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Comparison of Size Determination Using Fenton and World Health Organization Growth Charts in Term Infants

Michaela Wagner1, Katherine A Poehling2, Jordan Yokoyama3

  • 1Pediatrics (M Wagner), Geisinger Health System, Lewistown, Pa; Departments of Pediatrics (M Wagner, KA Poehling, A Elmore, and J Check), Wake Forest University School of Medicine, Winston-Salem, NC.

Academic Pediatrics
|June 22, 2026
PubMed

Insights

Birth weight classification for term infants differs between WHO and Fenton growth charts, impacting postnatal glucose screening protocols. These variations depend on gestational age and infant sex.

Area of Science:

  • Neonatalogy
  • Pediatric Endocrinology
  • Public Health

Background:

  • Growth curves for determining infant size at birth vary across U.S. hospitals.
  • Accurate size classification is crucial for appropriate neonatal care.

Purpose of the Study:

  • To evaluate systematic differences in classifying term infants as small for gestational age (SGA), appropriate for gestational age (AGA), or large for gestational age (LGA) between Fenton and World Health Organization (WHO) growth charts.
  • To assess the clinical impact of these classification differences on postnatal glucose screening.

Main Methods:

  • Analysis of 10,825 term infants (37-0/7 to 41-6/7 weeks gestational age) born over three years in North Carolina hospitals (rural, suburban, urban).
  • Comparison of infant size classifications using Fenton and WHO growth charts.
  • Evaluation of implications for postnatal glucose screening based on 2011 American Academy of Pediatrics (AAP) guidelines.

Main Results:

  • 71% concordance between Fenton and WHO classifications; 29% discordance.
  • Discordance was higher for SGA (Fenton) vs. AGA (WHO) and LGA (WHO) vs. AGA (Fenton).
  • Classification differences decreased with advancing gestational age and were more pronounced in male infants. WHO resulted in more SGA/LGA classifications, but potentially shorter glucose screening durations.

Conclusions:

  • WHO and Fenton growth charts yield varying birth weight classifications for term infants, influenced by gestational age and sex.
  • These discrepancies have clinical implications for neonatal care, specifically affecting postnatal glucose screening durations and protocols.
Abstract

Keywords:
cross-sectional studiesgrowth chartslarge for gestational agenewbornsmall for gestational age

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