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Updated: Jan 7, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Individualised growth charts for preterm infants based on a cohort with healthy neurodevelopment
Aneurin Young1, Tim J Cole2, James Ashton1
1Faculty of Medicine, University of Southampton, University Road, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton, UK.
Insights
New growth charts for very preterm infants, based on those with positive developmental outcomes, can predict neurodevelopmental success. A web app is available to plot individual infant growth against these new standards.
Area of Science:
- Neonatalogy
- Developmental Pediatrics
- Biostatistics
Background:
- Early infant growth significantly impacts later neurodevelopmental outcomes in very preterm infants.
- Existing growth charts are based on in utero standards, not optimal growth patterns for healthy development.
- There is a need for growth standards reflecting optimal development in preterm populations.
Purpose of the Study:
- To create new growth standards for very preterm infants using data from those with favorable neurodevelopmental outcomes.
- To identify key growth parameters associated with healthy development at two years of age.
- To develop a tool for individualized growth assessment in preterm infants.
Main Methods:
- Utilized data from the National Neonatal Research Database (37,700 infants).
- Employed logistic regression to link in-hospital and post-discharge growth with 2-year developmental outcomes.
- Applied the LMS method to construct centile curves, excluding infants with surgical necrotizing enterocolitis or significant brain injury.
Main Results:
- Healthy development was associated with in-hospital weight gain (aOR 1.09), post-discharge weight gain (aOR 1.08), and in-hospital head growth (aOR 1.12).
- Growth data from 14,120 infants with developmental assessments were analyzed.
- A web application (www.bit.ly/preterm-plotter) was developed for individualized growth charting.
Conclusions:
- A novel method for creating individualized growth charts for preterm infants has been established.
- These charts are based on a cohort of infants with favorable developmental outcomes.
- The tool can be integrated into clinical settings or used via a web app to monitor infant growth trajectories.
Background & Aims:
Early growth of very preterm infants is associated with later neurodevelopmental outcome. Current growth charts are based on in utero growth rather than a growth pattern associated with good outcomes. This study aimed to generate growth standards using infants who were developing normally.
Methods:
Data were obtained from the National Neonatal Research Database. Logistic regression identified associations of in-hospital and post-discharge weight gain and head circumference growth with the chance of healthy development at two years. The LMS method was used to construct centile curves reflecting the growth of very preterm infants with a positive developmental outcome. Infants with surgical necrotising enterocolitis or a significant brain injury were excluded from the cohort used to generate growth charts.
Results:
Growth data were available for 37700 infants, of whom 14120 had a documented developmental assessment. Healthy development was positively associated with three factors: In-hospital weight gain (adjusted OR 1·09 per unit z-score change, 95 % CI: 1·02-1·17), weight gain from discharge to two-year assessment (aOR 1·08, 1·04-1·12) and in-hospital head growth (aOR 1·12, 1.04-1·21). A web app is available (www.bit.ly/preterm-plotter) to generate individualised growth charts for preterm infants, conditioned on their weight and head circumference at birth, to plot their growth and indicate whether their growth was expected to align with that of healthily developing infants.
Conclusion:
This study presents a novel method of forming individualised growth charts. It can be implemented using a web app or by integration with clinical information systems to allow an infant's growth to be compared to a cohort of infants with a favourable developmental outcome.
