THE JOURNAL OF PEDIATRICS • www.jpeds.

com ORIGINAL
ARTICLES
An Attempt to Standardize the Calculation of Growth Velocity of Preterm
Infants—Evaluation of Practical Bedside Methods
Tanis R. Fenton, PhD, RD1,2, Diane Anderson, PhD, RD3, Sharon Groh-Wargo, PhD, RD4, Angela Hoyos, MD5,
Richard A. Ehrenkranz, MD6, and Thibault Senterre, MD, PhD7

Objective To examine how well growth velocity recommendations for preterm infants fit with current growth ref-
erences: Fenton 2013, Olsen 2010, INTERGROWTH 2015, and the World Health Organization Growth Standard
2006.
Study design The Average (2-point), Exponential (2-point), Early (1-point) method weight-gains were calcu-
lated for 1,4,8,12, and 16-week time-periods. Growth references’ weekly velocities (g/kg/d, gram/day and cm/
week) were illustrated graphically with frequently-quoted 15 g/kg/d, 10-30 grams/day and 1 cm/week rates superimposed.
The 15 g/kg/d and 1 cm/week growth velocity rates were calculated from 24-50 weeks, superimposed on the Fenton
and Olsen preterm growth charts.
Results The Average and Exponential g/kg/d estimates showed close agreement for all ages (range 5.0-18.9 g/
kg/d), while the Early method yielded values as high as 41 g/kg/d. All 3 preterm growth references were similar to
15 g/kg/d rate at 34 weeks, but rates were higher prior and lower at older ages. For gram/day, the growth refer-
ences changed from 10 to 30 grams/day for 24-33 weeks. Head growth rates generally fit the 1 cm/week velocity
for 23-30 weeks, and length growth rates fit for 37-40 weeks. The calculated g/kg/d curves deviated from the growth
charts, first downward, then steeply crossed the median curves near term.
Conclusions Human growth is not constant through gestation and early infancy. The frequently-quoted 15 g/kg/
d, 10-30 gram/day and 1 cm/week only fit current growth references for limited time periods. Rates of 15-20 g/
kg/d (calculated using average or exponential methods) are a reasonable goal for infants 23-36 weeks, but not
beyond. (J Pediatr 2018;196:77-83).

N
eonatologists, neonatal dietitians and nurses monitor hospitalized preterm infants’ growth based on daily weight, and
weekly length and head circumference measurements. Clinicians often use target growth velocities of 15 g/kg/d1-4 or
10-30 grams/day5 for weight gain and 1 cm/week for head and length gain4 to evaluate infants’ nutritional status. However,
expert advisory groups6-8 have not specified grams and centimeter per week growth goals, but rather recommend that preterm
infants grow and accrete nutrients similar to the fetus.6-8
Fenton et al recently reported on the variability of methods used to evaluate preterm infant growth velocity. In this system-
atic review of 373 studies, growth velocities were reported in g/kg/d (40%), g/d (32%), and changes in z-scores (29%).9 Most
of the authors did not report the kg denominator that was used to calculate the g/kg/d, but among those reporting their cal-
culations, a variety of methods were used (Table I).9 It is not known if differences in these daily growth targets and methods of
calculating growth velocities yield different patterns of preterm growth over time and how well these patterns fit with current
reference growth curves (Fenton 2013, Olsen 2010, INTERGROWTH 2015, and WHOGS 200610-14). Furthermore, as others have
noted,15 these variations in calculation methods make comparisons between studies difficult and meta-analysis of study results
unreliable.15
Our goal for this study was to examine how well the frequently-quoted growth velocity recommendations (15 g/kg/d,
10-30 grams/day and 1 cm/week) fit with current growth references. To accomplish this, we first compared 3 methods to cal-
culate g/kg/d for weight (the Avg2pt, Exp2pt, and Early1pt methods).9 Then we
calculated the weekly growth velocity of the 4 reference growth curves10-14 and
graphed these, superimposed over the frequently-quoted growth velocity
recommendations1-4,16 Finally, to illustrate the effects of using 15 g/kg/d and 1 cm/ From the 1Department of Community Health Sciences,
Institute of Public Health, Alberta Children’s Hospital
week cumulatively, these were calculated from 24 to 50 weeks and superimposed Research Institute, Cumming School of Medicine,
on the Fenton and Olsen growth chart curves. University of Calgary; 2Nutrition Services, Alberta Health
Services, Calgary, Alberta, Canada; 3Baylor College of
Medicine, Houston, TX; 4Case Western Reserve
University School of Medicine, Cleveland, OH; 5Clinica
Methods del Country Hospital, El Bosque University, Bogota,
Colombia; 6Yale School of Medicine, New Haven, CT; and
7Liege University Hospital, Liege Regional Hospital,

