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Birthweight centiles in preterm infants reappraised.

A Lucas, T J Cole, G M Gandy

    Early Human Development
    |June 1, 1986
    PubMed
    Summary

    Elective cesarean deliveries for preterm infants (25-31 weeks gestation) have increased significantly, leading to lower birthweights. A new birthweight chart based on spontaneous deliveries offers a more accurate standard for assessing intrauterine growth in preterm infants.

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    Area of Science:

    • Neonatalogy
    • Obstetrics
    • Perinatal Medicine

    Background:

    • The relationship between birthweight, gestation, and obstetric/neonatal outcomes is crucial for preterm infants.
    • Interventive deliveries, particularly elective cesarean sections, have increased for preterm births, often due to concerns about intrauterine growth.
    • Existing birthweight charts may not accurately reflect the impact of changing delivery practices on preterm infants.

    Purpose of the Study:

    • To examine the relationship between birthweight, gestation, and obstetric/neonatal course in preterm infants.
    • To investigate the impact of elective cesarean deliveries on birthweight centiles for preterm infants.
    • To develop a new, more accurate birthweight centile chart for preterm infants (<32 weeks gestation) based on spontaneous deliveries.

    Main Methods:

    • Analysis of data from 444 live births at 25-31 weeks gestation (1982-1984) and comparative data from 121 infants (<32 weeks, 1968-1972).
    • Comparison of birthweights between infants delivered electively via cesarean section and those delivered spontaneously.
    • Development of a new birthweight centile chart using data exclusively from spontaneous deliveries.

    Main Results:

    • The rate of elective cesarean deliveries for preterm infants has risen over tenfold, accounting for 42% of deliveries at 30 weeks gestation.
    • Electively delivered preterm infants were significantly lighter than spontaneously delivered infants, lowering overall birthweight centiles.
    • Infant sex, survival status, and gestational age assessment method did not significantly affect birthweight centiles.

    Conclusions:

    • Increased rates of elective cesarean deliveries may contribute to a secular trend of reduced birthweight for gestation in preterm infants.
    • A new birthweight centile chart based solely on spontaneous deliveries provides a more realistic standard for identifying abnormal intrauterine growth in preterm infants.
    • The findings suggest a need to re-evaluate current birthweight assessment standards for preterm infants given evolving obstetric practices.

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