Fetal Size Classified Using Gestational Days rather than Gestational Weeks Improves Correlation with Stillbirth Risk: A Statewide Population Study.

Objective: Many growth charts provide single centile cutoffs for each week of gestation, yet fetuses gain weight throughout the week. We aimed to assess whether using a single centile per week distorts the proportion of infants classified as small and their risk of stillbirth across the week. Design: Retrospective cohort study. Setting: Victoria, Australia. Population: Singleton, non-anomalous infants born from 2005-2015 (529,261). Methods: We applied growth charts to identify small-for-gestational-age (SGA) fetuses on week-based charts (single centile per gestational week) and day-based charts (centile per gestational day). Main outcome measures: Proportions <10th centile by each chart, and stillbirth risk amongst SGA infants. Results: Using week-based charts, 12.1% of infants born on the first day of a gestational week were SGA, but only 7.8% on the final day; ie. an infant born at the end of the week was 44% less likely to be classed as SGA (p<0.0001). The relative risk of stillbirth amongst SGA infants born on the final day of the week compared with the first was 1.47 (95%CI 1.09-2.00, p=0.01). Using day charts, SGA proportions were similar and stillbirth risk equal between the beginning and end of the week (9.5% vs 9.9%). Conclusions: Growth standards using a single cutoff for a gestational week overestimate the proportion of infants that are small at the beginning of the week and underestimate the proportion at the end. This distorts the risk of stillbirth amongst SGA infants based on when in the week an infant is born. Day-based charts should be used

Which chart and which cut-point: deciding on the INTERGROWTH, World Health Organization, or Hadlock fetal growth chart

Objective To determine how various centile cut points on the INTERGROWTH-21st (INTERGROWTH), World Health Organization (WHO), and Hadlock fetal growth charts predict perinatal morbidity/mortality, and how this relates to choosing a fetal growth chart for clinical use. Methods We linked antenatal ultrasound measurements for fetuses > 28 weeks’ gestation from the British Columbia Women’s hospital ultrasound unit with the provincial perinatal database. We estimated the risk of perinatal morbidity/mortality (decreased cord pH, neonatal seizures, hypoglycemia, and perinatal death) associated with select centiles on each fetal growth chart (the 3rd, 10th, the centile identifying 10% of the population, and the optimal cut-point by Youden’s Index), and determined how well each centile predicted perinatal morbidity/mortality. Results Among 10,366 pregnancies, the 10th centile cut-point had a sensitivity of 11% (95% CI 8, 14), 13% (95% CI 10, 16), and 12% (95% CI 10, 16), to detect fetuses with perinatal morbidity/mortality on the INTERGROWTH, WHO, and Hadlock charts, respectively. All charts performed similarly in predicting perinatal morbidity/mortality (area under the curve [AUC] =0.54 for all three charts). The statistically optimal cut-points were the 39th, 31st, and 32nd centiles on the INTERGROWTH, WHO, and Hadlock charts respectively. Conclusion The INTERGROWTH, WHO, and Hadlock fetal growth charts performed similarly in predicting perinatal morbidity/mortality, even when evaluating multiple cut points. Deciding which cut-point and chart to use may be guided by other considerations such as impact on workflow and how the chart was derived.

CUSTOMISED FETAL GROWTH CHARTS VERSUS POPULATION-BASED GROWTH CHARTS IN IDENTIFYING ADVERSE FETAL OUTCOMES: A SYSTEMATIC REVIEW

One for all antenatal growth charts may not adequately capture risks for adverse fetal outcomes. This review appraises studies on customised growth curves in preventing adverse fetal effects and compares them with population-based growth charts. A review was done on articles published in PubMed database, Cochrane database and Google Scholar. The search criteria were English written described fetal outcomes using a customised fetal growth chart published between 2007 and 2020. All selected articles reported antenatal follow-up data and compared the intervention using the customised antenatal growth chart to the population-based antenatal growth chart. The primary outcome measure was the incidence of small for gestational age (SGA) and stillbirths. The feasibility of using a customised fetal growth chart versus a population-based fetal growth chart was assessed as the process indicator. Twenty-two articles comparing the use of customised growth charts to population-based growth charts were found. Sixteen studies depicted a significant improvement in the detection of pathological SGA over a population-based growth chart ,and another two studies showed significant in detecting large gestational age (LGA). In conclusion, the customised growth charts improve the detection of pathological SGA antenatally. The feasibility of the intervention depends on the training, policy, infrastructure, staffing, awareness and ethics. A summarised framework analysis for implementing customised growth charts is proposed for future research.

