早产儿生长曲线图

A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants

Tanis R Fenton 1,2*and Jae H Kim 3

Background

The expected growth of the fetus describes the fastest human growth,increasing weight over six-fold between 22and 40weeks.Preterm infants,who are born during this rapid growth phase,rely on health professionals to assess their growth and provide appropriate nutrition and medical care.

In 2006,the World Health Organization (WHO)published their multicentre growth reference study,which is considered superior [1]to previous growth surveys since the measured infants were selected from communities in which economics were not likely to limit growth,among culturally diverse non-smoking mothers who planned to breastfeed [2].Weekly longitudinal measures of the infants were made by trained data collection teams during the first 2years of this study [3].These WHO growth charts,although recommended for preterm infants after term age [4],begin at term and so do not inform preterm infant growth assessments younger than this age.

*Correspondence:tfenton@ucalgary.ca 1

Alberta Children ’s Hospital Research Institute,The University of Calgary,Calgary,AB,Canada 2

Department of Community Health Sciences,The University of Calgary,3280Hospital Drive NW,Calgary,AB,Canada

Full list of author information is available at the end of the

article

?2013Fenton and Kim;licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://www.wendangku.net/doc/159968186.html,/licenses/by/2.0),which permits unrestricted use,distribution,and reproduction in any medium,provided the original work is properly cited.

Fenton and Kim BMC Pediatrics 2013,13:59

https://www.wendangku.net/doc/159968186.html,/1471-2431/13/59

Optimum growth of preterm infants is considered to be equivalent to intrauterine rates[5-7]since a superior growth standard has not been defined.Perhaps the best estimate of fetal growth may be obtained from large population-based studies,conducted in developed coun-tries[8],where constraints on fetal growth may be less frequent.

A recent multicentre study by our group(the Preterm Multicentre Growth(PreM Growth)Study)revealed that although the pattern of preterm infant growth was gener-ally consistent with intrauterine growth,the biggest devi-ation in weight gain velocity between the preterm infants and the fetus and infant was just before term,between37 and40weeks(Fenton TR,Nasser R,Eliasziw M,Kim JH, Bilan D,Sauve R:Validating the weight gain of preterm in-fants between the reference growth curve of the fetus and the term infant,The Preterm Infant Multicentre Growth Study.Submitted BMC Ped2012).Rather than demon-strating the slowing growth velocity of the term infant during the weeks just before term,the preterm infants had superior,close to linear,growth at this age.This finding has been observed by others as well[9-11].Therefore, there is evidence to support a smooth transition on growth charts between late fetal and early infant ages. Several previous growth charts based on size at birth presented their data as completed age,which affects the interpretation and use of a growth chart[12].The use of completed weeks when plotting a growth chart requires all the measurements to be plotted on the whole week vertical axes.However,the use of completed weeks in a neonatal unit may not be intuitive,as nursery staff and parents think of infants as their exact age,and not age truncated to previous whole weeks.The advent of computers in health care,for clinical care and health recording,allow the use of the computer to plot growth charts,daily and with accuracy.It would make sense to support plotting daily measurements continuously by shifting the data collected as completed weeks to the midpoint of the next week to remove the truncation of the data collection as completed weeks.

The objectives of this study were to revise the2003 Fenton Preterm Growth Chart,specifically to:a)use more recent data on size at birth based on an inclusion criteria, b)harmonize the preterm growth chart with the new WHO Growth Standard,c)to smooth the data between the preterm and WHO estimates while maintaining integrity with the data from22to36and at50weeks, d)to derive sex specific growth curves,and to e)re-scale the chart x-axis to actual age rather than completed weeks,to support growth monitoring.

Methods

To revise the growth chart,thorough literature searches were performed to find published and unpublished population-based preterm size at birth(weight,length, and/or head circumference)references.The inclusion criteria,defined a priori,designed to minimize bias by restriction[13],were to locate population-based studies of preterm fetal growth,from developed countries with: a)Corrected gestational ages through fetal ultrasound

and/or infant assessment and/or statistical

correction;

b)Data percentiles at24weeks gestational age or

lower;

c)Sample of at least25,000babies,with more than500

infants aged less than30weeks;

d)Separate data on females and males;

e)Data available numerically in published form or

from authors,

f)Data collected within the past25years(1987to2012)

to account for any secular trends.

A.Data selection and combination

Major bibliographic databases were searched:MEDLINE (using PubMed)and CINHAL,by both authors back to year1987(given our25year limit),with no language restrictions,and foreign articles were translated.The following search terms as medical subject headings and textwords were used:(“Preterm infant”OR“Premature Birth”[Mesh])OR(“Infant,Premature/classification”[Mesh] OR“Infant,Premature/growth and development”[Mesh] OR“Infant,Premature/statistics and numerical data”[Mesh] OR“Infant,very low birth weight”[Mesh])AND (percentile OR*centile*OR weeks)AND(weight OR head circumference OR length).Grey literature sites including clinical trial websites and Google were searched in February 2012.Reference lists were reviewed for relevant studies.

All of the found data was reported as completed weeks except for the German Perinatal Statistics,which were reported as actual daily weights[14].To combine the datasets,the German data was temporarily converted to completed weeks.A final step converted the meta-analyses to actual age.

https://www.wendangku.net/doc/159968186.html,bine the data to produce weighted intrauterine growth curves for each sex

The located data(3rd,10th,50th,90th,and97th percentiles for weight,head circumference,and length)that met the inclusion criteria were extracted by copying and pasting into spreadsheets.The male and female percentile curves from each included data set for weight,head circumference and length were plotted together so they could be examined visually for heterogeneity(Figures1,2, and3).The data for each gender were combined by using the weekly data for the percentiles:3rd,10th,50th,90th, and97th,weighted by the sample sizes.The combined data was represented by relatively smooth curves.

C.Develop growth monitoring curves

To develop the growth monitoring curves that joined the intrauterine meta-analysis data with the WHO Growth Standard(WHOGS)smoothly,the following cubic spline procedure was used to meet two objectives:a)To maintain integrity with the meta-analysis curves

from22to36weeks.Integrity of the fit was

assumed to be agreement within3%at each week. b)To ensure fit of the data to the WHO values at50

weeks,within0.5%.

Procedure:

1)Cubic splines were used to interpolate smooth

values between selected points(22,25,28,32,34,36 and50weeks).Extra points were manually selected at40,43and46weeks in order to produce

acceptable fit through the underlying data.The

PreM Growth study(Fenton TR,Nasser R,Eliasziw M,Kim JH,Bilan D,Sauve R:Validating the weight gain of preterm infants between the reference

growth curve of the fetus and the term infant,The Preterm Infant Multicentre Growth Study.

Submitted BMC Ped2012)conducted to inform the transition between the preterm and WHO data,was used to inform this step.The Prem Growth Study

found that preterm infants growth in weight

followed approximately a straight line between37

and45weeks,as others have also noted[9-11].

2)LMS values(measures of skew,the median,and the

standard deviation)[15]were computed from the

interpolated cubic splines at weekly intervals.Cole’s

procedures[15]and an iterative least squares method were used to derive the LMS parameters(L=Box-Cox power,M=median,S=coefficient of variation)from

Figure1Boys birthweight centiles(3rd,50th and97th)from the six included studies,along with the boy’s meta-analysis curves (bold).

Figure2Girls head circumference centiles(3rd,50th and97th) centiles from the included studies,along with the girl’s

meta-analysis curves(dotted),and after40weeks,the World Health Organization centiles (dashed).Figure3Girls length centiles(3rd,50th and97th)centiles from the included studies,along with the meta-analysis curves (dotted),and after40weeks,the World Health Organization centiles(dashed).

Table2Number of infants each week from each study

Gestational age Voight,2010Olsen,2010Bertino,2010Kramer,2001Roberts,1999Bonellie,2008 Females Males Females Males Females Males Females Males Females Males Females Males 22188321----80827174--23431560133153381061147995--245757044384512024148156115135120126 257138466037224038184202136180115118 268129687738813558191234188235179172 271073120396610305261188254231284174177 2812761536118712817963287330287361246239 2915161838125415057072299392325397245265 301853221216061992107114390467440571317313 312283295620442460126140461584548743136148 32**300736771651837959978771117193205 33**418650142112401055136812001471239256 34**593672912633492018255320862657374422 35**508269523664183391431434184092644653 36**46907011562665820396487320878810481265 37**43726692129114921730819965161051866020062499 38**57558786352439764751651947478095140446306387 39**597883245295545275068776236884672871869910706 40**55297235567256531107381127371375701415531264414230 *Not reported.

the multicentre meta-analyses for weight,head

circumference and length.The LMS splines were

smoothed slightly while maintaining data integrity as

noted above.

