Monitoring postnatal growth of preterm infants: present and future [Supplement-Evaluating the Evidence to Support Guidelines for the Nutritional Care of Preterm Infants: the Pre-B Project]

Background: There is no consensus with regard to which charts are most suitable for monitoring the postnatal growth of preterm infants.

Objective: We aimed to assess the strategies used to develop existing postnatal growth charts for preterm infants and their methodologic quality.

Design: A systematic review of observational longitudinal studies, having as their primary objective the creation of postnatal growth charts for preterm infants, was conducted. Thirty-eight items distributed in 3 methodologic domains ("study design," "statistical methods," and "reporting methods") were assessed in each study. Each item was scored as a "low" or "high" risk of bias. Two reviewers independently selected the studies, assessed the risk of bias, and extracted data. A total quality score [(number of "low risk" of bias marks/total number of items assessed) x 100%] was calculated for each study. Median (range, IQR) quality scores for each methodologic domain and for all included studies were computed.

Results: Sixty-one studies met the inclusion criteria. Twenty-seven (44.3%) of the 61 studies scored ≥50%, of which 10 scored >60% and only 1 scored >66%. The median (range, IQR) quality score for the 61 included studies was 47% (26–75%, 34–56%). The scores for the domains study design, statistical methods, and reporting methods were 44% (19–67%, 33–52%), 25% (0–88%, 13–38%), and 33% (0–100%, 0–33%), respectively. The most common shortcomings were observed in items related to anthropometric measures (the main variable of interest), gestational age estimation, follow-up duration, reporting of postnatal care and morbidities, assessment of outliers, covariates, and chart presentation.

Conclusions: The overall methodologic quality of existing longitudinal studies was fair to low. To overcome these problems, the Preterm Postnatal Follow-up Study, 1 of the 3 main components of The International Fetal and Newborn Growth Consortium for the 21st Century Project, was designed to construct preterm postnatal growth standards from a prospective cohort of "healthy" pregnancies and preterm newborns without evidence of fetal growth restriction.

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