Monitoring the Growth of Preterm Infants During and After Their Stay in the Neonatal Intensive Care Units: A Focus on WHO Growth Curves After Discharge



The growth curves routinely used for monitoring preterm infants are four decades old and may not be suitable for the current population. Intrauterine growth rate theoretically appears to be the ideal growth that needs to be replicated in the immediate postnatal period, but this may not be feasible given the limitations set by the morbidities of prematurity. Postnatal growth curves describe the actual growth of the preterm infants during their stay in neonatal units and are descriptive rather than prescriptive. The Fenton chart which has updated the Babson and Benda’s chart with data from very large sample size of preterm infants born in the last two decades appears to be suitable for monitoring growth of preterm infants during their stay in the neonatal units. After discharge from the neonatal intensive care units and post-conceptional age of 40 weeks is reached, the recently released WHO growth curves appear suitable for monitoring their ongoing growth. While aiming to achieve intrauterine growth velocities in the immediate postnatal life, one should not overlook the potential short-term (e.g. necrotising enterocolitis and broncho-pulmonary dysplasia) and long-term (excessive catch-up growth with cardiovascular morbidity and diabetes) adverse effects of aggressive nutrition. Further research is needed to identify the best growth curves for monitoring these high-risk infants.


Preterm Infant Growth Chart Fetal Weight Mental Developmental Index Psychomotor Developmental Index 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



World Health Organisation


Bayley Scale of Infant Development


Mental Developmental Index


Psychomotor Developmental Index


Extremely low birth weight


Neonatal Intensive Care Unit


Intelligence quotient


Small for gestational age


Appropriate for gestational age


Cerebral palsy


Standard deviation


Centers for Disease Control and Prevention


Expected fetal weight


Royal College of Obstetricians and Gynaecologists.


Royal College of Paediatrics and Child health


United Kingdom


Biparietal diameter


Head circumference


Abdominal circumference


Femoral length



We are thankful to Drs Tanis Fenton, Mercedes de Onis, and Jason Gardosi for giving us the permission to reproduce relevant material from their published work.