3)The final percentile curves were produced from the

smoothed LMS values.

4)A grid similar to the2003growth chart was used,

but the growth curves were re-scaled along the

x-axis from completed weeks to allow clinicians to

plot infant growth by actual age in weeks,and a

slight modification(scaled to60centimeters instead

of65)was made to the y-axis.

https://www.wendangku.net/doc/159968186.html,pared the revised charts with the2003version The revised growth charts were compared graphically with the original2003Fenton preterm growth chart.To make

the differences in chart values more apparent,the2003 chart data was also shifted to actual weeks for these com-parison figures.

Results

Six large population based surveys[14,16-20]of size at preterm birth from countries Germany,United States, Italy,Australia,Scotland,and Canada were located that met the inclusion criteria(Table1).The literature search identified2436papers,of which2373were discarded as being not relevant or duplicates based on the titles (Figure4).Reviewing reference lists identified another 12studies.Seventy-five studies were examined in detail, however27of these did not meet the date criteria.Among the48studies that met the date of birth criteria,some did not meet the other inclusion criteria for the following reasons:Did not meet the criterion for more than25,000 babies[21-35],no low gestational age infants less than25 weeks[31,36-41],insufficient number less than30weeks [34,42-45],no statistical correction for inaccurate gestational ages[46-48],numerical data not available [49-51],number of infants each week were not available [52],number of infants in the subgroups each week were not available[53],was not population based[54-56],no direct measurements[27],some of the data[57]was also in one of the larger included studies[17].

Included in the meta-analyses were almost four million (3,986,456)infants at birth(34,639less than30weeks) from six studies for weight(Table2),and173,612infants for head circumference,and151,527for length[16,18]. The World Health Organization data measurements were made longitudinally on882infants.

The individual datasets from the literature showed good agreement with each other,especially along the 50th and lower centiles(Figures1,2,and3)and the meta-analysis curves had a close fit with the individual datasets up to36weeks and at50weeks(Figures5,6,7). The final splined weight curves were within3%of the meta-analysis curves for24through36weeks for both gen-ders,except for a3.8%difference for girls at32weeks along the90th centile.None of the length measurements differed by more than1.8%percent between the meta-analysis and the splined curves;all weeks of the head circumference curves were within 1.5%.The meta-analyses for head

Figure5Boys meta-analysis weight curves(dotted)with the final smoothed growth chart curves (dashed).Figure6Boys meta-analysis head circumference curves (dotted)with the final smoothed growth chart curves (dashed). Figure7Boys meta-analysis length curves(dotted)with the final smoothed growth chart curves(dashed).

circumference and length for girls and boys were close enough to normal distributions that normal distributions were used to summarize the data.The measures at50 weeks were within0.5%of the WHOGS values.

Girl and boy charts were prepared(Figure8and9),by shifting the age by0.5weeks to allow plotting by exact age instead of completed weeks.The LMS Parameters [15]were used to develop the exact z-score and percentile calculators for the new growth chart.

In the two graphical comparisons between the revised growth charts,one for each sex,with the2003Fenton preterm growth chart revealed that the curves were quite similar(Figures10and11).Generally the new girls’curves were slightly lower(Figure10)and the new boys’slightly higher(Figure11)for all3parameters(weight,head cir-cumference,and length)than the2003curves.The most dramatic visual and numerical difference between the new charts and the2003chart was the higher shift of the boys’weight curves after40weeks compared to the2003chart, reaching a maximum difference at50weeks of650,580, and740grams at the3rd,50th,and97th percentiles,re-spectively.The second biggest visual difference was the

growth chart for girls.

lower pattern of the girls’length curves below37weeks; the difference in length reached a maximum numerical value of1.7centimeters at24weeks along the97th percentile.

Discussion

We used a strict set of inclusion criteria to include only the best data available to convert fetal and infant size data into fetal-infant growth charts for preterm infants.The re-vised sex-specific actual-age(versus completed weeks) growth charts(Figure9and10),are based on birth size in-formation of almost four million births with confirmed or corrected gestational ages,born in developed countries (See Features of the new growth chart).The revised charts are based on the recommended growth goal for preterm infants,the fetus and the term infant,with smoothing of the disjunction between these datasets,based on the find-ings of our international multicentre validation study (Fenton TR,Nasser R,Eliasziw M,Kim JH,Bilan D,Sauve R:Validating the weight gain of preterm infants between the reference growth curve of the fetus and the term in-fant,The Preterm Infant Multicentre Growth Study. Submitted BMC Ped2012).These charts are consist-ent with the meta-analysis data up to and including

growth chart for boys.

36weeks,thus they can be used for the assessment of size for gestational age for preterm infants under37 weeks of gestational age.This growth chart is likely ap-plicable to preterm infants in both developed and de-veloping countries since the data was selected from developed countries to minimize the influence from cir-cumstances that may not have been ideal to support growth.

Features of the new growth chart

Based on the recommended growth goal for preterm infants:The fetus and the term infant

Girl and boy specific charts

Equivalent to the WHO growth charts at50weeks gestational age(10weeks post term age).

Large preterm birth sample size of4million infants; Recent population based surveys collected between 1991to2007

Data from developed countries including

Germany,Italy,United States,Australia,Scotland, and Canada

Curves are consistent with the data to36weeks, thus can be used to assign size for gestational age up to and including36weeks.

Chart is designed to enable plotting as infants are measured,not as completed weeks.The x axis was

adjusted for this chart so that infant size data can be plotted without age adjustment,i.e.Babies should be plotted as exact ages,that is a baby at253/7weeks

should be plotted along the x axis between25and

26weeks.

Exact z-score and percentile calculator available for download from http://ucalgary.ca/fenton.Data is

available for research upon request.

It may be more intuitive to plot on growth charts using exact ages rather than on the basis of complete

the revised growth chart for girls(solid curves)and the2003Fenton growth chart for length,head circumference,and weight).Both the2003and the revised growth

weeks.Several years ago,the WHO used completed age for growth chart development[12].This recommenda-tion was likely due to the way data had been collected in the past,that is all260/7through266/7week infants were included in the26week completed week category. However,with the use of computers to plot on growth charts comes the potential to more accurately plot mea-surements to the exact day of data collection.Thus the time scale of the horizontal axes of these new growth charts were re-scaled to actual age,for ease of use and un-derstanding.For example,a baby at253/7can be intui-tively plotted between25and26weeks.

Exact z-score and centile calculators for the revised charts are available for download:http://ucalgary.ca/ fenton.Data is available for research upon request.

The data revealed that between22weeks to50weeks post menstrual age,the fetus/infant multiplies its weight tenfold,for example,the girls’median weight increased from a median https://www.wendangku.net/doc/159968186.html,ing a fetal-infant growth chart allows clinicians to compare preterm infants’growth to an estimated reference of the fetus and the term infant.

There was a remarkably close fit of the included preterm surveys for weight,head circumference and length from the6countries,especially at the50th percentile,even though the data came from different countries.

The splining procedures we used have produced a chart that has integrity and good agreement with the original data.Smoothing of the LMS parameters is recommended since minor fluctuations are more likely due to sampling errors rather than physiological events [15].Experts recommend that growth charts be developed based on smoothed L,M and S,to constrain the adjacent curves so that they relate to each other smoothly[15].The World Health Organization set their L parameter to1for head circumference and length,while they maintained the exact L values for infants’weights[58].The data under study here revealed the same effect as the WHO data;we

the revised growth chart for boys(solid curves)and the2003Fenton growth chart for length,head circumference,and weight).Both the2003and the revised growth

found that both head circumference and length were close enough to normal distributions that normal distributions could summarize the data,while the exact L’s were needed to retain the nuances of the weight curves.

