Electronic health record (EHR) systems are increasingly being adopted in pediatric practices; however, requirements for integrated growth charts are poorly described and are not standardized in current systems. The authors integrated growth chart functionality into an EHR system being developed and installed in a multispecialty pediatric clinic in an academic medical center. During a three-year observation period, rates of electronically documented values for weight, stature, and head circumference increased from fewer than ten total per weekday, up to 488 weight values, 293 stature values, and 74 head circumference values (p<0.001 for each measure). By the end of the observation period, users accessed the growth charts an average 175 times per weekday, compared to 127 patient visits per weekday to the sites that most closely monitored pediatric growth. Because EHR systems and integrated growth charts can manipulate data, perform calculations, and adapt to user preferences and patient characteristics, users may expect greater functionality from electronic growth charts than from paper-based growth charts.
Growth charts are used in pediatric medicine to plot anthropomorphic measurements over time, serving as a screen for diseases related to a patient's nutritional and general health status. Whereas reference data for term infants are available from the Center for Disease Control, reference data for premature infants in a neonatal intensive care unit have not been established. Predictive curves for preterm patients, which are based on a patient's postmenstrual age and anthropomorphic measurements at birth, cannot be easily implemented with traditional paper-based methods. Preterm growth charts can be generated in an electronic health record system, but doing so requires mathematical equations or computer-readable tables. This report examines published perinatal growth curves and presents equations for predicted postnatal weight, head circumference and length in preterm infants.
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