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Comparison of regional versus global growth charts for the classification of small-for-gestational age neonates
Pratima Anand1, Deena Thomas1, Ramesh Agarwal1
1Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Objective:
To compare the performance of regional versus global charts for identifying small-for-gestational age (SGA) neonates with short-term adverse outcomes.
Design:
Prospective cohort study.
Setting:
Level-3 neonatal unit in India.
Patients:
Neonates were categorised into SGA and appropriate-for-gestational age (AGA; 10th-90th centile) using four charts, namely, the AIIMS, Lubchenco, Fenton and Intergrowth 21st charts. They were followed up for adverse outcomes until 28 days.
Outcomes:
We evaluated the (1) burden of SGA, (2) sensitivity and diagnostic OR (DOR), (3) relative risk (RR) and number needed to screen (NNS) to detect adverse outcomes in SGA versus 'optimal' AGA (50th-90th centile) and (4) RR of morbidities in 'additional SGA' (ie, classified as SGA by others but not by AIIMS chart).
Results:
Among 1367 neonates, 19.6%, 4.5% and 12.5% were classified as SGA by Intergrowth 21st, AIIMS and Lubchenco charts, respectively. Intergrowth 21st had the highest sensitivity (39.1%) but the least DOR (2.6) to detect adverse outcomes; AIIMS chart had low sensitivity (19.3%) but higher DOR (4.3). RR and NNS were 3.7 and 14; 4.4 and 7; 4.0 and 8; 3.6 and 10 with Intergrowth 21st, AIIMS, Lubchenco and Fenton charts, respectively. 'Additional SGA' identified by Intergrowth 21st had lower risk of adverse outcomes than SGA identified by both the charts (RR 0.39; 95% CI 0.19 to 0.82).
Conclusions:
Compared with AIIMS and Lubchenco charts, Intergrowth 21st runs the risk of overdiagnosing SGA neonates who may not be at a higher risk of short-term morbidities.
