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Using the new UK-WHO growth charts with new born babies and preterm infants

Presentation F

Adapted from training materials of the Royal College of Paediatrics and Child Health [RCPCH]

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Plotting in the first 2 weeks

• Birth weight centiles based on UK 1990 data

• WHO charts start from 2 weeks

• No centile lines between birth (0 weeks) and 2 weeks

• Allows for weight loss and regain before week 2

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Plotting in thefirst 2 weeks

Plot all term infants (37 or more weeks)

at age 0 weeks

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Weighing in the neonatal period• Weigh within the first week as part of the

assessment of feeding…

– Early weighing does not discourage breast-feeders and may help identify problems in a timely manner

– Weigh thereafter as needed

• Assess early weight gain relevant to birthweight…

– Most babies lose some weight after birth– Recovery of birthweight indicates that feeding is

effective and that the child is well– If large weight loss or still below birthweight at 2

weeks, calculate % weight loss

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Calculating Percentage Weight Loss

It is good practice to calculate percentage weight loss on order to check exactly how much weight an infant has lost

Weight Change

= current weight – birth weight

e.g. (2.700 kg – 2.900kg )=-200kg A fall of 200g.in weight

Percentage Weight Loss

= Weight loss ÷ Birth weight x 100%

e.g.(200 ÷ 2.900g) x 100 = 6.9% A weight loss of 6.9%

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Assessing neonatal weight loss

• Most babies lose some weight after birth– 80% will have regained this by 2 weeks of age

• Fewer than 5% of babies lose more than 10%– Only 1 in 50 are 10% lighter at 2 weeks

• A baby 10% or more below birth weight at or before 2 weeks needs careful assessment for:– feeding problems– unrecognised illness

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Summary

• Plot birthweight at age 0 for all infants born 37 + weeks,

• Weigh within first week as part of the assessment of feeding as early weighing...– does not discourage breast-feeders– allows timely identification of feeding problems

• Assess early weight gain relative to birthweight…– Recovery of birthweight by 2 weeks suggests that

feeding is effective and that the child is well– If large weight loss at any time, or still below

birthweight at 2 weeks, calculate % weight loss• 10% weight loss needs careful assessment

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Plotting pre-term infants using the new UK-WHO growth charts

Plotting Per-term infants

Adapted from training materials of the Royal College of Paediatrics and Child Health [RCPCH]

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Background

• A child born before 37 weeks completed weeks gestation is preterm

• The WHO standard does not include data for preterm babies

• The “preterm” section of the UK/WHO chart has been compiled using UK reference data for size at birth

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Plotting on the preterm section• Use the preterm section of the UK-WHO 0-4 years

chart– For infants born 32-36 weeks gestation– Up till EDD (term) plus 2 weeks

• Use the Neonatal and Infant Close Monitoring (NICM) low birthweight chart – For infants<32 weeks– For any neonate needing close monitoring

• After EDD plus two weeks move over to 0-1 chart with gestation age correction

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What is Gestational Correction?

• Gestational correction adjusts the plot of a measurement to account for the number of weeks a baby was born early

• Number of weeks early = 40 weeks minus gestational age

• Should not be used for term infants (37 weeks+)• Should be continued till

– 1 year for infants born 32-36 weeks– 2 years for infants born before 32 weeks

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Plotting with gestational correction

Plot measurement at actual age

Draw a line back the number of

weeks the baby was early and mark this with a arrow.

The arrow point should show the gestationally corrected centile

When measuring frequently, plot all actual or corrected age and use arrow for a section to avoid crowding on page.

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Transfer preterm to infancy section

Born 6 weeks preterm plot on preterm section of chart until 43 weeks (EDD +2)

Then plot on infancy section using gestational correction

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Weight

faltering in

infant born at

34 weeks?

or are the

plots in the

wrong place?

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Failure to allow for gestation

• Need to be clear which plots are adjusted for gestation

• Other users may not adjust

• Could place the child at risk

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Summary• Preterm = birth before 37 weeks completed

weeks gestation• Infants born before 32 weeks, plus any sick

neonate, should be plotted on Neonatal and Infant Close Monitoring (NICM) low birth weight chart

• Well preterm infants born after 32 weeks should be plotted in preterm section until 42 weeks gestation

• Then plot on the 0-1 year chart using arrow drawn back method of gestational correction

• Continue gestational correction till 12-24 months

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Plotting term infants: Activity 1 Answers

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Plotting term infants: Activities 2 to 4 Answers

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Plotting term infants: Activities 2 to 4 Answers