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Updated: Aug 7, 2026
Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Postnatal weight trajectories drives beter head circumference growth in preterm infants ≤32 weeks: a multicenter
Angela B Hoyos1, Pablo Vásquez-Hoyos2,3, Carlos A Fajardo4
1Division of Neonatology, El Bosque University, Bogota, Colombia. angelahoyos@hotmail.com.
Insights
Postnatal weight gain in preterm infants is linked to head growth. Supporting weight recovery is crucial for adequate head circumference (HC) development in the NICU.
Area of Science:
- Neonatalogy
- Pediatric Growth Monitoring
- Nutritional Support in Preterm Infants
Background:
- Postnatal weight loss is common in preterm infants, impacting head circumference (HC) growth.
- Updated Fenton 2025 growth charts provide new parameters for assessing infant growth.
- The relationship between weight trajectory and HC growth in preterm infants requires further characterization.
Purpose of the Study:
- To investigate the association between postnatal weight trajectory and HC growth in preterm infants (≤32 weeks gestation).
- To utilize the Fenton 2025 growth standards for analysis in a large Latin American cohort.
- To assess HC growth from birth to discharge in relation to weight changes.
Main Methods:
- Secondary analysis of a prospective cohort study (EpicLatino registry) across 35 NICUs in Latin America and the Caribbean.
- Inclusion criteria: preterm infants ≤32 weeks gestation admitted within 48 hours of birth.
- Statistical analysis: Multivariable linear regression examining the change in weight Z-score (Fenton 2025) as exposure and change in HC Z-score as primary outcome, adjusting for multiple clinical factors.
Main Results:
- The study included 3757 preterm infants with a median gestational age of 30 weeks.
- A significant, progressive association was observed between weight trajectory and HC growth (p < 0.001).
- Infants with lower weight Z-score changes exhibited substantially reduced HC Z-score changes, ranging from -0.34 to -2.71.
Conclusions:
- Postnatal weight trajectory is an independent predictor of HC growth in preterm infants.
- Promoting weight recovery towards the birth Z-score is a critical nutritional goal for optimal HC development.
- Findings highlight the importance of nutritional strategies to support head growth in neonatal intensive care units (NICUs).
Background:
Postnatal weight loss is nearly universal in preterm infants, and its relationship to head circumference (HC) growth remains incompletely characterized. Growth standards were recently updated with the Fenton 2025 charts, which modify Z-score parameters compared to the 2013 version.
Objective:
To evaluate the association between postnatal weight trajectory and HC growth from birth to discharge in preterm infants ≤32 weeks of gestation across a large multicenter Latin American cohort, using Fenton 2025 growth standards.
Methods:
This observational cohort study by secondary analysis of a prospective cohort study using data from EpicLatino, a quality improvement registry of 35 neonatal intensive care units (NICUs) across Latin America and the Caribbean (2015-2024). Infants ≤32 weeks admitted within 48 h of birth were included. The exposure was the change in weight Z-score (Fenton 2025) from birth to discharge, categorized into 10 groups at 0.4-unit intervals. The primary outcome was the change in HC Z-score (Fenton 2025). Multivariable linear regression with average marginal predictions was used, adjusting for gestational age, necrotizing enterocolitis (NEC), sepsis, SNAP-II score, length of stay, treated patent ductus arteriosus, Apgar score at 5 min, HC Z-score at birth, and outborn status.
Results:
3926 infants were included (analytical sample n = 3757). Median gestational age was 30 [IQR 29-32] weeks. Adjusted HC Δ Z-score ranged from -0.34 (95% CI -0.38 to -0.30) in infants with weight Δ Z-score >0, to -2.71 (95% CI -2.83 to -2.58) in those with weight Δ Z-score ≤-3.2. All group comparisons were statistically significant (p < 0.001). The model explained 37.6% of the variance in HC growth.
Conclusions:
Postnatal weight trajectory is independently and progressively associated with HC growth in preterm infants ≤32 weeks across Latin America. Supporting weight recovery toward birth Z-score is a key nutritional target to promote adequate HC growth in the NICU.
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