neonatal anthropometry – measurement and reporting of

SLHD Guideline

Neonatal anthropometry – measurement and reporting of newborn size and growth

TRIM Document No SD21/17112 (POL/310)

Policy Reference SLHD_GL2021_017

Related MOH Policy N/A

Keywords Neonatal; anthropometry; newborn; measurement; growth

Applies to All clinical staff who provide newborn care in SCN and NICU

in SLHD

Clinical Stream Women’s Health, Neonatology and Paediatrics

Tier 2 Sign-off Executive Director Medical Services SLHD

Clinical Director Women’s Health, Neonatology & Paediatrics

Date approved by SLHD

Policy Committee 11/03/2021

Author Clinical Associate Professor, Neonatology RPAH

Status Active

Review Date 11/03/2026

Risk Rating H

Replaces N/A

Version History

Current Version V.1 – 11/03/2021

Sydney Local Health District Policy No: SLHD_GL2021_017

Date Issued: MARCH 2021

Compliance with this Guideline is Recommended 2


Contents 1. Introduction ................................................................................................................ 3

2. The Aims / Expected Outcome of this Guideline ......................................................... 3

3. Risk Statement ........................................................................................................... 3

4. Scope ......................................................................................................................... 3

5. Implementation ........................................................................................................... 3

6. Service Measures ....................................................................................................... 3

7. Summary of Practice Guidelines ................................................................................ 4

8. Background ................................................................................................................ 5

Size versus growth: ............................................................................................. 5

Small for gestational age (SGA) .......................................................................... 5

Postnatal growth failure (extrauterine growth restriction) and failure to thrive ...... 5

Large for gestational age (LGA) and macrosomia ............................................... 6

Microcephaly ....................................................................................................... 6

Macrocephaly ...................................................................................................... 6

Short stature ........................................................................................................ 6

Tall stature .......................................................................................................... 7

9. Guidelines .................................................................................................................. 7

Routine anthropometry: ....................................................................................... 7

9.1.1 Routine monitoring: ...................................................................................... 7

Audit (NICUS and ANZNN):................................................................................. 7

9.2.1 Criteria for review ......................................................................................... 8

10. Growth Charts ......................................................................................................... 8

Growth goals.................................................................................................. 10

Anthropometry ............................................................................................... 11

10.2.1 When to measure? ..................................................................................... 11

10.2.2 How to measure weight? ............................................................................ 11

10.2.3 How to measure length?............................................................................. 11

10.2.4 How to measure head circumference? ....................................................... 12

11. Reporting .............................................................................................................. 13

12. Definitions ............................................................................................................. 13

13. References ........................................................................................................... 14

14. Consultation .......................................................................................................... 17

15. National Safety and Quality Standard/s, 2nd ed ..................................................... 17





1. Introduction

All newborn infants should have size at birth and subsequent growth measured to document

normal size and growth, and to diagnose and document disorders of growth and nutrition.

Size and growth should be recorded on an appropriate validated growth chart.

Size at birth and subsequent postnatal growth velocity are critically related to long-term

neurological and metabolic outcomes. Preterm infants and neonates are more vulnerable in

the first months of life to nutritional deficits than any other time of the life cycle. Indicators are

required to diagnose and document growth disorders and malnutrition related to

undernutrition in preterm and neonatal populations. However, neonatal anthropometry is

characterized by a lack of validation and consensus of available indexes. There is little

harmonization between the different criteria to assess pre- and postnatal nutritional status for

constant and continuous growth monitoring in the different stages of development.

2. The Aims / Expected Outcome of this Guideline

Indicators are required to diagnose and document growth disorders as well as

malnutrition related to undernutrition in preterm and newborn populations.

3. Risk Statement

SLHD Enterprise Risk Management System (ERMS) Risk # 1: Unwarranted Deviations from

standards of clinical care:

Preterm infants and neonates are more vulnerable to nutritional deficits than any

other time of the life cycle.

4. Scope

This guideline applies only to clinical staff providing newborn care in the Neonatal Intensive

Care Unit (NICU) and Special Care Nursery (SCN) in SLHD.

5. Implementation

Notification and distribution of this guideline via management and clinical stream

meetings, ward meetings, group email and SLHD Intranet.

6. Service Measures

Complete anthropometry (weight, length and head circumference) will be collected

on all NICU enrolled infants at birth, 28 days, 36 weeks postmenstrual age, discharge

from hospital and/or discharge to home.

Incidents are reported and managed in ims+.




