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

Abstract

Postnatal growth restriction has high prevalence in very low birth weight (VLBW) preterm neonates, and this could affect their long-term prognosis. Nowadays, there is no consensus on how to monitor growth in these neonates.Objective: This study aimed to compare prevalence of intra- and extrauterine growth restriction (IUGR and EUGR) in a sample of VLBW infants according to the Fenton 2013 charts and INTERGROWTH-21st (IW-21) standards and to analyze concordance between both in the different EUGR definitions criteria (cross-sectional, dynamic, and true).Patients and Methods: An observational retrospective study of 635 VLBW preterm was performed. The study was carried out in Central University Hospital of Asturias. Body measurements (weight, length, and head circumference) were collected at birth and at hospital discharge and expressed in z-scores for the two references (Fenton 2010 and IW-21). Kappa concordance was calculated.Results: Kappa concordance between Fenton and IW-21 was 0.887 for IUGR and 0.580 for static EUGR. Prevalence was higher according to Fenton in IUGR (36.5 vs. 35.1%), in static EUGR (73.8 vs. 59.3%), and in dynamic EUGR (44.3 vs. 29.3%). Despite observing low prevalence of EUGR when IW-21 was used to define EUGR, a statistical association between neonatal morbidity and diagnosis of EUGR was observed.Conclusion: The Fenton and IW-21 concordance for IUGR is good. IW-21 is more restrictive than Fenton in EUGR. Patients diagnosed by IW-21 as EUGR are more likely to have neonatal morbidity, especially if we use EUGR dynamic definition. In our study, we cannot conclude that one graph is better than the other.

Extrauterine growth restriction in very low birth weight infants according to different growth charts: a retrospective 10 years observational study

“…As far as we know, no other study found preeclampsia as a protective factor for EUGR. However, IUGR, which is frequently associated with preeclampsia, was found to be protective on longitudinal EUGR in a Spanish cohort of preterm babies [11]. This nding may be explained by the fact that having both a low z-score at birth and losing >1 SD may be di cult to occur.…”

“…For the analysis of EUGR risk factors in our population, we used the longitudinal-EUGR de nition since it seems to better predict the auxological long-term outcome [4] and psychomotor development at 18-24 months [16,17]. Moreover, it limits the impact of IUGR on EUGR diagnosis, since SGA babies have a high probability to be discharged < 10°centile, despite of an adequate postnatal growth [11]. Weight loss of 1 SD was chosen as a cut-off, as the prevalence of 2 SD loss was low in our group.…”

“…Previous studies showed that the rate of neonates either classi ed as small for gestational age (SGA) or as having EUGR changes remarkably when assessed with different charts [9][10][11][12], and the prevalence of EUGR is strongly in uenced by its different de nitions [11].…”

Extrauterine Growth Restriction in Preterm Infants: How to Achieve Optimal Catch-Up Growth During Hospitalization?

“…The widely used Fenton2013 curves may not serve as a perfect growth evaluation tool in China since it is based on large preterm sample from different ethnicities in developed countries. And the recently published intergrowth-21st growth curve is prescriptively developed from data of multiethnic and multi country including USA, UK, Italy, China, India, Brazil, Oman, and Kenya [17] . Gonzalez Garcia et al [17] compared the intergrowth-21st and fenton2013 growth curves in 635 VLBWIs in India and found that the former was more rigorous in the diagnosis of EUGR and better related to neonatal complications than the latter.…”

“…And the recently published intergrowth-21st growth curve is prescriptively developed from data of multiethnic and multi country including USA, UK, Italy, China, India, Brazil, Oman, and Kenya [17] . Gonzalez Garcia et al [17] compared the intergrowth-21st and fenton2013 growth curves in 635 VLBWIs in India and found that the former was more rigorous in the diagnosis of EUGR and better related to neonatal complications than the latter. An Korea study of 1356 very preterm infants by Kim et al[18] also reached similar results.…”