  1. Alexander GR, Kogan MD, Himes JH, Mor JM, Goldenberg R. Racial differences in birthweight for gestational age and infant mortality in extremely-low-risk US populations. Paediatr Perinat Epidemiol. 1999;13:205–17.PubMedCrossRefGoogle Scholar
  2. American Academy of Pediatrics Committee on Nutrition. Nutritional needs of low-birth-weight infants. Pediatrics 1985;75:976–86.Google Scholar
  3. Beeby PJ, Bhutap T, Taylor LK. New South Wales population-based birthweight percentile charts. J Paediatr Child Health. 1996;32:512–8.PubMedCrossRefGoogle Scholar
  4. Berseth CL, Bisquera JA, Paje VU. Prolonging small feeding volumes early in life decreases the incidence of necrotizing enterocolitis in very low birth weight infants. Pediatrics 2003;111:529–34.PubMedCrossRefGoogle Scholar
  5. Bertino E, Coscia A, Mombro M, Boni L, Rossetti G, Fabris C, Spada E, Milani S. Postnatal weight increase and growth velocity of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed. 2006;91:F349–56.PubMedCrossRefGoogle Scholar
  6. Bertino E, Milani S, Fabris C, De Curtis M. Neonatal anthropometric charts: what they are, what they are not. Arch Dis Child Fetal Neonatal Ed. 2007;92:F7–10.PubMedCrossRefGoogle Scholar
  7. Black MM, Matula K. Essentials of Bayley scales of infant development II assessment. New York, NY: Wiley; 1999.Google Scholar
  8. Casey PH, Whiteside-Mansell L, Barrett K, Bradley RH, Gargus R. Impact of prenatal and/or postnatal growth problems in low birth weight preterm infants on school-age outcomes: an 8-year longitudinal evaluation. Pediatrics 2006;118:1078–86.PubMedCrossRefGoogle Scholar
  9. Chan LW, Fung TY, Leung TY, Sahota DS, Lau TK. Volumetric (3D) imaging reduces inter- and intraobserver variation of fetal biometry measurements. Ultrasound Obstet Gynecol. 2009;33:447–52.PubMedCrossRefGoogle Scholar
  10. Chauhan SP, Hendrix NW, Magann EF, Morrison JC, Scardo JA, Berghella V. A review of sonographic estimate of fetal weight: vagaries of accuracy. J Matern Fetal Neonatal Med. 2005;18:211–20.PubMedCrossRefGoogle Scholar
  11. Coombes R. UK adopts growth charts based on data from breastfed babies. BMJ. 2009;338:b1892.PubMedCrossRefGoogle Scholar
  12. de Onis M. Growth curves for school age children and adolescents. Indian Pediatr. 2009;46:463–5.PubMedGoogle Scholar
  13. de Onis M, Habicht JP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr. 1996;64:650–8.PubMedGoogle Scholar
  14. Diekmann M, Genzel-Boroviczeny O, Zoppelli L, von Poblotzki M. Postnatal growth curves for extremely low birth weight infants with early enteral nutrition. Eur J Pediatr. 2005;164:714–23.PubMedCrossRefGoogle Scholar
  15. Doubilet PM, Benson CB, Wilkins-Haug L, Ringer S. Fetuses subsequently born premature are smaller than gestational age-matched fetuses not born premature. J Ultrasound Med. 2003;22:359–63.PubMedGoogle Scholar
  16. Dudley NJ. A systematic review of the ultrasound estimation of fetal weight. Ultrasound Obstet Gynecol. 2005;25:80–9.PubMedCrossRefGoogle Scholar
  17. Ehrenkranz RA, Dusick AM, Vohr BR, Wright LL, Wrage LA, Poole WK. Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants. Pediatrics. 2006;117:1253–61.PubMedCrossRefGoogle Scholar
  18. Ekelund U, Ong K, Linne Y, Neovius M, Brage S, Dunger DB, Wareham NJ, Rossner S. Upward weight percentile crossing in infancy and early childhood independently predicts fat mass in young adults: the Stockholm Weight Development Study (SWEDES). Am J Clin Nutr. 2006;83:324–30.PubMedGoogle Scholar
  19. Euser AM, Finken MJ, Keijzer-Veen MG, Hille ET, Wit JM, Dekker FW. Associations between prenatal and infancy weight gain and BMI, fat mass, and fat distribution in young adulthood: a prospective cohort study in males and females born very preterm. Am J Clin Nutr. 2005;81:480–7.PubMedGoogle Scholar
  20. Fenton TR. A new growth chart for preterm babies: Babson and Benda’s chart updated with recent data and a new format. BMC Pediatr. 2003;16;3:13.CrossRefGoogle Scholar
  21. Finken MJ, Keijzer-Veen MG, Dekker FW, Frolich M, Hille ET, Romijn JA, Wit JM. Preterm birth and later insulin resistance: effects of birth weight and postnatal growth in a population based longitudinal study from birth into adult life. Diabetologia. 2006;49S(3):478–85.CrossRefGoogle Scholar
  22. Gardosi J. Customized fetal growth standards: rationale and clinical application. Semin Perinatol. 2004;28:33–40.PubMedCrossRefGoogle Scholar
