A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format
Tanis R Fenton*
Address: Department of Community Health Sciences, Faculty of Medicine, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, T2N 4N1, Canada Email: Tanis R Fenton* - email@example.com *Corresponding author
Published: 16 December 2003 BMC Pediatrics 2003, 3:13 This article is available from: http://www.biomedcentral.com/1471-2431/3/13
Received: 10 June 2003 Accepted: 16 December 2003
© 2003 Fenton; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice ispreserved along with the article's original URL.
Background: The Babson and Benda 1976 "fetal-infant growth graph" for preterm infants is commonly used in neonatal intensive care. Its limits include the small sample size which provides low confidence in the extremes of the data, the 26 weeks start and the 500 gram graph increments. The purpose of this study was to develop an updatedgrowth chart beginning at 22 weeks based on a meta-analysis of published reference studies. Methods: The literature was searched from 1980 to 2002 for more recent data to complete the pre and post term sections of the chart. Data were selected from population studies with large sample sizes. Comparisons were made between the new chart and the Babson and Benda graph. To validate the growth chart thegrowth results from the National Institute of Child Health and Human Development Neonatal Research Network (NICHD) were superimposed on the new chart. Results: The new data produced curves that generally followed patterns similar to the old growth graph. Mean differences between the curves of the two charts reached statistical significance after term. Babson's 10th percentiles fell between thenew data percentiles: the 5th to 17th for weight, the 5th and 15th for head circumference, and the 6th and 16th for length. The growth patterns of the NICHD infants deviated away from the curves of the chart in the first weeks after birth. When the infants reached an average weight of 2 kilograms, those with a birthweight in the range of 700 to 1000 grams had achieved greater than the 10thpercentile on average for head growth, but remained below the 3rd percentile for weight and length. Conclusion: The updated growth chart allows a comparison of an infant's growth first with the fetus as early as 22 weeks and then with the term infant to 10 weeks. Comparison of the size of the NICHD infants at a weight of 2 kilograms provides evidence that on average preterm infants are growth retarded withrespect to weight and length while their head size has caught up to birth percentiles. As with all meta-analyses, the validity of this growth chart is limited by the heterogeneity of the data sources. Further validation is needed to illustrate the growth patterns of preterm infants to older ages.
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Growth monitoring is a part of the medical and nutritional assessment of preterm infants. Growth charts provide the basis for this assessment by providing a comparison to a reference which allows for a visual picture of both the infant's achieved size and growth trajectory. Parents and health professionals like to know whether a preterm infant is ableto maintain growth velocity or achieve catch-up in growth compared to the fetus and the term infant. Intrauterine growth charts allow this comparison for infants before term. Babson and Benda (Babson)  extended an intrauterine chart past term age by including a section based on the growth of infants born at term. They published this chart in 1976 which they referred to as a "fetal-infant...