The differences between the revised growth charts and the2003Fenton preterm growth chart may reflect improvements since the selected preterm growth references for the new versions are more likely globally representative of fetal and infant growth.Some of the differences between the current charts and the2003version are likely due to the separation into girl and boy charts,since the shifts of the girls’curves tend to be downward and the boys’curves upward.The weight shifts after40weeks were upward for both sexes,due to the higher values for the WHOGS compared to the CDC growth reference[59]at 10weeks post term.

The ideal growth pattern of preterm infants remains undefined.These revised growth charts were developed based on the growth patterns of the fetus(as has been determined by size at birth in the large population stud-ies)and the term infant(based on the WHO Growth Standard)[2].Ultrasound studies and comparison of subgroups of prematurely born infants suggest that the fetal studies,such as those used in this development,may be biased by the premature birth since fetuses who remain in utero likely differ in important ways from babies who are born early[60,61].However,fetal size from these imperfect studies may be the best data available at this point in time for comparing the growth of preterm infants since the alternative,to compare to in utero infants requires extrapolation from ultrasound measurements.To use other premature infants as the growth reference for preterm infants may not be ideal since the ideal growth of preterm infants has not been defined,has been changing over time[62],and is influenced by the nutrition and medical care received after birth[63,64].

Although the WHOGS is considered to be a growth standard,the infants in the population-based surveys of size at birth are more likely representative of the reference populations and were not selected to be healthy.Thus these growth charts are growth references and are not a growth standard.The INTERGROWTH study,currently underway,will rectify this problem,since their purpose is to develop prescriptive standards for fetal and preterm growth[65].

Conclusion

The inclusion of data from a number of developed countries increases the generalizability of the growth chart.The revised preterm growth chart,harmonized with the World Health Organization Growth Standard at50weeks,may support an improved transition of preterm infant growth monitoring to the WHO https://www.wendangku.net/doc/159968186.html,peting interests

The authors declare that they have no competing interests.

Authors’contributions

The author’s responsibilities were as follows:JHK suggested the study,TRF& JHK designed the study and conducted independent literature searches,TRF extracted the data,performed the statistical analysis,and wrote the manuscript.Both of the authors contributed to interpret the findings and writing the manuscript,and both authors read and approved the final manuscript.

Acknowledgements

Many thanks to Patrick Fenton and Misha Eliasziw for statistical assistance, Roseann Nasser,Reg Sauve,Debbie O’Connor,and Sharon Unger for encouragement and advice,and Jayne Thirsk for editing advice.

Author details

1Alberta Children’s Hospital Research Institute,The University of Calgary, Calgary,AB,Canada.2Department of Community Health Sciences,The University of Calgary,3280Hospital Drive NW,Calgary,AB,Canada.3Division of Neonatology,UC San Diego Medical Center,200West Arbor Drive MPF 1140,San Diego,CA,USA.

Received:12October2012Accepted:10April2013

Published:20April2013

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早产儿生长曲线图

A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants Tanis R Fenton 1,2*and Jae H Kim 3 Background The expected growth of the fetus describes the fastest human growth,increasing weight over six-fold between 22and 40weeks.Preterm infants,who are born during this rapid growth phase,rely on health professionals to assess their growth and provide appropriate nutrition and medical care. In 2006,the World Health Organization (WHO)published their multicentre growth reference study,which is considered superior [1]to previous growth surveys since the measured infants were selected from communities in which economics were not likely to limit growth,among culturally diverse non-smoking mothers who planned to breastfeed [2].Weekly longitudinal measures of the infants were made by trained data collection teams during the first 2years of this study [3].These WHO growth charts,although recommended for preterm infants after term age [4],begin at term and so do not inform preterm infant growth assessments younger than this age. *Correspondence:tfenton@ucalgary.ca 1 Alberta Children ’s Hospital Research Institute,The University of Calgary,Calgary,AB,Canada 2 Department of Community Health Sciences,The University of Calgary,3280Hospital Drive NW,Calgary,AB,Canada Full list of author information is available at the end of the article ?2013Fenton and Kim;licensee BioMed Central Ltd.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://www.wendangku.net/doc/159968186.html,/licenses/by/2.0),which permits unrestricted use,distribution,and reproduction in any medium,provided the original work is properly cited. Fenton and Kim BMC Pediatrics 2013,13:59 https://www.wendangku.net/doc/159968186.html,/1471-2431/13/59

最新使用世界卫生组织(WHO)的生长曲线图

使用世界卫生组织（WHO）的生长曲线图 成长不仅是营养的结果，还是遗传因素的结果。种族会影响孩子的成长模式，因此有些国家有他们自己的生长曲线图。不过，世界卫生组织（WHO）的生长曲线图用得最普遍，并被认为是全世界的标准。了解更多关于： ?怎样进行测量 ?怎样将测量应用到生长曲线图中 怎样进行测量 0-24 月龄的孩子进行的典型测量包括： ?头围 ?身长 ?体重 测量应定期进行，以观察可靠的趋势。建议的测量时间间隔包括： ?婴儿(0-12 月龄)：每2 个月 ?幼儿：分别在15, 18, 24 和30 月龄 ? 3 岁以上：每年 点击这里获取详细的测量时间表。 头围 头围是在孩子头部最大部分进行的测量。这种测量通常为0-3 岁的孩子进行。测量时应当使用不可拉伸的卷尺。卷尺通常是可弯曲的金属量尺。测量时，卷尺尽可能紧贴着头部最宽围度缠绕。通常，此部位在前额眉毛上方1-2 指宽到后脑勺最突出的部分。测量三次，取精确到0.1 厘米的最大测量值。

在孩子生命的早期，头围是一种很重要的测量，因为它间接地反映大脑尺寸和发育。几乎所有的大脑发育都在两岁以前，因此绘制的头部生长曲线可以作为幼儿大脑健康的通用指标。 了解关于头围-年龄生长曲线图。 身长 身长是为不足24 月龄的婴儿进行的线性测量。24 到36 月龄的孩子，如果无法独立站立，也可以进行身长测量（代替身高）。 身长是在孩子卧位（平躺）时测量的。测量身长最准确的方法是使用校准的身长量板。身长量板应当有一块与板表面垂直的固定头部挡板和一块可移动的足板。测量时，将孩子平放在板上，头靠着固定挡板。确定孩子没有穿鞋或戴帽子。有个助手也许可以帮助保持孩子不动并在板中间。让孩子的腿伸直，调整活动足板，使孩子的脚底靠着足板。精确到0.1 厘米记录身长。

胎儿个性化生长曲线的研究现状

胎儿个性化生长曲线的研究现状 胎儿生长,尤其是体质量的增加,是胎儿健康状况的一项重要指标。除母体某些遗传特质和生理因素如身高、体质量、产次、社会经济状况、孕周、胎儿性别等影响胎儿体质量外;更重要的是一些病理情况,如各种妊娠并发症及合并症造成的胎盘功能不良、糖尿病造成的持续性高Ill糖转运、胎儿白身结构缺陷或染色体异常等均不同程度地影响着胎儿的出生体质量。日前,对小于胎龄儿(SGA)的定义是出生体质量低于同胎龄平均体质量的第10百分位;大于胎龄儿(LcΙA)的定义是出生体质量高于同胎龄平均体质量的第90百分位，我国应用的胎儿出生体质量标准是以人群为基础的测量标准,其缺点是不能l 区分是生理因素还是病理囚素造成的SGA或LGA,这对妊娠期保健和胎儿体质量管理极为不利,由于病理因素造成的胎儿生长受限(FGR)是围产儿发病与死亡的主要原因,50%的早产儿和⒛%的足月儿围产期死亡原囚与此有关ilJ。而且,FGR与新生儿窒启、及代谢性酸中毒、脑瘫关系密切,也与成年代谢综合征相关因此,如能根据母亲特征及妊娠特点估算出某一具体胎儿的生长潜能,即每个胎儿生理情况下能达到的最适出生体质量,以此为基础,与实际胎儿体质量比较,进行个性化胎儿出生体质量判断,这对于合理的孕期保健、早期发现及评估妊娠合并症、并发症对胎儿生长的影响,及时采取千预措施有十分重要的临床意义。 一、影响胎儿个性化生长曲线的因素 个性化生长曲线customized birth weight centile)的概念最早由

