RD, LDN, c/o Louise Lawson, PhD, Kennesaw State, Department of Math and Stats, Box 1204, building 12, 1000 Chastain Rd, Kennesaw, GA 30144-5591, USA.
Pediatrics. 2010 Feb;125(2):e214-24. doi: 10.1542/peds.2009-0913. Epub 2010 Jan 25.
The objective of this study was to create and validate new intrauterine weight, length, and head circumference growth curves using a contemporary, large, racially diverse US sample and compare with the Lubchenco curves.
Data on 391 681 infants (Pediatrix Medical Group) aged 22 to 42 weeks at birth from 248 hospitals within 33 US states (1998-2006) for birth weight, length, head circumference, estimated gestational age, gender, and race were used. Separate subsamples were used to create and validate curves. Smoothed percentile curves (3rd to 97th) were created by the Lambda Mu Sigma (LMS) method. The validation sample was used to confirm representativeness of the curves. The new curves were compared with the Lubchenco curves.
Final sample included 257 855 singleton infants (57.2% male) who survived to discharge. Gender-specific weight-, length-, and head circumference-for-age curves were created (n = 130 111) and successfully validated (n = 127 744). Small-for-gestational age and large-for-gestational age classifications using the Lubchenco curves differed significantly from the new curves for each gestational age (all P < .0001). The Lubchenco curves underestimated the percentage of infants who were small-for-gestational-age except for younger girls (< or =36 weeks), for whom it was more likely to be overestimated; underestimated percentage of infants (< or =36 weeks) who were large-for-gestational-age; and overestimated percentage of infants (>36 weeks) who were large-for-gestational-age.
The Lubchenco curves may not represent the current US population. The new intrauterine growth curves created and validated in this study, based on a contemporary, large, racially diverse US sample, provide clinicians with an updated tool for growth assessment in US NICUs. Research into the ability of the new definitions of small-for-gestational-age and large-for-gestational-age to identify high-risk infants in terms of short-term and long-term health outcomes is needed.
本研究旨在创建和验证新的宫内体重、长度和头围生长曲线，使用当代、大规模、种族多样化的美国样本，并与 Lubchenco 曲线进行比较。
使用了来自美国 33 个州的 248 家医院的 391681 名 22 至 42 周龄出生的婴儿（Pediatrix Medical Group）的数据，包括出生体重、长度、头围、估计胎龄、性别和种族。分别使用单独的子样本来创建和验证曲线。通过 Lambda Mu Sigma（LMS）方法创建了平滑百分位数曲线（第 3 至 97 百分位）。验证样本用于确认曲线的代表性。新曲线与 Lubchenco 曲线进行了比较。
最终样本包括 257855 名存活至出院的单胎婴儿（57.2%为男性）。创建了性别特异性的体重、长度和头围-年龄曲线（n=130111）并成功验证（n=127744）。使用 Lubchenco 曲线对每种胎龄的小于胎龄儿和大于胎龄儿的分类与新曲线差异显著（均 P<0.0001）。除了年龄较小的女孩（<或=36 周）外，Lubchenco 曲线低估了小于胎龄儿的比例，而对于这些女孩，其比例更可能被高估；低估了<或=36 周的大于胎龄儿的比例；高估了>36 周的大于胎龄儿的比例。
Lubchenco 曲线可能无法代表当前的美国人群。本研究基于当代、大规模、种族多样化的美国样本创建和验证的新的宫内生长曲线，为美国 NICU 中的生长评估提供了一个更新的工具。需要研究新的小于胎龄儿和大于胎龄儿定义在短期和长期健康结果方面识别高危婴儿的能力。
