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Application of a global reference for fetal-weight and birthweight percentiles in predicting infant mortality
1Ministry of Education and Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Insights
The Global Reference for birthweight percentiles improves the identification of infant mortality, especially for preterm infants. This new standard offers a better classification of newborn size at birth compared to older references.
Area of Science:
- Perinatal epidemiology
- Neonatal health outcomes
- Biostatistics
Background:
- Accurate classification of fetal and birth weight is crucial for identifying infants at risk of adverse outcomes.
- Existing references for small- (SGA), appropriate- (AGA), and large-for-gestational-age (LGA) infants may have limitations in predicting mortality.
- The recently published Global Reference offers a new standard for assessing fetal and birth weight percentiles.
Purpose of the Study:
- To evaluate if the Global Reference improves the prediction of infant mortality compared to existing references.
- To assess the impact of the Global Reference on the classification of SGA, AGA, and LGA infants.
- To determine if the Global Reference offers advantages in identifying high-risk infants, particularly preterm neonates.
Main Methods:
- A population-based cohort study utilizing US Linked Livebirth and Infant Death records (1995-2004).
- Included singleton births with birthweight >500 g, from 24-41 weeks of gestation.
- Compared infant mortality rates using three references: Global Reference, a common birthweight reference, and Hadlock's ultrasound reference.
Main Results:
- The Global Reference reclassified 25% of preterm and 9% of term infants compared to the birthweight reference.
- Higher mortality rates were observed in preterm SGA and LGA infants classified by the Global Reference.
- Infants classified as preterm SGA by the Global Reference but not the birthweight reference had significantly higher mortality (105.7 vs 12.9 per 1000).
Conclusions:
- The Global Reference enhances the identification of infant deaths by improving the classification of abnormal newborn size at birth.
- These benefits are more pronounced in preterm infants compared to term infants.
- The Global Reference provides a more accurate assessment of mortality risk associated with SGA and LGA classifications, particularly in preterm neonates.
Objective:
To determine whether the recently published A global reference for fetal-weight and birthweight percentiles (Global Reference) improves small- (SGA), appropriate- (AGA), and large-for-gestational-age (LGA) definitions in predicting infant mortality.
Design:
Population-based cohort study.
Setting:
The US Linked Livebirth and Infant Death records between 1995 and 2004.
Population:
Singleton births with birthweight >500 g born at 24-41 weeks of gestation.
Methods:
We compared infant mortality rates of SGA, AGA, and LGA infants classified by three different references: the Global Reference; a commonly used birthweight reference; and Hadlock's ultrasound reference.
Main Outcome Measures:
Infant mortality rates.
Results:
Among 33 997 719 eligible liveborn singleton births, 25% of preterm and 9% of term infants were classified differently for SGA, AGA, and LGA by the Global Reference and the birthweight reference. The Global Reference indicated higher mortality rates in preterm SGA and preterm LGA infants than the birthweight reference. The mortality rate was considerably higher in infants classified as preterm SGA by the Global Reference but not by the birthweight reference, compared with the corresponding infants classified by the birthweight reference but not by the Global Reference (105.7 versus 12.9 per 1000, RR 8.17, 95% CI 7.38-9.06). Yet, the differences in mortality rates were much smaller in term infants than in preterm infants. Black infants had a particularly higher mortality rate than other races in AGA and LGA preterm and term infants.
Conclusions:
In respect to the commonly used birthweight reference, the Global Reference increases the identification of infant deaths by improved classification of abnormal newborn size at birth, and these advantages were more obvious in preterm than in term infants.
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