University of Liege, Liege, Belgium

To evaluate potential differences in the three methods used to calculate growth The authors declare no conflicts of interest.
velocity, the medians from the Fenton 2013 growth chart (average combined) were
0022-3476/$ - see front matter. © 2017 Elsevier Inc. All rights
used to calculate weight gain over 5 time frames (1, 4, 8, 12, and 16-weeks) using reserved.
each of the three frequently cited weight gain calculation methods (Avg2pt, Exp2pt https://doi.org10.1016/j.jpeds.2017.10.005

77
THE JOURNAL OF PEDIATRICS • www.jpeds.com Volume 196 • May 2018

Table I. Weight gain calculation methods over a period of time

Early 1-point method (Early1pt) (W2 – W1) / (W1/1000) / number of days
Exponential 2-point method (Exp2pt) 1000 x ln (W2/W1) / number of days
Average 2-point average method (Avg2pt) (W2 – W1) / [(W2 + W1)/2] /1000 / number of days

W1 and W2 are initial and final body weight expressed in grams.

and Early1pt methods) (Table I).9 The differences between the
3 calculation methods were expressed as percentages [(method
A – method B) / method B] (Table II).
Using 4 growth references,10-14 growth velocity rates were cal-
culated weekly from 22-50 postmenstrual weeks and illus-
trated graphically for weight using g/kg/d (Avg2pt (Figure 1,
A), Exp2pt (Figure 1, B), and gram/day (Figure 1, C), and for
head circumference and length using cm/week (Figure 1, D
and E). Male and female data median curves were averaged
together for these calculations. The four growth references were
the Olson 2010 curves,11 the Fenton 2013 curves,10 the 2015
INTERGROWTH-21 curves,12 and a term infant growth stan-
dard (WHOGS 2006).13,14 For the WHOGS, we used the ex-
panded tables that illustrate postnatal weight loss.14
These dynamic growth velocities were then compared with
the frequently-quoted fixed growth velocities of 15 g/kg/d and
10-30 grams/day for weight and 1 cm/week4 for length and head
circumference. This was done by superimposing the fixed
growth velocities over the curves generated using the four ref-
erence curves (Figure 1, A-E).
Last, the 15 g/kg/d and 1 cm/week growth velocity rates were
calculated from 24 to 50 weeks, and superimposed on the
Fenton 2013 and Olsen 2010 preterm growth charts using the
combined gender Fenton chart median values at 24 weeks as
a starting point and then using a daily increment of 15 g/
kg/d and the Exp2pt-method for weight and the weekly in-
crement of 1 cm/week for length and head circumference
(Figure 2, A-C).

