Vol 92, No 12 (2021)
Research paper
Published online: 2021-04-28

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Polish growth charts for preterm infants — comparison with reference Fenton charts

Izabela Mikulak1, Maria Borszewska-Kornacka1, Joanna Puskarz-Gasowska1, Renata Bokiniec1
Pubmed: 33914307
Ginekol Pol 2021;92(12):865-871.


Objectives: Proper infant classification, particularly a preterm infant, as small or large for gestational age, is crucial to undertake activities to improve postnatal outcomes. This study aimed to assess the usability of the Fenton preterm growth charts to evaluate the anthropometric parameters of Polish preterm neonates.
Material and methods: In this single-center, retrospective study data extracted from the medical documentation of preterm neonates born 2002–2013 were analyzed. Body weight, body length, and head circumference were evaluated and used to develop growth charts, which were compared with the reference Fenton growth charts.
Results: This study included 3,205 preterm neonates, of whom 937 were born before 30 weeks of pregnancy. Overall, 11.04%, 3.3%, and 5.2% of neonates were below the 10th percentile on the Fenton charts for birth weight, body length, and head circumference, respectively. Only 26 (6.67%) of 390 analyzed anthropological parameters differed significantly between the study and the Fenton groups. Statistically significant differences between the study and the Fenton populations were found only in body length for both sexes, and in head circumference for female neonates.
Conclusions: The growth charts developed in this study for a population of Polish preterm neonates corresponded to the Fenton charts in terms of birth weight but differed in terms of body length and head circumference. Our findings suggest the need to evaluate growth charts for Polish preterm newborns.