7. Summary of Practice Guidelines

Within 24

hours of birth

All infants should have weight, length and head circumference measured at

birth.

Weight Weight should be assessed using a calibrated electronic scale with 10 g

resolution and tared to zero.

Average weight gain for infants <34 weeks gestation is approximately 17

g/kg/day and for term infants 10 g/kg/day.

Term or late preterm infants with >10% weight loss day 3 should have a

lactation / feeding consult.

Term or late preterm infants with >12% weight loss day 3 or 10% on day 5

should have a medical review.

Term or late preterm infants with <7g/kg/day weight gain after 2 weeks age


Preterm infants <34 weeks gestation with <12g/kg/day weight gain after 2

weeks age should have a medical review.

Length The Premie Stadiometer 26-50 cm is preferred for measurement of premature

infants including within the incubator.

The Newborn Stadiometer 35-70 cm is preferred for measurement of term

infants.

All infants should have length measured at birth, 28 days, 36 weeks

postmenstrual age, discharge from admitting hospital and discharge to

home.

Head

circumference

Use a non-stretchable, disposable paper 1–2 cm wide marked in 0.1 cm

increments.

To measure the head circumference, securely wrap the tape measure

around the widest possible circumference of the infant’s head (typically 1 to

2 finger-widths above the eyebrow (supraorbital ridges) on the forehead,

above the ears, to the most prominent part of the back of the head

(occiput). Repeat the measurement three times and select the largest

measurement to the nearest 0.1 cm

All infants with growth in head circumference ≥1.0 cm per week must have

a senior medical review.

Referral or

Escalation

The Resident Medical Officer/neonatal Nurse Practitioner should be notified

and review infants with excess weight loss or head circumference gain

according to specified criteria.

The first on call neonatal senior Staff Specialist should be notified of infants

with excess gain in head circumference according to specified criteria.

Documentation Document in PowerChart.

Use the Fenton Chart to monitor growth to 42 weeks postmenstrual age (PMA)

and the WHO chart for term infants and preterm infants after 42 weeks PMA.




8. Background

Size versus growth:

A single weight, length or head circumference measurement is an assessment of ‘size’.

Longitudinal measurements over time document ‘growth’ which may be linear (along centile

lines) or non-linear (crossing centile regions).

The terms intrauterine growth restriction (IUGR) and small for gestational age (SGA),

although often used as synonyms, are not interchangeable. SGA infants have not

necessarily experienced IUGR and, conversely, infants with documented IUGR are not

inevitably born SGA. Unlike SGA, IUGR always refers to a pathological process that results

in decelerating fetal growth velocity. Serial ultrasound assessment (of fetal anthropometric

traits, umbilical cord flow, and amniotic fluid) is necessary to confirm IUGR.

A recent consensus defined growth restriction as: birth weight less than the third percentile,

or 3 out of the following: birth weight <10th percentile; head circumference <10th percentile;

length <10th percentile; prenatal diagnosis of fetal growth restriction; and maternal

pregnancy information.

Numerical methods used to describe weight, length, and head circumference growth velocity

in preterm infants include grams/kilogram/day (g/kg/d), grams/day (g/d), centimetres/week

(cm/week), and change in z scores.

Small for gestational age (SGA)

The definition of SGA requires:

a. Accurate knowledge of gestational age (ideally based on first trimester ultrasound

exam);

b. Accurate measurements at birth of weight, length, and head circumference; and,

c. A cut-off against reference data from a relevant population. This cut-off has been

variably set at the 10th centile, 3rd centile, or > 2 standard deviations below the mean

(~2nd centile).

Babies can then be sub-classified into SGA for weight, SGA for length, or SGA for both

weight and length. Additionally, those SGA babies who have small head circumference

should be recognized.

Infants born small for gestational age are defined by the WHO Expert Committee and the

American College of Obstetrics and Gynaecology as those weighing below the 10th centile

of birth weight by sex for a specific completed gestational age of a given reference

population, which identifies infants at increased risk of perinatal morbidities. In low and

middle income countries, infants born SGA defined as weight < 10th centile are at increased

risk of mortality.

A Paediatric Endocrine Consensus recommended SGA be defined as weight and/or length

more than 2 standard deviations below the mean as this identifies the majority of those in

whom ongoing growth assessment is required.

Postnatal growth failure (extrauterine growth restriction - EUGR) and failure to

thrive

Underweight at a given gestational age may result from stunting or wasting, or both

phenotypes:




• Wasting: low weight for length, or low body mass index [BMI] for age, often reflecting

recent weight loss.

