An Introduction to the UK-WHO
Neonatal and Infant Close Monitoring
(NICM) Growth Chart
Definitions and Terminology
Gestational age: time elapsed between the first day of the
last menstrual period and the day of delivery
Preterm: birth date before 37 completed weeks gestation
Number of weeks preterm: 40 weeks minus gestational age
Chronological age: time elapsed since birth
Postmenstrual age: gestational age plus chronological age
in weeks
Corrected age: chronological age minus number of weeks
preterm
American Academy of Pediatrics, Pediatrics 2004;114:1362-4
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Special features of the NICM Chart
• A date box system to aid accurate calculation of
gestational age
– Calculating corrected age is difficult and prone to
mistakes
– Arrow drawn back method of gestational age
correction not practical for very early gestations
• Large scale
• Extra low reading (-3, -4, -5 SD) lines to allow
assessment of very small infants
• Does not require gestational age correction as
time axis is continuous from birth
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
When to use the NICM chart
• Infants born before 32 weeks gestation
• Unwell infants born 32-36 weeks gestation
• Term unwell neonates needing close monitoring
e.g. those with cardiac or renal disease
• Infants with significant growth or weight faltering
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Data sources for the NICM Chart
23 weeks gestation to 42 weeks:
• Reanalysed UK1990 data
• Describes size at birth only
• Does not describe how preterm infants should
grow
2 weeks to 2 years corrected age charts:
• WHO growth standard
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Head and length
curves in reverse
order to fit on page
Birth weight, and HC for
gestation from 23
weeks to 42 weeks,
length from 26 weeks
Special features:
• Large scale
• SD lines for assessment
of very small infants
• Date boxes
Infancy chart
starts at 2
weeks
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Preparing the chart using date
boxes
• Start with either
–
a) estimated date of delivery (EDD)
– or b) date of birth and known or estimated
gestational age
• Use the calendar to fill in the date boxes
• Mark boxes up in pencil
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Use of the calendar to
fill in the date boxes
• Move up or down column to
find dates for each
preceding (arrow 1) or
succeeding (arrow 2) week
on page 1 or fortnight on
page 2
• At the end of year start
again in same column at
the top or bottom
• Ignore December 31st and
leap years
Nearest
completed week
of gestation
Arrow 1 (working
backwards from known
EDD to birth date)
EDD
Date of birth
Arrow 2 (working
forwards from exact
gestational age to EDD)
EDD
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
1) Preparing the 23-42 weeks gestation
chart using EDD (working backwards)
1. Write expected date of delivery into EDD box
2. Work up calendar column to identify
preceding dates for each completed week of
gestation until first completed week after birth
date is reached
3. Write dates into date boxes (day and month
only)
4. Plot birth measurements at exact gestational
age (weeks and days)
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Example of preparing the 23 to 42 week
chart from EDD (working backwards)
EDD 29/9, date of birth
3/7 = 27 weeks 3 days
gestation, birthweight
800g
1/9
8/9
15/9
7/7
22/9
29/9
14/7 21/7 28/7
6/10 13/10
4/8
11/8 18/8
27/10
25/8 1/9
8/9
10/11
15/9 22/9 29/9
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
2) Preparing the 23 to 42 week chart
from gestational age (working
forwards)
1. Write date of birth in box under exact gestational
age
2. Calculate date of next completed week of
gestation
3. Work down calendar column to identify date for
each subsequent completed week of gestation
until EDD box is reached
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Example of preparing the 23-42 week chart from
known gestation in completed weeks (working
forwards)
Find date of first
completed week of
gestation then write in
the date at each
completed week of
gestation until EDD
Date of birth
4/9/09
28 weeks 3 days
gestation
8/9
15/9
22/9
29/9
6/10
13/10 20/10 27/10 3/11 10/11 17/11 24/11
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Preparing the 2 weeks to 6 months
chart
Date boxes are per fortnight
Preterm infants
• Starting from date in 42 weeks/ 2 weeks box
• Mark the date of each fortnight of age in successive
boxes
Term infants
• Write date of birth in EDD box
• Enter weekly dates up to 42 weeks / 2 weeks box
• Then mark the date of each fortnight in successive
boxes
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Preparing the 2 weeks to 6 months
chart
22/9 29/9 6/10
13/10
27/10
10/11
24/11
8/12
22/12
6/1
20/1
3/2
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
17/2
3/3
17/3
31/3
Preparing the 2 weeks to 6 months
chart
• Date boxes are per calendar month
• Enter date at corrected age 6 months
– For preterm infants use date in EDD box + 6 months
– For term infants use date of birth + 6 months
– e.g. EDD/dob = 24/11/09  enter 24/5/10
• Check that this date is within 2 days of last date box on 2
weeks to 6 months chart
• Mark up remaining date boxes
– 24/6 at 7 months, 24/7 at 8 months etc…
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Preparing the 2 weeks to 6 months
chart
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Summary
UK-WHO Neonatal and Infant Close
Monitoring (NICM) chart
• Use for all extremely preterm (<32 weeks) infants and
any neonate or infant needing close monitoring
• Provides larger plotting area and low reading lines
• No need for gestational age correction
• Use date boxes for speed and accuracy
– Mark up before plotting
– Use to find exact gestational and corrected age
– Use calendar to work out dates up to age 6 months
– After 6 months use calendar months
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Date box group exercise: Jason
• Date of birth 08/06/2006, approximately 26 weeks
gestation
• Expected Date of Delivery (EDD) 10/09/2006
• Mark up the 23-42 week chart date boxes
– What was his exact gestation in weeks and days?
• Mark up the 2 week to 6 month chart date boxes for
– What is the date in the 6 month (26 weeks) box?
• Mark up the 6-24 month chart
– What date will you enter at 6 months?
– Why is it different from the 6 month date on the last page?
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
1. Exact gestational age: 26 weeks 4 days
2. Postmenstrual age at discharge: 40 weeks 3 days
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Date in 26 week box: 12/3
3. Corrected age when admitted with RSV: 10 weeks
(chronological age: 23 weeks and 3 days)
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk
Date in 6 month box: 10/3
4. Current corrected age ; 20 months 1 week
(Chronological age: 23 months)
© 2011 Royal College of Paediatrics and Child Health, 3RD edition Spring 2011. www.growthcharts.rcpch.ac.uk