Review Article| Volume 49, ISSUE 2, P295-311, June 2022

Neonatal and Preterm Infant Growth Assessment

  • Tanis R. Fenton
    Corresponding author. Community Health Sciences, O’Brien Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Nutrition Services, Alberta Health Services, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
    Community Health Sciences, O’Brien Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada

    Nutrition Services, Alberta Health Services, Calgary, Canada
    Search for articles by this author
  • Susan Dai
    Nutrition Services, Alberta Health Services, Calgary, Canada

    Alberta Children's Hospital Neonatal Follow-up Clinic, Alberta Health Services, 28 Oki Drive NW, Calgary, Alberta T3B 6A8, Canada
    Search for articles by this author
  • Vikki Lalari
    Neonatal Intensive Care Unit, Neonatal Program, BC Women’s Hospital and Health Centre, 4500 Oak Street, Vancouver, British Columbia V6H 3N, Canada
    Search for articles by this author
  • Belal Alshaikh
    Community Health Sciences, O’Brien Institute of Public Health, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4Z6, Canada

    Pediatrics, Cumming School of Medicine, University of Calgary, Room C211, Foothills Medical Centre, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada
    Search for articles by this author


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribers receive full online access to your subscription and archive of back issues up to and including 2002.

      Content published before 2002 is available via pay-per-view purchase only.


