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    2023 Aap Nce Presentation

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    Juan M Aguilar
    The document describes postnatal growth reference charts for very preterm infants. It discusses how modern nutrition practices have allowed postnatal growth rates in the NICU to approximate intrauterine growth rates. The document presents a large dataset of postnatal growth measurements for preterm infants. It finds that while early postnatal growth is slower than fetal growth, growth accelerates to match fetal rates by 34 weeks. It then describes a web application called NICUgrowth that provides tools to visualize and track infant growth against these new references.

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    2023 Aap Nce Presentation

    Uploaded by

    Juan M Aguilar
    19 views26 pages
    The document describes postnatal growth reference charts for very preterm infants. It discusses how modern nutrition practices have allowed postnatal growth rates in the NICU to approximate intrauterine growth rates. The document presents a large dataset of postnatal growth measurements for preterm infants. It finds that while early postnatal growth is slower than fetal growth, growth accelerates to match fetal rates by 34 weeks. It then describes a web application called NICUgrowth that provides tools to visualize and track infant growth against these new references.

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    The document describes postnatal growth reference charts for very preterm infants. It discusses how modern nutrition practices have allowed postnatal growth rates in the NICU to approximate intrauterine growth rates. The document presents a large dataset of postnatal growth measurements for preterm infants. It finds that while early postnatal growth is slower than fetal growth, growth accelerates to match fetal rates by 34 weeks. It then describes a web application called NICUgrowth that provides tools to visualize and track infant growth against these new references.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    19 views26 pages

    2023 Aap Nce Presentation

    Uploaded by

    Juan M Aguilar
    The document describes postnatal growth reference charts for very preterm infants. It discusses how modern nutrition practices have allowed postnatal growth rates in the NICU to approximate intrauterine growth rates. The document presents a large dataset of postnatal growth measurements for preterm infants. It finds that while early postnatal growth is slower than fetal growth, growth accelerates to match fetal rates by 34 weeks. It then describes a web application called NICUgrowth that provides tools to visualize and track infant growth against these new references.

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    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 26

    Postnatal Growth Reference Charts

    for Very Preterm Infants


    Fu-Sheng Chou, MD PhD
    ---
    Kaiser Permanente Riverside Medical Center, Riverside, CA
    Southern California Permanente Medical Group, Pasadena, CA
    ---
    X: @nicugrowth_app | https://nicugrowth.app
    ---
    [email protected] | [email protected]
    Conflict of Interest Disclosure

    I have NO relevant financial relationships with the manufacturer(s) of


    any commercial product(s) and/or provider(s) of commercial services
    discussed in this CME activity.

    I DO NOT intend to discuss an unapproved/investigative use of a


    commercial product/device in my presentation.

    [email protected] X/Twitter: @nicugrowth_app


    Acknowledgements
    • Dr. Reese Clark for project approval & mentorship
    • Dr. Hung-Wen (Henry) Yeh for introducing model technique,
    mentorship, and friendship
    • Dr. Mitchell Goldstein for introducing me to Dr. Clark
    • Dr. Tanis Fenton for the LMS table for 2013 Fenton growth charts and
    the discussion around intrauterine vs. postnatal growth references
    • Dr. Irene Olsen & Dr. Veeral Tolia for insightful comments on the
    early versions of the manuscript

    [email protected] X/Twitter: @nicugrowth_app


    The Clinical Question

    “The goal of feeding regimens for low-birth-weight infants is to obtain a prompt


    postnatal resumption of growth to a rate approximating intrauterine growth because
    this is believed to provide the best possible conditions for subsequent normal
    development.”
    ~ AAP 1977

    How does the rate of postnatal growth under modern nutrition


    practice approximate the rate of intrauterine growth?

    [email protected] X/Twitter: @nicugrowth_app


    Racially Diverse Large Data Set
    Method

    Pediatrix Clinical Data Warehouse Total Female Male


    Number of infants (22 4/7-30 3/7wk) n = 89,218 n = 41,798 n = 47,420
    Number of Data points
    Weight 5,478,055 2,602,008 2,876,047
    Length 755,687 358,968 396,719
    Head Circumference 1,316,087 620,079 696,008
    Race/ethnicity
    White 36,628 (41%) 16,930 (40%) 19,698 (43%)
    Black 25,577 (29%) 12,537 (30%) 13,040 (27%)
    Hispanic 17,008 (19%) 7,772 (19%) 9,236 (19%)
    Asian 2,643 (3%) 1,179 (3%) 1,464 (3%)
    Other 7,362 (8%) 3,380 (8%) 3,982 (8%)

    [email protected] X/Twitter: @nicugrowth_app


    Difference in intrauterine vs. Postnatal Growth
    Figure 1

    Black: 2013 Fenton weight curves Pink: 25-week female group

    [email protected] X/Twitter: @nicugrowth_app


    Intrauterine vs. Postnatal Growth Rate
    Figure 2

    Weight Length Head Circumference

    cm/week

    cm/week
    g/day

    0
    0
    0

    PMA PMA PMA

    Solid: 97th percentile | Dashed: 3rd percentile


    Intrauterine vs. Postnatal Growth
    Figure 3

    g/day
    Three Phases of Postnatal Growth
    Expected daily weight
    Initial Weight Loss gain (g/day)
    Birth to BW regained 0