Gard。“等于19∞年提lH,他通过对4179例超声确定孕龄的胎儿出生体质量研究发现,母亲孕前体质量、身高、种族、产次、孕龄、胎儿性别对胎儿出生体质量有明显影响,从而认为每个胎儿的生长潜能有很大的不同。分别用个性化生长曲线与基于人群的出生体质量曲线为标准,判断同一组胎儿是否存在SGA或LGAc结果发现,根据人群出生体质量曲线判定的28%SG八和”%ICA,在使用个性化生长曲线衡量时均为适于胎龄儿;相反,用个性化生长曲线标准却筛选出了人群出生体质量曲线标准漏诊的⒉%的⒌;A和⒛%的LGA。Gardo“等:4〗刈38l14例旱孕期行超声确定孕龄的单胎孕妇进行研究,分析影响胎儿足月出生体质量的囚素,运用多元回归方法筛选H有意义的变量及相关系数,结果显示,母亲孕前体质量、身高、种族、产次、孕龄、胎儿性别是对胎儿出生体质量有重要影响的独立的生理变量。根据回归变量相关系数以及标准母亲状态汁算出胎儿最适出生体质量(tterm optimal weight ,TOW),即孕280d,在理想的环境下胎儿应该达到的体质量。通过Halldtlck等5∶的公式,预测每个孕周的胎儿生长体质量,结合T0W 即⒎f得出孕龄相关的最适体质量曲线(GROW),同时nT估算出健康胎儿体质量在孕期的分布。目前,很多国家与地区如新西兰、法国?、澳大利亚:∶、西班牙、美国Ⅱ、瑞典n分别构建了本地L/K的胎儿个性化生长曲线的标准。英国皇家妇产科学会已建议对胎儿出生体质量进行个性化顶测。 在胎儿个性化出生体质量的影响因素研究中,对父亲的因素也进行丁分析,除极端情况外,父亲因素影响相对较小i13j。Ma1l等ⅡX忄

生长发育对照“生长曲线图”

近日，卫生部制定并公布了《中国7岁以下儿童生长发育参照标准》。该标准制定的数据来源于“2005年第四次九市儿童体格发育调查”中城区数据。参照标准主要有体重、身高以及头围等，且配有方便、实用的生长曲线图。 “生长曲线图是家长监测孩子生长发育情况更简单、直观的工具。”省儿童医院儿保科主任刘丽君说，儿童生长指标在上下两实曲线之间都属正常，接近中间的实曲线则为平均水平，接近上下两条虚曲线则说明孩子的指标稍高或稍低于正常范围。 家长判断孩子的生长情况，应该动态地观察不同阶段的数据，把各个阶段监测到的数值连成一条曲线，若这条曲线在正常范围内，且与参考曲线呈大体平行，这说明孩子的生长发育是比较正常的。否则，出现偏高或偏低的情况，应尽早带孩子到医院进行检查。 刘丽君主任指出，在孩童生长发育正常的情况下，1岁之前前6个月每个月到医院监测一次，第9个月和12个月各监测一次；1—3岁之间，则半年监测一次；3—7岁至少每年监测一次。若孩子生长发育出现异常，则需根据医生建议定期监测。 此外，对于头围的监测在囟门未闭合之前显得更为重要，主要在孩童2岁之前。头围的增长代表大脑发育情况，若头围过大，则要警惕有脑积水，头围过小则会增加有小头畸形的可能性。 刘丽君主任指出，从临床上来看，贫血、营养不良、微量元素缺乏、呼吸道疾病、肠道疾病等多发于1—3岁的孩童，从而影响孩子的正常发育水平。这个年龄段，家长们更应该注意孩子的营养状况。 如今，厌食的孩子越来越多，但经医生检查后发现，大多为非疾病性厌食，主要是家长们喂养方式不当造成的情绪厌食症，如有的家长以叫骂方式强迫孩子进食等导致孩子厌食。刘丽君主任建议家长们，应在孩子主动进食的情况下科学合理喂养孩子。而且，孩子的食谱应多样化，给孩子多食用一些含优质蛋白的食物，讲究营养均衡。另外，许多家长认为孩子又白又胖才健康，让孩子过多地进食，实际上孩子的体重不应超出儿童生长发育参照曲线的正常范围。孩童肥胖是成人代谢综合征的高发危险因素，会增加患高血压、高血脂、糖尿病等心脑血管疾病的风险。她主张孩子少吃高糖、高脂以及油炸快餐食品。 □本报记者方素菊.corrTxt_01{border-top:1px dashed #F0C8C8;margin-top:10px;}.corrTxt_01 h3{font-weight:bold;padding:5px 0 0 3px;line-height:25px;margin:0;}.corrTxt_01 ul{padding:0 0 0 18px;}.corrTxt_01 ul li{font-size:14px;line-height:%;}.corrTxt_01 a {text-decoration:none;}> 相关阅读：诠释10-11月龄生长发育规律家长应为孩子制作生长曲线图视频：婴儿生长发育及护理保健视频：2-3岁孩子生长发育指标家长应走出孩子生长发育误区为何5月是儿童生长高峰期？视频：婴儿生长发育知多少早产儿面临三大生长挑战4-5个月婴儿生长发育规律 了解育儿知识，看育儿博文和论坛，上手机新浪网亲子频道

学前儿童生长发育的评价方法

学前儿童生长发育的评价方法 （一）常用的评价方法 生长发育评价在儿少卫生工作中应用广泛，主要用于：①评价个体、群体儿童少年现时的生长发育水平，处于什么等级。②筛查、诊断生长发育障碍、评价营养和生活环境因素对生长发育的影响，提供保健咨询建议。③列入社区健康水平的指标体系，通过观察指标变化，评价各项学校卫生措施的实效，作为实施学校卫生监督的依据。根据这些需要，生长发育评价的基本内容包括生长发育水乎、生长发育速度、各指标相关关系等三个方面。 选择合理的评价方法，是进行正确评价的关键。迄今没有一种方法能完全满足对个体、群体儿童的发育进行全面评价的要求。因此，应根据评价目的选择适当的方法，力求简单易行，直观而不需要附加计算；可结合体格检查、生活环境条件、健康和疾病状况进行综合分析，以得出较全面、准确的评价结果。 （二）指数法 指数法利用数学公式，根据身体各部分的比例关系，将两项或多项指标相关联，转化成指数进行评价。本方法计算方便，便于普及，所得结果直观，应用广泛。常用指数有： （1）身高体重指数，表示单位身高的体重，体现人体充实度，也反映营养状况。 （2）身高胸围指数，反映胸廓发育状况，借以反映体型。 （3）身高坐高指数，通过坐高和身高比值，反映人体躯于和下肢的比例关系，反映体型特点。可根据该指数大小，将个体的体型分为长躯型、中躯型和短躯型。 （4）BMI指数（body mass index，BMI，体重kg／身高m2），又称体重指数。近年来受国内外学者高度重视，认为它不仅能较敏感地反映身体的充实度和体型胖瘦，且受身高的影响较小，与皮脂厚度、上臂围等反映体脂累积程度指标的相关性也高。我国已建立的"学龄儿童青少年BMI超重、肥胖性别一年龄别筛查标准"，是BMI在儿童生长发育领域的具体应用。l8岁时该指数≥24和≥28，可分别筛查为超重和肥胖。 （5）握力指数和背肌力指数：均利用肌力与体重的密切关系，借助单位体重的握力和背肌力校正体重的影响，分别显示上臂和腰背部的肌肉力量，比原指标更具可比性。 （6）肺活量指数：分别利用肺活量和体重、身高的密切关系，利用单位体重或身高校正肺活量，以更确切反映机体肺通气能力的大小。 由于身体指数存在显着的种族、域乡、性别、年龄和身高等差异，应结合专业知识应用，注意克服指数的机械性弱点。制定和应用评价标准时应注意以下问题：①不能忽视身高因素。同性别、年龄而身高不同的儿童，身材高大而粗壮者和身材矮小而瘦弱者可同样被评价为"体型匀称".克服方法是利用年龄别身高标准，先筛出那些生长发育迟滞者。②充分注意指数（尤其源自体格指标者）鲜明的种族、地区差异。③大多数指数呈非正态分布。因此，最好依据百分位数法先将指数分若干等级，确定其等级含义。 （三）等级评价法 等级评价法是离差法（用于评价个体、群体儿童少年生长发育现状的常用方法）中最常用的一种。它利用标准差与均值的位置远近，划分等级。评价时将个体该发育指标的实测值与同年龄、同性别相应指标的发育标准比较，以确定发育等级。国内最常用五等级评价标准见表9-1. 一般生长发育评价中，身高和体重是最常用的指标。个体的身高、体重值在判定标准均值±2个标准差范围内（约占儿童总数的95％）均可视为正常。但在均值±2个标准差外的儿童少年，不能据此定为异常；需定期连续观察，结合其他检查，慎重做出结论。个体的体重有升有降，易受内外环境影响。若儿童体重连续数月下降，则应先排除疾病再评价营养状况。 等级评价法亦可用于集体儿童的发育评价，称"等级百分数法".评价时先将两个班或两所学校所有学生的测量资料，分别按不同发育指标，采用统一标准，对照相应的等级评价标准，确定各个体的等级。