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  1. Chawanpaiboon S, Vogel JP, Moller AB, et al. Global, regional, and national estimates of levels of preterm birth in 2014: a systematic review and modelling analysis. Lancet Glob Health. 2019; 7(1): e37–e46.
  2. UN Inter-Agency Group for Child Mortality. Estimation Levels and trends in child mortality: Report 2017. New York: United Nations Children's Fund. https://www.unicef.org/publications/files/Child_Mortality_Report_2017.pdf (2020-02-25).
  3. Zeitlin J, Szamotulska K, Drewniak N, et al. Euro-Peristat Preterm Study Group. Preterm birth time trends in Europe: a study of 19 countries. BJOG. 2013; 120(11): 1356–1365.
  4. Shrestha S, Thakur A, Goyal S, et al. Growth charts in neonates. Curr Med Res Pract. 2016; 6(2): 79–84.
  5. Yudkin PL, Aboualfa M, Eyre JA, et al. New birthweight and head circumference centiles for gestational ages 24 to 42 weeks. Early Hum Dev. 1987; 15(1): 45–52.
  6. Dubiel M, Krajewski M, Pietryga M, et al. Fetal biometry between 20–42 weeks of gestation for Polish population. Ginekol Pol. 2008; 79(11): 746–753.
  7. Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr. 2013; 13: 59.
  8. Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr. 2003; 3: 13.
  9. Kajdy A, Modzelewski J, Filipecka-Tyczka D, et al. Development of birth weight for gestational age charts and comparison with currently used charts: defining growth in the Polish population. J Matern Fetal Neonatal Med. 2019 [Epub ahead of print]: 1–8.
  10. Katz J, Wu LA, Mullany LC, et al. Prevalence of small-for-gestational-age and its mortality risk varies by choice of birth-weight-for-gestation reference population. PLoS One. 2014; 9(3): e92074.
  11. Katz J, Lee ACc, Kozuki N, et al. CHERG Small-for-Gestational-Age-Preterm Birth Working Group. Mortality risk in preterm and small-for-gestational-age infants in low-income and middle-income countries: a pooled country analysis. Lancet. 2013; 382(9890): 417–425.
  12. Lubchenco LO, Hansman C, Boyd E. Intrauterine growth in length and head circumference as estimated from live births at gestational ages from 26 to 42 weeks. Pediatrics. 1966; 37(3): 403–408.
  13. Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967; 71(2): 159–163.
  14. Babson SG, Benda GI. Growth graphs for the clinical assessment of infants of varying gestational age. J Pediatr. 1976; 89(5): 814–820.
  15. WHO Multicentre Growth Reference Study Group. WHO Child Growth Standards based on length/height, weight and age. Acta Paediatr Suppl. 2006; 450: 76–85.
  16. Tuzun F, Yucesoy E, Baysal B, et al. Comparison of INTERGROWTH-21 and Fenton growth standards to assess size at birth and extrauterine growth in very preterm infants. J Matern Fetal Neonatal Med. 2018; 31(17): 2252–2257.
  17. Reddy KV, Sharma D, Vardhelli V, et al. Comparison of Fenton 2013 growth curves and Intergrowth-21 growth standards to assess the incidence of intrauterine growth restriction and extrauterine growth restriction in preterm neonates ≤ 32 weeks. J Matern Fetal Neonatal Med. 2019 [Epub ahead of print]: 1–8.
  18. Kozuki N, Katz J, Christian P, et al. Child Health Epidemiology Reference Group Preterm Birth–SGA Working Group. Comparison of US birth weight references and the international fetal and newborn growth consortium for the 21st century standard. JAMA Pediatr. 2015; 169(7): e151438.
  19. Gardosi J, Chang A, Kalyan B, et al. Customised antenatal growth charts. Lancet. 1992; 339(8788): 283–287.
  20. Gardosi J, Mongelli M, Wilcox M, et al. An adjustable fetal weight standard. Ultrasound Obstet Gynecol. 1995; 6(3): 168–174.
  21. Gardosi J. Customized fetal growth standards: rationale and clinical application. Seminars in Perinatology. 2004; 28(1): 33–40.
  22. Anderson NH, Sadler LC, McKinlay CJD, et al. INTERGROWTH-21st vs customized birthweight standards for identification of perinatal mortality and morbidity. Am J Obstet Gynecol. 2016; 214(4): 509.e1–509.e7.
  23. Pritchard N, Lindquist A, Siqueira ID, et al. INTERGROWTH-21st compared with GROW customized centiles in the detection of adverse perinatal outcomes at term. J Matern Fetal Neonatal Med. 2020; 33(6): 961–966.
  24. Vieira MC, Relph S, Persson M, et al. Determination of birth-weight centile thresholds associated with adverse perinatal outcomes using population, customised, and Intergrowth charts: A Swedish population-based cohort study. PLoS Med. 2019; 16(9): e1002902.
  25. Francis A, Hugh O, Gardosi J. Customized vs INTERGROWTH-21 standards for the assessment of birthweight and stillbirth risk at term. Am J Obstet Gynecol. 2018; 218(2S): S692–S699.
  26. Burkhardt T, Schäffer L, Zimmermann R, et al. Newborn weight charts underestimate the incidence of low birthweight in preterm infants. Am J Obstet Gynecol. 2008; 199(2): 139.e1–139.e6.
  27. Pritchard NL, Hiscock RJ, Lockie E, et al. Identification of the optimal growth charts for use in a preterm population: An Australian state-wide retrospective cohort study. PLoS Med. 2019; 16(10): e1002923.
  28. Mikolajczyk RT, Zhang J, Betran AP, et al. A global reference for fetal-weight and birthweight percentiles. Lancet. 2011; 377(9780): 1855–1861.
  29. Landau-Crangle E, Rochow N, Fenton TR, et al. Individualized postnatal growth trajectories for preterm infants. JPEN J Parenter Enteral Nutr. 2018; 42(6): 1084–1092.
  30. Clark RH, Thomas P, Peabody J. Extrauterine growth restriction remains a serious problem in prematurely born neonates. Pediatrics. 2003; 111(5 Pt 1): 986–990.
  31. Royal College of Obstetricians and Gynaecologists. The investigation and management of the small-for-gestational-age fetus. RCOG Green–top Guideline No. 31, 2 edition; 2013. https://www.rcog.org.uk/globalassets/documents/guidelines/gtg_31.pdf (2020-02-25).
  32. American Diabetes Association. Position statement: gestational diabetes mellitus. Diabetes Care. 2003; 26(Suppl 1): S103–S105.
  33. Eades CE, Cameron DM, Evans JMM. Prevalence of gestational diabetes mellitus in Europe: A meta-analysis. Diabetes Res Clin Pract. 2017; 129: 173–181.
  34. Wilczyński J, Dziatosz K. Cukrzyca ciążowa – ryzyko dla matki i jej dziecka [Gestational diabetes mellitus – risks for mother and child]. Perinatol Neonatol i Ginekol. 2009; 2: 85–89.