• Stunting: short length for age, reflecting linear growth restriction.

Postnatal growth failure is commonly considered as weigh <10th centile at 36 weeks

postmenstrual age or at discharge from hospital. However, a large proportion of healthy

preterm infants have weights < 10th centile after the extracellular water loss early in

postnatal life, thus this definition may not be appropriate. Postnatal growth trajectory in

healthy preterm infants was reported to be adjusted to −0.8 z-scores below intrauterine

percentiles after infants had completed postnatal adaptation.

Failure to thrive is defined as a faltering of growth from a previously established pattern of

growth. Diagnostic certainty is provided by a documented birth date, weights obtained using

an electronic scale, at least 2 weights measured at least 4 weeks apart, and weight for age

deceleration through at least 2 centile spaces on a growth chart.

Large for gestational age (LGA) and macrosomia

Large-for-gestational-age is usually defined as weight > 90th centile compared with the size

of infants of the same gestation at the time of birth. However, this cut-off is physiologically

arbitrary, based on statistics rather than health status, and does not assess whether the

infants are large relative to their individual genetic potential. Being born LGA (birth weight

>90th centile) is a risk factor for prolonged first stage of labour, shoulder dystocia,

caesarean, hypoglycaemia and jaundice.

The term macrosomia is used to describe an individual who is considerably larger than

average. Fetal macrosomia is defined as birth weight >4000 g (or 4500 g) and is associated

with maternal and fetal complications including maternal birth canal trauma, shoulder

dystocia, and perinatal asphyxia.

Constitutional (large parents), diabetes in pregnancy and genetic syndromes are causes of

LGA and macrosomic infants.

Microcephaly

Microcephaly is usually defined by the measurement of occipitofrontal circumference (head

circumference) that is more than 2 standard deviations below the mean for age and sex or <

3rd centile for age and sex. Severe microcephaly is defined as head circumference > 3

standard deviations below the mean for age and sex.

Macrocephaly

Macrocephaly is defined as an abnormally large head with an occipitofrontal circumference

greater than 2 standard deviations above the mean for a given age and sex.

Short stature

Short stature is defined as length or height more than 2 standard deviations below the mean

for a given age and sex, which corresponds to approximately 2.3% of the population and

usually includes healthy individuals. Stricter classifications define short stature as heights 2.5

to 3 standard deviations less than the given population’s mean height, which represents 0.6

and 0.1% of the general population respectively and is frequently associated with syndromic

conditions.




Tall stature

Tall stature is defined as length or height more than 2 standard deviations above the mean

for a given age and sex. Tall stature can also be defined relative to the target height, with

height >2 standard deviations above the target height being considered tall. Ideally, both

parents should be measured to calculate the target height. Tall stature is usually not a

pathological condition and generally does not need treatment.

9. Guidelines

Routine anthropometry:

Size at birth: All infants should have weight, length and head circumference measured at

birth as current charts reflect measurements taken in the first 24 hours after birth.

9.1.1 Routine monitoring:

All infants should have weight measured at birth and day 3 if stable, then 2nd daily until

discharge.

o Weight should be assessed using a calibrated electronic scale with 10 g

resolution and tared to zero.

All infants should have length measured at birth (or as soon as possible within 7 days if

not done at birth), 28 days, 36 weeks postmenstrual age (PMA), discharge from

admitting hospital and discharge to home.

o The Premie Stadiometer 26-50 cm is preferred for measurement of premature

infants including within the incubator.

o The Newborn Stadiometer 35-70 cm is preferred for measurement of term

infants.

All infants should have head circumference measured at birth and every 7 days until

discharge.

o Use a non-stretchable, disposable paper 1–2 cm wide marked in 0.1 cm

increments.

o To measure the head circumference, securely wrap the tape measure around the

widest possible circumference of the infant’s head (typically 1 to 2 finger-widths

above the eyebrow (supraorbital ridges) on the forehead, above the ears, to the

most prominent part of the back of the head (occiput). Repeat the measurement

three times and select the largest measurement to the nearest 0.1 cm.

Document in PowerChart. Use the Fenton Chart to monitor growth to 42 weeks PMA and

the WHO chart for term infants and preterm infants after 42 weeks PMA.

Audit (NICUS and ANZNN):

Growth: All infants should have weight, length and head circumference measured at the

following intervals:

28 days

At 36 weeks PMA

At discharge from admitting hospital

At discharge to home




9.2.1 Criteria for review

Weight:

Average weight gain for infants <34 weeks gestation is approximately 17 g/kg/day and for

term infants 10 g/kg/day.