      Subscribe to Clinics in Perinatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Fenton T.R.
        • Nasser R.
        • Creighton D.
        • et al.
        Weight, length, and head circumference at 36 weeks are not predictive of later cognitive impairment in very preterm infants.
        J Perinatol. 2020; 41: 606-614
      1. World Health Organization. Growth standards.
        (Available at:) (Accessed May 16, 2021)
        • Fenton T.R.
        • McMillan D.D.
        • Sauve R.S.
        Nutrition and growth analysis of very low birth weight infants.
        Pediatrics. 1990; 86: 378-383
        • Embleton N.E.
        • Pang N.
        • Cooke R.J.
        Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants?.
        Pediatrics. 2001; 107: 270-273
        • Fenton T.R.
        • Cormack B.
        • Goldberg D.
        • et al.
        Extrauterine growth restriction” and “postnatal growth failure” are misnomers for preterm infants.
        J Perinatol. 2020; 40: 704-714
        • American Academy Pediatrics Committee on Nutrition
        Nutritional needs of preterm infants.
        in: Kleinman R.E. Greer F.R. Pediatric nutrition handbook. 8th edition. Itasca Il, 2020
        • Agostoni C.
        • Buonocore G.
        • Carnielli V.P.
        • et al.
        Enteral nutrient supply for preterm infants: commentary from the European Society of Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition.
        J Pediatr Gastroenterol Nutr. 2010; 50: 85-91
        • Villar J.
        • Giuliani F.
        • Barros F.
        • et al.
        Monitoring the postnatal growth of preterm infants: a paradigm change. Basel(Switserland):.
        Pediatrics. 2018; 141: e20172467
        • Villar J.
        • Giuliani F.
        • Bhutta Z.A.
        • et al.
        Postnatal growth standards for preterm infants: the preterm postnatal follow-up study of the INTERGROWTH-21(st) project.
        Lancet Glob Heal. 2015; 3: e681-e691
        • American Academy Pediatrics Committee on Nutrition
        Assessment of Nutritional status.
        in: Kleinman R.E. Greer F.R.E. Pediatric Nutrition Handbook. 8th edition. Itasca Il, 2020
        • Franz A.R.
        • Pohlandt F.
        • Bode H.
        • et al.
        Intrauterine, early neonatal, and postdischarge growth and neurodevelopmental outcome at 5.4 years in extremely preterm infants after intensive neonatal nutritional support.
        Pediatrics. 2009; 123: e101-e109
        • Lainwala S.
        • Kosyakova N.
        • Power K.
        • et al.
        Delayed achievement of oral feedings is associated with adverse neurodevelopmental outcomes at 18 to 26 months follow-up in preterm infants.
        Am J Perinatol. 2020; 37
        • Cormack B.E.
        • Jiang Y.
        • Harding J.E.
        • et al.
        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
        • 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. 2021; 41: 650-651
        • Fenton T.R.
        • Kim J.H.
        A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants.
        BMC Pediatr. 2013; 13: 59
        • Olsen I.E.
        • Groveman S.A.
        • Lawson M.L.
        • et al.
        New intrauterine growth curves based on United States data.
        Pediatrics. 2010; 125: e214-e224
        • Goldberg D.L.
        • Becker P.J.
        • Brigham K.
        • et al.
        Identifying malnutrition in preterm and neonatal populations: recommended indicators.
        J Acad Nutr Diet. 2018; 118: 1571-1582
        • Rochow N.
        • Raja P.
        • Liu K.
        • et al.
        Physiological adjustment to postnatal growth trajectories in healthy preterm infants.
        Pediatr Res. 2016; 79: 870-879
        • Fabrizio V.
        • Shabanova V.
        • Taylor S.N.
        Factors in early feeding practices that may influence growth and the challenges that arise in growth outcomes research.
        Nutrients. 2020; 12: 1939
        • Fenton C.J.
        • Elmrayed S.
        • Fenton T.R.
        Growth standards.
        in: 3rd ed. Pediatric nutrition in practice. 124. 2021
        • Foote J.M.
        • Brady L.H.
        • Burke A.L.
        • et al.
        Development of an evidence-based clinical practice guideline on linear growth measurement of children.
        J Pediatr Nurs. 2011; 26: 312-324
        • Fenton T.R.
        • Griffin I.J.
        • Hoyos A.
        • et al.
        Accuracy of preterm infant weight gain velocity calculations vary depending on method used and infant age at time of measurement.
        Pediatr Res. 2019; 85: 650-654
        • Wells N.
        • Stokes T.A.
        • Ottolini K.
        • et al.
        Anthropometric trends from 1997 to 2012 in infants born at ⩽28 weeks’ gestation or less.
        J Perinatol. 2017; 37: 521-526
        • Ehrenkranz R.A.
        • Dusick A.M.
        • Vohr B.R.
        • et al.
        Growth in the neonatal intensive care unit influences neurodevelopmental and growth outcomes of extremely low birth weight infants.
        Pediatrics. 2006; 117: 1253-1261
        • National Academies Press
        Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids.
