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Improving the Accuracy of Newborn Weight Classification.

Kathy Kay Pickerel1, Julee Waldrop1, Emily Freeman2

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The Olsen and Fenton growth references more accurately classify newborn weight for gestational age than the Lubchenco reference, potentially reducing risks like hypoglycemia for term infants.

Keywords:
Birth weightInfantLarge for gestational ageNewbornSmall for gestational age

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Area of Science:

  • Neonatalogy
  • Pediatric Growth Standards
  • Quality Improvement Science

Background:

  • Accurate classification of newborn weight for gestational age is crucial for identifying infants at risk for adverse outcomes.
  • The Lubchenco growth reference is widely used but may not accurately reflect current infant populations.
  • Updated growth references are needed to improve the identification of small for gestational age (SGA) and large for gestational age (LGA) infants.

Purpose of the Study:

  • To enhance the accuracy of newborn weight classification using the Olsen regional growth reference compared to the Lubchenco reference.
  • To determine the impact of using updated growth references on SGA, appropriate for gestational age (AGA), and LGA classifications in term infants.

Main Methods:

  • Quality improvement methods guided by Lewin's Change Theory were employed.
  • Term infants (N=314) at an academic medical center were evaluated using Lubchenco and other preferred growth references.
  • Nursing and provider staff received education on the new growth reference interpretation.

Main Results:

  • The Olsen regional growth reference identified more infants as small for gestational age (SGA) and fewer as large for gestational age (LGA).
  • Post hoc analysis using the Fenton global growth reference yielded similar results, identifying more SGA and fewer LGA infants.
  • No statistically significant difference was observed between the Olsen and Fenton growth references.

Conclusions:

  • Updated growth references, such as Olsen and Fenton, provide more accurate infant weight-for-gestational age classification than the Lubchenco reference.
  • Improved classification may lead to better identification and management of at-risk newborns.
  • This practice change has the potential to decrease newborn health risks, including hypoglycemia.