• Routine accurate measurement and documentation of weight, length and occipitofrontal circumference (OFC)

• To detect any abnormal growth patterns, including faltering growth

• Neonatal nutrition and resulting postnatal growth are major determinants in the short- and long-term outcomes of preterm babies
• Optimal postnatal nutrition and growth associated with more positive later health and developmental outcomes
• Preterm babies who demonstrate low weight gain in the early years have a higher probability of poorer cognitive developmental outcomes, while those with excessive weight gain have an increased risk of childhood and adult obesity, cardiovascular disease and diabetes
• Plot measurements of weight, length and OFC on appropriate and sex specific growth chart to allow assessment of adequate velocity and proportionate growth
  
  • measurements to be undertaken by qualified member of staff trained in the use of the equipment in presence of parents as per FICare plan
• Involve parents/carers with all growth monitoring procedures 

Frequency

• Weigh all babies on admission to NNU 
• Weigh at least 3 times/week while an inpatient
• Plan weighing schedules taking into account developmental care needs
• If baby too unstable to be weighed for >5 consecutive days, and incubator does not have inbuilt scales:
  
  • calculate weight-for-age from appropriate growth chart 
  • use as working weight (assuming baby is following their previous centile line) to ensure adequate fluids, enteral and parenteral nutrition, and drugs administered 
  • reinstate routine weighing once baby stable
• If baby unstable, assess for fluid overload – impacts on accuracy of weighing for growth monitoring

Equipment

• Class III electronic baby scales or incubator with inbuilt scales (if available) – accurate to 5 g 
• All scales to be: 
  
  • tested and recalibrated annually
  • cleaned between patients in accordance with local infection control policy

Method

• Wash and sanitise hands and equipment as per local infection prevention policy
• Weigh baby in nappy only (no clothing)
• Use swaddled weighing for optimal developmental care
  
  • wrap baby in a warm, pre-weighed blanket deduct weight of swaddle blanket
  • no need to deduct weights of medical equipment (e.g. NGT, CVL, cannula etc.)
• Record actual calculated weight on unit documentation/BadgerNet
  
  • ≤999 g: to nearest 5 g  
  • ≥1 kg: to nearest 10 g
• Plot weight at least weekly on BadgerNet or sex appropriate WHO Neonatal and infant close monitoring growth chart [see chart or refer to RCPCH website (www.growthcharts.rcpch.ac.uk) for instructions on use]
• In babies <2 kg: calculate velocity of weight gain in g/kg/day at least weekly 
  
  • aim 15–20 g/kg/day as steady weight gain for babies 23–36 weeks’ GA at birth 
• If parent is present baby will benefit from skin-to-skin contact before returning to incubator/cot 

Frequency

• Measure all babies on admission to NNU and weekly thereafter coinciding with a weigh day whilst inpatient

Equipment

• ≤33 weeks or <45 cm: use Leicester Incubator Measure 
• ≥33⁺¹ weeks: use length mat 
• Requires 2 people to obtain an accurate measurement (1 may be parent/carer alongside trained member of staff)

Method

• Wash and sanitise hands and equipment as per local infection prevention policy
• Measure baby supine, lying flat, ensuring no clothing or nests restrict extension
• Remove hat or ventilation/non-invasive ventilation hat ties 
• Preterm babies do not need to be naked
• Term babies to be measured naked, no nappy
• Operator 1: place fixed headpiece against crown of baby’s head, stabilising head by gently cupping palms of hands over baby’s ears
• Operator 2: gently place palm of hand over baby’s knee encouraging extension, sliding base plate up to meet the soles of the feet 
• If baby settled and relaxed, take 3 measurements to ensure consistency
• Record length in cm to nearest 0.1 cm  
• Plot length weekly on BadgerNet or sex appropriate WHO Neonatal and infant close monitoring growth chart [see chart or refer to RCPCH website (www.growthcharts.rcpch.ac.uk) for instructions on use] 
• Calculate velocity of linear growth in cm/week monthly
  
  • aim 1.4 cm/week as steady linear growth in preterm baby

[heading]Frequency[/heading2]

• Measure on admission to NNU and weekly thereafter coinciding with a weigh day while inpatient

Equipment

• Disposable paper tape measure

Method

• Wash and sanitise hands as per local infection prevention policy
• Remove or fold down hat or head gear that may obstruct measurement
• Using disposable paper tape measure, take measurement at the widest part of baby’s head
  • above ears, midway between eyebrows and hairline at the front, and to the occipital prominence at the back of the head 
• Record in cm to nearest 0.1 cm on NNU documentation
• Plot OFC weekly on BadgerNet or sex appropriate WHO Neonatal and infant close monitoring growth chart [see chart or refer to RCPCH website (www.growthcharts.rcpch.ac.uk) for instructions on use]
• Calculate velocity of OFC growth in cm/week monthly
  
  • aim 0.9 cm/week as steady OFC growth in preterm baby

• Growth charts are a tool to monitor growth and growth velocity 
• All babies lose weight after birth and may cross down 2–3 marked centiles with an expectation they will return to their birth centile
• Stable preterm babies with adequate nutritional intake are expected to grow along/parallel to centiles from aged 2–3 weeks 
• Babies with slow growth velocity (less than expected over 1 week period), growth failure or whose growth parameters continue to fall across centiles into week 3 of life, to have a full nutritional review
  
  • include calculation of any parenteral nutrition received (not only prescribed), and enteral nutrition intake
• If combined nutritional intake falls short of recommended requirements: optimise nutritional intake (see Nutrition and enteral feeding guideline)
  
  • if growth remains suboptimal: see Nutrition and enteral feeding guideline - Inadequate growth 
• If baby exhibiting suboptimal growth: refer to NNU nutrition team or neonatal/paediatric dietitian 

• Transfer key information regarding growth to Personal Child Health Record (PCHR) or Red Book

• Must include birth and discharge weight, length and OFC