长高秘诀：用生长曲线图

可不要小看孩子每次体检时医生使用的小小的格子和划出的点线,对孩子生长发育过程中的生长曲线加以重视,是及时发现问题和采取对策的关键。下面是如何能够从简单的格子和图表中得到更多我们需要的东西。 1、热心于孩子的发育曲线 每次带孩子去检查身体或做常规保健,要仔细观察医生是否给他量了身高和体重,并且详细地记在了生长发育监测表上。 2、看看医生是否使用了最新的图表 每隔几年,国家会根据调查结果制定新的儿童生长发育监测表和标准,要保证医生使用的是最新的图表。 3、比较相临两次检查结果 保证孩子的检查具有连续性,并且每次检查方式是一样的。从身高角度来说,孩子每次查身高时应站得笔直,并且脱掉鞋子。3岁以下的孩子可以笔直地躺着量身长,称体重最好是每次都脱光衣服和尿裤,以得到净重。 4、保留自己的记录 如果可以,向医生要一份复印件,或者自己制作一个图表,每次检查都带着,并做好详细记录,这会是一个非常有意义的纪念品。 5、不要从字面上理解测量结果 医生不会对一次偶然的测量结果表示担心,他们关注的是孩子发育的长期的倾向。例如,一次流感或者其他疾病可能会使孩子的生长发育出现倒退,而季节性快速生长(春天一般是孩子们发育最快的季节)和年龄上的快速发育期都会使测量结果出现暂时超前。不要仅仅专注于某个数字,只要孩子的生长发育一直保持稳定的速度,并且处于他这个年龄的平均值百分比中,不管他是高点儿还是矮点儿,都是正常的。 6、了解警戒线 如果孩子的发育突然横跨两条曲线,如从50%掉到10%;或者突然进入极端,如跳到5%以下或95%以上,就要提高警惕了。也许他会有肥胖的危险或者因为某种慢性疾病而影响了正常的生长发育,都需要看医生了。 生长加速期 0~12个月:在生命的最初一年里,刚做了妈妈的你很可能会发现孩子的食量忽然间增大了,几乎总是处于饥饿状态,在最初的几个月,这一现象表现得尤其明显,这种突然增加的食欲正是孩子生长加速期的表现。第一年里,比较突出的几个阶段是10天~3周,6周,3个月,6个月。绝大多数婴儿在满一岁时,可以达到出生体重的3倍,身高增长25厘米。 1岁:生长放慢了速度,但你的宝贝平均可以增加10~13厘米,每月体重增加230克。 2岁:大部分孩子在这一年会增加8~10厘米,并增长1400~1800克。到了3岁,孩子们会达到他们成年身高的50%,但之后生长速度明显放慢,直到青春期再次加速。 3岁:到这一年末,孩子会增加5~8厘米,身高约达到出生身长的两倍。 4~10岁:在这几年当中,孩子们大约每年增长5厘米,增加2750克。有些孩子在6~8岁期间会经历一次小小的生长加速。 青春期:女孩子的青春期从8~13岁开始,她们大约会增长2~25厘米,体重共增加7000~25000克,直到达到最后的成年体格。男孩子的青春期开始于10~15岁,他们的身高大约增加10~30厘米,体重增加7000~30000克。

2014.6.28早产儿营养及指南推荐

早产儿营养及指南推荐 早产儿：<37孕周（259天）的活产儿 LBW:<2500g VLBW:<1500g ELBW:<1000g 原则：尽早开始肠外营养，尽快达到目标值，同时条件允许下，尽早肠内营养，尽早达到全肠内营养。 生后第1天即提供至少2g/Kg.d的蛋白质（2.2-2.4g/Kg.d），并尽早增加到目标量。 生后第1天即可提供脂肪乳（0.5-2g/Kg.d不等），逐渐增加目标量。 根据糖耐受情况，逐日增加葡萄糖（4→10-12mg/Kg.min），静脉营养中应包括钙，磷，镁在内矿物质，维生素及微量元素。 静脉通路：UVC/PICC/外周静脉 计算方法：NICU静脉营养管理软件NICUTPN 肠内营养 AAP指南18推荐的能量摄入量：105-130Kcal/Kg.d ESPGHAN指南19推荐的能量摄入量：110-135Kcal/Kg.d 小于胎龄儿（SGA）比适于胎龄儿（AGA）需要更多的能量，中国新生儿营养支持临床应用指南20推荐能量摄入量：110-135Kcal/Kg.d AAP指南18推荐的蛋白质摄入量：3.0-4.0g/Kg.d ESPGHAN指南19推荐的蛋白质摄入量：体重<1000g：4.0-4.5g/Kg.d（3.6-4.1g/100Kcal） 体重<1000-1800g：3.5-4.0g/Kg.d（3.2-3.6g/100Kcal）中国新生儿营养支持临床应用指南20推荐蛋白质摄入量：足月儿2-3g.kg-1.d-1 早产儿3.5-4.5g.kg-1.d-1 <1kg, 4.0-4.5g.kg-1.d-1 1-1.8kg, 3.5-4.0g.kg-1.d-1 AAP指南18推荐的碳水化合物摄入量：10-14g/Kg.d，占总能量40%-50% ESPGHAN指南19推荐的碳水化合物摄入量：10.5-12.0g/100Kcal，（11.6-13.2g/kg.d） 中国新生儿营养支持临床应用指南20推荐碳水化合物摄入量：10-14g/Kg.d，占总能量40%-50% AAP指南18 ESPGHAN指南19 钙100-220mg/kg.d 120-140mg/kg.d 磷60-140mg/kg.d 60-90mg/kg.d 钙磷比-- 1.5-2.0 铁2-4mg/kg.d 2-3mg/kg.d VitD 150-400IU/kg.d 800-1000IU/d（此处不按体重计算） VitA 700-1500IU/d 400-1000ug/kg.d（1ug=3.33IU）

如何使用生长曲线图

如何使用生长曲线图？ 生长曲线图很重要，那父母应该如何掌握使用方法呢？崔其亮教授提出了以下几个要点： 1、生长曲线图底部的直线代表孩子的年龄，每一小格表示一个月。旁边的竖条代表孩子的体重。 2、当你给孩子称体重时，在底部找月龄，在旁边的竖条找体重，然后在两者交叉处划一小圆点。 3、当你给孩子称过几次体重之后，你可以将几个黑点连成线，这就是孩子的生长曲线。 4、生长曲线图上有两条曲线是参考线，两者间的范围代表孩子是否健康成长。 “生长曲线图”意义是将100个同年龄儿童身高、体重、头围的数值作出统计与测量，画出常态分布曲线图，排在中间位置数值称为“第50百分位”，这通常就是最多数的一群。以体重来看，排在第97百分位数值的宝宝，表示该体重表现在同年龄孩子宝宝来说，属于体重较重的一群，反之，排在第3个百分位的宝宝就表示体重不足。不过，崔其亮教授强调，“生长曲线图并非单看其中一个点，身高、体重、头围三者缺一不可，且环环相扣，要正确判读，还是需靠医师的专业分析。” 1、认识生长发育监测图 ●生长发育监测图有分为男童和女童两种。 ●生长发育监测图底部的直线代表孩子的年龄，每一小格表示一个月。旁边的竖条代表孩子的体重。 ●当你给孩子称体重时，在底部找月龄，在旁边的竖条找体重，然后在两者交叉处划一小圆点。 ●当你给孩子称过几次体重之后，你可以将几个黑点连成线，这就是孩子的生长曲线。 ●生长监测图上有两条曲线是参考线，两者间的范围代表孩子健康生长，称“健康之路”。