        • Giannì M.L.
        • Roggero P.
        • Piemontese P.
        • et al.
        Boys who are born preterm show a relative lack of fat-free mass at 5 years of age compared to their peers.
        Acta Paediatr. 2015; 104: e119-e123
        • Forsum E.
        • Flinke E.
        • Olhager E.
        Premature birth was not associated with increased body fatness in four-year-old boys and girls.
        Acta Paediatr. 2020; 109
        • Hack M.
        • Schluchter M.
        • Andreias L.
        • et al.
        Change in prevalence of chronic conditions between childhood and adolescence among extremely low-birth-weight children.
        JAMA. 2011; 306: 394-401
        • Nuysink J.
        • Eijsermans M.J.C.
        • van Haastert I.C.
        • et al.
        Clinical course of asymmetric motor performance and deformational plagiocephaly in very preterm infants.
        J Pediatr. 2013; 163: 658-665
        • Ifflaender S.
        • Rüdiger M.
        • Konstantelos D.
        • et al.
        Prevalence of head deformities in preterm infants at term equivalent age.
        Early Hum Dev. 2013; 89: 1041-1047
        • Olsen I.E.
        • Lawson M.L.
        • Ferguson A.N.
        • et al.
        BMI curves for preterm infants.
        Pediatrics. 2015; 135: e572-e581
        • Lorch S.A.
        The clinical and policy implications of new measures of premature infant growth.
        Pediatrics. 2015; 135: e703-e704
        • Kiger J.R.
        • Taylor S.N.
        • Wagner C.L.
        • et al.
        Preterm infant body composition cannot be accurately determined by weight and length.
        J Neonatal Perinatal Med. 2016; 9: 285-290
        • Hamatschek C.
        • Yousuf E.I.
        • Möllers L.S.
        • et al.
        Fat and fat-free mass of preterm and term infants from birth to six months: a review of current evidence.
        Nutrients. 2020; 12: 288
        • Griffin I.J.
        • Cooke R.J.
        Development of whole body adiposity in preterm infants.
        Early Hum Dev. 2012; 88: S19-S24
        • Fields D.A.
        • Gilchrist J.M.
        • Catalano P.M.
        • et al.
        Longitudinal body composition data in exclusively breast-fed infants: a multicenter study.
        Obesity. 2011; 19: 1887-1891
        • Ramel S.E.
        • Haapala J.
        • Super J.
        • et al.
        Nutrition, illness and body composition in very low birth weight preterm infants: implications for nutritional management and neurocognitive outcomes.
        Nutrients. 2020; 12: 145
        • Fenton T.R.
        • Elmrayed S.
        • Alshaikh B.
        Nutrition, growth and long-term outcomes.
        in: Koletzko B. Cheah F. Domellöf M. Nutr Care Preterm Infants, Scientific Basis Pract Guidel. 122. World Rev Nutr Diet, 2021: 12-31 (Available at)
        • McCain G.C.
        • Gartside P.S.
        • Greenberg J.M.
        • et al.
        A feeding protocol for healthy preterm infants that shortens time to oral feeding.
        J Pediatr. 2001; 139: 374-379
        • Wellington A.
        • Perlman J.M.
        Infant-driven feeding in premature infants: a quality improvement project.
        Arch Dis Child - Fetal Neonatal Ed. 2015; 100: F495-F500
        • Dalgleish S.R.
        • Kostecky L.L.
        • Blachly N.
        Eating in “SINC”: safe individualized nipple-feeding competence, a quality improvement project to explore infant-driven oral feeding for very premature infants requiring noninvasive respiratory support.
        Neonatal Netw. 2016; 35: 217-227
        • Celen R.
        • Arslan F.T.
        • Soylu H.
        Effect of SINC feeding protocol on weight gain, transition to oral feeding, and the length of hospitalization in preterm infants: a randomized controlled trial.
        JPEN J Parenter Enteral Nutr. 2021; 45
      2. Satter E. The ellyn satter.
        (Available at:) (Accessed May 31, 2021)
        • Fenton T.R.
        • Chan H.T.
        • Madhu A.
        • et al.
        Preterm infant growth velocity calculations: a systematic review.
        Pediatrics. 2017; 139: e20162045
        • Cormack B.E.
        • Embleton N.D.
        • van Goudoever J.B.
        • et al.
        Comparing apples with apples: it is time for standardized reporting of neonatal nutrition and growth studies.
        Pediatr Res. 2016; 79: 810-820
        • Belfort M.B.
        • Gillman M.W.
        • Buka S.L.
        • et al.
        Preterm infant linear growth and adiposity gain: trade-offs for later weight status and intelligence quotient.
        J Pediatr. 2013; 163 (e2): 1564-1569
        • Belfort M.B.
        • Rifas-Shiman S.L.
        • Sullivan T.
        • et al.
        Infant growth before and after term: effects on neurodevelopment in preterm infants.
        Pediatrics. 2011; 128: e899-e906
        • Fenton T.R.
        • Senterre T.
        • Griffin I.J.
        Time interval for preterm infant weight gain velocity calculation precision.
        Arch Dis Child - Fetal Neonatal Ed. 2019; 104: F218-F219
      3. Molony CL, Growth trajectory of preterm small-for-gestational-age neonates, J Matern Fetal Neonatal Med, 2021, PMID: 34503371,, In preparation.