Université de Paris, CRESS, Obstetrical Perinatal and Pediatric Epidemiology Research Team,EPOPé, INSERM, INRA, F-75004, Paris, France
Sorbonne Université, Collège Doctoral, F-75005, Paris, France.
Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):316-323. doi: 10.1136/archdischild-2020-319946. Epub 2020 Dec 2.
Extrauterine growth restriction (EUGR) among very preterm infants is related to poor neurodevelopment, but lack of consensus on EUGR measurement constrains international research. Our aim was to compare EUGR prevalence in a European very preterm cohort using commonly used measures.
Population-based observational study.
19 regions in 11 European countries.
6792 very preterm infants born before 32 weeks' gestational age (GA) surviving to discharge.
We investigated two measures based on discharge-weight percentiles with (1) Fenton and (2) Intergrowth (IG) charts and two based on growth velocity (1) birth weight and discharge-weight Z-score differences using Fenton charts and (2) weight-gain velocity using Patel's model. We estimated country-level relative risks of EUGR adjusting for maternal and neonatal characteristics and associations with population differences in healthy newborn size, measured by mean national birth weight at 40 weeks' GA.
About twofold differences in EUGR prevalence were observed between countries for all indicators and these persisted after case-mix adjustment. Discharge weight <10th percentile using Fenton charts varied from 24% (Sweden) to 60% (Portugal) and using IG from 13% (Sweden) to 43% (Portugal), while low weight-gain velocity ranged from 35% (Germany) to 62% (UK). Mean term birth weight strongly correlated with both percentile-based measures (Spearman's rho=-0.90 Fenton, -0.84 IG, p<0.01), but not Patel's weight-gain velocity (rho: -0.38, p=0.25).
Very preterm infants have a high prevalence of EUGR, with wide variations between countries in Europe. Variability associated with mean term birth weight when using common postnatal growth charts complicates international benchmarking.
极早产儿宫外生长受限（EUGR）与神经发育不良有关，但 EUGR 测量方法缺乏共识，限制了国际研究。本研究旨在比较使用常用方法的欧洲极早产儿队列中的 EUGR 发生率。
基于人群的观察性研究。
欧洲 11 个国家的 19 个地区。
胎龄<32 周且存活至出院的 6792 例极早产儿。
我们研究了两种基于出院体重百分位数的方法，分别使用 Fenton 和 Intergrowth（IG）图表，以及两种基于生长速度的方法，分别是 Fenton 图表的出生体重和出院体重 Z 评分差值，以及 Patel 模型的体重增长速度。我们根据母亲和新生儿特征以及与健康新生儿大小的人群差异（以 40 周 GA 的全国平均出生体重衡量）调整了国家水平的 EUGR 相对风险。
所有指标的 EUGR 发生率在国家之间存在约两倍的差异，并且在病例混合调整后仍然存在。使用 Fenton 图表的出院体重<第 10 百分位数的情况从 24%（瑞典）到 60%（葡萄牙）不等，使用 IG 的情况从 13%（瑞典）到 43%（葡萄牙）不等，而低体重增长速度的范围从 35%（德国）到 62%（英国）不等。足月出生体重与基于百分位数的两种方法均呈强相关（Spearman 相关系数=-0.90 Fenton，-0.84 IG，p<0.01），但与 Patel 的体重增长速度不相关（rho：-0.38，p=0.25）。
欧洲极早产儿 EUGR 的发生率很高，各国之间存在很大差异。使用常见的产后生长图表时，与平均足月出生体重相关的变异性使得国际基准比较变得复杂。
