Fenton vs. Intergrowth-21st: Postnatal Growth Assessment and Prediction of Neurodevelopment in Preterm Infants

Abstract

Although the survival rate of preterm infants has improved over the years, growth failure and associated impaired neurodevelopmental outcome remains a significant morbidity. Optimal nutrition plays an important role in achieving adequate postnatal growth. Accurate growth monitoring of preterm infants is critical in guiding nutritional protocols. Currently, there is no consensus regarding which growth assessment tool is suitable for monitoring postnatal growth of preterm infants to foster optimal neurodevelopmental outcomes while avoiding future consequences of aggressive nutritional approaches including increased risk for cardiovascular disease and metabolic syndrome. A retrospective single center cohort study was conducted to compare the performance of two growth-assessment tools, Fenton and Intergrowth-21st (IG-21st) in the classification of size at birth, identification of impaired growth and predicting neurodevelopment. A total of 340 infants with mean gestational age of 30 weeks were included. Proportion of agreement between the two tools for identification of small for gestational age (SGA) was high 0.94 (0.87, 0.1) however, agreement for classification of postnatal growth failure at discharge was moderate 0.6 (0.52, 0.69). Growth failure at discharge was less prevalent using IG-21st. There was significant association between weight-based growth failure and poor neurodevelopmental outcomes at 12 and 24 months of age.

Comparison of Fenton and Intergrowth-21st growth charts: a retrospective study of preterm neonates at ≤34 weeks

“…The studies conducted by Tuzun et al, [11] Reddy et al, [12] Yitayew et al [13] and Patel et al [14] found that there was significant difference in identifying the EUGR rates by both growth charts, contrary to our study, in which we found no statistical difference. The reason for this contradiction could be due to the difference in sample size used, feeding strategy in our unit, which follows a restricted feeding during the period of illness and also we had a higher number of mature infants compared to other studies.…”

“…In a study conducted by Yitayew et al [13] in infants born between 24-33 weeks of gestation, the authors also found that the SGA rate identified by Intergrowth-21st was high but not significant, and the EUGR rate identified was low when compared to Fenton growth charts which was found to be statistically significant. These results were similar to our study except for the statistical significance.…”

The Prevalence of Small for Gestational Age and Extrauterine Growth Restriction among Extremely and Very Preterm Neonates, Using Different Growth Curves, and Its Association with Clinical and Nutritional Factors

“…On the contrary, in another study, Reddy et al pointed out that neonates classified as SGA at birth by INTERGROWTH-21st and not by Fenton2013 growth charts had a higher incidence of morbidities such as sepsis and ROP [41]. In other studies, no significant difference was observed for the classification of birth weight for GA in preterm neonates born before 33 weeks between the two assessment growth charts [42,43]. It is very essential to accurately define SGA with appropriate charts, since being born SGA is associated with an increased risk of higher mortality, postnatal growth failure, and neurodevelopmental impairment at 18-22 months of corrected age [44].…”

“…The extrauterine environment presents a completely different context for preterm babies, exposing them to unique metabolic responses and morbidities, which contrast significantly with the conditions experienced by fetuses in utero. A retrospective study published in 2021 presented a lower percentage of EUGR with respect to weight and length at discharge when INTERGROWTH-21st curves were used, compared to Fenton2013 curves, and this was associated with poorer language development assessed either at 12 or 24 months [43]. It is important to note that the main limitation of the INTERGROWTH-21st preterm postnatal standards is the limited number of infants born before 33 weeks' gestation who contributed to the development of the growth curves, which potentially affects the validity of the standards.…”

Relationship between nutrient intakes in the transition phase and postnatal growth of preterm infants: a systematic review

“…Parenteral and enteral nutritional support for newborns is based on continuous nutrition guidelines [ 2 – 4 ], and the risk of postnatal growth failure (PGF) in preterm infants remains high [ 5 , 6 ]. Moreover, PGF is associated with subsequent poor neurodevelopment outcomes [ 7 ]. Therefore, the prevention of PGF in preterm infants remains a challenge for physicians.…”