早产儿生长曲线图.pdf

1、TECHNICAL ADVANCEOpen AccessA systematic review and meta-analysis to revisethe Fenton growth chart for preterm infantsTanis R Fenton1,2*and Jae H Kim3AbstractBackground:The aim of this study was to revise the 2003 Fenton Preterm Growth Chart,specifically to:a)harmonize the preterm growth chart with

2、the new World Health Organization(WHO)Growth Standard,b)smooththe 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 actualage(rather than complet

3、ed weeks)to support growth monitoring.Methods:Systematic review,meta-analysis,and growth chart development.We systematically searchedpublished and unpublished literature to find population-based preterm size at birth measurement(weight,length,and/or head circumference)references,from developed count

4、ries with:Corrected gestational agesthrough infant assessment and/or statistical correction;Data percentiles as low as 24 weeks gestational age orlower;Sample with greater than 500 infants less than 30 weeks.Growth curves for males and females wereproduced using cubic splines to 50 weeks post menstr

5、ual age.LMS parameters(skew,median,and standarddeviation)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 inmeta-analyses.Smo

6、oth growth chart curves were developed,while ensuring close agreement with the data between24 and 36 weeks and at 50 weeks.Conclusions:The revised sex-specific actual-age growth charts are based on the recommended growth goal forpreterm infants,the fetus,followed by the term infant.These preterm gro

7、wth charts,with the disjunction betweenthese datasets smoothing informed by the international PreM Growth study,may support an improved transition ofpreterm infant growth monitoring to the WHO growth charts.Keywords:Infant,Premature,Infant,very low birth weight,Preterm infant,Growth,Weight,Head circ

8、umference,Length,PercentileBackgroundThe expected growth of the fetus describes the fastesthuman growth,increasing weight over six-fold between22 and 40 weeks.Preterm infants,who are born duringthis rapid growth phase,rely on health professionals toassess their growth and provide appropriate nutriti

9、onand medical care.In 2006,the World Health Organization(WHO)published their multicentre growth reference study,whichis considered superior 1 to previous growth surveys sincethe measured infants were selected from communities inwhich economics were not likely to limit growth,amongculturally diverse

10、non-smoking mothers who planned tobreastfeed 2.Weekly longitudinal measures of the infantswere made by trained data collection teams during the first2 years of this study 3.These WHO growth charts,although recommended for preterm infants after term age4,begin at term and so do not inform preterm inf

11、antgrowth assessments younger than this age.*Correspondence:tfentonucalgary.ca1Alberta Childrens Hospital Research Institute,The University of Calgary,Calgary,AB,Canada2Department of Community Health Sciences,The University of Calgary,3280Hospital Drive NW,Calgary,AB,CanadaFull list of author inform

12、ation is available at the end of the article 2013 Fenton and Kim;licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of theCreative Commons Attribution License(http:/creativecommons.org/licenses/by/2.0),which permits unrestricted use,distribution,and reproduction i

13、n any medium,provided the original work is properly cited.Fenton and Kim BMC Pediatrics 2013,13:59http:/ growth of preterm infants is considered to beequivalent to intrauterine rates 5-7 since a superiorgrowth standard has not been defined.Perhaps the bestestimate of fetal growth may be obtained fro

14、m largepopulation-based studies,conducted in developed coun-tries 8,where constraints on fetal growth may be lessfrequent.A recent multicentre study by our group(the PretermMulticentre Growth(PreM Growth)Study)revealed thatalthough the pattern of preterm infant growth was gener-ally consistent with

15、intrauterine growth,the biggest devi-ation in weight gain velocity between the preterm infantsand the fetus and infant was just before term,between 37and 40 weeks(Fenton TR,Nasser R,Eliasziw M,Kim JH,Bilan D,Sauve R:Validating the weight gain of preterm in-fants between the reference growth curve of

16、 the fetus andthe term infant,The Preterm Infant Multicentre GrowthStudy.Submitted BMC Ped 2012).Rather than demon-strating the slowing growth velocity of the term infantduring the weeks just before term,the preterm infants hadsuperior,close to linear,growth at this age.This findinghas been observed by others as well 9-11.Therefore,there is evidence to support a smooth transition ongrowth charts between late fetal and early infant ages.Several previous growth charts based on size at birthpresent