Table II. Differences in weight gain calculation results according to the calculation method and time frame, using the
Fenton 2013 growth chart median curve
Period for Post Average Exponential Early Exponential 2-point Early 1-point Early 1-point
calculation menstrual 2-point 2-point 1-point method vs Average method vs Average method vs Exponential
(wk) age (weeks) method method method 2-point method 2-point method 2-point method
1 week 23 to 24 18.1 18.1 19.3 0.13% 6.8% 6.6%
1 week 24 to 25 18.9 18.9 20.2 0.15% 7.1% 6.9%
1 week 25 to 26 18.4 18.4 19.7 0.14% 6.9% 6.7%
1 week 26 to 27 17.9 17.9 19.1 0.13% 6.7% 6.5%
1 week 27 to 28 17.7 17.8 18.9 0.13% 6.6% 6.5%
1 week 28 to 29 17.8 17.8 19.0 0.13% 6.6% 6.5%
1 week 29 to 30 18.0 18.0 19.2 0.13% 6.7% 6.6%
1 week 30 to 31 18.2 18.2 19.4 0.14% 6.8% 6.7%
1 week 31 to 32 18.0 18.0 19.2 0.13% 6.7% 6.6%
1 week 32 to 33 17.2 17.2 18.3 0.12% 6.4% 6.3%
1 week 33 to 34 16.0 16.0 17.0 0.11% 5.9% 5.8%
1 week 34 to 35 14.7 14.7 15.5 0.09% 5.4% 5.3%
1 week 35 to 36 13.2 13.3 13.9 0.07% 4.9% 4.8%
1 week 36 to 37 11.7 11.7 12.2 0.06% 4.3% 4.2%
1 week 37 to 38 10.1 10.1 10.5 0.04% 3.7% 3.6%
1 week 38 to 39 8.8 8.8 9.1 0.03% 3.2% 3.1%
1 week 39 to 40 8.1 8.1 8.3 0.03% 2.9% 2.9%
1 week 40 to 41 7.9 7.9 8.1 0.03% 2.8% 2.8%
1 week 41 to 42 7.9 7.9 8.1 0.03% 2.9% 2.8%
1 week 42 to 43 7.8 7.8 8.0 0.02% 2.8% 2.8%
1 week 43 to 44 7.5 7.5 7.7 0.02% 2.7% 2.7%
1 week 44 to 45 7.1 7.1 7.3 0.02% 2.6% 2.5%
1 week 45 to 46 6.7 6.7 6.9 0.02% 2.4% 2.4%
1 week 46 to 47 6.2 6.2 6.4 0.02% 2.2% 2.2%
1 week 47 to 48 5.8 5.8 5.9 0.01% 2.1% 2.1%
1 week 48 to 49 5.4 5.4 5.5 0.01% 1.9% 1.9%
1 week 49 to 50 5.0 5.0 5.1 0.01% 1.8% 1.8%
4 weeks 24 to 28 17.9 18.3 23.8 2.2% 33% 31%
4 weeks 28 to 32 17.6 18.0 23.4 2.1% 33% 30%
4 weeks 32 to 36 15.1 15.3 19.1 1.5% 27% 25%
4 weeks 36 to 40 9.6 9.7 11.1 0.6% 16% 15%
4 weeks 40 to 44 7.8 7.8 8.7 0.4% 12% 12%
4 weeks 44 to 48 6.5 6.5 7.1 0.3% 10% 10%
8 weeks 28 to 36 15.5 16.7 28 7% 77% 65%
12 weeks 24 to 36 12.8 14.3 28 12% 117% 94%
12 weeks 28 to 40 14.7 17.2 39 17% 162% 124%
16 weeks 24 to 40 12.4 15.3 41 23% 228% 166%

78 Fenton et al
May 2018 ORIGINAL ARTICLES

A B

D E

Figure 1. Weekly median growth velocity of common preterm growth references (Fenton 2013, Olsen 2010, INTERGROWTH
2015, and the World Health Organization [WHO] Growth Standard 200610-14), (A) in g/kg/d using the a constant gain of 15 g/
kg/d superimposed (B) the Exp2pt method g/kg/d, with a constant 15 g/kg/d superimposed, (C) in grams per day calculated
weekly with 10 and 30 g/day constants superimposed, (D) head circumference in cm/week with a constant 1 cm/week super-
imposed, and (E) length in cm/week with a constant 1 cm/week superimposed.

An Attempt to Standardize the Calculation of Growth Velocity of Preterm Infants—Evaluation of Practical Bedside Methods 79
THE JOURNAL OF PEDIATRICS • www.jpeds.com Volume 196

B C

Figure 2. Growth calculation methods superimposed on the Fenton 201310 and Olsen 201011 preterm growth chart curves from
22 to 50 weeks calculated weekly: (A) 15 g/kg/d, daily and exponential calculation methods; (B) 1 cm/week for head circum-
ference; (C) 1 cm/week for length.