2、如何根据生长发育监测图，判断孩子生长是否达到标准？ 将孩子的生长曲线与参考曲线相比较，我们由此可得知孩子随年龄增长体重增加的情况： 如果发现生长发育不良情况，可以向当地的医疗保健单位医生咨询，获得保健指导。

世卫组织最新标准-(0-5岁)体重生长曲线图身高生长曲线图BMI生长曲线图

世卫组织最新标准-（0-5 岁）体重生长曲线图~身咼生长曲线图? BMI生长曲线图 世界卫生组织的最新标准是完全根据母乳宝宝的生长情况制定的。而我国的标准是综合国内不同地区和不同喂养分方式的数据统计出来的。 但这样的数据并不能说明它更正确，而恰恰会由于混合或人工喂养宝宝的因素使数据偏高。 这些新指标是基于8440名母乳喂养的孩子的生长发育状况做出的。 与吃母乳的婴幼儿比起来，吃配方奶的孩子体重比吃母乳的孩子要增长得快些。而“世卫组织”旧的有关婴幼儿的成长发育指标却是根据吃配方奶的孩子的发育情况制定的，这就意味着这一套标准存在着重大缺陷。 从1997年到2003年间，世界卫生组织对包括巴西等6个国家的孩子进行了跟踪调查。这些孩子来自巴西、加纳、印度、挪威、阿曼和美国等6个不同的国家，身体都很健康，且他们的母亲都不吸烟，对孩子的照顾也非常周到。而之前的指标只是取单独一个国家的儿童为样本（也就是美国儿科学会公布的美国婴幼儿生长发育曲线）。 男宝体重生长曲线图— 女宝体重生长曲线图 男宝身高生长曲线图 女宝身高生长曲线图

男宝BMI生长曲线图 女宝BMI生长曲线图 新的婴幼儿生长发育指标中还包含了身体质量指数（BMI二体重（公斤）宁身高（米）的平方，单位为公斤/平方米）,这是WHC首次 在婴幼儿生长发育指标中引入此项指标。BMI为评估体重与身高比例 提供了工具，对于监控孩子的肥胖症非常有效。它是评估儿童健康的一个重大革新。 男宝宝体重生长曲线图 irihH-i rib rd r-■■? Mfa r?M ?f?专家认为，新指标的发表不会给中国孩子生长发育情况带来大影 响。我国每10年都要在北部、中部、南部各选三地，对0-18岁儿童 和青少年的身高、体重等情况进行调查统计，并综合了各种喂养方式，

早产儿的“追赶生长”家长别走进了误区

早产儿的“追赶生长”家长别走进了误区 早产儿的生长发育是让家长头疼的问题。家长们大多知道，五六月是孩子生长发育的最好时间，但很多家长不知道，早产的宝宝常身高落后，也许正趁着这个机会在“追赶生长”呢！下面就看看专家们怎么说早产儿的生长吧。 有些家长能惊喜地发现规律：早产的宝宝看上去总显得比同龄小孩先天不足矮小瘦弱，但在一段时间内会“疯狂”地长，赶上同龄小孩。就像别的孩子在正常走的时候，他因为某些原因走得慢点，再努力用加速度跑来使自己能跟他们齐头并进。这叫“追赶生长”，是早产宝宝的特殊发育现象，大多数孩子的追赶生长发生于2岁之内。 如果孩子是早产儿，或在成长过程中发生营养不良、生病或缺乏激素时，就会逐渐偏离生长发育轨道，出现生长迟缓。而一旦这些阻碍生长的因素被祛除，孩子将以超过相应年龄正常的速度加速生长，以便重新回到原有的生长轨道上。这便是“追赶生长”出现的原理。 追赶生长，有助身心发育 教授说，“追赶生长”对孩子体格和智力发育均非常有益，比如，早产宝宝认知发育延迟、学习能力差，脑瘫患病率是正常出生体重的16.2倍。“追赶生长”中脑的快速发育可弥补这些缺陷。还有临床观察表明，没有“追赶生长”

的小于胎龄儿成年后导致终身矮小的概率要比普通孩子高7~8倍。 家长误区 虽然与正常婴儿相比，早产儿出生时营养储备明显不足，家长万万不能盲目“追肥”，试图让孩子快点“追赶生长”，以至宝宝出现“追赶性肥胖”。 乱“追肥”，反惹宝宝肥胖 专家说，在宝宝的“追赶生长”中，以科学饮食最为重要，即按照孩子生长发育规律，给予相匹配的饮食，事实上不少家长却错误施爱，反帮倒忙。她在门诊中发现，有些家长过于急于求成，盼望孩子胖乎乎，心里才踏实，看见自己的孩子因早产或生病瘦瘦小小，便违反喂养规律，过度喂养造成过度营养，孩子胖是胖了，但常胖得一发不可收拾，为将来肥胖、糖尿病埋下祸根。 专家解释道，宝宝在1岁前处于长脂肪细胞数量的时期，1岁后处于脂肪细胞长大的时期，如果宝宝在1岁前就肥胖，脂肪细胞的数量就会增多，等1岁后脂肪细胞变长，便不可收拾地肥胖了。 过快“追赶”，为成年糖尿病埋祸根 很多研究发现“追赶生长”过快与一些成年期疾病如肥胖、Ⅱ型糖尿病、心血管疾病及代谢综合症等密切相关。追赶过快，就好比营养缺乏使子宫培育出一个对付终生贫困

男孩健康生长曲线图(图)

下列各曲线表示儿童的平均生长情况（连续的曲线）以及经正规测量得出的数值范围。你可以通过给孩子称体重、定期测量其头围的尺寸，然后在图纸上画出他的生长曲线。他的曲线形态应与“平均”曲线极为接近才算健康和正常，因为“平均”曲线显示的是健康的生长速度。 头围 保健员或医生用卷尺恰在婴儿眉毛和两耳的上方绕过头部最膨大的部分一圈，测出的尺寸既是头围。在１岁以内，头围是比身长更容易测量的并用来评价婴儿健康生长的一项标准。 决定孩子衣服尺码的参考数据： 0～3个月身长60厘米体重到4.5公斤 3～6个月身长70厘米体重到6.5公斤 6～12个月身长80厘米体重到8.5公斤 12～18个月身长85～90厘米 18～24个月身长90～100厘米 孩子的身高 大约每6个月就给孩子测量1次身高，方法是：让孩子不穿鞋，两脚并拢地紧靠墙壁的某一固定的地方站好。将直尺与墙壁成直角地放在孩子的头上，按此高度在墙上作好标记，然后测量从地面到标记的距离，测出的数据既是孩子的身高。如果孩子在一短暂的阶段生长缓慢，你不必担心，但是如果连续两次测出的数值都很低的话，就要去看医生。

平均数 数值范围。次数值范围是在正常儿童中经可靠的测量得出的数值范围。94%的男孩都在这个数值范围之内。 婴儿的体重 婴儿体重的增加，在整个第一年中是反映其一般体质和健康状况的一项必不可少的指标。你可要求保健员或医生每个月给他称重一次，称重时只包一块干净的尿片。如果你怀疑他体重的增加可能不正常，可以要求增加称重次数。 孩子的体重

过了第一个生日以后可每6个月给他称重1次，称重时只包一块干净的尿片或全裸。孩子体重的增加不可能是稳定不变的，而是缓慢生长期与快速二者最后可相互补偿平衡。不应出现减重的情况，在他身高达到一定标准前，体重最多只会是出现一个暂停增加的阶段，如果孩子的体重有下降，或者连续两次测出的结果都比你预期的少，应征询医生的意见。

世卫组织最新标准 - (0-5岁)体重生长曲线图 身高生长曲线图 BMI生长曲线图

世卫组织最新标准 - (0-5岁)体重生长曲线图 ~ 身高生长 曲线图 ~ BMI生长曲线图 世界卫生组织的最新标准是完全根据母乳宝宝的生长情况制定的。而我国的标准是综合国内不同地区和不同喂养分方式的数据统计出来的。 但这样的数据并不能说明它更正确，而恰恰会由于混合或人工喂养宝宝的因素使数据偏高。 这些新指标是基于8440名母乳喂养的孩子的生长发育状况做出的。 与吃母乳的婴幼儿比起来，吃配方奶的孩子体重比吃母乳的孩子要增长得快些。而“世卫组织”旧的有关婴幼儿的成长发育指标却是根据吃配方奶的孩子的发育情况制定的，这就意味着这一套标准存在着重大缺陷。 从1997年到2003年间，世界卫生组织对包括巴西等6个国家的孩子进行了跟踪调查。这些孩子来自巴西、加纳、印度、挪威、阿曼和美国等6个不同的国家，身体都很健康，且他们的母亲都不吸烟，对孩子的照顾也非常周到。而之前的指标只是取单独一个国家的儿童为样本（也就是美国儿科学会公布的美国婴幼儿生长发育曲线）。

