Growth charts and growth monitoring

Neonatal Growth Charts & Growth monitoring
WE SHALL LEARN ABOUT: Need for growth monitoring of preterm babies, Growth parameters to be measured, Which growth charts to be used, How to plot growth charts, Identification of growth impairment & it’s management.
Premature infants have greater nutritional needs to achieve optimal growth in the neonatal period than at any other time in life. AAP recommends that extra uterine growth of a preterm baby should parallel the intrauterine growth trajectory of a fetus of comparable GAwithout stressing the developing metabolic or excretory system.
The ideal growth targets of preterm babies based on intra uterine growth rates is: Weight – 15 to 18 g/kg per day. Length – 1 cm/week. Head circumference – 0.7 cm/week
Objectives Of Growth Monitoring: To ensure that post-natal growth is as optimal as is possible and that the baby is growing along the birth trajectory,post-natal growth parameters of these babies should be diligently monitored using growth charts. This will help in early identification of growth faltering so that nutritional and other interventions (like management of cold stress, sepsis, anemia etc.) may be carried out for improving the growth trajectory and the response to our interventions can be assessed.
For monitoring growth, the three parameters that are routinely tracked are weight, length & head circumference of the baby. Before, we learn more about the growth charts to be used for monitoring VLBW babies, let us first take a look how these anthropometric measurements are taken.
Two growth charts are commonly used for monitoring preterm babies: Intrauterine growth curves from that are generated from anthropometric data at birth from preterm babies delivered at various gestations. Examples are the Fenton’s charts & the Intergrowth 21st charts. The other are the Post Natal Growth curvesbased on longitudinal postnatal weights of preterm babies at various gestations.The Ehrenkranz charts are postnatal growth charts.
Most neonatal units plot early growth the Fenton intrauterine growth reference chart whichare based on the recommended growth goal for preterm infants and are called Standard or prescriptive charts. They have separate charts for boys and girls for all the three parameters of weight, length & HC on the same chart. The same charts are used at birth to characterize babies as adequate, large or small for gestational age. As these charts are based on IU growth standards of apparently normal babies of different gestational ages, taken at birth, they do not account for the normal postnatal weight loss that occurs in babies in the early days after birth. Weights plotted on these charts are equivalent to the WHO growth charts at 50 weeks gestational, so no change in centile when transitioning.
Many centers also use the Ehrenkranz postnatal growth charts to assess the adequacyof postnatal growth, weights. These longitudinal curves represent postnatal growth & portray how the baby is growing after birth. These charts allow for the initial postnatal weight loss seen in newborn infants. They are also known as reference / (descriptive) curves.
The commonest reason for poor postnatal growth in the convalescent period is inadequate protein & caloric intake, which needs to be addressed by optimizing feeding volumes to 160 to 180 cc/ kg /day of EBM as well as by fortifying milk to provide 120 Kcal / kg / gay & 3.5-4 gm /kg / day of proteins. Occult cold stress may also impair growth & maximizing KMC duration per day may help better growth. Other problems like anemia of prematurity, hyponatremia and occult infections like urinary infections, fungal sepsis may also cause growth faltering & need to be investigated and treated appropriately. If poor growth, or growth faltering is identified, the likely cause needs to be identified and addressed appropriately. Once a baby has reached a corrected age of term, further growth monitoring should be done on the universally used WHO growth charts.
VLBW & ELBWs prone to EUGR. Growth Monitoring of weight, length& head circumference essential for all preterm. Monitor on Fenton’s (prescriptive) for classification of nutritive status at birth & Fenton’s /Ehrenkranz (descriptive ) charts after birth. Use growth charts to monitor faltering and to monitor effectiveness of corrective intervention. Fortification of mothers milk, KMC for improved growth velocity.
  • Introduction...
  • 1. Learning object...
  • 2. Premature infan...
  • 3. Post natal grow...
  • 4. Objectives of ...
  • 5. Growth paramete...
  • 6. Growth charts c...
  • 7. Gender specific...
  • 8. Fenton charts 2...
  • 9. Ehrenkranz post...
  • 10. Plotting growt...
  • 11. Reasons for po...
  • 12. Key messages...
 

Introduction

DR. JAYASHREE MONDKAR
MD, DM (Neonatology)

Professor & Head
Department of Neonatology
LTMMC and Sion Hospital
Mumbai

1. Learning objectives

â–º Need for growth monitoring of preterm babies

â–º Growth parameters to be measured

â–º Which growth charts to be used?

â–º How to plot growth charts?

â–º Identification of growth impairment

â–º Management of growth impairment

2. Premature infants

â–º Premature infants have greater nutritional needs to
    achieve optimal growth

â–º Due to inherent limitations, many VLBW babies have
    cumulative deficits in protein and energy

â–º Show slower growth than intrauterine
    counterparts, causing EUGR

â–º Provision of adequate nutrition from birth along with
    growth monitoring is essential to prevent this

3. Post natal growth targets

â–º Expected as per intrauterine growth

      ♦ Weight – 15 to 18 gm/ kg/ day

      ♦ Length – 0.9 - 1 cm/ week

      ♦ Head circumference – 0.7 to 0.9 cm/ week

4. Objectives of growth monitoring

â–º To ensure that post natal growth is as optimal as possible
      ♦ Baby is growing along birth centile


â–º For early identification & management of growth impairment


â–º To assess response to interventions

5. Growth parameters to be tracked

6. Growth charts commonly used

â–º Intrauterine growth curves
      ♦ Anthropometric data at birth from preterm
        babies delivered at various gestations
      ♦ Example: Fenton’s charts, Intergrowth 21st charts

â–º Post natal growth curves
      ♦ Based on longitudinal post natal weights of preterm
        babies at various gestations
      ♦ Example: Ehrenkranz charts

7. Gender specific Fenton charts 2013

â–º Called standard or prescriptive charts

â–º Gender specific

â–º Used for categorizing into AGA/ SGA/ LGA

â–º Equivalent to WHO growth charts at 50 weeks gestation -
   so no change in centile when transitioning at term
   gestation

8. Fenton charts 2013

9. Ehrenkranz post natal growth charts

♦ Longitudinal curves represent postnatal growth
♦ Portray how babies grow after birth
♦ Called reference charts
♦ Allow for the initial postnatal weight loss seen in newborn

10. Plotting growth of 30 weeks 1100 grams, for first 28 days

11. Reasons for poor growth & management

12. Key messages

â–º VLBW & ELBW's prone to EUGR

â–º Growth monitoring of weight, length & head circumference
    is essential for all preterm babies

â–º Monitor on fenton’s (prescriptive) for classification of nutritive
    status at birth and Ehrenkranz (descriptive) charts after birth

â–º Use growth charts to monitor faltering and to monitor
    effectiveness of corrective intervention

â–º Fortification of mothers milk, KMC for improved growth
    velocity