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Conceptual issues related to the construction of prescriptive standards for the evaluation of postnatal growth of preterm infants
  1. J Villar1,
  2. H E Knight1,
  3. M de Onis2,
  4. E Bertino3,
  5. G Gilli3,
  6. A T Papageorghiou1,
  7. L Cheikh Ismail1,
  8. F C Barros4,
  9. Z A Bhutta5
  10. for the International Fetal and Newborn Growth Consortium (INTERGROWTH-21st)
  1. 1Nuffield Department of Obstetrics and Gynaecology, and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
  2. 2Department of Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
  3. 3Dipartimento di Scienze Pediatriche e dell' Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Torino, Italy
  4. 4Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil
  5. 5Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
  1. Correspondence to Dr J Villar, Nuffield Department of Obstetrics and Gynaecology, University of Oxford, Women's Centre, Level 3, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK; jose.villar{at}


Monitoring and interpreting the growth of preterm infants is a major clinical task for neonatologists. The effectiveness of this process depends upon the robustness of the standard selected. Concerns have been raised regarding the nature of the charts currently being used, as well as their appropriateness for present-day neonatal care. To overcome these problems, there is a need for new prescriptive standards based on a population of preterm infants without evidence of impaired fetal growth and born to low-risk women followed up since early pregnancy for precise gestational age dating. Preterm infants contributing to the new standards should be free of congenital malformations and major clinical conditions associated with impaired postnatal growth. These infants should receive standardised, evidence-based clinical care and should follow current feeding recommendations based on exclusive/predominant breastfeeding. This strategy should provide a population that is conceptually as close as possible to the prescriptive approach used for the construction of the WHO infant and child growth standards. New international standards constructed in this way should contribute to the evidence-based care of these preterm infants.

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  • Funding Bill and Melinda Gates Foundation.

    Mercedes de Onis is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the decisions, policy or views of the World Health Organization.

    Aris Papageorghiou is supported by the Oxford Partnership Comprehensive Biomedical Research Centre with funding from the Department of Health NIHR Biomedical Research Centres funding scheme.

  • Competing interests None.

  • Ethics approval Ethical approval for this study was granted by the Oxfordshire Ethics Committee C in December 2008.

  • Provenance and peer review Not commissioned; externally peer reviewed.