Observational studyPloS one2019
Z-score differences based on cross-sectional growth charts do not reflect the growth rate of very low birth weight infants.
Observational study in PloS one, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 35 citations in OpenAlex.
- Fenton Third-Generation Growth Charts of Preterm Infants Without Abnormal Fetal Growth: A Systematic Review and Meta-Analysis.Paediatric and perinatal epidemiology · 2025Pooled it
- Defining growth faltering and malnutrition among very preterm infants in a neonatal intensive care unit.Journal of perinatology : official journal of the California Perinatal Association · 2026Article
- Biological and environmental contributions to the growth rates of preterm children aged 0-2 years: a birth cohort study.Frontiers in public health · 2026Article
- Clinical Associations with Lenticulostriatal Vasculopathy (LSV) at Birth: A Case-Control Study.Children (Basel, Switzerland) · 2025Article
- Associations Between Gestational Residential Radon Exposure and Term Low Birthweight in Connecticut, USA.Epidemiology (Cambridge, Mass.) · 2024Article
- Infant BMI trajectories as early risk markers of poor psychosocial health in preadolescence.BMC public health · 2024Article
- Mortality and extrauterine growth restriction of necrotizing enterocolitis in very preterm infants with heart disease: a multi-center cohort study.European journal of pediatrics · 2024Observational
- Article
- Comment on Brinkis et al. Nutrient Intake with Early Progressive Enteral Feeding and Growth of Very Low-Birth-Weight Newborns.Nutrients · 2022Article
- Nonlinear relationship between early postnatal weight gain velocity and neurodevelopmental outcomes in very-low birth weight preterm infants: A secondary analysis based on a published prospective cohort study.Frontiers in pediatrics · 2022Article
- Comparison of growth curves in very low birth weight preterm infants after hospital discharge.European journal of pediatrics · 2022Article
- Poor postnatal weight growth is a late finding after sepsis in very preterm infants.Archives of disease in childhood. Fetal and neonatal edition · 2021Article
- Article
- Factors in Early Feeding Practices That May Influence Growth and the Challenges that Arise in Growth Outcomes Research.Nutrients · 2020Observational
- Incidence and associated factors of extrauterine growth restriction (EUGR) in preterm infants, a cross-sectional study in selected NICUs in Ethiopia.BMJ paediatrics open · 2020Article
- Review
Corrections and comments
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Authors and funding
8 authors at 6 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo test whether the assessment of growth in very low birth weight infants during the hospital stay using z-score differences (Zdiff) is confounded by gestational age (GA), birth weight percentiles (BW%ile), and length of the observation period (LOP). We hypothesize that Zdiff calculated from growth charts based on birth weight data introduces a systematic statistical error leading to falsely classified growth as restricted in infants growing similarly to the 50th percentile.
methodsThis observational study included 6,926 VLBW infants from the German Neonatal Network (2009 to 2015). Inclusion criterion was discharge between 37 and 41 weeks postmenstrual age. For each infant, Zdiff, weight gain velocity, and reference growth rate (50th percentile Fenton) from birth to discharge were calculated. To account for gestational age dependent growth rates, assessment of growth was standardized calculating the weight gain ratio (WGR) = weight gain velocity/reference growth rate. The primary outcome is the variation of the Zdiff-to-WGR relationship.
resultsZdiff and WGR showed a weak agreement with a Zdiff of -0.74 (-1.03, -0.37) at the reference growth rate of the 50th percentile (WGR = 1). A significant proportion (n = 1,585; 23%) of infants with negative Zdiff had weight gain velocity above the 50th percentile's growth rate. Zdiff to WGR relation was significantly affected by the interaction of GA x BW%ile x LOP.
conclusionThis study supports the hypothesis that Zdiff, which are calculated using birth weights, are confounded by skewed reference data and can lead to misinterpretation of growth rates. New concepts like individualized growth trajectories may have the potential to overcome this limitation.
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