Reply

Abstract

Leite et al raise concerns regarding the consensus definition of growth restriction in the newborn. We kindly thank them for their feedback and the chance to put these issues in perspective. First, we agree that global representation is important to come to a reliable consensus definition that also can be successfully implemented globally. We acknowledge the fact that our efforts at incorporating publishing experts from Latin America and Africa were unsuccessful. The essential phenotype of fetal growth restriction is universal as far as we know, and the use of local reference charts is included. Furthermore, the experts from other low- and middle-income countries that participated in the Delphi procedures voted similarly to the rest of the panel. We therefore believe that the definition is applicable in the mentioned areas. Second, the authors point out that gestational age influences clinical outcomes of fetuses and newborn infants who are growth restricted. We agree, and would like to point out that the Delphi procedure set out to define growth restriction, not to write a management protocol. Gestational age is vital information in the consultation between neonatologists/pathologists or other medical professionals as it affects prognosis and management. Third, antenatal suspected (fetal) growth restriction was defined in this Delphi procedure according to the previously developed international consensus definition by the same group.1Gordijn S.J. Beune I.M. Thilaganathan B. et al.Consensus definition of fetal growth restriction: a Delphi procedure.Ultrasound Obstet Gynecol. 2016; 48: 333-339Crossref PubMed Scopus (655) Google Scholar For maternal pregnancy complications, examples were given during the consensus procedure and include hypertension and pre-eclampsia. Both variables are included as contributory variables; thus, also without antenatal information the diagnosis of growth restriction in the newborn can be made. We thank Leite et al for stimulating the discussion on defining growth restriction in the newborn. Fetal and neonatal growth restriction: new criteria, renew challengesThe Journal of PediatricsVol. 203PreviewBeune et al published a statement on growth restriction in the newborn, building on a similar initiative in obstetrics.1,2 These statements press experts in both fields to critically evaluate their current diagnostic practices regarding fetal growth restriction. Full-Text PDF