A systematic review and meta-analysis to revi the Fenton growth chart for preterm infants
Tanis R Fenton 1,2*and Jae H Kim 3
Background
The expected growth of the fetus describes the fastest human growth,increasing weight over six-fold between 22and 40weeks.Preterm infants,who are born during this rapid growth pha,rely on health professionals to asss their growth and provide appropriate nutrition and medical care.
In 2006,the World Health Organization (WHO)published their multicentre growth reference study,which is considered superior [1]to previous growth surveys since the measured infants were lected from communities in which economics were not likely to limit growth,among culturally diver non-smoking mothers who planned to breastfeed [2].Weekly longitudinal measures of the infants were made by trained data collection teams during the first 2years of this study [3].The WHO growth charts,although recommended for preterm infants after term age [4],begin at term and so do not inform preterm infant growth asssments younger than this age.
*Correspondence:tfenton@ucalgary.ca 1
Alberta Children ’s Hospital Rearch Institute,The University of Calgary,Calgary,AB,Canada 2怎样洗草莓
Department of Community Health Sciences,The University of Calgary,3280Hospital Drive NW,Calgary,AB,Canada
Full list of author information is available at the end of the
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article
©2013Fenton and Kim;licene BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution Licen (creativecommons/licens/by/2.0),which permits unrestricted u,distribution,and reproduction in any medium,provided the original work is properly cited.
Fenton and Kim BMC Pediatrics 2013,13:59葱包桧儿
/1471-2431/13/59
Optimum growth of preterm infants is considered to be equivalent to intrauterine rates[5-7]since a superior growth standard has not been defined.Perhaps the best estimate of fetal growth may be obt
ained from large population-bad studies,conducted in developed coun-tries[8],where constraints on fetal growth may be less frequent.
A recent multicentre study by our group(the Preterm Multicentre Growth(PreM Growth)Study)revealed that although the pattern of preterm infant growth was gener-ally consistent with intrauterine growth,the biggest devi-ation in weight gain velocity between the preterm infants and the fetus and infant was just before term,between37 and40weeks(Fenton TR,Nasr R,Eliasziw M,Kim JH, Bilan D,Sauve R:Validating the weight gain of preterm in-fants between the reference growth curve of the fetus and the term infant,The Preterm Infant Multicentre Growth Study.Submitted BMC Ped2012).Rather than demon-strating the slowing growth velocity of the term infant during the weeks just before term,the preterm infants had superior,clo to linear,growth at this age.This finding has been obrved by others as well[9-11].Therefore, there is evidence to support a smooth transition on growth charts between late fetal and early infant ages. Several previous growth charts bad on size at birth prented their data as completed age,which affects the interpretation and u of a growth chart[12].The u of completed weeks when plotting a growth chart requires all the measurements to be plotted on the whole week vertical axes.However,the u of completed weeks in a neonatal unit may not be intuitive,as nurry staff and parents think of infants as their exact age,
and not age truncated to previous whole weeks.The advent of computers in health care,for clinical care and health recording,allow the u of the computer to plot growth charts,daily and with accuracy.It would make n to support plotting daily measurements continuously by shifting the data collected as completed weeks to the midpoint of the next week to remove the truncation of the data collection as completed weeks.
The objectives of this study were to revi the2003 Fenton Preterm Growth Chart,specifically to:a)u more recent data on size at birth bad on an inclusion criteria, b)harmonize the preterm growth chart with the new WHO Growth Standard,c)to smooth the data between the preterm and WHO estimates while maintaining integrity with the data from22to36and at50weeks, d)to derive x specific growth curves,and to e)re-scale the chart x-axis to actual age rather than completed weeks,to support growth monitoring.
Methods
To revi the growth chart,thorough literature arches were performed to find published and unpublished population-bad preterm size at birth(weight,length, and/or head circumference)references.The inclusion criteria,defined a priori,designed to minimize bias by restricti
on[13],were to locate population-bad studies of preterm fetal growth,from developed countries with: a)Corrected gestational ages through fetal ultrasound
and/or infant asssment and/or statistical
correction;
b)Data percentiles at24weeks gestational age or
lower;
c)Sample of at least25,000babies,with more than500
infants aged less than30weeks;
d)Separate data on females and males;
e)Data available numerically in published form or
from authors,
f)Data collected within the past25years(1987to2012)
to account for any cular trends.