Term or late preterm infants with >10% weight loss day 3 should have a lactation /

feeding consult.

Term or late preterm infants with >12% weight loss day 3 or 10% on day 5 should have a

medical review.

Term or late preterm infants with <7g/kg/day weight gain after 2 weeks age should have

a medical review.

Preterm infants <34 weeks gestation with <12g/kg/day weight gain after 2 weeks age


Head circumference

Average head growth for preterm infants is approximately 0.7 cm/week and for term

infants is 0.5 cm/week.

All infants with growth in head circumference ≥1.0 cm per week must have a senior

medical review.

10. Growth Charts

Current reference growth curves include Fenton 2013, Olsen 2010, INTERGROWTH 2015,

and World Health Organization Growth Standard (WHOGS) 2006.

The Fenton size at birth and growth curves were created from 6 large population-based

surveys of size at preterm birth representing 3986456 births (34639 births < 30 weeks) from

Germany, United States, Italy, Australia, Scotland, and Canada. Smoothed growth chart

curves were developed, while ensuring close agreement with the data between 24 and 36

weeks and at 50 weeks.

The Olsen growth curves are gender-specific weight-, length-, and head circumference-for-

age curves created from a USA hospital cohort of 257855 singleton infants born 1998 to

2006 aged 22 to 42 weeks at birth who survived to discharge.

The INTERGROWTH-21 Project assessed fetal, newborn, and postnatal growth in 8

geographically defined populations from 2009 to 2013, in which maternal health care and

nutritional needs were met. From these populations, low-risk women starting antenatal care

before 14 weeks' gestation were selected and fetal growth monitored by ultrasonography.

Preterm postnatal growth standards were selected from live singletons born between 26 and

before 37 weeks' gestation without congenital malformations, fetal growth restriction, or

severe postnatal morbidity. Only 408 infants born <33 weeks gestation were included.

WHOGS 2006 was a population-based study 1997 to 2003 in Brazil, Ghana, India, Norway,

Oman and the USA from birth to 24 months. Study populations had to have socio-economic

conditions favourable to growth, low mobility and ≥20% breastfed, no known environmental

constraints on growth, adherence to feeding recommendations, no maternal smoking, single

term birth and no significant morbidity. About 83% of 13741 subjects screened for the

longitudinal component were ineligible and 5% refused to participate. UK Scientific Advisory

Committee on Nutrition recommends not switching from preterm charts to the WHOGS until

42 or more weeks.




There were differences in growth velocities at 27-32 weeks PMA between the

INTERGROWTH reference and the Fenton and Olsen references. INTERGROWTH

standards differ from the size-at-birth derived growth references as they are based on

measurements made after the postnatal physiologic weight loss in healthy preterm infants

without fetal growth restriction or morbidity. INTERGROWTH postnatal growth charts are

based on limited data before 36 weeks so are also less precise and markedly deviate from

the Fenton and Olsen curves, especially for weight g/kg/day and length less than 33 weeks

(see Figure 1).

For very preterm infants, INTERGROWTH reference and the Fenton charts ascribe SGA

and extrauterine growth restriction differently. Several studies have now compared the

performance of the INTERGROWTH reference and the Fenton charts for SGA or non-AGA

status (SGA or LGA) for detection of neonatal morbidity, but none has compared the

performance of the various charts in detecting extrauterine growth restriction (EUGR).

Figure 1: Weekly median growth velocity of common preterm growth references (Fenton 2013, Olsen 2010,

INTERGROWTH 2015, and World Health Organization Growth Standard (WHOGS) 2006) in g/kg/day using a constant gain of 15 g/kg/day superimposed.

In the largest cohort to date in 45505 infants born 33 to 40 weeks gestation, the diagnostic

test properties of various charts (WHO, INTERGROWTH, Fenton and GROW) for non-AGA

status (SGA or LGA) for composite neonatal morbidity was compared. Similar sensitivity,

specificity, positive likelihood ratio, positive predictive value and negative predictive values

were reported for the various charts (see Table 1).




Table 1 (for illustration): Diagnostic test properties of various charts (WHO, INTERGROWTH, Fenton and

GROW) for non-AGA status (SGA or LGA) for composite neonatal morbidity.

In a cohort of 248 infants born <32 weeks gestation, one out of every four cases assessed

as SGA according to the INTERGROWTH-21st standards was within the normal interval

according to Fenton charts. One out of every five cases assessed as EUGR according to

Fenton standards was within the normal interval according to Intergrowth standards.

