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Classification of very low birth weight infants as small for gestational age: International vs. national standards

Marta Tejón-Fernández1, Ana Isabel Armenteros-López2, Nazareth Fernández-Rosales2

  • 1Department of Biomedical Investigation, Foundation for Biosanitary Research in Eastern Andalusia-FIBAO, Almeria, Spain.

Plos One
|May 8, 2025
PubMed

Insights

The INTERGROWTH-21 and Carrascosa 2008 standards show high concordance for classifying small-for-gestational-age infants. Both standards result in similar morbidity and mortality rates, but INTERGROWTH-21 is recommended for broader applicability.

Area of Science:

  • Neonatalogy
  • Pediatric Growth Standards
  • Public Health

Background:

  • Accurate classification of small-for-gestational-age (SGA) infants is crucial for predicting neonatal outcomes.
  • National (Carrascosa 2008) and international (INTERGROWTH-21) growth standards are used, but their concordance in SGA classification and impact on morbidity/mortality is unclear.

Purpose of the Study:

  • To evaluate the concordance between the Carrascosa 2008 and INTERGROWTH-21 standards for classifying SGA neonates weighing <1500g.
  • To compare the morbidity and mortality rates of SGA neonates identified by each standard.

Main Methods:

  • Retrospective cohort study of very low birth weight infants (<1500g) born between 26-36 weeks gestation.
  • Concordance analysis using Cohen's kappa, comparing SGA classification (z score ≤ -1.28) between INTERGROWTH-21 and Carrascosa 2008 standards.
  • Comparison of gestational age, weight, medical needs, morbidity, and mortality between SGA neonates identified by both standards.

Main Results:

  • High concordance (Cohen's kappa = 0.80, p < 0.001) was observed between the INTERGROWTH-21 and Carrascosa 2008 standards for SGA classification.
  • The INTERGROWTH-21 standard identified a lower incidence of SGA (31.6%) compared to Carrascosa 2008 (40.8%, p = 0.03).
  • No significant differences in mortality or morbidity were found among SGA neonates classified by either standard.

Conclusions:

  • The Carrascosa 2008 and INTERGROWTH-21 standards demonstrate comparable outcomes regarding morbidity and mortality for SGA infants.
  • The INTERGROWTH-21 standard is recommended due to its inclusion of multiple pregnancies, diverse ethnicities, and international comparability.
  • These findings support the use of INTERGROWTH-21 for consistent SGA classification in clinical practice and research.
Abstract

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