A.Data lection and combination
Major bibliographic databas were arched:MEDLINE (using PubMed)and CINHAL,by both authors back to year1987(given our25year limit),with no language restrictions,and foreign articles were translated.The following arch terms as medical subject headings and textwords were ud:(“Preterm infant”OR“Premature Birth”[Mesh])OR(“Infant,Premature/classification”[Mesh] OR“Infant,Premature/growth and development”[Mesh] OR“Infant,Premature/statistics and numerical data”[Mesh] OR“Infant,very low birth weight”[Mesh])AND (percentile OR*centile*OR weeks)AND(weight OR head circumference OR length).Grey literature sites including clinical trial websites and Google were arched in February 2012.Reference lists were reviewed for relevant studies.
All of the found data was reported as completed weeks except for the German Perinatal Statistics,which were reported as actual daily weights[14].To combine the datats,the German data was temporarily converted to completed weeks.A final step converted the meta-analys to actual age.
B.Combine the data to produce weighted intrauterine growth curves for each x
The located data(3rd,10th,50th,90th,and97th percentiles for weight,head circumference,and length)that met the inclusion criteria were extracted by copying and pasting into spreadsheets.The male and female percentile curves from each included data t for weight,head circumference and length were plotted together so they could be examined visually for heterogeneity(Figures1,2, and3).The data for each gender were combined by using the weekly data for the percentiles:3rd,10th,50th,90th, and97th,weighted by the sample sizes.The combined data was reprented by relatively smooth curves.
C.Develop growth monitoring curves
To develop the growth monitoring curves that joined the intrauterine meta-analysis data with the WHO Growth Standard(WHOGS)smoothly,the following cubic spline procedure was ud to meet two objectives:a)To maintain integrity with the meta-analysis curves
from22to36weeks.Integrity of the fit was
assumed to be agreement within3%at each week. b)To ensure fit of the data to the WHO values at50
weeks,within0.5%.
Procedure:
1)Cubic splines were ud to interpolate smooth
values between lected points(22,25,28,32,34,36 and50weeks).Extra points were manually lected at40,43and46weeks in order to produce
acceptable fit through the underlying data.The
PreM Growth study(Fenton TR,Nasr R,Eliasziw M,Kim JH,Bilan D,Sauve R:Validating the weight gain of preterm infants between the reference
growth curve of the fetus and the term infant,The Preterm Infant Multicentre Growth Study.
Submitted BMC Ped2012)conducted to inform the transition between the preterm and WHO data,was ud to inform this step.The Prem Growth Study
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found that preterm infants growth in weight
followed approximately a straight line between37
and45weeks,as others have also noted[9-11].
2)LMS values(measures of skew,the median,and the
standard deviation)[15]were computed from the
interpolated cubic splines at weekly intervals.Cole’s
procedures[15]and an iterative least squares method were ud to derive the LMS parameters(L=Box-Cox power,M=median,S=coefficient of variation)from胡萝卜丸子
Figure1Boys birthweight centiles(3rd,50th and97th)from the six included studies,along with the boy’s meta-analysis curves (bold).
德甲冠军Figure2Girls head circumference centiles(3rd,50th and97th) centiles from the included studies,along with the girl’s
meta-analysis curves(dotted),and after40weeks,the World Health Organization centiles (dashed).Fig
ure3Girls length centiles(3rd,50th and97th)centiles from the included studies,along with the meta-analysis curves (dotted),and after40weeks,the World Health Organization centiles(dashed).
Fenton and Kim BMC Pediatrics2013,13:59Page5of13 /1471-2431/13/59
Table2Number of infants each week from each study
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Gestational age Voight,2010Oln,2010Bertino,2010Kramer,2001Roberts,1999Bonellie,2008 Females Males Females Males Females Males Females Males Females Males Females Males 22188321----80827174--23431560133153381061147995--245757044384512024148156115135120126 257138466037224038184202136180115118 268129687738813558191234188235179172 271073120396610305261188254231284174177 2812761536118712817963287330287361246239 2915161838125415057072299392325397245265 301853221216061992107114390467440571317313 312283295620442460126140461584548743136148 32**300736771651837959978771117193205 33**418650142112401055136812001471239256 34**593672912633492018255320862657374422 35**508269523664183391431434184092644653 36**46907011562665820396487320878810481265 37**43726692129114921730819965161051866020062499 38**57558786352439764751651947478095140446306387 39**597883245295545275068776236884672871869910706 40**55297235567256531107381127371375701415531264414230 *Not reported.
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