However, in a cohort of 821 infants born ≤32 weeks, infants identified as IUGR at birth by

INTERGROWTH charts and not by Fenton growth charts had higher incidence of morbidities

including late onset sepsis and NEC. This report that an INTERGROWTH approach

(optimised growth) may be preferable for describing size at birth (i.e. fetal growth). This

cannot be extrapolated to the appropriateness of the different charts to measure postnatal

growth or detect extrauterine growth restriction.

Given the paucity of data below 33 weeks gestation, INTERGROWTH curves are currently

not appropriate / recommended for use in preterm infants.

Growth goals

Approximations of average growth for preterm infants of 15 to 20 g/kg/day are currently

reasonable estimates for infants 23 to 36 weeks’ gestation, but not beyond. There are no

clinical trials of different growth goals in newborn infants to inform practice. Fenton charts

report size at birth, so approximate (but underestimate) in utero growth. Typically, preterm

infants lose weight (extracellular fluid) and follow a growth velocity below the birth centile

resulting in a weight centile discrepancy if followed to term corrected age. Suggestions of

alternative approaches of targeting the original growth centile for early correction of the

postnatal growth profile, or a median of the postnatally adjusted centile and birth centile have

been made (see Figure 2), but not evaluated in clinical trial.

Figure 2 (for illustration): Individualized trajectories for preterm infants. (A) Birth-Weight-Percentile Approach; (B)

Postnatal-Percentile Approach; (C) Fetal-Median-Growth and Growth-Velocity Approach.




Anthropometry

10.2.1 When to measure?

Size at birth: All infants should have weight, length and head circumference measured at

birth as current charts reflect measurements taken in the first 24 hours after birth.

Growth: All infants should have weight, length and head circumference measured at the

following intervals:

28 days

At 36 weeks postmenstrual age

At discharge from admitting hospital

At discharge to home.

10.2.2 How to measure weight?

For birth weight the infant should be weighed within 24 hours of birth.

Weight should be assessed using a calibrated electronic scale with 10 g resolution and tared

to zero.

The infant should be bare weighed.

Any materials on the infant at the time of weighing should be weighed separately and

subtracted from the total weight.

10.2.3 How to measure length?

The Premie Stadiometer 26-50 cm is preferred for measurement of premature infants

including within the incubator; whilst the Newborn Stadiometer 35-70 cm is preferred for

measurement of term infants [https://www.ellardinstrumentation.com/stadiometers/].

The length-board measurement infantometer has been shown to be the most reliable and

accurate measurement of neonatal length. The infantometer should be placed on a flat

stable surface.

A rigid infantometer with an offset reading is preferred. For newborns either the ‘two leg’ or

‘one leg’ method may be used. For infants, the ‘two leg’ method has greater accuracy.

The Neorule may be used as an alternative method.

The neonate is placed supine and unclothed on the board and held gently with his or her

body aligned and head in a neutral position.

One person stands at the top of the length board and holds the baby’s head in contact with

the headboard.

The other person extends the legs by placing the hand over the knees, depressing the

knees, straightening the legs and moving the footboard to touch the plantar surface of the

feet at a right angle to the legs. Recheck that the head has not moved from the headboard

before taking the measurement. The actual reading is marked by an arrow as there is an

offset for greater ease of reading and accuracy.

Read the measurement and record the child’s length in centimetres to the last completed 0.1

cm.




Measuring length - Above Left: rigid infantometer placed on stable flat surface. Above Right:

Two people using the ‘two leg’ method on a rigid infantometer.

Alternative - the Neorule: Operator 1 holds the head gently with the eyes directly upwards

with the lower margin of the orbit in the same vertical plane as the external auditory meatus

and gently holds the headboard to the vertex. Operator 2 applies gentle traction to extend

the legs without displacing the pelvis and then slides the footplate to meet the heel with just

sufficient pressure to cause the skin to blanche; the CHL is then noted to the nearest mm.

10.2.4 How to measure head circumference?

Use a non-stretchable disposable paper 1–2 cm wide marked in 0.1 cm increments.

To measure the head circumference, securely wrap the tape measure around the widest

possible circumference of the infant’s head (typically 1 to 2 finger-widths above the eyebrow

(supraorbital ridges) on the forehead, above the ears, to the most prominent part of the back

of the head (occiput). Repeat the measurement three times and select the largest

measurement to the nearest 0.1 cm.




