Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Anthropometric trends from 1997 to 2012 in infants born at ⩽28 weeks’ gestation or less

Journal of Perinatology volume 37, pages 521–526 (2017)Cite this article

Subjects

Abstract

Objective:

Postnatal growth failure is common after preterm birth, in particular for infants born at ⩽28 weeks’ gestation, but it is unknown if growth-to-term equivalent age has improved over the years as neonatal intensive care in general, and infant nutrition in particular, have improved. The objective of the study was to evaluate anthropometric trends at NICU discharge for infants born at ⩽28 weeks’ gestation using a large national database.

Study Design:

Analysis of growth in weight, length, head circumference and body mass index (kg m2) in 23 005 infants born in 1997 to 2012 who survived to neonatal intensive care unit discharge at ⩽41 weeks’ postmenstrual age.

Results:

Discharge weight, length, head circumference and body mass index were converted to Z-scores using a reference database, and growth trends over the 16 years were summarized. Discharge results also were summarized for common neonatal morbidities, including chronic lung disease. Gestational age at birth and postmenstrual age at discharge were similar across the 16 years. Discharge weight, length and head circumference Z-scores were all below the median, but head circumference Z-scores consistently were closer to the median than were weight and length. In 1997 compared with 2012, the weight Z-score improved from −1.5 to −0.6; the length Z-score increased the least, from −1.68 to just −1.16; the head circumference Z-score improved from −0.68 to −0.30; and the body mass index Z-score increased from −0.66 to 0.19. Percent small-for-gestational age at birth was stable across the years at 8.4 to 9.3%, and the frequency of postnatal growth failure at discharge improved from 55.4% in 1997 to 19.6% in 2012.

Conclusions:

Growth-to-discharge progressively improved from 1997 to 2012, but Z-scores remained below the reference median for weight, length and head circumference. Length Z-scores were consistently significantly less than for weight, and body mass index Z-scores have been above the reference median since 2002. Prospective studies are needed to quantify anthropometric trends in relation to body composition and to current nutritional strategies.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3

Similar content being viewed by others

References

  1. Thureen PJ . Effect of low versus high intravenous amino acid intake on very low birth weight infants in the early neonatal period. Pediatr Res 2003; 53 (1): 24–32.

    Article  CAS  Google Scholar 

  2. Ehrenkranz RA, Younes N, Lemons JA, Fanaroff AA, Donovan EF, Wright LL et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999; 104 (2 Pt 1): 280–289.

    Article  CAS  Google Scholar 

  3. Horbar JD, Ehrenkranz RA, Badger GJ, Edwards EM, Morrow KA, Soll RF et al. Weight growth velocity and postnatal growth failure in infants 501 to 1500 grams: 2000-2013. Pediatrics 2015; 136 (1): e84–e92.

    Article  Google Scholar 

  4. Griffin IJ, Tancredi DJ, Bertino E, Lee HC, Profit J. . Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Arch Dis Child Fetal Neonatal Ed 2016; 101: F50–F55.

    Article  Google Scholar 

  5. Ofek Shlomai N, Reichman B, Lerner-Geva L, Boyko V, Bar-Oz B . Population-based study shows improved postnatal growth in preterm very-low-birthweight infants between 1995 and 2010. Acta Paediatr 2014; 103 (5): 498–503.

    Article  Google Scholar 

  6. Thureen PJ . The neonatologist's dilemma: catch-up growth or beneficial undernutrition in very low birth weight infants-what are optimal growth rates? J Pediatr Gastroenterolo Nutr 2007; 45 (Suppl 3): S152–S154.

    Article  Google Scholar 

  7. Belfort MB, Gillman MW, Buka SL, Casey PH, McCormick MC . Preterm infant linear growth and adiposity gain: trade-offs for later weight status and intelligence quotient. J Pediatr 2013; 163 (6): 1564–1569.

    Article  Google Scholar 

  8. Brown LD, Hay WW . The nutritional dilemma for preterm infants: how to promote neurocognitive development and linear growth, but reduce the risk of obesity. J Pediatr 2013; 163 (6): 1543–1545.

    Article  Google Scholar 

  9. Stokes TA, Holston A, Olsen C, Choi Y, Curtis J, Higginson J et al. Preterm infants of lower gestational age at birth have greater waist circumference-length ratio and ponderal index at term age than preterm infants of higher gestational ages. J Pediatr 2012; 161 (4): 735–741.

    Article  Google Scholar 

  10. Walker MW, Clark RH, Spitzer AR . Elevation in plasma creatinine and renal failure in premature neonates without major anomalies: terminology, occurrence and factors associated with increased risk. J Perinatol 2011; 31 (3): 199–205.

    Article  CAS  Google Scholar 

  11. Clark RH . Reported medication use in the neonatal intensive care unit: data from a large national data set. Pediatrics 2006; 117 (6): 1979–1987.

    Article  Google Scholar 

  12. Spitzer AR, Ellsbury DL, Handler D, Clark RH . The pediatrix babysteps data warehouse and the pediatrix qualitySteps improvement project system—tools for “meaningful use” in continuous quality improvement. Clin Perinatol 2010; 37 (1): 49–70.

    Article  Google Scholar 

  13. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS . New intrauterine growth curves based on United States data. Pediatrics 2010; 125 (2): e214–e224.

    Article  Google Scholar 

  14. Olsen IE, Lawson ML, Ferguson AN, Cantrell R, Grabich SC, Zemel BS et al. BMI curves for preterm infants. Pediatrics 2015; 135 (3): e572–e581.

    Article  Google Scholar 

  15. Euser AM, Finken MJJ, Keijzer-Veen MG, Hille ET, Wit JM, Dekker FW et al. 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 (2): 480–487.

