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The INTERGROWTH-21st (IG-21st) standards offer more accurate growth assessments for preterm infants compared to WHO Child Growth Standards (WHO GS). Using IG-21st standards improves classification and monitoring, especially in the first year of life.

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Area of Science:

  • Pediatrics
  • Neonatology
  • Growth Monitoring

Background:

  • Accurate growth assessment is crucial for identifying deviations from expected patterns in infants.
  • Existing growth standards may not adequately represent diverse infant populations, particularly preterm infants.
  • The WHO Child Growth Standards (WHO GS) and INTERGROWTH-21st Standards (IG-21st) are widely used but may yield different classifications.

Purpose of the Study:

  • To compare the classification and interpretation of infant growth trajectories using the WHO GS and IG-21st standards.
  • To evaluate the impact of different growth standards on identifying growth abnormalities in low birthweight infants.

Main Methods:

  • Secondary data analysis of an observational cohort study involving 608 moderately low birthweight infants in Malawi and Tanzania.
  • Calculation of Z-scores (weight-for-age, length-for-age, head circumference-for-age) at birth and longitudinally up to 24 months using both WHO GS and IG-21st standards.
  • Construction of conditional growth models to assess deviations from mean growth patterns within gestational age subgroups.

Main Results:

  • At birth, IG-21st Newborn Size Standard (NBS) z-scores were higher than WHO GS, particularly in lower gestational age subgroups.
  • The proportion of preterm infants classified with Z-scores below -2 was significantly lower using IG-21st Preterm Postnatal Standards (PPS) compared to WHO GS (e.g., weight: 6.1% vs. 95.6%).
  • Between-standard z-score differences were largest in preterm infants from birth to 6 months, diminishing by 6-12 months, with minimal differences observed in term infants.

Conclusions:

  • The WHO GS alone may misclassify the growth status of preterm and term infants, especially at birth and in early infancy.
  • The IG-21st standards provide more appropriate GA-specific classifications, aligning better with expected growth patterns and supporting accurate monitoring.
  • Recommendations include using IG-21st NBS at birth, IG-21st PPS from 27 to 64 weeks postmenstrual age, and WHO GS thereafter.