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All referees should ensure that the source of the growth data are clearly referenced. In our article we did refer to (and use) the growth and percentile charts and on-line z-score calculator of Tanis Fenton. Which would seem to be self-evident, but is apparently not. It is important for researchers to identify which growth charts were used to calculate z scores. The lack of standardization of methods used to calculate preterm infant growth velocity makes comparisons between studies difficult and presents an obstacle to using research results to guide clinical practice. After reviewing hundreds of articles they finally state: You can present such data as grams per kilogram per day, or as gains in z-scores, or in many different ways, the question of this review was whether or not there is some sort of consensus. Tanis Fenton is the source of the growth charts that we use in our NICU, she has performed several systematic reviews that have led to our adoption of her charts, and now presents a systematic review of measures of growth velocity calculation. Preterm Infant Growth Velocity Calculations: A Systematic Review. They haven’t yet proven that they are a useful addition to our other measures, but I am hopeful that something this clinical and simple could give new insight into the quality of growth of our babies, rather than just the quantity.įenton TR, et al. They showed that the measures are simple and reproducible, and seem to have different progression to measures of weight and head circumference. In this new publication the use of additional measures, mid-upper arm circumference, and mid-thigh circumference were compared with repeated measures of weight, length, and head circumference. It would be great if there was some other measure that was shown to correlate with fat-free mass, that you could simply add to weekly weight and head circumference measurement, and that could then be used to evaluate changes in nutritional practice. So what else could we do? Body composition measurements would be ideal, but all current methods require either expensive equipment or extensive manipulation of the baby, or both. When I started working at the Royal Victoria Hospital in Montreal they were using a stadiometer, which is more accurate, but requires a lot more disturbance of the babies, so was only done after they were quite stable, and would be difficult to introduce into routine practice elsewhere. Also, measuring length is rather inaccurate in usual daily practice, knemometry seems to be more accurate, but I can’t find a source of a device to do it. Head circumference z-scores were maintained, though, and, as a very rough proxy for brain growth, that is re-assuring that the enhanced nutrition allowed good cerebral growth. Just looking at our most immature, longest stay, babies you can see that many of them are ‘short and plump’.
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We showed in our study that enhanced nutrition can almost completely prevent post-natal growth failure in the preterm infant, when calculated as loss of body weight Z-scores, but that length z-scores still fell between admission and discharge (by a mean of 1.5, compared to 1.7 with the older cohort).
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Although it can be measured easily, reproducibly and precisely, just because body weight is increasing along the wanted percentiles does not mean that growth is optimal: excess fat, and not enough of everything else, is common in preterm infants. It is clear that body weight is not good enough. Assessing the growth of preterm infants using detailed anthropometry.
![feed and grow feed and grow](https://sysrqmts.com/images/games/feed-and-grow-fish.jpg)
#Feed and grow how to
Several related articles in today’s post, the first two are about how to measure growth in preterm infants:Īshton JJ, et al. How to measure growth? How to describe growth rates? What does it matter?