Measuring head circumference: Above image reproduced from reference.

11. Reporting

Numerical methods used to describe weight, length, and head circumference growth velocity

in preterm infants include grams/kilogram/day (g/kg/d), centimetres/week (cm/week), and

change in z scores reported at 28 days and 36 weeks postmenstrual age.

Z scores should be calculated using a validated size at birth chart and growth chart (e.g.

Fenton chart) up to 42 weeks postmenstrual age. Subsequently the INTERGOWTH 21 /

WHO growth chart will be used.

12. Definitions

Excess weight loss: >12% on day 3 and >10% on day 5.

Primary indicators of neonatal malnutrition (Not appropriate for first 2 weeks of life except for

days to regain birth weight)

Mild malnutrition:

Days to regain birth weight 15-18

Decline in weight-for-age z score 0.8-1.2 SD

Weight gain velocity <75% of expected

Moderate malnutrition

Days to regain birth weight 19-21

Decline in weight-for-age z score >1.2-2 SD

Weight gain velocity <50% of expected

Severe malnutrition

Days to regain birth weight >21

Decline in weight-for-age z score >2 SD

Weight gain velocity<25% of expected

Mild stunting

Decline in length-for-age z score 0.8-1.2 SD

Length gain velocity <75% of expected




Moderate stunting

Decline in length-for-age z score >1.2-2 SD

Length gain velocity <50% of expected

Severe stunting

Decline in length-for-age z score >2 SD

Length gain velocity<25% of expected

Microcephaly: head circumference >2 standard deviations below the mean for age and sex

or <3rd centile for age and sex.

Severe microcephaly: head circumference >3 standard deviations below the mean for age

and sex.

Macrocephaly: occipitofrontal circumference >2 standard deviations above the mean for a

given age and sex.

13. References

1. Prevention CfDCa. Measuring head circumference. CDC’s response to Zika. 2016.

2. Villar J, Giuliani F, Fenton TR, Ohuma EO, Ismail LC, Kennedy SH. INTERGROWTH-21st very preterm size at birth reference charts. The Lancet. 2016;387:844-5.

3. 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.

4. Bhutta ZA, Giuliani F, Haroon A, Knight HE, Albernaz E, Batra M, Bhat B, Bertino E, McCormick K, Ochieng R, Rajan V, Ruyan P, Cheikh Ismail L, Paul V, International F, Newborn Growth Consortium for the 21st C. Standardisation of neonatal clinical practice. BJOG. 2013;120 Suppl 2:56-63, v.

5. Goldberg DL, Becker PJ, Brigham K, Carlson S, Fleck L, Gollins L, Sandrock M, Fullmer M, Van Poots HA. Identifying Malnutrition in Preterm and Neonatal Populations: Recommended Indicators. J Acad Nutr Diet. 2018;118:1571-82.

6. Martinez JI, Roman EM, Alfaro EL, Grandi C, Dipierri JE. Geographic altitude and prevalence of underweight, stunting and wasting in newborns with the INTERGROWTH-21st standard. J Pediatr (Rio J). 2018.

7. Giuliani F, Ohuma E, Spada E, Bertino E, Al Dhaheri AS, Altman DG, Conde-Agudelo A, Kennedy SH, Villar J, Cheikh Ismail L. Systematic review of the methodological quality of studies designed to create neonatal anthropometric charts. Acta Paediatr. 2015;104:987-96.

8. Finken MJJ, van der Steen M, Smeets CCJ, Walenkamp MJE, de Bruin C, Hokken-Koelega ACS, Wit JM. Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev. 2018;39:851-94.

9. Lee S, Walker SP. The role of ultrasound in the diagnosis and management of the growth restricted fetus. Australas J Ultrasound Med. 2010;13:31-6.

10. Beune IM, Bloomfield FH, Ganzevoort W, Embleton ND, Rozance PJ, van Wassenaer-Leemhuis AG, Wynia K, Gordijn SJ. Consensus Based Definition of Growth Restriction in the Newborn. J Pediatr. 2018;196:71-6 e1.

11. Fenton TR, Chan HT, Madhu A, Griffin IJ, Hoyos A, Ziegler EE, Groh-Wargo S, Carlson SJ, Senterre T, Anderson D, Ehrenkranz RA. Preterm Infant Growth Velocity Calculations: A Systematic Review. Pediatrics. 2017;139.