男宝BMI生长曲线图 女宝BMI生长曲线图 新的婴幼儿生长发育指标中还包含了身体质量指数（BMI=体重（公斤）÷身高（米）的平方，单位为公斤/平方米），这是WHO首次在婴幼儿生长发育指标中引入此项指标。BMI为评估体重与身高比例提供了工具，对于监控孩子的肥胖症非常有效。它是评估儿童健康的一个重大革新。 男宝宝体重生长曲线图 专家认为，新指标的发表不会给中国孩子生长发育情况带来大影响。我国每10年都要在北部、中部、南部各选三地，对0-18岁儿童和青少年的身高、体重等情况进行调查统计，并综合了各种喂养方式，

得出我国儿童的身高、体重等指标的参照值。 用生长曲线检测孩子的身高、体重的发育，比起简单用一个数字断定孩子是高是胖要更科学。使用方法如下： 1、做顺时记录。 每个月为孩子测量一次身高、体重，把测量结果描绘在生长曲线图上（不要在孩子生病期间测量），连成一条曲线。如果孩子的生长曲线一直在正常值范围内（3号线到-3号线之间）匀速顺时增长就是正常的。有些孩子的生长速度比较快，生长曲线呈斜线，只要一直在正常值范围内就不用担心。 误区：追求最高值，认为平均值以下就是不正常。 孩子的生长发育与遗传、饮食习惯等多种因素有关，每个孩子的生长发育曲线都不同。平均值曲线不是判断发育正常与否的标准。即使孩子的生长曲线一直在平均曲线之下，最低值曲线之上，只要一直在匀速顺时增长就是正常的。 2、做动态观察。 每2-3个月对生长曲线增长速度进行一次横向比较，如果出现突然增（减）速，就要提起注意，定期体检时可向医生讲述情况，听取医生的建议。 误区：生长曲线突破正常值才引起注意。 很多父母都是在孩子的身高、体重超出或低出正常值勤后才发现问题，似乎有点亡羊补牢。生长曲线总是超过2号线，或低于-2号线时，就应提起注意，是不是你的喂养方式有问题，或者孩子的健康

使用世界卫生组织(WHO)的生长曲线图

使用世界卫生组织(WHO)得生长曲线图 成长不仅就是营养得结果,还就是遗传因素得结果。种族会影响孩子得成长模式,因此有些国家有她们自己得生长曲线图。不过,世界卫生组织(WHO)得生长曲线图用得最普遍,并被认为就是全世界得标准。了解更多关于: ?怎样进行测量 ?怎样将测量应用到生长曲线图中 怎样进行测量 0-24 月龄得孩子进行得典型测量包括: ?头围 ?身长 ?体重 测量应定期进行,以观察可靠得趋势。建议得测量时间间隔包括: ?婴儿(0-12 月龄):每2 个月 ?幼儿:分别在15, 18, 24 与30 月龄 ? 3 岁以上:每年 点击这里获取详细得测量时间表。 头围 头围就是在孩子头部最大部分进行得测量。这种测量通常为0-3 岁得孩子进行。测量时应当使用不可拉伸得卷尺。卷尺通常就是可弯曲得金属量尺。测量时,卷尺尽可能紧贴着头部最宽围度缠绕。通常,此部位在前额眉毛上方1-2 指宽到后脑勺最突出得部分。测量三次,取精确到0.1 厘米得最大测量值。

在孩子生命得早期,头围就是一种很重要得测量,因为它间接地反映大脑尺寸与发育。几乎所有得大脑发育都在两岁以前,因此绘制得头部生长曲线可以作为幼儿大脑健康得通用指标。 了解关于头围-年龄生长曲线图。 身长 身长就是为不足24 月龄得婴儿进行得线性测量。24 到36 月龄得孩子,如果无法独立站立,也可以进行身长测量(代替身高)。 身长就是在孩子卧位(平躺)时测量得。测量身长最准确得方法就是使用校准得身长量板。身长量板应当有一块与板表面垂直得固定头部挡板与一块可移动得足板。 测量时,将孩子平放在板上,头靠着固定挡板。确定孩子没有穿鞋或戴帽子。有个助手也许可以帮助保持孩子不动并在板中间。让孩子得腿伸直,调整活动足板,使孩子得脚底靠着足板。精确到0.1 厘米记录身长。

生长发育曲线

生长发育曲线 怎么知道孩子生长发育是否正常，怎么掌握孩子的自身生长发育规律呢？这就要利用生长发育曲线了。生长发育曲线是通过检测众多正常婴幼儿发育过程后描绘出来的，整个曲线由若干条连续曲线组成。 0-5岁男孩身高发育曲线 0-5岁女孩身高发育曲线 0-5岁男孩体重发育曲线 从生长曲线判断发育速度GoTop 年轻的爸爸妈妈们带孩子一起玩时，在一起聊天时，带孩子体检时，都会互相交流孩子的生长状况，看看别人家的孩子现在多高了、多重了，再和自己的孩子比一比。一比之下，有喜有忧：如果孩子长得偏快，家长心中就暗暗高兴；如果长得偏慢，家长心中则忐忑不安。难道每个同龄的孩子都要具有一样的身高、体重等发育指标，家长才不会担心吗？究竟如何评价孩子的生长才准确呢？ 诊室场景回放镜头1 宝宝为孕38周经自然分娩的男婴，出生体重3.2千克、身长49厘米，纯母乳喂养。生后前4个月的体重分别为4.2千克、5.4千克、6.2 千克和6.8千克；身长分别为54.5厘米、58厘米、61厘米和63.5厘米。体重/身长指数始终保持在50% 水平。与同龄孩子相比，妈妈总觉得自己的孩子偏小，担心孩子出现生长落后。甚至怀疑自己的母乳营养不够丰富，耽误了孩子生长发育。 诊室场景回放镜头2

强强也是足月顺产出生的男婴，出生体重4.2千克、身长51.5厘米，用婴儿配方奶喂养，妈妈是严格按照奶粉包装罐上的推荐用量给孩子喂养。生后前4 个月的体重分别为5.05千克、6.1千克、6.8千克和7.2千克；身长分别为56.5厘米、60厘米、63厘米和66厘米。体重/身长指数起在75% 水平，逐渐降至50%水平，4个月时降至20%水平。 诊室场景回放镜头3 壮壮是经剖宫产出生的男婴，出生体重3.6千克、身长51厘米，生后混合喂养，喂养过程非常顺利。生后前4个月的体重分别为5.4千克、6.8千克、8 千克和9千克；身长分别为57厘米、61厘米、64.5厘米和67.5厘米。出生时体重/身高指数在50%水平，以后迅速上升，满4个月时达到90% 水平。 生长发育曲线：最好的观测工具 最下面的一条曲线为3%，意思是将有3% 的婴幼儿低于这一水平，可能存在生长发育迟缓；最上面的一条曲线为97%，意思是将有3%的婴幼儿高于这一水平，可能存在生长过速。这两种情况都应该引起关注。中间的一条曲线为50%，代表平均值；另外，还有15% 和85%等曲线，提示在正常曲线中的不同水平。我们经常谈及的正常值，应该是3%～97%涉及的范围。 家长需要注意的是，任何时候，都会有近50%的孩子生长发育指标高于正常值，50% 左右的孩子低于正常值，刚好在平均水平的孩子为数极少。所以，千万不要以“平均值”作为自己心中可以接受的最低限度。 生长发育曲线：找出后面的原因 其实，将孩子某一时刻的生长发育数据与生长发育曲线进行比较，找出孩子生长发育的百分位意义并不大。拿前面提到的3 个孩子来说，宝宝虽然每次监测的身高和体重发育指标似乎都略低于正常曲线的第

