A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format

BACKGROUND: The Babson and Benda 1976 "fetal-infant growth graph" for preterm infants is commonly used in neonatal intensive care. Its limits include the small sample size which provides low confidence in the extremes of the data, the 26 weeks start and the 500 gram graph increments. The purpose of this study was to develop an updated growth chart beginning at 22 weeks based on a meta-analysis of published reference studies. METHODS: The literature was searched from 1980 to 2002 for more recent data to complete the pre and post term sections of the chart. Data were selected from population studies with large sample sizes. Comparisons were made between the new chart and the Babson and Benda graph. To validate the growth chart the growth results from the National Institute of Child Health and Human Development Neonatal Research Network (NICHD) were superimposed on the new chart. RESULTS: The new data produced curves that generally followed patterns similar to the old growth graph. Mean differences between the curves of the two charts reached statistical significance after term. Babson's 10(th )percentiles fell between the new data percentiles: the 5th to 17th for weight, the 5th and 15th for head circumference, and the 6th and 16th for length. The growth patterns of the NICHD infants deviated away from the curves of the chart in the first weeks after birth. When the infants reached an average weight of 2 kilograms, those with a birthweight in the range of 700 to 1000 grams had achieved greater than the 10(th )percentile on average for head growth, but remained below the 3(rd )percentile for weight and length. CONCLUSION: The updated growth chart allows a comparison of an infant's growth first with the fetus as early as 22 weeks and then with the term infant to 10 weeks. Comparison of the size of the NICHD infants at a weight of 2 kilograms provides evidence that on average preterm infants are growth retarded with respect to weight and length while their head size has caught up to birth percentiles. As with all meta-analyses, the validity of this growth chart is limited by the heterogeneity of the data sources. Further validation is needed to illustrate the growth patterns of preterm infants to older ages

Postnatal weight velocity pattern in very low birthweight infants

The care of very-low-birth-weight infants has improved over the years with continuing changes in medical and nutritional management. In view of these changes, there is a need to study the pattern of postnatal weight gain. Postnatal weight gain patterns of 32 very-low-birth-weight infants were examined during the first two months of life. Their mean gestational age was 29.5 ± 2.3 weeks and mean birth weight was 1255 ± 258 grams. The babies were weighed daily and weight changes were expressed in gram/day. All data were accurately recorded. When mean weight gain profiles were obtained by computing increments at 1, 3, 7 and 14 day intervals, the babies weight gain showed a non-linear pulsatile pattern which did not change even after full enteral nutrition had been established. This study demonstrates that weight velocity profile in very-low-birth-weight infants is not linear as expected from available standard curves and these data might therefore be considered while monitoring the adequacy of the increments of the weight gain of the individual subjects