    Article  CAS  Google Scholar 

  16. Euser AM, de Wit CC, Finken MJJ, Rijken M, Wit JM . Growth of preterm born children. Horm Res 2008; 70 (6): 319–328.

    CAS  PubMed  Google Scholar 

  17. Johnson MJ, Wootton SA, Leaf AA, Jackson AA . Preterm birth and body composition at term equivalent age: a systematic review and meta-analysis. Pediatrics 2012; 130 (3): e640–e649.

    Article  Google Scholar 

  18. Sammallahti S, Pyhälä R, Lahti M, Lahti J, Pesonen AK, Heinonen K et al. Infant growth after preterm birth and neurocognitive abilities in young adulthood. J Pediatr 2014; 165 (6): 1109–1115 e3.

    Article  Google Scholar 

  19. Lorch SA . The clinical and policy implications of new measures of premature infant growth. Pediatrics 2015; 135 (3): e703–e704.

    Article  Google Scholar 

  20. Rubin LP . Postnatal growth in preterm infants: too small, too big, or just right? J Pediatr 2009; 154 (4): 473–475.

    Article  Google Scholar 

  21. De Cunto A, Paviotti G, Ronfani L, Travan L, Bua J, Cont G et al. Can body mass index accurately predict adiposity in newborns? Arch Dis Child Fetal Neonatal Ed 2014; 99: F238–F239.

    Article  Google Scholar 

  22. Cooke RJ, Griffin I . Altered body composition in preterm infants at hospital discharge. Acta Paediatr 2009; 98 (8): 1269–1273.

    Article  Google Scholar 

  23. Huysman WA, de Ridder M, de Bruin NC, van Helmond G, Terpstra N, Van Goudoever JB et al. Growth and body composition in preterm infants with bronchopulmonary dysplasia. Arch Dis Child Fetal Neonatal Ed 2003; 88: F46–F51.

    Article  CAS  Google Scholar 

  24. Madden J, Kobaly K, Minich NM, Schluchter M, Wilson-Costello D, Hack M . Improved weight attainment of extremely low-gestational-age infants with bronchopulmonary dysplasia. J Perinatol 2010; 30 (2): 103–111.

    Article  CAS  Google Scholar 

  25. Giannì ML, Roggero P, Colnaghi MR, Piemontese P, Amato O, Orsi A et al. The role of nutrition in promoting growth in pre-term infants with bronchopulmonary dysplasia: a prospective non-randomised interventional cohort study. BMC Pediatr 2014; 14: 235.

    Article  Google Scholar 

  26. Clark RH, Thomas P, Peabody J . Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics 2003; 111 (5 Pt 1): 986–990.

    Article  Google Scholar 

  27. Ben X-M . Nutritional management of newborn infants: practical guidelines. World J Gastroenterol 2008; 14 (40): 6133–6139.

    Article  CAS  Google Scholar 

  28. Tully MR, Lockhart-Borman L, Updegrove K . Stories of success: the use of donor milk is increasing in North America. J Hum Lact 2004; 20 (1): 75–77.

    Article  Google Scholar 

  29. Berseth CL, Aerde JEV, Gross S, Stolz SI, Harris CL, Hansen JW . Growth, efficacy, and safety of feeding an iron-fortified human milk fortifier. Pediatrics 2004; 114 (6): e699–e706.

    Article  Google Scholar 

  30. Bartholomew J, Martin CR, Allred E, Chen ML, Ehrenkranz RA, Dammann O et al. Risk factors and correlates of neonatal growth velocity in extremely low gestational age newborns: the ELGA study. Neonatology 2013; 104 (4): 298–304.

    Article  Google Scholar 

  31. Bertino E . Postnatal weight increase and growth velocity of very low birthweight infants. Arch Dis Child Fetal Neonatal Ed 2006; 91 (5): F349–F356.

    Article  CAS  Google Scholar 

  32. Wood AJ, Raynes-Greenow CH, Carberry AE, Jeffery HE . Neonatal length inaccuracies in clinical practice and related percentile discrepancies detected by a simple length-board. J Paediatr Child Health 2013; 49 (3): 199–203.

    Article  Google Scholar 

Download references

Acknowledgements

The authors acknowledge and thank Reese H. Clark, MD, Pediatrix Medical Group, for his invaluable guidance in the planning and initial analysis of this study, and Devon Kuehn, MD, Department of Pediatrics, Brody School of Medicine, East Carolina University, Greenville, NC, for statistical analysis support.

Disclaimer

The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Army, Navy, Department of Defense, or the US Government. Nothing in the presentation implies any Federal/DOD/DON endorsement.

Author information

Authors and Affiliations

  1. Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA

    N Wells, T A Stokes, K Ottolini & C E Hunt

  2. Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    N Wells, T A Stokes & C E Hunt

  3. George Washington University (Children’s National Medical Center), Washington, DC, USA

    K Ottolini

  4. Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

    C H Olsen

  5. Pediatrix Center for Research, Education and Quality, Sunrise, FL, USA

    A R Spitzer

Authors
  1. N Wells
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. T A Stokes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K Ottolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C H Olsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A R Spitzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C E Hunt
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C E Hunt.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Additional information

Presented in part at Eastern Society for Pediatric Research, Philadelphia, March 2014.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wells, N., Stokes, T., Ottolini, K. et al. Anthropometric trends from 1997 to 2012 in infants born at ⩽28 weeks’ gestation or less. J Perinatol 37, 521–526 (2017). https://doi.org/10.1038/jp.2016.244

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/jp.2016.244

This article is cited by

Search

Advanced search

Quick links