A Longitudinal Preterm Growth Reference
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Transcript of A Longitudinal Preterm Growth Reference
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A Longitudinal Preterm Growth Reference
A study funded by the
MREC No: 07/ H0713/ 111
UCL Institute of Child Health
Co-ordinated by the Neonatal Data Analysis Unit
NDAUNeonatal Data Analysis Unit
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The Study Team
Investigators
Professor Neena Modi, Professor Tim Cole, Dr Huiqi Pan
Research Fellow
TBA
NDAU Manager
Mr Richard Colquhoun
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Objective
• To construct a growth reference for weight, length and
head circumference in preterm infants ≤ 34 weeks
gestation from birth to term/near term
• Using routinely collected clinical data entered into the
Standardised Electronic Neonatal Database (SEND)
and related neonatal.net systems
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A growth chart is series of
smooth curves representing the
distribution of measurements of
interest within a population
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Content of growth charts
a) Type of anthropometric indices
eg weight, length, head circumference
b) Summary data
eg z-scores and percentiles
c) Population
eg boys, girls
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Cole TJ BMJ 1994;308:641-Cole TJ BMJ 1994;308:641-642642
Centiles and standard deviation score; Centiles and standard deviation score; the bulleted points are two thirds of an SDS apart.the bulleted points are two thirds of an SDS apart.
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Is a neonatal chart a reference or a standard?
• A standard represents optimum growth
(prescriptive)
• A reference allows the comparison of any one
individual against a population (descriptive)
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History of preterm growth charts
In 1948 Dancis et al published the first
Preterm Growth Reference Followed by:
1) Lubchenco et al (1963)
2) Battaglia et al (1966)
3) Usher and McLean (1969)
4) Babson et al (1970)
5) Brenner et al (1976)
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Other Preterm Growth References
• Europe: Euro-Growth Reference; local (Brant 1976;
Excler 1987; Lozano 1998; Bertino 2006)
• Latin America: Gabriela (Chile 1989); Anchieta (Brazil
2004)
• China: Fok 2003
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Growth reference charts used in the United Kingdom
• Tanner-Whitehouse • Buckler-Tanner • Cambridge • Harvard • Gairdner Pearson • UK 1990 Reference
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The UK 1990 Growth Reference
Based on cross-sectional data, utilising
birth weights, and therefore not suitable
to follow longitudinal growth
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Study Methods
POPULATION
Infants born ≤ 34 weeks gestation
admitted to neonatal units using a
neonatal.net electronic newborn record
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• Maintain routine practice
• No extra procedures
• Measurements as clinical situation
permits
Standard Clinical Practice
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Variables
Anonymised data comprising:
a) Gestational ageb) Sexc) Ethnicityd) Daily parenteral and enteral intakee) Maternal detailsf) Daily level of careg) Weight, length and head circumference
measurements from birth to discharge
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Statistical AnalysisThe Cole LMS method will be used to construct
smooth curves summarising the distribution of
measurements by age and sex:
L = Skewness of distribution
M= Median of measurement
S= Coefficient of variation
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Regulations and approvals
• Research Ethics approval obtained
• No patient consent required
• Site specific approval (SSA) exempt
• NHS Trust R&D approval necessary
• National Information Governance Board (NIGB) approval not needed as data are anonymised
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What is required from participating units?
• Nomination of 2 local co-ordinators
• Liaison with the Neonatal Data Analysis Unit (NDAU)
• Entry of high quality anthropometric measurements, at
a frequency determined locally
• We recommend no greater than weekly intervals
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The NDAU office will
• approach your R&D Office on your behalf to obtain Trust approval
• Local Principal Investigator not required
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Anthropometric measurements
• Measurements taken by staff who have received training
• Recommend 3 repeat measurements if clinical situation
permits
• Head circumference measurement between the forehead
and the occiput with the hat removed
• Weight measured net of attachments/devices
• Length taken on a firm and flat surface by 2 people; 1
person holding the head whilst the other extends and hold
the feet against the foot rest
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The neonatal.net record
Weight , head circumference and length measurements can be entered on any given day
1) Select Patient Name2) Go to Patient Home Page3) Select Patient Data4) Select Daily Data (left hand column)5) Go to Input Forms box6) Click on Daily Details to load the Summary Data 7) Enter the new data (weight, head circumference & length) at
the top of the Summary8) When complete, click Save and Close
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Where are we now with the study?
To-date 77 UK neonatal units have
agreed to participate
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Benefits of Participation
• Contribution to a national study
• The Child Growth Foundation will provide each
unit with newly designed equipment
• We will offer you on-site training in obtaining high
quality anthropometric measurements
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References• Freeman JV, Cole TJ, Chinn S, Jones PRM, White EM. Preece
MA. Cross sectional stature and weight reference curves for the
UK, 1990. Arch Dis Child 1995;73:17-24
• Cole TJ, Green PJ. Smoothing reference centile curves: the LMS
method and penalized liklihood. Stat Med 1992; 11:1305-19
• Growth reference charts for use in the United Kingdom. Wright
CM, Booth IW, Buckler JM, Cameron N, Cole TJ, Healy MJ, Hulse
JA, Preece MA, Reilly JJ, Williams AF. Arch Dis Child 2002;86:11-
14
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The new longitudinal reference will provide
a unique tool for child health professionals
to assess the growth of UK preterm infants
Overview
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The Research Office
For further information or queries please contact:
Mr Richard Colquhoun
NDAU ManagerAcademic Neonatal MedicineImperial College LondonChelsea and Westminster Hospital 4th Floor, Lift Bank D369 Fulham RoadLondon, SW10 9NH
T: 020 8746 5841