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A holistic approach to infant growth assessment considers clinical, social and genetic factors rather than an assessment of weight at a set timepoint

Journal of Perinatology volume 41, pages 650–651 (2021)Cite this article

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We thank Chou et al. for their letter [1] in response to our paper [2] and appreciate that their analysis of infants with placental insufficiency supports our proposal that it is not always practical for every infant to follow intrauterine growth rates and a diagnosis of growth failure is not appropriate either at 36–40 weeks.

It is important to consider an infant’s genetic potential when evaluating an individual’s growth. It is normal to see a distribution of sizes at any age due to the range of genetic potentials which is suggested in part by parental size [5]. In addition, two modifiable preterm infant nutrition factors that could contribute to suboptimum growth are low protein and energy intakes during the transition from parenteral to enteral nutrition [6] and the postnatal decrease in breastmilk protein content. These factors are also time-dependent as suggested by Chou et al. Moreover, the protein content of breastmilk is highly variable and may not meet the needs of all infants even when fortified [7]. As neonatal health care providers, we need to ensure that our nutrition care is adequately supporting these infants by providing nutrition as per consensus recommendations, but also to have realistic expectations about growth, bearing in mind that not all small babies are faltering since other factors may play a role.

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Fig. 1: Directed acyclic graph of relationship between factors affecting growth and development.

References

  1. Chou F, Paney V, Yeh H. Postnatal growth in extremely low birth weight newborns: nature or nurture? J Perinatol. https://doi.org/10.1038/s41372-020-0737-7.

  2. Fenton TR, Cormack B, Goldberg D, Nasser R, Alshaikh B, Eliasziw M, et al. “Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants. J Perinatol. 2020;40:704–14.

    Article  Google Scholar 

  3. Horbar JD, Edwards EM, Greenberg LT, Profit J, Draper D, Helkey D, et al. Racial Segregation and Inequality in the Neonatal Intensive Care Unit for Very Low-Birth-Weight and Very Preterm Infants. JAMA Pediatr. 2019;173:455–61.

    Article  Google Scholar 

  4. Bushnik T, Yang S, Kaufman JS, Kramer MS, Wilkins R. Socioeconomic disparities in small-for-gestational-age birth and preterm birth. Heal Rep. 2017;28:3–10.

    Google Scholar 

  5. Rochow N, AlSamnan M, So HY, Olbertz D, Pelc A, Däbritz J, et al. Maternal body height is a stronger predictor of birth weight than ethnicity: analysis of birth weight percentile charts. J Perinat Med. 2018;47:22–9.

    Article  Google Scholar 

  6. Cormack BE, Jiang Y, Harding JE, Crowther CA, Bloomfield FH. Relationships between neonatal nutrition and growth to 36 weeks’ corrected age in ELBW babies–secondary cohort analysis from the provide trial. Nutrients. 2020;12:760.

    Article  CAS  Google Scholar 

  7. Nakano Y, Hirabayashi C, Murase M, Mizuno K, Itabashi K. Malnutrition caused by unexpectedly low protein concentration in breast milk. Pediatr Int. 2017;59:1100–1.

    Article  Google Scholar 

  8. Fenton TR, Anderson D, Groh-Wargo S, Hoyos A, Ehrenkranz RA, Senterre T. An attempt to standardize the calculation of growth velocity of preterm infants-evaluation of practical bedside methods. J Pediatr. 2018;196:77–83.

    Article  Google Scholar 

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Authors and Affiliations

  1. Community Health Sciences, Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada

    Tanis R. Fenton & Belal Alshaikh

  2. Nutrition Services, Alberta Health Services, Calgary, AB, Canada

    Tanis R. Fenton

  3. Carilion Clinic, Roanoke, VA, USA

    Dena Goldberg

  4. Pediatrics, University of Calgary, Calgary, AB, Canada

    Belal Alshaikh

  5. Saskatchewan Health Authority, Nutrition and Food Services, Regina, SK, Canada

    Roseann Nasser

  6. University of Colorado, Denver, CO, USA

    William W. Hay

  7. Pediatrics and Nutrition, Case Western Reserve University, Cleveland, OH, USA

    Sharon Groh-Wargo

  8. Paediatrics and Institute of HPME, University of Toronto, Mount Sinai Hospital, Toronto, ON, Canada

    Prakesh S. Shah

  9. Pediatrics, Yale School of Medicine, New Haven, CT, USA

    Sarah Taylor

  10. Neonatology, University of Liege, CHU de Liege, Liege, Belgium

    Thibault Senterre

  11. Clínica del Country, Universidad el Bosque, Bogotá, Colombia

    Angela Hoyos

  12. Newcastle Hospitals NHS Foundation Trust, Royal Victoria Infirmary, Newcastle upon Tyne, UK

    Nicholas Embleton

  13. Pediatrics, McMaster University, Hamilton, ON, Canada

    Niels Rochow

  14. Liggins Institute, University of Auckland, Auckland, NZ, New Zealand

    Frank Bloomfield

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  1. Tanis R. Fenton
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Correspondence to Tanis R. Fenton.

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Fenton, T.R., Goldberg, D., Alshaikh, B. et al. A holistic approach to infant growth assessment considers clinical, social and genetic factors rather than an assessment of weight at a set timepoint. J Perinatol 41, 650–651 (2021). https://doi.org/10.1038/s41372-020-00785-x

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