The Weight-by-Date Chart: A Personalized Tool for Following Hospitalized Children

Abstract

To the Editor. Monitoring changes in weight on a daily basis is critical to the care of children hospitalized for a wide range of conditions. This is especially important for children being treated for failure-to-thrive, dehydration, and feeding disorders, and also for many with chronic conditions of the gastrointestinal, pulmonary, cardiac, and other major organ systems. Change in weight over time remains one of the most important clinical measures of nutritional status,1 an important parameter in most hospitalized children,2 and the most accurate measure of fluid status.3To facilitate the tracking of daily weight in hospitalized children, we have created a software program that generates an individualized growth chart suitable for plotting weight-for-age on a daily basis. The “Weight-By-Date” program may be freely downloaded from the following website:www.bostonchildhealth.org/PrimaryCare/weight_by_date.html. It may then be installed on any personal computer running Windows 95 or higher. When opened, the program presents a dialogue box in which the user may enter the patient's name, medical record number, gender, date of birth, starting date and number of days to be plotted on thex axis, and desired weight range to be plotted on they axis. The weight-by-date program generates a growth chart with the specified parameters, as well as percentile lines for any major percentiles (including −2 and −3 standard deviation [SD]) included in the plotted area. These percentile lines were obtained from reference data4 corresponding to the revised growth charts published by the Centers for Disease Control and Prevention and the National Center for Health Statistics in June 2000.5The following example illustrates the use of the weight-by-date chart. A 5-month-old male infant was admitted to the inpatient pediatrics service for failure-to-thrive and suspected cow's milk allergy. His name, medical record number, date of birth (12/9/99), and gender were entered into the weight-by-date dialogue box. The program asks the user to select the number of days to be plotted on the x axis; the default of a 10-day plot was accepted. The program also asks for the starting date, and again the default was accepted, which is the date the plot was generated (the admitting date, 4/12/00). Because the patient's admission weight was 4.20 kg, the weight range on they axis was specified as 4.0 to 6.0 kg; in this case, each grid line on the y axis represents 0.02 kg. The patient was placed on an elemental formula, and after his admission a radioallergosorbent test for cow milk was reported as positive. Weight-by-date plot is shown in Fig 1. The child gained weight rapidly, as can be seen by the plot, with a slope exceeding that of the reference curves. By the ninth day of hospitalization, his weight exceeded the −3 SD curve of weight-for-age.We encourage any clinician who might find this program useful to download and use it. As of yet, there are no data with which to evaluate its impact on patient care.