Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Growth management in preterm infants

Ian J Griffin, MB ChB
Section Editors
Steven A Abrams, MD
Kathleen J Motil, MD, PhD
Deputy Editor
Melanie S Kim, MD


Growth impairment during early infancy, a period of substantial cellular hyperplasia and hypertrophy, can have permanent detrimental effects. Abnormalities in growth during this time period may persist into adulthood, especially in patients who were preterm infants. This was illustrated in a report of very low birth weight (VLBW, <1500 g) infants who were twice as likely to have a height less than the third percentile at 20 years of age than that of normal birth weight (BW) controls (10 versus 5 percent) [1].

Preterm infants are at risk for poor growth while in the neonatal intensive care unit (NICU) and after discharge from the NICU. They must be closely monitored and may require interventions to promote better growth.

Growth in the preterm infant, including monitoring of growth and managing growth impairment while in the NICU and after discharge, will be discussed here. Enteral and parenteral nutrition for preterm infants are discussed separately. (See "Approach to enteral nutrition in the premature infant" and "Parenteral nutrition in premature infants".)


Normative growth data are available for healthy term infants. However, data are limited for preterm infants during both hospitalization and after discharge. (See "Normal growth patterns in infants and prepubertal children", section on 'Evaluation of growth'.)

Term infants — Normative data are available for intrauterine growth in the last trimester and during infancy [2,3]:

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Oct 2017. | This topic last updated: Jun 06, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Hack M, Flannery DJ, Schluchter M, et al. Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med 2002; 346:149.
  2. Costarino AT Jr, Baumgart S. Water as Nutrition. In: Nutritional Needs of the Preterm Infant: Scientific Basis and Practical Guidelines, Tsang RC, et al (Eds), William and Wilkins, Baltimore 1992.
  3. Babson SG. Growth of low-birth-weight infants. J Pediatr 1970; 77:11.
  4. Ehrenkranz RA, Younes N, Lemons JA, et al. Longitudinal growth of hospitalized very low birth weight infants. Pediatrics 1999; 104:280.
  5. Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics 1966; 37:403.
  6. Lucas A, Gore SM, Cole TJ, et al. Multicentre trial on feeding low birthweight infants: effects of diet on early growth. Arch Dis Child 1984; 59:722.
  7. Griffin IJ. Nutritional assessment in preterm infants. Nestle Nutr Workshop Ser Pediatr Program 2007; 59:177.
  8. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13:59.
  9. Bertino E, Spada E, Occhi L, et al. Neonatal anthropometric charts: the Italian neonatal study compared with other European studies. J Pediatr Gastroenterol Nutr 2010; 51:353.
  10. Olsen IE, Groveman SA, Lawson ML, et al. New intrauterine growth curves based on United States data. Pediatrics 2010; 125:e214.
  11. Fenton TR, Nasser R, Eliasziw M, et al. Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term infant. BMC Pediatr 2013; 13:92.
  12. Villar J, Giuliani F, Fenton TR, et al. INTERGROWTH-21st very preterm size at birth reference charts. Lancet 2016; 387:844.
  13. Villar J, Giuliani F, Bhutta ZA, et al. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21(st) Project. Lancet Glob Health 2015; 3:e681.
  14. Sankilampi U. One size may not fit all when it comes to growth references for preterm infants. Acta Paediatr 2016; 105:228.
  15. Boghossian NS, Geraci M, Edwards EM, et al. Anthropometric Charts for Infants Born Between 22 and 29 Weeks' Gestation. Pediatrics 2016; 138.
  16. Cooke RJ, Embleton ND. Feeding issues in preterm infants. Arch Dis Child Fetal Neonatal Ed 2000; 83:F215.
  17. Embleton NE, Pang N, Cooke RJ. Postnatal malnutrition and growth retardation: an inevitable consequence of current recommendations in preterm infants? Pediatrics 2001; 107:270.
  18. Guilfoy VM, Wright-Coltart S, Leitch CA, Denne SC. Energy expenditure in extremely low birth weight infants near time of hospital discharge. J Pediatr 2008; 153:612.
  19. Horbar JD, Ehrenkranz RA, Badger GJ, et al. Weight Growth Velocity and Postnatal Growth Failure in Infants 501 to 1500 Grams: 2000-2013. Pediatrics 2015; 136:e84.
  20. Griffin IJ, Tancredi DJ, Bertino E, et al. Postnatal growth failure in very low birthweight infants born between 2005 and 2012. Arch Dis Child Fetal Neonatal Ed 2016; 101:F50.
  21. Wells N, Stokes TA, Ottolini K, et al. Anthropometric trends from 1997 to 2012 in infants born at ⩽28 weeks' gestation or less. J Perinatol 2017; 37:521.
  22. Cooke RJ, Griffin IJ, McCormick K, et al. Feeding preterm infants after hospital discharge: effect of dietary manipulation on nutrient intake and growth. Pediatr Res 1998; 43:355.
  23. Puckett B, Grover VK, Holt T, Sankaran K. Cue-based feeding for preterm infants: a prospective trial. Am J Perinatol 2008; 25:623.
  24. Newland L, L'huillier MW, Petrey B. Implementation of cue-based feeding in a level III NICU. Neonatal Netw 2013; 32:132.
  25. Greer FR. Post-discharge nutrition: what does the evidence support? Semin Perinatol 2007; 31:89.
  26. Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr 2003; 3:13.
  27. Fenton TR, Sauve RS. Using the LMS method to calculate z-scores for the Fenton preterm infant growth chart. Eur J Clin Nutr 2007; 61:1380.
  28. Manser JI. Growth in the high-risk infant. Clin Perinatol 1984; 11:19.
  29. Hack M, Breslau N, Weissman B, et al. Effect of very low birth weight and subnormal head size on cognitive abilities at school age. N Engl J Med 1991; 325:231.
  30. Carver JD. Nutrition for preterm infants after hospital discharge. Adv Pediatr 2005; 52:23.
  31. Griffin IJ, Cooke RJ. Nutrition of preterm infants after hospital discharge. J Pediatr Gastroenterol Nutr 2007; 45 Suppl 3:S195.
  32. Young L, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Cochrane Database Syst Rev 2016; 12:CD004696.
  33. Griffin IJ. Postdischarge nutrition for high risk neonates. Clin Perinatol 2002; 29:327.
  34. Abrams SA, Schanler RJ, Garza C. Bone mineralization in former very low birth weight infants fed either human milk or commercial formula. J Pediatr 1988; 112:956.
  35. Schanler RJ, Burns PA, Abrams SA, Garza C. Bone mineralization outcomes in human milk-fed preterm infants. Pediatr Res 1992; 31:583.
  36. Young L, Embleton ND, McCormick FM, McGuire W. Multinutrient fortification of human breast milk for preterm infants following hospital discharge. Cochrane Database Syst Rev 2013; :CD004866.
  37. O'Connor DL, Khan S, Weishuhn K, et al. Growth and nutrient intakes of human milk-fed preterm infants provided with extra energy and nutrients after hospital discharge. Pediatrics 2008; 121:766.
  38. Gewolb IH, Bosma JF, Taciak VL, Vice FL. Abnormal developmental patterns of suck and swallow rhythms during feeding in preterm infants with bronchopulmonary dysplasia. Dev Med Child Neurol 2001; 43:454.
  39. Motion S, Northstone K, Emond A, et al. Early feeding problems in children with cerebral palsy: weight and neurodevelopmental outcomes. Dev Med Child Neurol 2002; 44:40.
  40. Ortenstrand A, Waldenström U, Winbladh B. Early discharge of preterm infants needing limited special care, followed by domiciliary nursing care. Acta Paediatr 1999; 88:1024.
  41. Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database Syst Rev 2015; :CD003743.
  42. Johnson DB, Cheney C, Monsen ER. Nutrition and feeding in infants with bronchopulmonary dysplasia after initial hospital discharge: risk factors for growth failure. J Am Diet Assoc 1998; 98:649.
  43. Wilson DC, McClure G. Energy requirements in sick preterm babies. Acta Paediatr Suppl 1994; 405:60.
  44. Denne SC. Energy expenditure in infants with pulmonary insufficiency: is there evidence for increased energy needs? J Nutr 2001; 131:935S.
  45. Boehm G, Bierbach U, Moro G, Minoli I. Limited fat digestion in infants with bronchopulmonary dysplasia. J Pediatr Gastroenterol Nutr 1996; 22:161.
  46. Chye JK, Gray PH. Rehospitalization and growth of infants with bronchopulmonary dysplasia: a matched control study. J Paediatr Child Health 1995; 31:105.
  47. Mizuno K, Nishida Y, Taki M, et al. Infants with bronchopulmonary dysplasia suckle with weak pressures to maintain breathing during feeding. Pediatrics 2007; 120:e1035.
  48. Leitch CA, Ahlrichs J, Karn C, Denne SC. Energy expenditure and energy intake during dexamethasone therapy for chronic lung disease. Pediatr Res 1999; 46:109.
  49. Brunton JA, Saigal S, Atkinson SA. Growth and body composition in infants with bronchopulmonary dysplasia up to 3 months corrected age: a randomized trial of a high-energy nutrient-enriched formula fed after hospital discharge. J Pediatr 1998; 133:340.
  50. Atkinson SA. Special nutritional needs of infants for prevention of and recovery from bronchopulmonary dysplasia. J Nutr 2001; 131:942S.
  51. Roberts G, Cheong J, Opie G, et al. Growth of extremely preterm survivors from birth to 18 years of age compared with term controls. Pediatrics 2013; 131:e439.
  52. Horemuzova E, Amark P, Jacobson L, et al. Growth charts and long-term sequelae in extreme preterm infants--from full-term age to 10 years. Acta Paediatr 2014; 103:38.
  53. Belfort MB, Rifas-Shiman SL, Sullivan T, et al. Infant growth before and after term: effects on neurodevelopment in preterm infants. Pediatrics 2011; 128:e899.