scope:

INTRODUCTION

Growth charts help health professionals provide size-appropriate care to preterm infants. Preterm infants are not mature enough to adequately communicate their nutritional needs as do older infants, so health professionals must determine each baby's individual needs. Without awareness of an infant's growth pattern, nutrition decisions are based on average estimated needs, which is not likely appropriate for all individuals.

For example, enteral energy requirements likely vary from 110 to 135 kcal/kg/ day, in healthy preterm infants.¹ If an infant requires the upper end of the range, but is being fed at the lower end, the infant will not likely grow at a desirable rate, which would show its growth curve as flatter than desired.

Health professionals need to know three things about the growth chart they are using:

1. What type of growth reference it represents (fetal estimates, previous preterm infants, or term infants)

2. The strengths of that methodology

3. The limitations of the methodology

This chapter will review the history of growth chart development for preterm infants, outline the strengths and weakness of each type, discuss the use of additional tools (percentiles and z-scores), as well as provide some perspectives on the growth goals of preterm infants.

Growth charts also can provide a quick assessment of whether an infant's head and length are growing appropriately relative to the infant's weight gain. A check of head size against a growth reference could identify pathological head growth such as hydrocephalus. Evaluation of length assists assessment of whether the infant might be gaining too much weight for its length growth. Growth of very low birth weight infants has been observed to be a predictor of neurodevelopmental outcomes.^2-7 Low weight,^2-4,7 head,⁵ and length⁶ growth have all been associated with poorer development. Recognizing instances of faltering growth enables the health care team to institute changes that not only may improve growth outcomes but also may improve neurodevelopmental outcomes.