12. Clayton PE, Cianfarani S, Czernichow P, Johannsson G, Rapaport R, Rogol A. Management of the child born small for gestational age through to adulthood: a consensus statement of the International Societies of Pediatric Endocrinology and the Growth Hormone Research Society. J Clin Endocrinol Metab. 2007;92:804-10.




13. de Onis M, Habicht JP. Anthropometric reference data for international use: recommendations from a World Health Organization Expert Committee. Am J Clin Nutr. 1996;64:650-8.

14. American College of O, Gynecologists. ACOG Practice bulletin no. 134: fetal growth restriction. Obstet Gynecol. 2013;121:1122-33.

15. Lee ACC, Kozuki N, Cousens S, Stevens GA, Blencowe H, Silveira MF, Sania A, Rosen HE, Schmiegelow C, Adair LS, Baqui AH, Barros FC, Bhutta ZA, Caulfield LE, Christian P, Clarke SE, Fawzi W, Gonzalez R, Humphrey J, Huybregts L, Kariuki S, Kolsteren P, Lusingu J, Manandhar D, Mongkolchati A, Mullany LC, Ndyomugyenyi R, Nien JK, Roberfroid D, Saville N, Terlouw DJ, Tielsch JM, Victora CG, Velaphi SC, Watson-Jones D, Willey BA, Ezzati M, Lawn JE, Black RE, Katz J. Estimates of burden and consequences of infants born small for gestational age in low and middle income countries with INTERGROWTH-21 st standard: Analysis of CHERG datasets. BMJ (Online). 2017;358 (no pagination).

16. Raiten DJ, Steiber AL, Carlson SE, Griffin I, Anderson D, Hay WW, Jr., Robins S, Neu J, Georgieff MK, Groh-Wargo S, Fenton TR, Pre BCWG. Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr. 2016;103:648S-78S.

17. Rochow N, Raja P, Liu K, Fenton T, Landau-Crangle E, Gottler S, Jahn A, Lee S, Seigel S, Campbell D, Heckmann M, Poschl J, Fusch C. Physiological adjustment to postnatal growth trajectories in healthy preterm infants. Pediatr Res. 2016;79:870-9.

18. Ross E, Munoz FM, Edem B, Nan C, Jehan F, Quinn J, Mallett Moore T, Sesay S, Spiegel H, Fortuna L, Kochhar S, Buttery J, Brighton Collaboration Failure to Thrive Working G. Failure to thrive: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine. 2017;35:6483-91.

19. Rosen H, Shmueli A, Ashwal E, Hiersch L, Yogev Y, Aviram A. Delivery outcomes of large-for-gestational-age newborns stratified by the presence or absence of gestational diabetes mellitus. Int J Gynaecol Obstet. 2018;141:120-5.

20. Araujo Junior E, Peixoto AB, Zamarian AC, Elito Junior J, Tonni G. Macrosomia. Best Pract Res Clin Obstet Gynaecol. 2017;38:83-96.

21. Ye J, Torloni MR, Ota E, Jayaratne K, Pileggi-Castro C, Ortiz-Panozo E, Lumbiganon P, Morisaki N, Laopaiboon M, Mori R, Tuncalp O, Fang F, Yu H, Souza JP, Vogel JP, Zhang J. Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America. BMC Pregnancy Childbirth. 2015;15:324.

22. Neylon OM, Werther GA, Sabin MA. Overgrowth syndromes. Curr Opin Pediatr. 2012;24:505-11.

23. DeSilva M, Munoz FM, Sell E, Marshall H, Tse Kawai A, Kachikis A, Heath P, Klein NP, Oleske JM, Jehan F, Spiegel H, Nesin M, Tagbo BN, Shrestha A, Cutland CL, Eckert LO, Kochhar S, Bardaji A, Brighton Collaboration Congenital Microcephaly Working G. Congenital microcephaly: Case definition & guidelines for data collection, analysis, and presentation of safety data after maternal immunisation. Vaccine. 2017;35:6472-82.

24. Pavone P, Pratico AD, Rizzo R, Corsello G, Ruggieri M, Parano E, Falsaperla R. A clinical review on megalencephaly: A large brain as a possible sign of cerebral impairment. Medicine (Baltimore). 2017;96:e6814.

25. Tan AP, Mankad K, Goncalves FG, Talenti G, Alexia E. Macrocephaly: Solving the Diagnostic Dilemma. Top Magn Reson Imaging. 2018;27:197-217.

26. Seaver LH, Irons M, American College of Medical Genetics Professional P, Guidelines C. ACMG practice guideline: genetic evaluation of short stature. Genet Med. 2009;11:465-70.

