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Comparison of two fetal growth curves in screening for high-risk neonates
Insights
The mean bodyweight -1.5 standard deviation (SD) is a more effective screening tool for identifying high-risk small-for-gestational-age infants than the 10th percentile cutoff. This finding impacts neonatal screening protocols for light- and small-for-gestational-age infants.
Area of Science:
- Neonatalogy
- Perinatal Medicine
- Public Health
Background:
- The International Statistical Classification of Diseases and Related Health Problems (ICD-10) uses the 10th percentile for defining small-for-gestational-age (SGA) infants.
- Japan has historically used the mean bodyweight -1.5 standard deviation (SD) as a screening criterion for SGA infants since 1983.
Purpose of the Study:
- To evaluate the clinical utility of the 10th percentile versus the mean bodyweight -1.5 SD cutoff for screening high-risk SGA neonates.
- To compare the morbidity rates associated with different screening criteria for SGA infants.
Main Methods:
- Analysis of data from 5260 term neonates born between January 1993 and June 1995.
- Comparison of morbidity rates between neonates identified as SGA by the 10th percentile cutoff and the mean bodyweight -1.5 SD cutoff.
Main Results:
- Neonates below the mean bodyweight -1.5 SD cutoff exhibited a statistically significant higher morbidity rate compared to those below the 10th percentile cutoff.
- No significant difference in morbidity was observed between neonates between the mean bodyweight -1.5 SD and 10th percentile cutoffs and those above the 10th percentile cutoff.
Conclusions:
- The mean bodyweight -1.5 SD is a more effective screening criterion for identifying high-risk SGA infants than the 10th percentile cutoff.
- This suggests a need to reconsider current screening guidelines for SGA neonates to improve risk identification and management.
Abstract:
The International Statistical Classification of Diseases and Related Health Problems (ICD-10) defines the 10th percentiles on the fetal growth curve as the cutoff point for light- and small-for-gestational-age infants, instead of the mean bodyweight -1.5 standard deviation (SD) on the fetal growth curve, which has been used in Japan since 1983. Data on a 5260 sample of term neonates who were born during the 30-month period between January 1993 and June 1995 were obtained. The clinical usefulness of the 10th percentiles and mean bodyweight -1.5 SD cutoff on the fetal growth curve as screening criteria for high-risk neonates of light- and small-for-gestational-age infants was evaluated. There was a statistically significant higher morbidity rate among the neonates whose birthweight was below mean bodyweight -1.5 SD than for those whose birthweight was below the 10th percentile cut off. But there was no significant difference between the morbidity rate of neonates whose birthweight was between mean bodyweight -1.5 SD and the 10th percentile cutoff and the morbidity rate of neonates whose birthweight was above the 10th percentile cutoff. Therefore, mean bodyweight -1.5 SD on the fetal growth curve is a more effective means of screening for high-risk light- and small-for-gestational-age infants than the 10th percentile cutoff on the fetal growth curve.