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Identification of intrauterine growth retardation among low birth weight preterm infants
M W Yogman1, H C Kraemer, D Kindlon
1Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
Insights
Assessing intrauterine growth requires careful consideration of reference standards. Using length and weight as standards, instead of solely gestational age, improves classification accuracy for preterm infants.
Area of Science:
- Neonatalogy
- Pediatric Growth Standards
- Intrauterine Growth Restriction
Background:
- Accurate assessment of intrauterine growth is crucial for identifying preterm infants at risk.
- Existing reference standards, often relying on gestational age, may exhibit variability across populations.
- Defining intrauterine growth retardation (IUGR) and low birth weight (LBW) requires robust and universally applicable criteria.
Purpose of the Study:
- To evaluate the variability of intrauterine growth reference standards (weight, length, head circumference) across ethnic groups and geographic locations.
- To assess the specificity of these standards in classifying preterm LBW infants as short, thin, or with small heads.
- To question the sole reliance on gestational age as a reference standard for infant growth parameters.
Main Methods:
- Comparison of reference standards for intrauterine growth in weight, length, and head circumference.
- Analysis of data from 985 inborn preterm LBW infants across eight participating sites.
- Evaluation of growth parameters using gestational age, and alternative reference standards (length for weight, weight for head circumference).
Main Results:
- Significant ethnic and site-specific differences were observed in the prevalence of LBW when gestational age was the sole reference standard.
- These disparities and classification overlaps were reduced when length and weight were used as alternative reference standards.
- The study highlights potential inaccuracies in classifying infant growth when relying exclusively on gestational age.
Conclusions:
- Gestational age alone may not be the optimal reference standard for assessing birth weight and head circumference in preterm infants.
- Alternative reference standards, such as using length for weight and weight for head circumference, may offer improved accuracy.
- Further research is needed to refine growth assessment methods for diverse preterm infant populations.
Abstract:
This study describes an attempt to define intrauterine growth retardation low birth weight preterm infants by comparing reference standards for intrauterine growth in weight, length, and head circumference on their variability across ethnic groups and cities, and on their specificity in independently classifying infants as short, thin, or having small heads. The sample consisted of 985 inborn preterm low birth weight infants enrolled at eight participating sites in a randomized clinical trial using uniform sampling criteria. When gestational age was used as the reference standard, striking differences were found by ethnicity and site in the prevalence of low weight infants at birth. These differences, as well as the potentially false overlap of classification, were attenuated when the use of gestational age as a reference standard was used only for birth length, while length itself was used (as an alternative to gestational age) as the reference standard for birth weight, and weight was used as the reference standard for head circumference. These results raise questions about the use of gestational age as the primary or only reference standard in assessing weight and head circumference at bith.