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Differences When Classifying Small for Gestational Age Preterm Infants According to the Growth Chart Applied.
Javier Estañ-Capell1,2, Beatriz Alarcón-Torres1, Magdalena Miró-Pedro1
1Neonatal Unit, Hospital Clínico Universitario, Valencia, Spain.
American Journal of Perinatology
|January 29, 2023
Summary
Classifying small for gestational age (SGA) preterm infants varies significantly by growth chart, with Olsen identifying more cases than Fenton or Intergrowth-21st. Further research is needed to determine the optimal chart for these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Growth Standards
- Perinatal Epidemiology
Background:
- Accurate classification of preterm infants, especially those small for gestational age (SGA), is crucial due to clinical and therapeutic implications.
- There is a lack of consensus on the ideal growth chart for assessing preterm neonates.
- Growth charts significantly impact the identification and management of SGA infants.
Purpose of the Study:
- To compare the Olsen, Intergrowth-21st, and Fenton growth charts for classifying preterm infants at birth.
- To evaluate the incidence of SGA preterm infants using these different charts.
- To assess the concordance and differences in SGA classification among the selected growth charts.
Main Methods:
- A retrospective study involving 529 preterm infants born at or before 32 weeks of gestational age.
- Calculation of birth weight Z-scores using Olsen, Intergrowth-21st, and Fenton charts.
- Estimation of ponderal index (PI) and comparison of SGA incidence (birth weight < 10th percentile) and clinical outcomes across charts.
Main Results:
- The Olsen chart identified a significantly higher incidence of SGA (19.1%) compared to Intergrowth-21st (14.2%) and Fenton (10%).
- Differences were observed in the classification of SGA infants' symmetry (PI), with Olsen identifying more symmetric SGA.
- Kappa concordance was high between Intergrowth-21st and Fenton (0.805) and Intergrowth-21st and Olsen (0.824), but poor between Fenton and Olsen (0.641). No differences in neonatal morbidities or mortality were noted.
Conclusions:
- Significant variations exist in classifying very preterm infants at birth depending on the growth chart used, particularly for symmetric SGA.
- While Intergrowth-21st demonstrates high concordance with both Fenton and Olsen, the poor agreement between Fenton and Olsen highlights chart-specific discrepancies.
- Further research is essential to identify the optimal growth chart, considering factors like population variability and pregnancy dating accuracy.
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