Abstract
There remains controversy regarding whether the growth charts constructed from data of term infants, such as those produced by the World Health Organization (WHO) standards, can appropriately evaluate the postnatal growth of preterm infants. This retrospective cohort study, conducted in the First Affiliated Hospital of Shandong First Medical University in Jinan China, aimed to compare the postnatal growth charts of singleton preterm and term infants using WHO standards at 40–160 weeks postmenstrual age (PMA). A total of 5,459 and 15,185 sets of longitudinal measurements [length/height, weight, head circumference (HC), and body mass index (BMI)] from birth to 160 weeks PMA were used to construct growth charts for 559 singleton preterm (mean PMA at birth, 33.84 weeks) and 1,596 singleton term infants (born at 40 weeks PMA), respectively, using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Z-scores (prematurity corrected) were calculated using WHO Anthro software. Compared to WHO standards, all parameters of preterm infants were increased, especially in terms of length/height and weight; the gap between the two almost spanned two adjacent centile curves. Compared to term controls, the length/height, weight, and BMI of preterm infants were higher at 40 weeks PMA, surpassed by term infants at 52–64 weeks PMA, and quite consistent thereafter. The HC of preterm infants at 40–160 weeks PMA was quite consistent with both term controls and the WHO standards. The Z-scores for length/height, weight, and BMI of preterm infants relative to the WHO standards gradually decreased from 1.20, 1.13, and 0.74 at 40–44 weeks PMA to 0.67, 0.42, and 0.03 at 132–160 weeks PMA, respectively; Z-scores for HC of preterm infants rapidly decreased from 0.73 to 0.29 at 40–50 weeks PMA, and then fluctuated in the range of 0.08–0.23 at 50–160 weeks PMA. Preterm infants had higher growth trajectories than the WHO standards and similar but not identical trajectories to term infants during the first 2 years of life. These findings reemphasize the necessity of constructing local growth charts for Chinese singleton preterm infants.
Highlights
Growth impairment during early postnatal life can have permanent detrimental effects in later life, such as short stature, high blood pressure, and impaired neurodevelopment [1,2,3,4]
The selection of control subjects who were born at strictly 40 weeks postmenstrual age (PMA) took into account the fact that term infants born at 37–41 weeks PMA might have varying growth trajectories
The study demonstrated that the postnatal growth trajectories of the preterm infants were different from the World Health Organization (WHO) standards and similar but not identical to those of their term counterparts
Summary
Growth impairment during early postnatal life can have permanent detrimental effects in later life, such as short stature, high blood pressure, and impaired neurodevelopment [1,2,3,4]. A full understanding of optimal postnatal growth is of critical importance for improving survival and long-term outcomes in preterm infants [2]. This requires robust growth charts to monitor whether preterm infants have potentially abnormal growth that might be indicative of adverse health conditions [5]. The most prominent of these growth charts are the World Health Organization (WHO) growth standards [9], which are widely used to evaluate the postnatal growth of preterm infants after they reach corrected term age due to the scarcity of high-quality growth charts for preterm infants
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