27. Grunauer M, Jorge AAL. Genetic short stature. Growth Hormone & Igf Research. 2018;38:29-33.

28. Grunauer M, Jorge AAL. Genetic short stature. Growth Horm IGF Res. 2018;38:29-33.

29. Hannema SE, Savendahl L. The Evaluation and Management of Tall Stature. Hormone research in paediatrics. 2016;85:347-52.




30. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013;13:59.

31. Olsen IE, Groveman SA, Lawson ML, Clark RH, Zemel BS. New intrauterine growth curves based on United States data. Pediatrics. 2010;125:e214-24.

32. Villar J, Giuliani F, Bhutta ZA, Bertino E, Ohuma EO, Ismail LC, Barros FC, Altman DG, Victora C, Noble JA, Gravett MG, Purwar M, Pang R, Lambert A, Papageorghiou AT, Ochieng R, Jaffer YA, Kennedy SH, International F, Newborn Growth Consortium for the C. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. Lancet Glob Health. 2015;3:e681-91.

33. de Onis M, Onyango AW, Borghi E, Garza C, Yang H, Group WHOMGRS. Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes. Public Health Nutr. 2006;9:942-7.

34. WHO. Multicentre Growth Reference Study Group. Enrolment and baseline characteristics in the WHO Multicentre Growth Reference Study. Acta Paediatr Suppl. 2006;450:7-15.

35. Fenton TR, Nasser R, Eliasziw M, Kim JH, Bilan D, Sauve R. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr. 2013;13:92.

36. Cole TJ, Wright CM, Williams AF, Group RGCE. Designing the new UK-WHO growth charts to enhance assessment of growth around birth. Arch Dis Child Fetal Neonatal Ed. 2012;97:F219-22.

37. Reddy KV, Sharma D, Vardhelli V, Bashir T, Deshbotla SK, Murki S. Comparison of Fenton 2013 growth curves and Intergrowth-21 growth standards to assess the incidence of intrauterine growth restriction and extrauterine growth restriction in preterm neonates </=32 weeks. J Matern Fetal Neonatal Med. 2019:1-8.

38. Tuzun F, Yucesoy E, Baysal B, Kumral A, Duman N, Ozkan H. Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants. J Matern Fetal Neonatal Med. 2018;31:2252-7.

39. Cartwright RD, Anderson NH, Sadler LC, Harding JE, McCowan LME, McKinlay CJD. Neonatal morbidity and small and large size for gestation: a comparison of birthweight centiles. J Perinatol. 2020;20:20.

40. Landau-Crangle E, Rochow N, Fenton TR, Liu K, Ali A, So HY, Fusch G, Marrin ML, Fusch C. Individualized Postnatal Growth Trajectories for Preterm Infants. JPEN J Parenter Enteral Nutr. 2018;42:1084-92.

41. Schlaudecker EP, Munoz FM, Bardaji A, Boghossian NS, Khalil A, Mousa H, Nesin M, Nisar MI, Pool V, Spiegel HML, Tapia MD, Kochhar S, Black S, Brighton Collaboration Small for Gestational Age Working G. Small for gestational age: Case definition & guidelines for data collection, analysis, and presentation of maternal immunisation safety data. Vaccine. 2017;35:6518-28.

42. World Health Organization. Training Course on Child Growth Assessment. Geneva, WHO. 2008.

43. Cheikh Ismail L, Puglia FA, Ohuma EO, Ash ST, Bishop DC, Carew RM, Al Dhaheri AS, Chumlea WC. Precision of recumbent crown-heel length when using an infantometer. BMC Pediatr. 2016;16:186.

44. Wood AJ, Raynes-Greenow CH, Carberry AE, Jeffery HE. Neonatal length inaccuracies in clinical practice and related percentile discrepancies detected by a simple length-board. J Paediatr Child Health. 2013;49:199-203.

45. Lawn CJ, Chavasse RJ, Booth KA, Angeles M, Weir FJ. The neorule: a new instrument to measure linear growth in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2004;89:F360-3.




14. Consultation

Enterprise Risk Management System Coordinator SLHD

Neonatology Clinical Nurse Consultant RPAH

SLHD Centre for Education and Workforce Policy Committee

SLHD Maternity Policy Committee

15. National Safety and Quality Standard/s, 2nd ed

Clinical Governance Standard

Comprehensive Care Standard

Communicating for Safety Standard

neonatal anthropometry – measurement and reporting of

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