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Published on: June 29, 2013
Fenton Third-Generation Growth Charts of Preterm Infants Without Abnormal Fetal Growth: A Systematic Review and
Tanis R Fenton1, Seham Elmrayed2, Belal N Alshaikh1,3
1Community Health Sciences, Alberta Children's Hospital Research Institute, O'Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Insights
New Fenton growth charts provide a better standard for preterm infant growth assessment. These sex-specific charts align with fetal growth estimates, improving accuracy for premature babies.
Area of Science:
- Neonatalogy and Perinatal Medicine
- Pediatric Growth and Development
- Biostatistics and Epidemiology
Background:
- Accurate assessment of preterm infant growth is crucial and ideally uses fetal growth patterns.
- Challenges exist in estimating healthy fetal growth for preterm infants due to intrauterine growth restriction.
- Current growth charts may not adequately represent healthy growth trajectories for this population.
Purpose of the Study:
- To develop updated, sex-specific Fenton preterm growth charts using data from infants without abnormal fetal growth.
- To enhance the assessment of preterm infant growth by aligning with fetal growth standards.
- To evaluate the consistency and accuracy of growth velocities depicted by the new charts.
Main Methods:
- Conducted a systematic review of population-based, sex-specific anthropometric data for preterm infants (born ≤24 weeks gestation) without abnormal fetal growth.
- Included data from seven studies across 15 countries, representing over 4.8 million births (174,184 preterm).
- Harmonized weight, length, and head circumference data using meta-analyses and adjusted the gestational age scale to exact weeks and days.
Main Results:
- The Fenton third-generation preterm growth charts exhibit improved, more uniform slopes across percentiles.
- Growth velocities for weight, length, and head circumference show consistent declines with increasing post-menstrual age.
- Birthweight meta-analysis curves closely resemble fetal ultrasound estimates, indicating improved accuracy.
Conclusions:
- The updated Fenton preterm growth charts offer a more accurate and consistent growth standard for preterm infants.
- These charts better reflect fetal growth patterns, aiding in the assessment of premature infant development.
- The improved alignment with fetal ultrasound estimates enhances their clinical utility for monitoring preterm infants.
Background:
Experts recommend assessing preterm infant growth against fetal growth patterns. However, obtaining accurate estimates of healthy fetal growth from preterm infants is challenging as many had intrauterine faltering growth.
Objectives:
To improve preterm infant growth assessments by developing Fenton third-generation sex-specific preterm growth charts based on anthropometric distributions of preterm infants without abnormal fetal growth. We also aimed to evaluate the consistency of the new charts' growth velocities.
Data Sources:
From the last search for the 2013 Fenton growth charts to November 2024, MEDLINE and EMBASE databases, grey literature, as well as US Vital statistics and iNeo Consortium.
Study Selection And Data Extraction:
We followed systematic review methodology to identify population-based sex-specific anthropometric estimates of preterm cohorts without abnormal fetal growth beginning ≤ 24 weeks of gestation. Specified a priori, outcomes included newborn sex-specific estimates of birthweight, length, and head circumference.
Synthesis:
We followed PRISMA guidelines. Literature screening and quality assessment were performed in duplicate. We harmonised weight, length, and head circumference weighted-average meta-analyses with the World Health Organization growth standard and rescaled the charts' x-axis from completed gestational weeks to exact gestational age (weeks and days).
Results:
Seven studies from 15 countries (Australia, Brazil, Canada, China, Finland, Israel, Italy, Japan, Netherlands, New Zealand, Sweden, Switzerland, Spain, United Kingdom and United States) were included, representing 4.8 million births 22-42 weeks of gestation. 174,184 were < 30 weeks gestational age. The Fenton third-generation preterm growth charts' weights showed improved growth velocity across percentiles with consistent declines for weight, length and head circumference velocity as post-menstrual age increased. The birthweight meta-analysis curves had similar shapes to fetal ultrasound estimates.
Conclusions:
The Fenton third-generation preterm infant growth chart curves demonstrate improved and more uniform slopes across percentiles and closer alignment with fetal ultrasound estimates, offering a growth standard for preterm infants.
Prospero Registration:
CRD42024589756.
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