  23. Gardosi J, Chang A, Kalyan B, Sahota D, Symonds EM. Customised antenatal growth charts. Lancet 1992;339:283–7.PubMedCrossRefGoogle Scholar
  24. Garner P, Panpanich R, Logan S. Is routine growth monitoring effective? A systematic review of trials. Arch Dis Child. 2000;82:197–201.PubMedCrossRefGoogle Scholar
  25. Johnsen SL, Rasmussen S, Wilsgaard T, Sollien R, Kiserud T. Longitudinal reference ranges for estimated fetal weight. Acta Obstet Gynecol Scand. 2006;85:286–97.PubMedCrossRefGoogle Scholar
  26. Karna P, Brooks K, Muttineni J, Karmaus W. Anthropometric measurements for neonates, 23 to 29 weeks gestation, in the 1990s. Paediatr Perinat Epidemiol. 2005;19:215–26.PubMedCrossRefGoogle Scholar
  27. Kramer MS, Platt RW, Wen SW, Joseph KS, Allen A, Abrahamowicz M, Blondel B, Bréart G. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics. 2001;108:E35.PubMedCrossRefGoogle Scholar
  28. Latal-Hajnal B, von Siebenthal K, Kovari H, Bucher HU, Largo RH. Postnatal growth in VLBW infants: significant association with neurodevelopmental outcome. J Pediatr. 2003;143:163–70.PubMedCrossRefGoogle Scholar
  29. Lejarraga H, del Pino M, Fano V, Caino S, Cole TJ. Growth references for weight and height for Argentinian girls and boys from birth to maturity: incorporation of data from the World Health Organisation from birth to 2 years and calculation of new percentiles and LMS values. Arch Argent Pediatr. 2009;107:126–33.PubMedGoogle Scholar
  30. Niklasson A, Ericson A, Fryer JG, Karlberg J, Lawrence C, Karlberg P. An update of the Swedish reference standards for weight, length and head circumference at birth for given gestational age (1977–1981). Acta Paediatr Scand. 1991;80:756–62.CrossRefGoogle Scholar
  31. Nutrition Committee, Canadian Paediatric Society. Nutrient needs and feeding of premature infants. CMAJ 1995;152:1765–85.Google Scholar
  32. Nutritional Committee, Canadian Paediatrics Society. Paediatr Child Health. 2004;9:171–80.Google Scholar
  33. Oh W, Poindexter BB, Perritt R, Lemons JA, Bauer CR, Ehrenkranz RA, Stoll BJ, Poole K, Wright LL. Association between fluid intake and weight loss during the first ten days of life and risk of bronchopulmonary dysplasia in extremely low birth weight infants. J Pediatr 2005;147:786–90.PubMedCrossRefGoogle Scholar
  34. RCOG. Small for gestational age fetus, Investigation and Management(Green-top guideline 31; 2002). http://wwwrcogorguk/files/rcog-corp/uploaded-files/GT31SmallGestationalAgeFetuspdf (2002). Accessed Sept 2010.
  35. Salomon LJ, Bernard JP, Ville Y. Estimation of fetal weight: reference range at 20–36 weeks’ gestation and comparison with actual birth-weight reference range. Ultrasound Obstet Gynecol. 2007;29:550–5.PubMedCrossRefGoogle Scholar
  36. Schild RL, Maringa M, Siemer J, Meurer B, Hart N, Goecke TW, Schmid M, Hothorn T, Hansmann ME. Weight estimation by three-dimensional ultrasound imaging in the small fetus. Ultrasound Obstet Gynecol. 2008;32:168–75.PubMedCrossRefGoogle Scholar
  37. Shah PS, Wong KY, Merko S, Bishara R, Dunn M, Asztalos E, Darling PB. Postnatal growth failure in preterm infants: ascertainment and relation to long-term outcome. J Perinat Med. 2006;34:484–9.PubMedCrossRefGoogle Scholar
  38. Sices L, Wilson-Costello D, Minich N, Friedman H, Hack M. Postdischarge growth failure among extremely low birth weight infants: correlates and consequences. Paediatr Child Health. 2007;12:22–8.PubMedGoogle Scholar
  39. Singhal A, Cole TJ, Fewtrell M, Kennedy K, Stephenson T, Elias-Jones A, Lucas A. Promotion of faster weight gain in infants born small for gestational age: is there an adverse effect on later blood pressure? Circulation. 2007;115:213–20.PubMedCrossRefGoogle Scholar
  40. WHO. WHO Multicentre Growth Reference Study. Acta Pediatr Suppl. 2006;450:5–101.Google Scholar
  41. Wright CM, Booth IW, Buckler JM, Cameron N, Cole TJ, Healy MJ, Hulse JA, Preece MA, Reilly JJ, Williams AF. Growth reference charts for use in the United Kingdom. Arch Dis Child. 2002;86:11–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Princess Margaret Hospital for Children, Centre for Neonatal Research and Education, University of Western AustraliaSubiacoAustralia
  2. 2.King Edward Memorial Hospital for Women, Centre for Neonatal Research and Education, University of Western AustraliaSubiacoAustralia

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