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Published on: December 31, 2015
Expert recommendations for preterm neonates' growth goals: Considerations for clinicians
Tanis R Fenton1, Nicholas D Embleton2, Marc Beltempo3
1Community Health Sciences, O'Brien Institute of Public Health, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada.
Insights
Individualized growth expectations are crucial for preterm infants, recognizing variations in postnatal growth phases and influencing factors. Experts suggest avoiding terms like "failure" for growth, favoring "faltering" to acknowledge temporary issues.
Area of Science:
- Neonatalogy
- Pediatric Nutrition
- Growth Monitoring
Background:
- Traditional recommendations for preterm infant growth approximate intrauterine rates.
- Preterm infant growth involves distinct phases: postnatal weight loss, parallel growth, and catch-up growth.
- Growth patterns are multifactorial, influenced by genetics, maternal health, infant morbidity, and nutrition.
Purpose of the Study:
- To re-evaluate traditional growth recommendations for preterm infants.
- To emphasize individualized growth expectations over arbitrary percentile goals.
- To address the terminology used to describe suboptimal infant growth.
Main Methods:
- Review of expert opinions and traditional recommendations on preterm infant growth.
- Analysis of growth patterns, including postnatal weight loss and catch-up growth.
- Discussion of factors influencing infant growth trajectories.
Main Results:
- Growth parallel to growth charts can be appropriate, even below specific percentiles.
- Individualized growth assessment is necessary, accounting for physiological and genetic variations.
- Expert groups discourage terms like "failure" or "restriction" for postnatal growth.
Conclusions:
- Universal growth goals (percentiles, z-scores) are inappropriate for preterm infants.
- Individualized growth monitoring is essential to identify modifiable factors and support optimal development.
- The term "faltering" is preferred over "failure" to describe growth deviations, reflecting potential for recovery.
Abstract:
Neonatal nutrition experts traditionally recommend that preterm infants achieve postnatal growth approximating intrauterine fetal growth rates. Preterm infant growth has three phases: postnatal weight loss, approximately parallel growth, and catch-up growth. Growth approximately parallel to growth chart curves can be appropriate even when plotting below any given percentile. Growth patterns are influenced by genetic potential, health determinants, pre-birth environment (maternal morbidities), post-birth morbidity, nutrition and feeding ability. To achieve genetic potential, some infants need growth to catch-up and some catch-down. There is considerable overlap between the growth of healthy infants and those with growth faltering. Growth expectations must be individualized in order to account for normal physiological and genetic variations and to help identify modifiable factors. No specific percentile, z-score or change in z-scores should be set as universal growth goals; rather, individual variability should be expected. The expert groups did not favour the words "failure" and "restriction" to describe postnatal growth perhaps because these words are usually based on arbitrary percentile/z-score cut-offs using one-point-in-time measures and ignore that postnatal weight loss places infants lower on growth chart curves. The word "failure" is pejorative while "faltering" suggests a temporary problem.
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