80 Fenton et al
May 2018
Results
Comparisons of Weight Gain by Calculation
Method and Time Frame
Male and female velocity rates were almost identical so male
and female rates were averaged in Table II. For the 1-week cal-
culations, g/kg/d growth velocities were similar between the
Avg2pt and Exp2pt g/kg/d estimates for all ages, with a
maximum difference of 0.15% (Table II). In contrast to the
close agreement between the Exp2pt and the Avg2pt, the
1-week weight gain velocities using the Early1pt-method rates
differed from both other methods by 1.8% (49 weeks) to 7%
(23-25 weeks).
As the time periods for calculation increased in duration,
the differences between the Early1pt-method and the other two
methods increased. When weight gain velocity was calcu-
lated for 4-week periods, the difference between the Exp2pt-
method and the Avg2pt versus the Early1pt-method increased
to 30-33% (Table II), with growth velocities of up to 23.8 g/kg/d
using the Early 1pt-method (Table II). Use of the Early 1pt-
method inflated the weight gain velocity estimates to 41 g/kg/d
for the 16-week period of 24 weeks (629 g) to 40 weeks (3492 g).
This estimate was 166-228% higher than estimates obtained
with the other two methods (Table II).
Comparison of Growth References for Weight
Velocity
Using the 2-point methods, the growth reference rates (g/kg/
d) decreased with increasing postmenstrual age (PMA). The
highest rates of growth in weight were from 23-32 weeks (ap-
proximately 18 g/kg/day), followed by a decline to 5 g/kg/d at
50 weeks (Figure 1, A and B). The patterns and magnitude of
the Avg2pt and Exp2pt methods were virtually identical
(Figure 1, A and B).
Using the median curves, the average weekly growth
rates from the start of the curves to 36 weeks were
17.4 g/kg/d (Fenton), 16.6 g/kg/d (Olsen) and 20.9 g/kg/d
(INTERGROWTH) using both the Avg2pt and Exp2pt methods
(Figure 1, A and B). The average rate along the WHOGS
median curve from 40 to 50 weeks was 7.6 g/kg/d for both the
Avg2pt and Exp2pt methods. Note that the Fenton and Olsen
curves both start at 23 weeks whereas the INTERGROWTH
curve starts at 27 weeks. The INTERGROWTH curve had
higher rates of g/kg/d weight velocity between 27-32 weeks (up
to 31 g/kg/d for 27 weeks), similar rates from 32-36 weeks, and
higher rates between 36-40 weeks than the Fenton and Olsen
curves, calculated by both 2-point methods (Figure 1, A and B).
Comparison to 15 g/kg/day Weight Velocity
Standard
When compared graphically (Figure 1, A and B), there were
considerable differences between the frequently used 15 g/
kg/d growth velocity and the 4 growth references. Although
all 3 preterm growth references were similar to 15 g/kg/d rate
at 34 weeks, the growth reference g/kg/d rates were higher before
this age and lower at older ages. The WHOGS g/kg/d rates were
all well below 15 g/kg/d.
An Attempt to Standardize the Calculation of Growth Velocity of Preterm Infants—Evaluation of Practical Bedside Methods
ORIGINAL ARTICLES
In contrast, at most ages, a range of weight velocities of 15-
20 g/kg/d fit the Fenton (23-34 weeks) and Olsen (23-33 weeks)
growth references. This range also fit the INTERGROWTH’s
g/kg/d calculations for 32 through 34 weeks.
Comparison with the 10- to 30-g/Day Weight
Velocity Standard
Gram/day rates for the growth references increased with
postmenstrual age, beginning at 10 gram/day at 23-24 weeks
increasing to 30-34 gram/day between 33 and 37 weeks, lev-
eling off at a median of approximately 30 gram/day between
34 and 50 weeks PMA (Figure 1, C). These rates were within
the recommended 10-30 gram/day weight velocity between
23 and 33 weeks; however, the growth references all rapidly
changed during this time (Figure 1, C).
At 27 weeks, the INTERGROWTH rate (23 gram/day) was
higher than the Olsen (18 gram/day) and Fenton values
(17 gram/day) but similar to the Fenton and Olsen rates
for weeks 30 and 31. The Fenton and Olsen gram/day values
were similar from 23 to 34 weeks, followed by higher then
lower values by Olsen. Although the WHOGS was temporar-
ily within the 10-30 gram/day range at 40 weeks and 47 to 50
weeks, the gram/day values were greater than this range for
41 to 47 weeks.
General Patterns of the Growth References
The growth references showed a decreased rate of head growth
with advancing PMA. Rates of approximately 1 cm/week
between 24-32 weeks decreased to 0.3-0.4 at 48 to 50 weeks
(Figure 1, D). The Fenton, Olsen, and INTERGROWTH head
cm/week curves were very similar throughout, reaching a
maximum difference at 38 weeks of 0.33 cm. For the WHOGS
curve, the rate of head growth along the median decreased
over 40-50 weeks, and was similar to the Fenton and
INTERGROWTH curves between 46 to 50 weeks.
