Incidence of Small for Gestational Age Neonates, According to the Fenton and Intergrowth-21st Curves in a Level Ii Maternity

Abstract

Objective: To compare the incidence of small for gestational age infants among late preterm and term newborns, using the Fenton and Intergrowth-21st curves. Methods: Observational and retrospective study with newborns in a level II maternity. The study was approved by the Institution’s Ethics Committee. Live births from July 2007 to February 2009 with a gestational age from 34 to 41 weeks and seven days were included. Neonates with incomplete data were excluded. Appropriate weight for gestational age was assessed by the Fenton and Intergrowth-21st intrauterine growth curves, considering birth weight <10th percentile as small for gestational age. The degree of agreement between the two curves was assessed by the Kappa coefficient. Numerical variables were compared using the Student t-test or the Mann-Whitney. Categorical variables were compared using the chi-square test. Statistical analyzes were performed using SPSS17® software, considering significant, p<0.05. Results: We included 2849 newborns with a birthweight of 3210±483 g, gestational age of 38.8±1.4 weeks; 51.1% male. The incidence of small for gestational age in the full sample was 13.0 vs. 8.7% (p<0.001, Kappa=0.667) by the Fenton and Intergrowth-21st curves, respectively. Among late preterm, the incidence of small neonates was 11.3 vs. 10.9% (p<0.001; Kappa=0.793) and among full-term infants it was 13.1% vs. 8.5% (p<0.001; Kappa=0.656), respectively for the Fenton and Intergrowth-21st curves. Conclusions: The incidence of small for gestational age newborns was significantly higher using the Fenton curve, with greater agreement between the Fenton and Intergrowth-21st curves among late preterm, compared to full term neonates.

Extrauterine Growth Restriction in Very Low Birth Weight Infants: Concordance Between Fenton 2013 and INTERGROWTH-21st Growth Charts

“…No significant differences were observed in morbidities of patients in whom both graphs differ when defining IUGR. IUGR frequency in our series is higher than that of other studies (10–20%) ( 15 , 20 , 21 ), probably due in large part to the use of birth weight instead of GA as a selection criterion. This frequency is similar to the total of the SEN1500 network (33.3%) ( 22 ).…”

“…Lebrao et al ( 23 ) in a retrospective study with 26–33 weeks preterms ( n = 173) showed that IW-21 and Fenton were similar for classifying IUGR by weight (35.2 vs. 39.2%). In Barreto's series, which included 2,489 newborns between 34 and 41 weeks, fewer patients were only identified as IUGR using IW-21 (13 vs. 8.7%) ( 21 ). However, Tuzun et al ( 17 ), using newborns under 32 weeks GA, identified more IUGR (15 vs. 12%) with IW-21.…”

“…IW-21 charts include patients from eight countries and overlap WHO growth charts at 64 PMA and are universally applicable (8,13). In IW-21 growth standards, whose data were prospectively collected between 2009 and 2014, lowrisk healthy women who conceived spontaneously with a reliable estimate GA from first trimester without IUGR were eligible Abbreviations: AAP, American Academy of Pediatrics; BMI, body mass index; BPD, bronchopulmonary dysplasia; CRIB, Clinical Risk Index for Babies; EUGR, extrauterine growth restriction; GA, gestational age; HC, head circumference; IUGR, intrauterine growth restriction; IVH, intraventricular hemorrhage; IW- 21 to participate. Standardized anthropometric measurements were made in preterm births from this cohort (13).…”

Demographic, Clinical, and Obstetrical Characterization of Women with Hyperemesis Gravidarum Using a More Restrictive Diagnosis

“…Thus, the average weight gain of 2.6 kg was at least a quarter of what it should have been. This fact may be related to the high rate of SGA new-borns (22.5%), which is almost double the Brazilian rate [16]. Recent studies [17] also point to the importance of insufficient weight gain during the first two trimesters in its association with SGA newborns, a situation that occurred with most of our patients.…”

Differences When Classifying Small for Gestational Age Preterm Infants According to the Growth Chart Applied

“…In contrast, some other studies comparing SGA among late preterm and term newborns found opposite results with higher incidence by Fenton versus Intergrowth-21st curve. 6,36 González-García et al described a good concordance between Intergrowth-21st and Fenton charts, but SGA infants incidence in their study was higher than other series, probably due to the use of birth weight instead of GA as a selection criterion. 23 The current study showed that the main difference between the three growth charts was focused on the identification of the SGA infant.…”