Comparison of Postnatal Growth Charts of Singleton Preterm and Term Infants Using World Health Organization Standards at 40-160 Weeks Postmenstrual Age: A Chinese Single-Center Retrospective Cohort Study

Li Zhang; Jian-Gong Lin; Shuang Liang; Jin Sun; Nan-Nan Gao; Qiong Wu; Hui-Yun Zhang; Hui-Juan Liu; Xiang-Deng Cheng; Yuan Cao; Yan Li

doi:10.3389/fped.2021.595882

Comparison of Postnatal Growth Charts of Singleton Preterm and Term Infants Using World Health Organization Standards at 40-160 Weeks Postmenstrual Age: A Chinese Single-Center Retrospective Cohort Study

Front Pediatr. 2021 Mar 15:9:595882. doi: 10.3389/fped.2021.595882. eCollection 2021.

Authors

Li Zhang¹, Jian-Gong Lin², Shuang Liang³, Jin Sun¹, Nan-Nan Gao¹, Qiong Wu¹, Hui-Yun Zhang⁴, Hui-Juan Liu¹, Xiang-Deng Cheng¹, Yuan Cao¹, Yan Li¹

Affiliations

¹ Department of Developmental Pediatrics and Child Health Care, The First Affiliated Hospital of Shandong First Medical University, Shandong Provincial Qianfoshan Hospital, Shandong Engineering and Technology Research Center for Pediatric Drug Development, Jinan, China.
² Department of Nephrology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
³ Department of Pediatrics, The Second Hospital of Shandong University, Jinan, China.
⁴ Department of Pediatrics, Maternal and Child Health Care Hospital of Shandong Province, Jinan, China.

Abstract

There remains controversy regarding whether the growth charts constructed from data of term infants, such as those produced by the World Health Organization (WHO) standards, can appropriately evaluate the postnatal growth of preterm infants. This retrospective cohort study, conducted in the First Affiliated Hospital of Shandong First Medical University in Jinan China, aimed to compare the postnatal growth charts of singleton preterm and term infants using WHO standards at 40-160 weeks postmenstrual age (PMA). A total of 5,459 and 15,185 sets of longitudinal measurements [length/height, weight, head circumference (HC), and body mass index (BMI)] from birth to 160 weeks PMA were used to construct growth charts for 559 singleton preterm (mean PMA at birth, 33.84 weeks) and 1,596 singleton term infants (born at 40 weeks PMA), respectively, using the Generalized Additive Models for Location, Scale, and Shape (GAMLSS) method. Z-scores (prematurity corrected) were calculated using WHO Anthro software. Compared to WHO standards, all parameters of preterm infants were increased, especially in terms of length/height and weight; the gap between the two almost spanned two adjacent centile curves. Compared to term controls, the length/height, weight, and BMI of preterm infants were higher at 40 weeks PMA, surpassed by term infants at 52-64 weeks PMA, and quite consistent thereafter. The HC of preterm infants at 40-160 weeks PMA was quite consistent with both term controls and the WHO standards. The Z-scores for length/height, weight, and BMI of preterm infants relative to the WHO standards gradually decreased from 1.20, 1.13, and 0.74 at 40-44 weeks PMA to 0.67, 0.42, and 0.03 at 132-160 weeks PMA, respectively; Z-scores for HC of preterm infants rapidly decreased from 0.73 to 0.29 at 40-50 weeks PMA, and then fluctuated in the range of 0.08-0.23 at 50-160 weeks PMA. Preterm infants had higher growth trajectories than the WHO standards and similar but not identical trajectories to term infants during the first 2 years of life. These findings reemphasize the necessity of constructing local growth charts for Chinese singleton preterm infants.

Keywords: WHO standards; growth assessment; growth charts; postnatal growth; preterm infants; singleton; term infants.