    Weight Acceleration (g/kg/day)


    BW regained to 34 weeks PMA

    g/kg/day
    Stable Weight Gain (g/day)
    34 weeks PMA and beyond
    0 Expected % daily weight
    gain (g/kg/day)
    BW regained

    34 weeks
    PMA
    [email protected] X/Twitter: @nicugrowth_app
    Details available in the manuscript

    https://doi.org/10.1038/s41467-023-41069-0

    [email protected] X/Twitter: @nicugrowth_app


    Altered Growth Trajectory Following Preterm Birth

    Conception Term Fully


    Birth grown

    Early Fenton/Olsen/INTERGROWTH 21st


    fetal
    growth Preterm
    Birth NICU Postnatal Growth
    Charts

    [email protected] X/Twitter: @nicugrowth_app


    Postnatal Growth Charts WebApp

    nicugrowth.app

    USER ID: test


    PASSWORD: Password is
    test Encrypted!
    All lower-case

    [email protected] X/Twitter: @nicugrowth_app


    Accessing the Data Entry Table
    Step 3.
    Double-click on a corresponding cell to enter value

    Step 1. Baby X

    Select or create an ID
    Enter GA/Sex if new
    ID

    nicugrowth.app
    Full-Version WebApp

    Step 4.
    Step 2. Click to (re)calculate percentile/z-
    Click READY-SET-GO to load datatable score
    Step 5.
    & calculate percentile/z-score Save the entered data

    [email protected] X/Twitter: @nicugrowth_app


    Hover Over Measurement Data Points to Reveal
    Details DOL starts from 0

    Scroll
    down

    [email protected] X/Twitter: @nicugrowth_app


    Actual Weight Gain vs. Trajectory

    [email protected] X/Twitter: @nicugrowth_app


    Trajectory Percentile Calculation

    ( )
    𝑛
    1
    𝑇𝑟𝑎𝑗𝑒𝑐𝑡𝑜𝑟𝑦 𝑝𝑒𝑟𝑐𝑒𝑛𝑡𝑖𝑙𝑒= min ∑(
    0 <𝑝<100 𝑛 𝑖=1
    𝑚𝑒𝑎𝑠𝑢𝑟𝑒𝑚𝑒𝑛𝑡 𝑖 − 𝔼𝑝 𝑖)
    2

    [email protected] X/Twitter: @nicugrowth_app


    Clinical Use of Trajectory Percentile

    1. Predict growth rate

    2. Guide timing of transitioning to the WHO charts

    3. Guide post-illness growth goal and nutrition needs

    4. Assess postnatal growth failure

    [email protected] X/Twitter: @nicugrowth_app


    #1. Predict Growth Rates & Nutrition Needs

    [email protected] X/Twitter: @nicugrowth_app


    #1. Predict Growth Rates & Nutrition Needs

    [email protected] X/Twitter: @nicugrowth_app


    #2. Guide timing of transitioning to WHO Charts

    [email protected] X/Twitter: @nicugrowth_app


    #2. Guide timing of transitioning to WHO
    Charts

    23.6%ile = 2913g

    [email protected] X/Twitter: @nicugrowth_app


    #2. Guide timing of transitioning to WHO
    Charts

    Trajectory percentile
    as birth weight
    percentile

    2913g

    [email protected] X/Twitter: @nicugrowth_app


    #3. Identify Pre-Illness Trajectory Percentile

    Surgical
    NEC on
    DOL14

    [email protected] X/Twitter: @nicugrowth_app


    #3. Identify Pre-Illness Trajectory Percentile

    Surgical
    NEC on
    DOL14

    [email protected] X/Twitter: @nicugrowth_app


    #4. Assess Postnatal Growth Failure
    • Snapshot of growth at 36 weeks PMA vs. growth falling off the percentile

    • Longitudinal intra-personal comparison


    • Correlate better with long-term neurodevelopmental and cardiometabolic
    outcomes?
    [email protected] X/Twitter: @nicugrowth_app
    Reflecting on This Project
    • Growth rate is dynamic
    • The three-phase growth is likely valid, what we can work on is
    setting growth rate goals for each phase
    • The existence of measurement errors, including birth measurements
    Trajectory percentile (longitudinal) vs. individual z-scores
    (snapshots)

    [email protected] X/Twitter: @nicugrowth_app


    Summary & Limitations
    • Racially diverse, large-scale real-world dataset
    • Allow peer-to-peer comparisons
    • Provides realistic expectation of growth
    • One additional way to involve parents in infant care nicugrowth.app

    • Now available from 22 4/7 to 34 3/7 weeks


    • Do not represent optimal growth
    • A valuable clinical and research tool

    Thank You! Any Questions?


    [email protected] X/Twitter: @nicugrowth_app

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