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Growth of preterm infants at the time of global obesity
  1. José Villar1,
  2. Francesca Giuliani2,
  3. Josep Figueras-Aloy3,
  4. Fernando Barros4,5,
  5. Enrico Bertino6,
  6. Zulfiqar A Bhutta7,
  7. Stephen H Kennedy1
  1. 1 Nuffield Department of Women’s & Reproductive Health and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
  2. 2 Ospedale Infantile Regina Margherita-Sant’Anna, Città della Salute e della Scienza di Torino, Torino, Italy
  3. 3 Department of Pediatrics, University of Barcelona, Barcelona, Spain
  4. 4 Programa de Pós-Graduação em Saúde e Comportamento, Catholic University of Pelotas, Pelotas, Brazil
  5. 5 Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
  6. 6 Dipartimento di Scienze Pediatriche e dell’Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Torino, Italy
  7. 7 Center for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
  1. Correspondence to Professor José Villar, Nuffield Department of Women’s & Reproductive Health, University of Oxford, Oxford OX3 9DU, UK; jose.villar{at}wrh.ox.ac.uk

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Preterm birth, 90% of which occurs between 32 and <37 weeks’ gestation,1 2 is a complex heterogeneous syndrome interlinked with the stillbirth and intrauterine growth restriction syndromes.3 4 Its phenotypes are associated with different gains in neonatal weight,5 morbidity and mortality,6 and perhaps body composition, growth and development. Preterm birth is related to several aetiologies, although nearly 30% of all preterm births are not associated with any maternal/pregnancy conditions or fetal growth restriction.6 This group is, therefore, the target population for constructing postnatal growth standards for preterm infants.7 8 There is disagreement, however, about how best to monitor the postnatal growth of such a heterogeneous group of newborns. In fact, a systematic review identified 61 existing longitudinal charts for preterm infants, many with considerable limitations in gestational age estimation, body measurement, length of follow-up and description of feeding practices and morbidities.9

The problem requires four fundamental issues to be considered.10 

First, size at birth measures (eg, birth weight, length and head circumference), which are taken only once per infant, are a retrospective summary of fetal growth reflecting the intrauterine environment and overall efficiency of placental nutrient transfer. Postnatal growth, on the other hand, requires repeated anthropometric measures after birth, complemented by feeding practices and morbidity data. Therefore, the use of size at birth by gestational age, cross-sectional data taken only at birth to evaluate the postnatal growth of preterm infants cannot be justified either physiologically or clinically. Implicit in the concept of growth is the requirement for repeated measures over time, which can obviously not be captured with a single birth measure. Furthermore, fundamental factors determining the postnatal growth of preterm infants that change over time, such as feeding regimens and organ maturity influencing morbidity, are by definition not included in the …

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