INCIDENCE OF SMALL FOR GESTATIONAL AGE NEONATES, ACCORDING TO THE FENTON AND INTERGROWTH-21ST CURVES IN A LEVEL II MATERNITY.

Claudia Malisano Barreto,Amélia Miyashiro Nunes Dos Santos,Dante Mario Langhi Junior,Anna Carolina Boni Rolim,Marley Aparecida Lambert Pereira,Samira Ali Abbas

doi:10.1590/1984-0462/2021/39/2019245

Abstract

ABSTRACTObjective: To compare the incidence of small for gestational age infants among late preterm and term newborns, using the Fenton and Intergrowth-21st curves.Methods: Observational and retrospective study with newborns in a level II maternity. The study was approved by the Institution’s Ethics Committee. Live births from July 2007 to February 2009 with a gestational age from 34 to 41 weeks and seven days were included. Neonates with incomplete data were excluded. Appropriate weight for gestational age was assessed by the Fenton and Intergrowth-21st intrauterine growth curves, considering birth weight <10th percentile as small for gestational age. The degree of agreement between the two curves was assessed by the Kappa coefficient. Numerical variables were compared using the Student t-test or the Mann-Whitney. Categorical variables were compared using the chi-square test. Statistical analyzes were performed using SPSS17® software, considering significant, p<0.05.Results: We included 2849 newborns with a birthweight of 3210±483 g, gestational age of 38.8±1.4 weeks; 51.1% male. The incidence of small for gestational age in the full sample was 13.0 vs. 8.7% (p<0.001, Kappa=0.667) by the Fenton and Intergrowth-21st curves, respectively. Among late preterm, the incidence of small neonates was 11.3 vs. 10.9% (p<0.001; Kappa=0.793) and among full-term infants it was 13.1% vs. 8.5% (p<0.001; Kappa=0.656), respectively for the Fenton and Intergrowth-21st curves.Conclusions: The incidence of small for gestational age newborns was significantly higher using the Fenton curve, with greater agreement between the Fenton and Intergrowth-21st curves among late preterm, compared to full term neonates.

Highlights

Estimates show that 15 million premature babies[1] and 32 million newborns (NBs) that are small for gestational age (SGA) are born annually in the world, corresponding to an incidence of 27% of SGA NBs among live births in low and middle income countries.[2]
SGA NBs are five times more likely to die in the neonatal period and 4.7 times more likely to die in the first years of life when compared to newborns appropriate for gestational age.[5]
The results of the present study showed incidences of SGA NBs between late and full-term preterm live births, in a secondary level maternity hospital, using Fenton’s intrauterine growth[9] and the Intergrowth-21st curves.[10]

Summary

Introduction

Estimates show that 15 million premature babies[1] and 32 million newborns (NBs) that are small for gestational age (SGA) are born annually in the world, corresponding to an incidence of 27% of SGA NBs among live births in low and middle income countries.[2]. The growth curves differ from each other in accordance with the type of population included and the design of the study adopted The reference curves, such as Fenton’s,9 describe the growth of a sample of children without characterizing it as a normal pattern, and using cross-sections. Another type of curve represents a supposedly normal growth pattern for a population, such as the Intergrowth-21st curve.[10] The Fenton curve[9] is based on the analysis of various intrauterine growth reference curves treated by means of a meta-analysis, with the inclusion of patients from developed countries. The Intergrowth-21st curve[10] was constructed based on a prospective, multiethnic population study, including several countries, such as Brazil, Italy, Oman, the United Kingdom, the United States, China, India and Kenya, and it was designed to create an international growth pattern

Methods

Results

Conclusion