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  • Quality Improvement Article
  • Published:

Valid serial length measurements in preterm infants permit characterization of growth patterns

Journal of Perinatology volume 38, pages 1694–1701 (2018)Cite this article

Subjects

Abstract

Background:

The lack of a valid and safe method for measuring length in critically ill preterm neonates has led to a primary focus on weight gain.

Local problem:

Paucity of valid length measurements, precluding the accurate analysis of growth patterns.

Methods:

Quality improvement project among infants < 29 weeks or small for gestational age < 35 weeks with embedded validation of (1) a caliper (infantometer) for length measurements and (2) length measurements during the first week to estimate birth length.

Intervention:

Implementation of valid methods to measure length.

Results:

We validated infantometer measurements and first week length measurements. The percentage of neonates with valid measurements during the first week rose from 10% to 78%, resulting in increased identification of classifiable growth patterns from < 10% to 89%.

Conclusions:

By increasing the percentage of neonates with valid length measurements in the first week postnatal, we identified an increased number of neonates with classifiable growth abnormalities.

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Acknowledgements

We thank all members of the team. Sandra Gosser, NNP, Jessica Horner, RN, Timothy Brannon, MD, Katherine Stumpf, MD, Pritha Nayak, MD, Eric Ortigoza, MD, Julie Mirpuri, MD, Rebecca Thomas, RN, Emily Lentz, RD, and Catherine Vanbeek, RN, NP, were essential for building consensus, helping with education, or information technology. Susan Chako, RN, Maria DeLeon, RN, and Maria Caraig, RN, were research coordinators for this study. Cheryl Lair, RD, Chen Du, RD, Elizabeth Brammer, RD, Audrey Edwards, RD, and Theresa Jacob, RD, dietitians at Parkland Hospital, obtained most stadiometer measurements for this study and participated in infantometer measurements, patient recruitment, assessments of growth, and laboratory results, and recommendations for nutritional interventions. Elen Petrosyan, RD, dietitian at Parkland Hospital, helped organizing the logistics of patient recruitment, measurements, and research planning. Jeannette P. Burchfield, RN, research coordinator at UTSW, extracted data from the NICU database. Some of the patients included in the QI described in the current manuscript were enrolled in a blinded randomized trial: Clinicaltrials.gov NCT02372136. We thank Dr. Mackenzie Frost for reviewing the manuscript. Preliminary results were presented as follows: Pavageau L., Rosenfeld C., Heyne R., Brown L.S., DeLeon M., Chacko S., Caraig M., Brion L.P., Validation of Serial Length Measurements in Preterm Infants in the Neonatal Intensive Care Unit (NICU). Presentation at Western Conference on Perinatal Research, American Academy of Pediatrics Section on Neonatal-Perinatal Medicine, Indian Wells, California, 01/11–13/17.

Author contributions

L.P. conceptualized and designed the study. She recruited patients into the study, obtained infantometer and tape measure measurements, collected data into spreadsheets, participated in the interpretation of the data, participated in the writing of the first draft of the manuscript, critically reviewed the revisions, and approved the final manuscript as submitted. C.R.R. and R.H. conceptualized and designed the study. He participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. L.S.B., MS, conceptualized and designed the study. He conducted statistical analyses, participated in the interpretation of the data, critically reviewed the revisions, and approved the final manuscript as submitted. J.W. collected data and analyzed growth patterns in 69 neonates. She critically reviewed the revisions and approved the final manuscript as submitted. C.L., RD, participated in study design and data collection, critically revised the revisions, and approved the final manuscript as submitted. L.P.B. conceptualized and designed the study. He collected data on growth, participated in the interpretation of the data, conducted statistical analyses, participated in the writing of the first draft of the manuscript, critically reviewed the revisions, and approved the final manuscript as submitted.

Funding

This study was supported by the George L. MacGregor Professorship (CR Rosenfeld) and by Children’s Medical Center Clinical Advisory Committee (CCRAC) – Senior Investigator Research Award – New Direction (L.P.B., 2015–17). The funding organization had no role in design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, and approval of the manuscript; and decision to submit the manuscript for publication

Author information

Authors and Affiliations

  1. Division of Neonatal-Perinatal Medicine, Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA

    Lara Pavageau, Charles R. Rosenfeld, Roy Heyne & Luc P. Brion

  2. Parkland Health and Hospital System, Dallas, TX, USA

    L. Steven Brown & Cheryl Lair

  3. Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA

    Jenna Whitham

Authors
  1. Lara Pavageau
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  2. Charles R. Rosenfeld
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  3. Roy Heyne
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  4. L. Steven Brown
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  6. Cheryl Lair
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  7. Luc P. Brion
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Corresponding author

Correspondence to Luc P. Brion.

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The authors declare that they have no conflict of interest.

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Pavageau, L., Rosenfeld, C.R., Heyne, R. et al. Valid serial length measurements in preterm infants permit characterization of growth patterns. J Perinatol 38, 1694–1701 (2018). https://doi.org/10.1038/s41372-018-0242-4

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