婴幼儿生长发育曲线

婴幼儿生长发育曲线 什么是生长发育曲线 生长发育曲线简单来说，是将宝宝在不同月龄测得的体重值、身高值、头围值以及匀称度，分别绘制成的4条曲线。 通过生长曲线图： ●可以直观、快速地了解宝宝到底“长得好不好”； ●通过连续追踪观察，可以评估甚至预测宝宝的生长发育趋势，能够及时发现生长轨迹是否偏离正常水平； ●对于早产儿、低体重儿，利用它还可以评估宝宝追赶生长的情况。 ●我国采用的标准是综合世界卫生组织、国内不同地区和不同喂养方式的数据统计出来。 生长发育曲线如何绘制 正确测量宝宝身高、体重、头围，是描绘生长发育曲线的重要前提。 1.身长 2岁以内：测身长时，应让宝宝平躺着量。方法是让宝宝平躺，双腿捋顺、捋直，双脚并拢，头顶上放一本硬质的书，脚底下放一本硬质的书。平行移动两本书，测量两本书之间的直线距离，就是宝宝的身长。 2岁以上：可以让宝宝站着测量，取其身高值。 注意事项： 1）躺着测量时，要保证宝宝躺的地方要偏硬一些。如果在太软的地方测量，宝宝身体会陷下去一些，测量的结果肯定就会偏短。

2）为了确保测量结果的准确性，家长需要给宝宝测量三遍，取平均数值。 3）今后每次测量，尽量都让宝宝在同一个位置进行。 2.体重 体重是反映宝宝营养状况最灵敏的指标，某些疾病可以使孩子的体重在较短时间内发生变化，婴幼儿尤为明显。 测量工具与方法：婴儿秤或普通的电子秤均可（每次测量尽量使用同一个秤）。 注意事项： 宝宝的体重是用克计算的，所以无论什么时候测，尽量在同样的条件下进行。比如刚吃完100毫升奶的孩子和没吃奶的孩子，体重最起码能差100多克。再比如一宿没换尿不湿的孩子与换了尿不湿的孩子最少差半斤，这对于基数就很小的宝宝来说，是非常大的误差了。 3.头围 头围能反映脑和颅骨的发育情况。 测量方法： step 1：找到宝宝两条眉毛的中心点作为1点； step 2：找到宝宝后脑勺最高的位置（枕骨最高点）作为2点；

2019最新 长高秘诀：用生长曲线图 精心整理 育儿教育 精编 最实用

长高秘诀：用生长曲线图 可不要小看孩子每次体检时医生使用的小小的格子和划出的点线，对孩子生长发育过程中的生长曲线加以重视，是及时发现问题和采取对策的关键。下面是如何能够从简单的格子和图表中得到更多我们需要的东西。 1、热心于孩子的发育曲线 每次带孩子去检查身体或做常规保健，要仔细观察医生是否给他量了身高和体重，并且详细地记在了生长发育监测表上。 2、看看医生是否使用了最新的图表 每隔几年，国家会根据调查结果制定新的儿童生长发育监测表和标准，要保证医生使用的是最新的图表。 3、比较相临两次检查结果 保证孩子的检查具有连续性，并且每次检查方式是一样的。从身高角度来说，孩子每次查身高时应站得笔直，并且脱掉鞋子。3岁以下的孩子可以笔直地躺着量身长，称体重最好是每次都脱光衣服和尿裤，以得到净重。 4、保留自己的记录 如果可以，向医生要一份复印件，或者自己制作一个图表，每次检查都带着，并做好详细记录，这会是一个非常有意义的纪念品。 5、不要从字面上理解测量结果 医生不会对一次偶然的测量结果表示担心，他们关注的是孩

子发育的长期的倾向。例如，一次流感或者其他疾病可能会使孩子的生长发育出现倒退，而季节性快速生长(春天一般是孩子们发育最快的季节)和年龄上的快速发育期都会使测量结果出现暂时超前。不要仅仅专注于某个数字，只要孩子的生长发育一直保持稳定的速度，并且处于他这个年龄的平均值百分比中，不管他是高点儿还是矮点儿，都是正常的。 6、了解警戒线 如果孩子的发育突然横跨两条曲线，如从50%掉到10%；或者突然进入极端，如跳到5%以下或95%以上，就要提高警惕了。也许他会有肥胖的危险或者因为某种慢性疾病而影响了正常的生长发育，都需要看医生了。 生长加速期 0~12个月：在生命的最初一年里，刚做了妈妈的你很可能会发现孩子的食量忽然间增大了，几乎总是处于饥饿状态，在最初的几个月，这一现象表现得尤其明显，这种突然增加的食欲正是孩子生长加速期的表现。第一年里，比较突出的几个阶段是10天~3周，6周，3个月，6个月。绝大多数婴儿在满一岁时，可以达到出生体重的3倍，身高增长25厘米。 1岁：生长放慢了速度，但你的宝贝平均可以增加10~13厘米，每月体重增加230克。 2岁：大部分孩子在这一年会增加8~10厘米，并增长1400~1800克。到了3岁，孩子们会达到他们成年身高的50%，

生长曲线的测定

实验日期：2017.11.1实验班级：生物技术指导教师：张建丽 姓名：高熹学号：1120152430 测定细菌生长曲线 一．实验目的 1.通过对大肠杆菌生长曲线的测定，了解细菌生长的特点，综合训练微生物实验的基本实验技能。 2.巩固培养基的配制、灭菌、仪器的包扎、倒平板。 3.掌握用比浊法测定细菌的生长曲线。 二．实验原理 将少量细菌接种到一定体积的、适合的新鲜培养基中，在适宜的条件下进行培养，一定时间测定培养液中的菌量，以菌量的数量作纵坐标，生长时间作横坐标，绘制的曲线叫生长曲线。它反映了单细胞微生物在一定环境条件下于液体培养时所表现出的群体生长规律。依据其生长速率的不同，一般可把生长曲线分为延缓期、生长期、稳定期和衰亡期。将每一种一定量的细菌转入新鲜液体培养基中，在适宜的条件下培养细胞要经历延迟期、对数生长期、稳定期和衰亡期四个阶段。 延迟期：又叫调整期。细菌接种至培养基后，对新环境有一个短暂适应过程（不适应者可因转种而死亡）。此期曲线平坦稳定，因为细菌繁殖极少延迟期长短因素种、接种菌量、菌龄以及营养物质等不同而异，一般为1～4小时。此期中细菌体积增大，代谢活跃，为细菌的分裂增殖合成、储备充足的酶、能量及中间代谢产物。 对数生长期：又称指数期。此期生长曲线上活菌数直线上升。细菌以稳定的几何级数极快增长，可持续几小时至几天不等（视培养条件及细菌代时而异）。此期细菌形态、染色、生物活性都很典型，对外界环境因素的作用敏感，因此研究细菌性状以此期细菌最好。抗生素作用，对该时期的细菌效果最佳。 稳定期：该期的生长菌群总数处于平坦阶段，但细菌群体活力变化较大细菌浓度达到最大即环境最大容纳量。由于培养基中营养物质消耗、毒性产物（有机酸、过氧化物等）积累PH下降等不利因素的影响，细菌繁殖速度渐趋下降，相对细菌死亡数开始逐渐增加，此期细菌增殖数与死亡数渐趋平衡。细菌形态、染色、生物活性可出现改变，并产生相应的代谢产物如外毒素、内毒素、抗生素、以及芽孢等。 衰亡期：随着稳定期发展，细菌繁殖越来越慢，死亡菌数明显增多。活菌数与培养时间呈反比关系，此期细菌变长肿胀或畸形衰变，甚至菌体自溶，难以辩认其形。生理代谢活动趋于停滞。故陈旧培养物上难以鉴别细菌。 体内及自然界细菌的生长繁殖受机体免疫因素和环境因素的多方面影响，不会出现象培养基中那样典型的生长曲线。掌握细菌生长规律，可有目的地研究控制病原菌的生长，发现和培养对人类有用的细菌。 这4个时期的长短因菌种的遗传性、接种量和培养条件的不同而有所不同。因此通过测定微生物的生长曲线，可了解个菌的生长规律，对于科研和生产都具有重要的指导意义。 测定微生物的数量有多种不同的方法，可根据要求和实验室条件选用。本实