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European Journal of Pediatrics

, Volume 175, Issue 8, pp 1047–1057 | Cite as

Defining small-for-gestational-age: prescriptive versus descriptive birthweight standards

  • Liset HoftiezerEmail author
  • Chantal W. P. M. Hukkelhoven
  • Marije Hogeveen
  • Huub M. P. M. Straatman
  • Richard A. van Lingen
Original Article

Abstract

Descriptive population-based birthweight standards possess low sensitivity in detecting infants with growth impairment. A prescriptive birthweight standard based on a ‘healthy’ subpopulation without risk factors for intrauterine growth restriction might be superior. We created two birthweight standards based on live born, singleton infants with gestational age 24–42 weeks and born in The Netherlands between 2000 and 2007. Inclusion criteria for the prescriptive birthweight standard were restricted to infants without congenital malformations, born to healthy mothers after uncomplicated pregnancies. We defined small-for-gestational-age (SGA) as birthweight <10th percentile and assessed the ability of both standards to predict adverse neonatal outcomes. The prescriptive birthweight standard identified significantly more infants as SGA, up to 38.0 % at 29 weeks gestation. SGA infants classified according to both standards as well as those classified according to the prescriptive birthweight standard only, were at increased risk of both major and minor adverse neonatal outcomes. The prescriptive birthweight standard was both more sensitive and less specific, with a maximum increase in sensitivity predicting bronchopulmonary dysplasia (+42.6 %) and a maximum decrease in specificity predicting intraventricular haemorrhage (−26.9 %) in infants aged 28–31 weeks.

Conclusion: Prescriptive birthweight standards could improve identification of infants born SGA and at risk of adverse neonatal outcomes.

What is Known:

Descriptive birthweight standards possess low sensitivity in detecting growth restricted infants at risk of adverse neonatal outcomes.

Prescriptive standards could improve identification of very preterm small-for-gestational-age (SGA) infants at risk of intraventricular haemorrhage.

What is New:

Prescriptive standards identify more preterm and term SGA infants at risk of major adverse neonatal outcomes.

Late preterm and term SGA infants classified according to the prescriptive standard are at increased risk of minor adverse neonatal outcomes with potentially harmful implications.

Keywords

Small for gestational age Intrauterine growth restriction Reference standards Sensitivity and specificity Perinatal mortality and morbidity 

Abbreviations

aOR

Adjusted odds ratio

BPD

Bronchopulmonary dysplasia

cPVL

Cystic periventricular leukomalacia

GA

Gestational age

HIE

Hypoxic ischemic encephalopathy

IRDS

Infant respiratory distress syndrome

IUGR

Intrauterine growth restriction

IVH

Intraventricular haemorrhage

NEC

Necrotising enterocolitis

PRN

The Netherlands Perinatal Registry

ROP

Retinopathy of prematurity

SGA

Small-for-gestational-age

Notes

Acknowledgments

We would like to thank The Netherlands Perinatal Registry (PRN) for granting us unlimited access to the required data.

Authors’ contributions

RvL and MH conceived the idea of the manuscript. LH, CH, MH, and RvL were responsible for the study concept and design. LH, CH, and HS analysed the data. LH wrote the initial draft of the manuscript, which was revised by LH, CH, MH, HS, and RvL. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Compliance with ethical standards

Ethical standards

The manuscript does not contain clinical studies or patient data.

Conflict of interest

The authors declare that they have no conflicts of interest.

Funding

No funding was secured for this study.

Supplementary material

431_2016_2740_MOESM1_ESM.pdf (516 kb)
Appendix 1 (PDF 272 kb)
431_2016_2740_MOESM2_ESM.pdf (134 kb)
Figure S1 Smoothed versus empirical descriptive and prescriptive percentiles for boys (A resp. B) and girls (C resp. D) (PDF 197 kb)
431_2016_2740_MOESM3_ESM.pdf (99 kb)
Figure S2 Test characteristics for infants aged 24+0-25+6 and 37+0-39+0 weeks. BW birthweight (PDF 38 kb)
431_2016_2740_MOESM4_ESM.docx (23 kb)
Table S1 (DOCX 23 kb)
431_2016_2740_MOESM5_ESM.docx (22 kb)
Table S2 (DOCX 22 kb)
431_2016_2740_MOESM6_ESM.docx (21 kb)
Table S3 (DOCX 21 kb)
431_2016_2740_MOESM7_ESM.docx (42 kb)
Table S4 (DOCX 20 kb)
431_2016_2740_MOESM8_ESM.docx (40 kb)
Table S5 (DOCX 20 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2016

Authors and Affiliations

  • Liset Hoftiezer
    • 1
    Email author
  • Chantal W. P. M. Hukkelhoven
    • 2
  • Marije Hogeveen
    • 3
  • Huub M. P. M. Straatman
    • 4
  • Richard A. van Lingen
    • 1
  1. 1.Princess Amalia Department of Paediatrics, Department of NeonatologyIsalaThe Netherlands
  2. 2.PerinedUtrechtThe Netherlands
  3. 3.Amalia Children’s Hospital, Department of NeonatologyRadboud University Medical CentreNijmegenThe Netherlands
  4. 4.PHARMO Institute for Drug Outcomes ResearchUtrechtThe Netherlands

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