早产儿生长曲线图.pdf

早产儿生长曲线图.pdf

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TECHNICALADVANCEOpenAccessAsystematicreviewandmeta-analysistorevisetheFentongrowthchartforpreterminfantsTanisRFenton1,2*andJaeHKim3AbstractBackground:

Theaimofthisstudywastorevisethe2003FentonPretermGrowthChart,specificallyto:

a）harmonizethepretermgrowthchartwiththenewWorldHealthOrganization（WHO）GrowthStandard,b）smooththedatabetweenthepretermandWHOestimates,informedbythePretermMulticentreGrowth（PreMGrowth）studywhilemaintainingdataintegrityfrom22to36andat50weeks,andtoc）re-scalethechartx-axistoactualage（ratherthancompletedweeks）tosupportgrowthmonitoring.Methods:

Systematicreview,meta-analysis,andgrowthchartdevelopment.Wesystematicallysearchedpublishedandunpublishedliteraturetofindpopulation-basedpretermsizeatbirthmeasurement（weight,length,and/orheadcircumference）references,fromdevelopedcountrieswith:

Correctedgestationalagesthroughinfantassessmentand/orstatisticalcorrection;Datapercentilesaslowas24weeksgestationalageorlower;Samplewithgreaterthan500infantslessthan30weeks.Growthcurvesformalesandfemaleswereproducedusingcubicsplinesto50weekspostmenstrualage.LMSparameters（skew,median,andstandarddeviation）werecalculated.Results:

Sixlargepopulation-basedsurveysofsizeatpretermbirthrepresenting3,986,456births（34,639births30weeks）fromcountriesGermany,UnitedStates,Italy,Australia,Scotland,andCanadawerecombinedinmeta-analyses.Smoothgrowthchartcurvesweredeveloped,whileensuringcloseagreementwiththedatabetween24and36weeksandat50weeks.Conclusions:

Therevisedsex-specificactual-agegrowthchartsarebasedontherecommendedgrowthgoalforpreterminfants,thefetus,followedbytheterminfant.Thesepretermgrowthcharts,withthedisjunctionbetweenthesedatasetssmoothinginformedbytheinternationalPreMGrowthstudy,maysupportanimprovedtransitionofpreterminfantgrowthmonitoringtotheWHOgrowthcharts.Keywords:

Infant,Premature,Infant,verylowbirthweight,Preterminfant,Growth,Weight,Headcircumference,Length,PercentileBackgroundTheexpectedgrowthofthefetusdescribesthefastesthumangrowth,increasingweightoversix-foldbetween22and40weeks.Preterminfants,whoarebornduringthisrapidgrowthphase,relyonhealthprofessionalstoassesstheirgrowthandprovideappropriatenutritionandmedicalcare.In2006,theWorldHealthOrganization（WHO）publishedtheirmulticentregrowthreferencestudy,whichisconsideredsuperior1topreviousgrowthsurveyssincethemeasuredinfantswereselectedfromcommunitiesinwhicheconomicswerenotlikelytolimitgrowth,amongculturallydiversenon-smokingmotherswhoplannedtobreastfeed2.Weeklylongitudinalmeasuresoftheinfantsweremadebytraineddatacollectionteamsduringthefirst2yearsofthisstudy3.TheseWHOgrowthcharts,althoughrecommendedforpreterminfantsaftertermage4,beginattermandsodonotinformpreterminfantgrowthassessmentsyoungerthanthisage.*Correspondence:

tfentonucalgary.ca1AlbertaChildrensHospitalResearchInstitute,TheUniversityofCalgary,Calgary,AB,Canada2DepartmentofCommunityHealthSciences,TheUniversityofCalgary,3280HospitalDriveNW,Calgary,AB,CanadaFulllistofauthorinformationisavailableattheendofthearticle2013FentonandKim;licenseeBioMedCentralLtd.ThisisanOpenAccessarticledistributedunderthetermsoftheCreativeCommonsAttributionLicense（http:

/creativecommons.org/licenses/by/2.0）,whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedtheoriginalworkisproperlycited.FentonandKimBMCPediatrics2013,13:

59http:

/growthofpreterminfantsisconsideredtobeequivalenttointrauterinerates5-7sinceasuperiorgrowthstandardhasnotbeendefined.Perhapsthebestestimateoffetalgrowthmaybeobtainedfromlargepopulation-basedstudies,conductedindevelopedcoun-tries8,whereconstraintsonfetalgrowthmaybelessfrequent.Arecentmulticentrestudybyourgroup（thePretermMulticentreGrowth（PreMGrowth）Study）revealedthatalthoughthepatternofpreterminfantgrowthwasgener-allyconsistentwithintrauterinegrowth,thebiggestdevi-ationinweightgainvelocitybetweenthepreterminfantsandthefetusandinfantwasjustbeforeterm,between37and40weeks（FentonTR,NasserR,EliasziwM,KimJH,BilanD,SauveR:

Validatingtheweightgainofpretermin-fantsbetweenthereferencegrowthcurveofthefetusandtheterminfant,ThePretermInfantMulticentreGrowthStudy.SubmittedBMCPed2012）.Ratherthandemon-stratingtheslowinggrowthvelocityoftheterminfantduringtheweeksjustbeforeterm,thepreterminfantshadsuperior,closetolinear,growthatthisage.Thisfindinghasbeenobservedbyothersaswell9-11.Therefore,thereisevidencetosupportasmoothtransitionongrowthchartsbetweenlatefetalandearlyinfantages.Severalpreviousgrowthchartsbasedonsizeatbirthpresent