Authors
Embleton ND, Koletzko B, Fewtrell MS, Jonat S, van Goudoever JB, Gruszfeld D, Lapillonne A, McNulty A, Szitanyi P
Preterm and ill term infants, and parents
Healthcare professionals, neonatal units, hospitals, and health services
Growth monitoring and assessment of nutritional status is performed using suitable equipment and appropriate growth charts in order to optimise nutritional support and outcomes.
Preterm infants grow more slowly than age matched in-utero fetuses. (1) Slow growth is frequently due to poor macronutrient intakes (2), compounded by clinical complications, common neonatal morbidities, and poorly prioritised nutritional care. Patterns of early growth and nutrient intakes are strongly associated with long term metabolic and cognitive outcomes. Growth acceleration in the first three months in infants born at term may increase the risk of metabolic complications in later life. (3) There is no conclusive evidence that catch-up growth in preterm infants increases this risk, and in general the risks of poor growth are far more common and serious. (4) Clinical practice must be considered alongside the strong evidence of worse neuro-developmental or cognitive outcomes in infants who gain weight more slowly (5,6), or who receive lower nutrient intakes. (7–9)
Nutritional screening tools are widely used in other patient groups, but have not been widely used in preterm infants, although tools exist and deserve further evaluation. (10) All infants on NICUs should have regular measurement of weight and head circumference. All measures must be plotted on growth charts appropriate to the population. Measurement of linear (length) growth is more complex, and shows high inter-observer variability. (11) Whilst more detailed growth measures can be used, e.g. tibial length, mid-arm/mid-thigh circumference, their usefulness in routine practice has not been established. (11) Body composition appears to be important but cannot be easily measured routinely in clinical practice. In the longer term weight gain should be interpreted in the context of linear growth to ensure that growth is proportional i.e. attempt to avoid excess fat deposition.
For parents and family
B (High quality)
Patient information sheet1*
For healthcare professionals
B (High quality)
Guideline
B (High quality)
Training documentation
For neonatal unit
B (High quality)
Guideline
For hospital
B (High quality)
Training documentation
B (High quality)
Audit report2
For health service
B (High quality)
Guideline
A (Low quality)
Audit report2, guideline
1The indicator “patient information sheet” is an example for written, detailed information, in which digital solutions are included, such as web-based systems, apps, brochures, information leaflets, and booklets.
2The indicator “audit report” can also be defined as a benchmarking report.
*The TEG Nutrition very much supports the need of good communication with families and regular sharing of key information, but it is not in favour of sharing information on each standard by a “parent information sheet”, which is the term chosen by the Chair Committee. In our view, sharing multiple parent information sheets bears the risk of overloading families with a plethora of written information during a stressful time period, which may not be very helpful. We suggest to consider other means of sharing information.
For parents and family
N/A
For healthcare professionals
N/A
For neonatal unit
N/A
For hospital
N/A
For health service
N/A
For parents and family
For healthcare professionals
For neonatal unit
For hospital
For health service
November 2018 / 1st edition / next revision: 2023
Recommended citation
EFCNI, Embleton N, Koletzko B et al., European Standards of Care for Newborn Health: Monitoring growth in the neonatal unit. 2018.
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