The frequently used 1 cm/week for head circumference was
similar to the growth references before 30 weeks, however all
of the growth reference velocities were less than 1 cm/week after
30 weeks (Figure 1, D).
For length, the growth references’ increments decreased from
approximately 1.4 cm/week between 24-32 weeks (Fenton and
Olsen curves) to 0.7 cm/week at 48-50 weeks (Figure 1, E).
Length velocities were higher for the INTERGROWTH refer-
ence curve between 27 and 32 weeks (up to 1.8 cm/week), with
similar rates to the Fenton curve from 32 to 50 weeks and the
Olsen curve from 32 to 37 weeks. Starting at approximately
42 weeks, the Fenton, INTERGROWTH and WHOGS length
velocity curves merged together to a velocity of approxi-
mately 0.7 cm/week from 48-50 weeks.
The frequently recommended 1 cm/week for length was
lower than all of the growth references prior to 37-40 weeks,
when each of the preterm growth references transitioned from
higher than to lower than 1 cm/week (Figure 1, E).
The Olsen and WHOGS growth velocity calculations had
differences in rates around term from the other growth ref-
erences, with lower rates around term age for weight (g/kg/d,
gram/day), head, and length methods (Figure 1).
81
THE JOURNAL OF PEDIATRICS • www.jpeds.com
Calculated Weight Gain Velocity of 15 g/kg/day
Figure 2, A shows the calculated weight gain velocity of
15 g/kg/d (using daily 15 g/kg/d and Exp2pt-method calcu-
lations) from 24 to 50 weeks superimposed on the Fenton and
Olsen growth charts. The calculated curves were almost iden-
tical and deviated from the growth chart medians, first curving
downward away from the median chart curves, then steeply
crossing the median curves near term and exponentially in-
creasing through 50 weeks. The downward deviation of the cal-
culated curves did not illustrate a postnatal weight loss, but
at 36 weeks, calculated weights were approximately 500 grams
below the median for the reference curves. Although the daily
15 g/kg/d and Exp2pt curves were within 200 g of the median
curves at 40 weeks, by 50 weeks, the differences increased to
3.6-3.8 kg from the Fenton median curve.
Calculated Head Circumference and Length
Velocity
The calculated 1 cm/week growth velocity curves for head cir-
cumference and length are compared with the Fenton and Olsen
curves in Figure 2, B and C. Head circumference fit the median
Fenton and Olsen curves well from 24-33 weeks, but not at
older ages (Figure 2, B). For length, the 1 cm/week estimate
led to a drop to the 3rd percentiles of both the Fenton and Olsen
curves at about 32 weeks and remained there subsequently
(Figure 2, C).
Discussion
Although a weight velocity of 15 g/kg/d is often quoted, as noted
in 1984 by Sparks (the original developer), this only applies
at a limited range of postmenstrual ages.17 In our study, a weight
growth velocity of 15 g/kg/d was consistent with the preterm
infant growth reference curves only at about 34 weeks. At earlier
ages, a growth velocity of 15 g/kg/d was low and at older ages
it was high (Figure 1, A and B). Similarly, the use of a 10-
30 g/day standard for weight and 1 cm/week for head circum-
ference and length velocities applied only to a limited age range
due to rapid changes in the reference rates through 50 weeks’
PMA.
Exponential growth rate calculations have been recom-
mended for preterm infants.15,18,19 Both Avg2pt and Exp2pt cal-
culations are exponential first-order kinetics because they are
based on continually increasing denominators (Figure 2, A).
Exponential growth velocity calculations, whether they are cal-
culated using a log function or an increasing 15 g/kg/d, imply
a continuous increase in growth rates, and do not reflect the
nadir in the first week of life from newborn postnatal weight
loss. Figure 2 shows the lack of fit of fetal-infant growth ve-
locity calculated beyond 34 and 40 weeks and reinforces the
fact that human growth only very temporarily can fit expo-
nential curves.
With respect to the methods used to calculate weight ve-
locities, the Early1pt method performed very differently from
the Avg2pt and Exp2pt methods, producing growth esti-
mates of up to 41 g/kg/d. The reason for larger estimates by
the Early1pt method is due to the division by a smaller de-
82
Volume 196
nominator, (the early weight). The use of a smaller denomi-
nator produces larger values, with the largest estimate produced
for the longest time period. Because the Early1pt method pro-
duced the poorest fit, we do not recommend that this method
be used to summarize growth of preterm infants for periods
longer than 1 week, especially for clinical studies.20
There were differences in growth velocities at 27-32 weeks
PMA between the INTERGROWTH reference and the Fenton
