for-age, weight-for-length, and mid-upper arm circumference.
- The need for standardized clinical records and supportive policies for interdisciplinary communication was highlighted.
Conclusions:
- Enhanced communication and a shared understanding of growth assessment among healthcare providers are vital.
- A supportive policy environment is a prerequisite for continuity of care.
- Implementing an integrated framework can optimize infant health and development outcomes.
Objectives:
Prenatal growth affects short- and long-term morbidity, mortality and growth, yet communication between prenatal and postnatal healthcare teams is often minimal. This paper aims to develop an integrated, interdisciplinary framework for foetal/infant growth assessment, contributing to the continuity of care across the first 1000 d of life.
Design:
A multidisciplinary think-tank met regularly over many months to share and debate their practice and research experience related to foetal/infant growth assessment. Participants’ personal practice and knowledge were verified against and supplemented by published research.
Setting:
Online and in-person brainstorming sessions of growth assessment practices that are feasible and valuable in resource-limited, low- and middle-income country (LMIC) settings.
Participants:
A group of obstetricians, paediatricians, dietitians/nutritionists and a statistician.
Results:
Numerous measurements, indices and indicators were identified for growth assessment in the first 1000 d. Relationships between foetal, neonatal and infant measurements were elucidated and integrated into an interdisciplinary framework. Practices relevant to LMIC were then highlighted: antenatal Doppler screening, comprehensive and accurate birth anthropometry (including proportionality of weight, length and head circumference), placenta weighing and incorporation of length-for-age, weight-for-length and mid-upper arm circumference in routine growth monitoring. The need for appropriate, standardised clinical records and corresponding policies to guide clinical practice and facilitate interdisciplinary communication over time became apparent.
Conclusions:
Clearer communication between prenatal, perinatal and postnatal health care providers, within the framework of a common understanding of growth assessment and a supportive policy environment, is a prerequisite to continuity of care and optimal health and development outcomes.
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