Small for gestational age neonates – are we missing some by only using standard population growth standards and does it matter?

Narchi, Hassib; Skinner, Andrew C.; Williams, Bernadette

doi:10.3109/14767050903067352

Cited by 27 publications

(13 citation statements)

References 31 publications

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“…Customized weight charts have in some studies proved superior to populations based charts in diagnosing SGA and predicting poor birth outcomes [4], [43]. Others argue that customisation only identifies a small additional group of only moderate increased risk of morbidity and mortality [44], [45].…”

Section: Discussionmentioning

confidence: 99%

Development of a Fetal Weight Chart Using Serial Trans-Abdominal Ultrasound in an East African Population: A Longitudinal Observational Study

et al. 2012

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ObjectiveTo produce a fetal weight chart representative of a Tanzanian population, and compare it to weight charts from Sub-Saharan Africa and the developed world.MethodsA longitudinal observational study in Northeastern Tanzania. Pregnant women were followed throughout pregnancy with serial trans-abdominal ultrasound. All pregnancies with pathology were excluded and a chart representing the optimal growth potential was developed using fetal weights and birth weights. The weight chart was compared to a chart from Congo, a chart representing a white population, and a chart representing a white population but adapted to the study population. The prevalence of SGA was assessed using all four charts.ResultsA total of 2193 weight measurements from 583 fetuses/newborns were included in the fetal weight chart. Our chart had lower percentiles than all the other charts. Most importantly, in the end of pregnancy, the 10th percentiles deviated substantially causing an overestimation of the true prevalence of SGA newborns if our chart had not been used.ConclusionsWe developed a weight chart representative for a Tanzanian population and provide evidence for the necessity of developing regional specific weight charts for correct identification of SGA. Our weight chart is an important tool that can be used for clinical risk assessments of newborns and for evaluating the effect of intrauterine exposures on fetal and newborn weight.

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Section: Discussionmentioning

confidence: 99%

Development of a Fetal Weight Chart Using Serial Trans-Abdominal Ultrasound in an East African Population: A Longitudinal Observational Study

et al. 2012

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“…5-10 Examination of the mortality risk by degree of prematurity and SGA as a proxy for IUGR might be crucial in understanding the attributable disease burden, especially because regions such as south Asia have a reported SGA prevalence of about 40%. 11,12 Such mortality risk estimates and attributable burden could enable the specific targeting of these disorders with appropriate interventions to more effectively save lives.…”

Section: Introductionmentioning

confidence: 99%

Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

et al. 2013

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Summary Background Babies with low birthweight (<2500 g) are at increased risk of early mortality. However, low birthweight includes babies born preterm and with fetal growth restriction, and not all these infants have a birthweight less than 2500 g. We estimated the neonatal and infant mortality associated with these two characteristics in low-income and middle-income countries. Methods For this pooled analysis, we searched all available studies and identified 20 cohorts (providing data for 2 015 019 livebirths) from Asia, Africa, and Latin America that recorded data for birthweight, gestational age, and vital statistics through 28 days of life. Study dates ranged from 1982 through to 2010. We calculated relative risks (RR) and risk differences (RD) for mortality associated with preterm birth (<32 weeks, 32 weeks to <34 weeks, 34 weeks to <37 weeks), small-for-gestational-age (SGA; babies with birthweight in the lowest third percentile and between the third and tenth percentile of a US reference population), and preterm and SGA combinations. Findings Pooled overall RRs for preterm were 6·82 (95% CI 3·56–13·07) for neonatal mortality and 2·50 (1·48–4·22) for post-neonatal mortality. Pooled RRs for babies who were SGA (with birthweight in the lowest tenth percentile of the reference population) were 1·83 (95% CI 1·34–2·50) for neonatal mortality and 1·90 (1·32–2·73) for post-neonatal mortality. The neonatal mortality risk of babies who were both preterm and SGA was higher than that of babies with either characteristic alone (15·42; 9·11–26·12). Interpretation Many babies in low-income and middle-income countries are SGA. Preterm birth affects a smaller number of neonates than does SGA, but is associated with a higher mortality risk. The mortality risks associated with both characteristics extend beyond the neonatal period. Differentiation of the burden and risk of babies born preterm and SGA rather than with low birthweight could guide prevention and management strategies to speed progress towards Millennium Development Goal 4—the reduction of child mortality. Funding Bill & Melinda Gates Foundation.

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“…11,12 Growth restriction in preterm infants requires a less strict cutoff than the 10th centile and needs to be investigated according to GA. However, growth restriction is a dynamic process, and being at the Ͻ10th centile at 25 weeks' gestation is different from being at the Ͻ10th centile at 31 weeks or at term.…”

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confidence: 99%

Neurologic Outcomes at School Age in Very Preterm Infants Born With Severe or Mild Growth Restriction

et al. 2011

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Small for gestational age neonates – are we missing some by only using standard population growth standards and does it matter?

Abstract: Customised charts identified six times more SGA infants than standard charts. These infants, considered appropriately grown by standard charts, are at a significantly higher risk of morbidity.

Cited by 27 publications

References 31 publications

Development of a Fetal Weight Chart Using Serial Trans-Abdominal Ultrasound in an East African Population: A Longitudinal Observational Study

Development of a Fetal Weight Chart Using Serial Trans-Abdominal Ultrasound in an East African Population: A Longitudinal Observational Study

Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis

Neurologic Outcomes at School Age in Very Preterm Infants Born With Severe or Mild Growth Restriction

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