Country-Specific vs. Common Birthweight-for-Gestational Age References to Identify Small for Gestational Age Infants Born at 24–28 weeks: An International Study
Lisa J. Martin
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorGunnar Sjörs
Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Search for more papers by this authorBrian Reichman
Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Israel Neonatal Network, Tel Hashomer, Israel
Search for more papers by this authorBrian A. Darlow
Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
Search for more papers by this authorNaho Morisaki
Department of Social Medicine, National Center for Child Health and Development, Neonatal Research Network Japan, Setagaya-ku, Tokyo, Japan
Search for more papers by this authorNeena Modi
Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, UK Neonatal Collaborative, London, UK
Search for more papers by this authorDirk Bassler
Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Search for more papers by this authorLucia Mirea
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorMark Adams
Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Search for more papers by this authorSatoshi Kusuda
Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
Search for more papers by this authorKei Lui
Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, NSW, Australia
Search for more papers by this authorLaura San Feliciano
Spanish Neonatal Network, Hospital Universitario de Salamanca, Valencia, Spain
Search for more papers by this authorStellan Håkansson
Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
Search for more papers by this authorTetsuya Isayama
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorRintaro Mori
Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
Search for more papers by this authorMax Vento
Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
Search for more papers by this authorShoo K. Lee
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorCorresponding Author
Prakesh S. Shah
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Correspondence:
Prakesh S Shah, Department of Paediatrics, Mount Sinai Hospital, Rm 19-231F, 600 University Ave, Toronto, ON M5G 1X5, Canada
E-mail: [email protected].
Search for more papers by this authorthe International Network for Evaluating Outcomes (iNeo) of Neonates Investigators
Search for more papers by this authorLisa J. Martin
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorGunnar Sjörs
Swedish Neonatal Quality Register, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
Search for more papers by this authorBrian Reichman
Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Centre, Israel Neonatal Network, Tel Hashomer, Israel
Search for more papers by this authorBrian A. Darlow
Australia and New Zealand Neonatal Network, Department of Paediatrics, University of Otago, Christchurch, New Zealand
Search for more papers by this authorNaho Morisaki
Department of Social Medicine, National Center for Child Health and Development, Neonatal Research Network Japan, Setagaya-ku, Tokyo, Japan
Search for more papers by this authorNeena Modi
Neonatal Data Analysis Unit, Section of Neonatal Medicine, Department of Medicine, Imperial College London, UK Neonatal Collaborative, London, UK
Search for more papers by this authorDirk Bassler
Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Search for more papers by this authorLucia Mirea
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorMark Adams
Swiss Neonatal Network, Department of Neonatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
Search for more papers by this authorSatoshi Kusuda
Neonatal Research Network Japan, Maternal and Perinatal Center, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
Search for more papers by this authorKei Lui
Australian and New Zealand Neonatal Network, Royal Hospital for Women, National Perinatal Epidemiology and Statistic Unit, University of New South Wales, Randwick, NSW, Australia
Search for more papers by this authorLaura San Feliciano
Spanish Neonatal Network, Hospital Universitario de Salamanca, Valencia, Spain
Search for more papers by this authorStellan Håkansson
Swedish Neonatal Quality Register, Department of Pediatrics/Neonatal Services, Umeå University Hospital, Umeå, Sweden
Search for more papers by this authorTetsuya Isayama
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorRintaro Mori
Neonatal Research Network Japan, Department of Health Policy, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
Search for more papers by this authorMax Vento
Spanish Neonatal Network, Health Research Institute La Fe, Valencia, Spain
Search for more papers by this authorShoo K. Lee
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Search for more papers by this authorCorresponding Author
Prakesh S. Shah
Maternal-Infant Care Research Centre, Mount Sinai Hospital, Canadian Neonatal Network, Toronto, ON, Canada
Correspondence:
Prakesh S Shah, Department of Paediatrics, Mount Sinai Hospital, Rm 19-231F, 600 University Ave, Toronto, ON M5G 1X5, Canada
E-mail: [email protected].
Search for more papers by this authorthe International Network for Evaluating Outcomes (iNeo) of Neonates Investigators
Search for more papers by this authorAbstract
Background
Controversy exists as to whether birthweight-for-gestational age references used to classify infants as small for gestational age (SGA) should be country specific or based on an international (common) standard. We examined whether different birthweight-for-gestational age references affected the association of SGA with adverse outcomes among very preterm neonates.
Methods
Singleton infants (n = 23 788) of 240–286 weeks' gestational age in nine high-resource countries were classified as SGA (<10th centile) using common and country-specific references based on birthweight and estimated fetal weight (EFW). For each reference, the adjusted relative risk (aRR) for the association of SGA with composite outcome of mortality or major morbidity was estimated.
Results
The percentage of infants classified as SGA differed slightly for common compared with country specific for birthweight references [9.9% (95% CI 9.5, 10.2) vs. 11.1% (95% CI 10.7, 11.5)] and for EFW references [28.6% (95% CI 28.0, 29.2) vs. 24.6% (95% CI 24.1, 25.2)]. The association of SGA with the composite outcome was similar when using common or country-specific references for the total sample for birthweight [aRRs 1.47 (95% CI 1.43, 1.51) and 1.48 (95% CI 1.44, 1.53) respectively] and for EFW references [aRRs 1.35 (95% CI 1.31, 1.38) and 1.39 (95% CI 1.35, 1.43) respectively].
Conclusion
Small for gestational age is associated with higher mortality and morbidity in infants born <29 weeks' gestational age. Although common and country-specific birthweight/EFW references identified slightly different proportions of SGA infants, the risk of the composite outcome was comparable.
Supporting Information
| Filename | Description |
|---|---|
| ppe12298-sup-0001-TableS1-S2.docxWord document, 41.9 KB |
Table S1. Characteristics of infants classified as SGA/non-SGA using different birthweight-for-gestational age references. Table S2. Association of small for gestational age (SGA) with mortality according to birthweight-for-gestational reference and collaborator list of contributing neonatal units. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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