A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

Tanis R Fenton, Jae H Kim, Tanis R Fenton, Jae H Kim

Abstract

Background: The aim of this study was to revise the 2003 Fenton Preterm Growth Chart, specifically to: a) harmonize the preterm growth chart with the new World Health Organization (WHO) Growth Standard, b) smooth the data between the preterm and WHO estimates, informed by the Preterm Multicentre Growth (PreM Growth) study while maintaining data integrity from 22 to 36 and at 50 weeks, and to c) re-scale the chart x-axis to actual age (rather than completed weeks) to support growth monitoring.

Methods: Systematic review, meta-analysis, and growth chart development. We systematically searched published and unpublished literature to find population-based preterm size at birth measurement (weight, length, and/or head circumference) references, from developed countries with: Corrected gestational ages through infant assessment and/or statistical correction; Data percentiles as low as 24 weeks gestational age or lower; Sample with greater than 500 infants less than 30 weeks. Growth curves for males and females were produced using cubic splines to 50 weeks post menstrual age. LMS parameters (skew, median, and standard deviation) were calculated.

Results: Six large population-based surveys of size at preterm birth representing 3,986,456 births (34,639 births < 30 weeks) from countries Germany, United States, Italy, Australia, Scotland, and Canada were combined in meta-analyses. Smooth growth chart curves were developed, while ensuring close agreement with the data between 24 and 36 weeks and at 50 weeks.

Conclusions: The revised sex-specific actual-age growth charts are based on the recommended growth goal for preterm infants, the fetus, followed by the term infant. These preterm growth charts, with the disjunction between these datasets smoothing informed by the international PreM Growth study, may support an improved transition of preterm infant growth monitoring to the WHO growth charts.

Figures

Figure 1
Figure 1
Boys birthweight centiles (3rd, 50th and 97th) from the six included studies, along with the boy’s meta-analysis curves (bold).
Figure 2
Figure 2
Girls head circumference centiles (3rd, 50th and 97th) centiles from the included studies, along with the girl’s meta-analysis curves (dotted), and after 40 weeks, the World Health Organization centiles (dashed).
Figure 3
Figure 3
Girls length centiles (3rd, 50th and 97th) centiles from the included studies, along with the meta-analysis curves (dotted), and after 40 weeks, the World Health Organization centiles (dashed).
Figure 4
Figure 4
Flow diagram of studies identified, excluded and included in the systematic review.
Figure 5
Figure 5
Boys meta-analysis weight curves (dotted) with the final smoothed growth chart curves (dashed).
Figure 6
Figure 6
Boys meta-analysis head circumference curves (dotted) with the final smoothed growth chart curves (dashed).
Figure 7
Figure 7
Boys meta-analysis length curves (dotted) with the final smoothed growth chart curves (dashed).
Figure 8
Figure 8
Revised growth chart for girls.
Figure 9
Figure 9
Revised growth chart for boys.
Figure 10
Figure 10
Comparison of the revised growth chart for girls (solid curves) and the 2003 Fenton growth chart (dashed curves) 3rd, 50th, and 97th percentile curves for length, head circumference, and weight). Both the 2003 and the revised growth curves are shown shifted to actual weeks.
Figure 11
Figure 11
Comparison of the revised growth chart for boys (solid curves) and the 2003 Fenton growth chart (dashed curves) 3rd, 50th, and 97th percentile curves for length, head circumference, and weight). Both the 2003 and the revised growth curves are shown shifted to actual weeks.

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