006–National Survey of Neonatal Growth Measurement Practices

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Background: Neonatal growth measurements, including frontal-occipital circumference (FOC), weight, and length, are used to assess size for gestational age, determine fluid and nutritional requirements, calculate medication doses, identify surveillance needs, and serve as a baseline for postnatal growth monitoring. Measurements are often inaccurate and unreliable. While evidence-based guidelines for growth measurements exist, little is known about current practices. Aims: Describe neonatal nurses’ growth measurement knowledge, attitudes, practice behaviors, bases of practice knowledge, and facilitators and barriers to changing practice. Methods: A descriptive, exploratory design with an online survey was used. The neonatal growth measurement survey (NGMS), created and pilot tested for validity and reliability by the research team, was distributed through the Association of Women’s Health, Obstetrical and Neonatal Nurses (AWHONN) and the National Association of Neonatal Nurses (NANN). Results: Of the 301 participants (members of AWHONN 51.8%, NANN 31.9%, both organizations 16.3%), there were 50.5% BSN and 39.5% graduate degree nurses practicing in well newborn (24.9%), special care nursery (23.3%), NICU (36.2%), and regional NICU (15.6%) units, with a mean 18.7 years of neonatal experience. Of 16 knowledge items, five items were answered incorrectly by more than half of participants. Most thought their measurements were accurate or highly accurate (FOC 96.7%, weight 99.3%, length 87.1%). Weights (72.8%) and lengths (60.4%) were routinely measured once before recording, compared to two or more times for FOC (61.9%). Measurements were frequently recorded using large increments of 0.25-1 cm (FOC 71.2%, length 57.6%) compared to smaller weight increments of 1-10 grams (78.8%). A majority reported measuring lengths without assistance from a second person (74.9%) using a tape measure (76.7%) without Frankfort plane positioning (96.7%). The most common bases of practice knowledge were clinical practice guidelines (86.7%) and unit policies and procedures (85.9%). Comparisons between AWHONN and NANN members, levels of care, education, and years of neonatal experience will be presented. Conclusions: Knowledge gaps and areas for practice improvement were identified. Clinical Implications: NGMS results can be used by endocrinology and neonatal nursing experts to develop interventions and targeted implementation strategies to improve growth measurement practices, thereby optimizing growth monitoring and clinical decision-making.