Statistical models for pediatric endocrinology

Background: Modelling references for biomarkers as reference curves enables calculation of patient z-scores that are adjusted for both gender and covariance with age during childhood.Aim: To establish biomarker reference curves using the ‘LMS’ method previously employed for conventional growth charts.Design, Setting and Participants: Cross-sectional study of healthy Norwegian girls (n=647) and boys (n=465) in ages 6 to 16 years were recruited in the Bergen Growth Study (2016). Blood samples were analyzed using state-of-the-art instruments.Results: Reference curves for several biomarkers were established in the ‘LMS’ framework and provided here for clinical implementation. Conclusion: The ‘LMS’ reference framework is already used to create conventional growth charts and may also be applied in clinical biochemistry.

Development of Local Percentile Growth Charts of Children between Birth to Ten Years

Growth pattern of human population changes with time and place. Particularly developing countries, country like India, is in a stage of nutritional transition hence it is necessary to update growth references regularly. The present study is carried out on 0-10 years from Baramati from Pune district of Maharashtra. We considered that children from maternity homes, BCG camps, well baby clinics, immunization camps, private clinics, ‘Anganwadis and Balwadis’, Nurseries’ and schools etc. Our study shows that growth performance of Anthropometric indices for Baramati children is much less than National Centre of Health Statistics (NCHS) and slightly less than Indian Council of Medical Research ICMR and Affluent Indians (AI). We have proposed growth charts for Baramati region to monitor growth parameters. Keywords: Anthropometric Indices, NCHS, ICMR, AI.

The Escape from Malnutrition of Chilean Boys and Girls: Height-for-Age Z Scores in Late XIX and XX Centuries

We studied the trends of height-for-age (HAZ) Z scores by socioeconomic status (SES) groups of Chilean boys and girls aged 5–18 born between 1877 and 2001, by performing a meta-analysis of 53 studies reporting height-for-age sample data from which 1258 HAZ score datapoints were calculated using the 2000 reference growth charts for the US of the Centers for Disease Control and Prevention (CDC). We found stagnant mean and median HAZ scores of about −1.55 to −1.75 for the general population, and −2.2 to −2.55 for lower SES groups up to cohorts born in the 1940s. However, we found an upwards structural change in cohorts born after the 1940s, a period in which HAZ scores grew at a pace of about 0.25 to 0.30 HAZ per decade. Since this change happened in a context of moderate Gross Domestic Product (GDP) growth, high and persistent income inequality, and stagnant wages of the working class, we discuss the extent to which our findings are associated with the increase in public social spending and the implementation and expansion of a variety of social policies since the 1940s and early 1950s.

Changing sex differences in undernutrition of African children: findings from Demographic and Health Surveys

The study investigates sex differences in the prevalence of undernutrition in sub-Saharan Africa. Undernutrition was defined by Z-scores using the CDC-2000 growth charts. Some 128 Demographic and Health Surveys (DHS) were analysed, totalling 700,114 children under-five. The results revealed a higher susceptibility of boys to undernutrition. Male-to-female ratios of prevalence averaged 1.18 for stunting (height-for-age Z-score <−2.0); 1.01 for wasting (weight-for-height Z-score <−2.0); 1.05 for underweight (weight-for-age Z-score <−2.0); and 1.29 for concurrent wasting and stunting (weight-for-height and height-for-age Z-scores <−2.0). Sex ratios of prevalence varied with age for stunting and concurrent wasting and stunting, with higher values for children age 0–23 months and lower values for children age 24–59 months. Sex ratios of prevalence tended to increase with declining level of mortality for stunting, underweight and concurrent wasting and stunting, but remained stable for wasting. Comparisons were made with other anthropometric reference sets (NCHS-1977 and WHO-2006), and the results were found to differ somewhat from those obtained with CDC-2000. Possible rationales for these patterns are discussed.