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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
PubMed

Insights

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.
Abstract

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