Historically, various growth charts have been used in Neonatal units to monitor growth in newborns. An Ideal growth chart that can be used, has always been an area of debate, because no single chart till date can be confidently recommended for preterm newborns, though efforts have been going on.
There are reference growth charts and standard growth charts available.
Reference growth charts are growth curves derived from anthropometric data of a population of a place at a specified time, irrespective of health status of the population. Reference charts simply represents the growth pattern of a population at certain time. eg. CDC charts. It is not prescriptive and can be used only to compare growth of the current baby with the populations growth pattern.
Standard growth charts are like growth reference but the population is selected on healthy grounds. Only well screened healthy population data is included in making the charts, so it is prescriptive and tells us how a child should grow.
Historically various charts have been used. Some significant ones are:
- Dancis charts, 1948
- Lubchenco intrauterine charts, 1963
- Babson and Benda charts, 1976
- Erenkranz postnatal growth charts, 1999
- Fenton charts, 2003
- WHO MGRS charts, 2006
- Fenton Fetal-Infant growth charts, 2013
- Intergrowth 21st charts
Types of charts used in Preterm neonates
Intrauterine Growth Charts: Intrauterine growth charts are those that are derived from data of anthropometric measurements of preterm infants of different gestational age at birth.
Fetal-Infant growth charts: These are based on two types of merged sets of reference data: intrauterine data and postnatal surveillance data of term babies. These chart permit growth comparison with fetus first and then to term standards, to see if the infant is growing optimally.
Post-natal growth charts: These growth charts are based on longitudinal measurements of parameters of infants as they grow and as such provide actual postnatal pattern of infant’s growth.
For use in Preterm and term infants
Fetal–infant growth charts were devised by combining cross-sectional intrauterine data and postnatal infant’s longitudinal parameters. New Fenton 2013 charts incorporating neonatal anthropometric data look to be most adequate for preterm infants of 22 weeks gestation till 50 weeks post-menstrual age.These growth references describe how infants grew in certain time in a defined population. There was a need of developing growth standard defining growth of healthy population in optimal conditions. WHO Multicentre Growth Reference Study charts were developed as growth standards describing the growth of healthy children from term gestation till 5 years of age. Intergrowth 21st growth chart is the new growth standards for preterm infants and looks promising in infants of gestation 33 weeks or more.
The details of the text are available in below slides.