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Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards

Liset Hoftiezer1, Chantal W P M Hukkelhoven2, Marije Hogeveen3

  • 1Princess Amalia Department of Paediatrics, Department of Neonatology, P.O. Box 10400, 8000 GK, Isala, Zwolle, The Netherlands. l.hoftiezer@isala.nl.

European Journal of Pediatrics
|June 4, 2016
PubMed

Insights

A new prescriptive birthweight standard identifies more infants as small-for-gestational-age (SGA) and at risk of adverse neonatal outcomes compared to traditional descriptive standards. This improved identification aids in better neonatal care for growth-restricted infants.

Area of Science:

  • Neonatalogy
  • Perinatal Medicine
  • Pediatric Growth Assessment

Background:

  • Descriptive birthweight standards have limited sensitivity in identifying infants with growth impairment and associated adverse outcomes.
  • Prescriptive standards, based on a healthy subpopulation, may offer superior detection of intrauterine growth restriction.
  • Existing research suggests prescriptive standards could enhance the identification of very preterm infants at risk of intraventricular hemorrhage.

Purpose of the Study:

  • To develop and evaluate a prescriptive birthweight standard for improved detection of small-for-gestational-age (SGA) infants.
  • To compare the sensitivity and specificity of prescriptive versus descriptive birthweight standards in predicting adverse neonatal outcomes.
  • To assess the clinical utility of prescriptive standards in identifying infants at risk for both major and minor adverse neonatal outcomes.

Main Methods:

  • Creation of two birthweight standards (descriptive and prescriptive) using data from live-born, singleton infants (24-42 weeks gestation) in the Netherlands (2000-2007).
  • Inclusion criteria for the prescriptive standard: infants without congenital malformations, born to healthy mothers after uncomplicated pregnancies.
  • Definition of small-for-gestational-age (SGA) as birthweight <10th percentile; assessment of prediction for adverse neonatal outcomes.

Main Results:

  • The prescriptive standard identified significantly more infants as SGA (up to 38.0% at 29 weeks gestation).
  • SGA infants identified by the prescriptive standard, or both standards, showed increased risk for major and minor adverse neonatal outcomes.
  • The prescriptive standard demonstrated higher sensitivity (e.g., +42.6% for bronchopulmonary dysplasia) and lower specificity (e.g., -26.9% for intraventricular hemorrhage) in specific gestational age windows.

Conclusions:

  • Prescriptive birthweight standards offer improved identification of SGA infants at risk for adverse neonatal outcomes.
  • These standards enhance the detection of both preterm and term SGA infants requiring closer monitoring.
  • The enhanced sensitivity of prescriptive standards aids in identifying infants with potentially harmful minor adverse outcomes.
Abstract

Keywords:
Intrauterine growth restrictionPerinatal mortality and morbidityReference standardsSensitivity and specificitySmall for gestational age

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