and Olsen references. One might expect INTERGROWTH stan-
dards to be different from the size-at-birth derived growth ref-
erences because they are based solely on measurements made
after the postnatal physiologic weight loss in healthy preterm
infants without fetal growth restriction or any morbidities.12
However, the INTERGROWTH postnatal growth charts were
based on limited data before 36 weeks (12 infants born at <33
weeks of gestation, reaching >100 infants per week at 36
weeks).12 Given the differences in sample size between the
INTERGROWTH curves (n = 12 <33 weeks)12 and the Fenton
curves (n = 34 639 <30 weeks),10 the INTERGROWTH mea-
surements are likely to be less precise than those for the Fenton
(or Olsen) curves below 36 weeks PMA. In addition to dif-
ferences in the methods used to create the INTERGROWTH
curves, this may explain why the INTERGROWTH curves
markedly deviate from the Fenton and Olsen curves, espe-
cially for weight g/kg/d and length less than 33 weeks. We believe
that the INTERGROWTH curves are not yet appropriate for
use in preterm infants, but a revised set of postnatal curves
from INTERGROWTH (based on a larger sample) will be a
valuable neonatal growth assessment tool.
Based on this work, when growth velocity is evaluated using
g/kg/d in clinical practice, we recommend aiming for growth
rates of 15-20 g/kg/d after the initial postnatal weight loss for
infants between 23 and 36 weeks, because these values sum-
marize the growth velocity of the mean estimates of fetal and
infant growth. Although the Avg2pt and Exp2pt weight gain
velocity methods provide similar results, the Avg2pt method
may be easier to perform in clinical settings.
Growth assessments may be better informed by plotting
infants on growth charts and monitoring how well they follow
a reference chart for weight, length and head circumference
than by calculating growth velocity. Growth charts provide an
assessment of both the size (z-score) as well as the growth
history of an infant so there are advantages to using growth
charts for preterm infant growth assessments. Growth assess-
ments of infants growing at 15 g/kg/d may be altered by knowl-
edge of their placement on a growth chart defined in terms
of z-scores (standard deviations above or below the mean). This
additional context may explain why evaluation of changes in
46-2804.pdfz-scores are increasingly used to quantify growth
velocity of preterm infants9 both clinically and for research.15,21
In addition, body composition may also need to be taken into
account to assess fat-free mass accretion.22
We noted that the Olsen and WHOGS growth velocity cal-
culations differed around term age equivalent from the other
growth references (Figure 1). For the Olsen curves, this is due
to the slowing of growth of the fetus in utero. For the WHOGS,
this is likely because we used the more detailed data that
Fenton et al
May 2018
illustrates the postnatal weight loss.14 However, research shows
that preterm infants do not slow their growth between 36 and
42 weeks as do term infants.3,23-25
Because the WHO charts do not show the term infant post-
natal weight loss and regain, the UK Scientific Advisory Com-
mittee on Nutrition recommends not switching from preterm
charts to the WHOGS until 42 or more weeks.26 We agree and
recommend that practitioners switch from preterm charts to
the WHOGS between 42 and 50 weeks.
We encourage expert guideline groups, such as the Ameri-
can Academy of Pediatrics, the European Society of Pediatric
Gastroenterology Hepatology and Nutrition, the Vermont
Oxford Network, the National Institutes of Child Health and
Human Development Neonatal Research Network, and pedi-
atric journals to support a standardized method to report
velocity of growth in preterm infants.
In conclusion, this study revealed a lack of fit between the
frequently-quoted growth velocity goals and growth refer-
ences in preterm infants, particularly after 32 to 36 weeks PMA.
Further research is needed to examine the factors influenc-
ing postnatal growth and the optimal growth trajectory on
growth charts for preterm infants. It is also important to de-
termine whether calculations of infant growth beginning at
birth, the weight nadir, or 1 week of age and ending at various
postnatal ages influences the fit with growth references. Whether
z-scores perform better than these growth velocity calcula-
tions also warrants examination. ■
Submitted for publication Feb 3, 2017; last revision received Jul 21, 2017;
accepted Oct 9, 2017
Reprint requests: Tanis R. Fenton, PhD, RD, FDC, Nutrition Services, Alberta
Health Services, 1403 29 Street NW, Calgary, Alberta, T2N 2T9, Canada.
E-mail: TFenton@ucalgary.ca
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