Nansi S Boghossian1, Marco Geraci2, Erika M Edwards3, Jeffrey D Horbar4. 1. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC. Electronic address: nboghoss@mailbox.sc.edu. 2. Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC. 3. Vermont Oxford Network, Burlington, VT; Department of Mathematics and Statistics, University of Vermont, Burlington, VT; Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT. 4. Vermont Oxford Network, Burlington, VT; Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT.
Abstract
BACKGROUND: It is unclear whether a neonatal or a fetal growth standard is a better predictor of adverse in-hospital newborn infant outcomes. OBJECTIVE: We aimed to evaluate and compare the power of birthweight for gestational age to predict adverse neonatal outcomes using neonatal and fetal growth charts. Gestational age-specific birthweight was examined either as a percentile score or as a binary indicator for birthweight <10th percentile (small for gestational age) with the use of 3 fetal growth charts (National Institute of Child Health and Human Development, World Health Organization, and Intergrowth-21st) and 1 neonatal sex-specific birthweight chart. STUDY DESIGN: Inborn singleton infants from 2006-2014 with gestational age between 22 and 29 weeks and who were enrolled at 1 of the 852 US centers that were participating in the Vermont Oxford Network were studied. Outcomes included death, necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, and chronic lung disease. Receiver operating characteristic curve analysis was used to assess the predictive power of birthweight for gestational age, either as a score or as a small-for-gestational-age indicator, with the use of the 4 charts. We also examined the relative risks of the outcomes by comparing small-for-gestational-age and non-small-for-gestational-age infants with the use of the 4 charts. RESULTS: The percentage of small-for-gestational-age newborn infants ranged from 25.9-29.7% when with used the fetal growth charts. In contrast, the percentage was 10% when we used the neonatal charts. The areas under the receiver operating characteristic curves were similar across the 4 classification methods and were all <0.60, which suggests a poor predictive power. Small-for-gestational-age status, as classified by the neonatal chart, showed stronger associations with death, necrotizing enterocolitis, severe retinopathy of prematurity, and chronic lung disease, compared with those associations that were based on the other classification methods. CONCLUSION: Neither the neonatal nor the fetal growth charts are predictive of adverse infant in-hospital outcomes. In contrast to fetal charts, the use of the neonatal charts results in stronger associations between small-for-gestational-age and adverse outcomes.
BACKGROUND: It is unclear whether a neonatal or a fetal growth standard is a better predictor of adverse in-hospital newborn infant outcomes. OBJECTIVE: We aimed to evaluate and compare the power of birthweight for gestational age to predict adverse neonatal outcomes using neonatal and fetal growth charts. Gestational age-specific birthweight was examined either as a percentile score or as a binary indicator for birthweight <10th percentile (small for gestational age) with the use of 3 fetal growth charts (National Institute of Child Health and Human Development, World Health Organization, and Intergrowth-21st) and 1 neonatal sex-specific birthweight chart. STUDY DESIGN: Inborn singleton infants from 2006-2014 with gestational age between 22 and 29 weeks and who were enrolled at 1 of the 852 US centers that were participating in the Vermont Oxford Network were studied. Outcomes included death, necrotizing enterocolitis, severe intraventricular hemorrhage, severe retinopathy of prematurity, and chronic lung disease. Receiver operating characteristic curve analysis was used to assess the predictive power of birthweight for gestational age, either as a score or as a small-for-gestational-age indicator, with the use of the 4 charts. We also examined the relative risks of the outcomes by comparing small-for-gestational-age and non-small-for-gestational-age infants with the use of the 4 charts. RESULTS: The percentage of small-for-gestational-age newborn infants ranged from 25.9-29.7% when with used the fetal growth charts. In contrast, the percentage was 10% when we used the neonatal charts. The areas under the receiver operating characteristic curves were similar across the 4 classification methods and were all <0.60, which suggests a poor predictive power. Small-for-gestational-age status, as classified by the neonatal chart, showed stronger associations with death, necrotizing enterocolitis, severe retinopathy of prematurity, and chronic lung disease, compared with those associations that were based on the other classification methods. CONCLUSION: Neither the neonatal nor the fetal growth charts are predictive of adverse infant in-hospital outcomes. In contrast to fetal charts, the use of the neonatal charts results in stronger associations between small-for-gestational-age and adverse outcomes.
Authors: Debora Farias Batista Leite; Aude-Claire Morillon; Elias F Melo Júnior; Renato T Souza; Fergus P McCarthy; Ali Khashan; Philip Baker; Louise C Kenny; Jose Guilherme Cecatti Journal: BMJ Open Date: 2019-08-10 Impact factor: 2.692
Authors: Natasha L Pritchard; Richard J Hiscock; Elizabeth Lockie; Michael Permezel; Monica F G McGauren; Amber L Kennedy; Brittany Green; Susan P Walker; Anthea C Lindquist Journal: PLoS Med Date: 2019-10-04 Impact factor: 11.069