Ex-premature infant

  • Amy was born at 32 weeks gestation measuring 38 cm and weighing 1420g.  She remained in hospital until 8 weeks of age. Since discharge she has been weighed and measured regularly (see table below).   She is now 10 months old and her parents are concerned that she is not growing well as she is much smaller than children of similar age.  They believe that a healthy weight for Amy at 10 months of age is 8.5 kg.

    Age

    Corrected Age

    Weight (kg)

    Length (cm)

    3 months

    1 month

    3.00 

    50.5

    5 months

    3 months

    4.80

    55.0

    7 ½ month s

    5 ½ months

    5.50

    61.5

    10 months

    8 months

    6.50

    64.0


    Case study questions and activities

    1. Plot  Amy's growth (weight for age and length for age) on the WHO growth charts. 

    case1_c_length_girls.gif

    case1_c_length_girls.gif

  • 2. How would you describe Amy’s growth pattern?

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    A: When Amy’s age is corrected to allow for her prematurity then her weight and length are both tracking around the 3rd Percentile.

    3. How would you interpret Amy’s growth?

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    She appears to be growing well; she is maintaining her growth around the 3rd percentile for corrected age.  Both weight and length are on the same percentiles indicating that she is growing in proportion. 

    4. What concepts will you include in your discussion with Amy's parents? What additional information would you take into consideration when discussing Amy's growth with her parents and deciding on the future monitoring of her growth? Do you share their parents concerns?

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    Amy’s parents can be reassured that she is growing well.  Points to include in your discussion with her parents include but are not limited to

    • Concept of corrected age. 
    • Range in normal growth i.e. concept of percentiles.   It is expected that 3% of children will grow at or below the 3rd percentile.

    Understanding these concept will highlight that it is not appropriate to compare Amy’s growth to a 10month old child on the 50th percentile
    Additional considerations could include but are not limited to

    • General health and development
    • Feeding practices. Feeding development
    • Parental height
    • Social history

    5. What recommendations would you make regarding future monitoring?

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    Provided there are no concerns regarding her general health and development, feeding practices or social history then she could continue routine monitoring as per the recommended schedule for her State or Territory.