Servicio de Neonatología, Área de Gestión Clínica de La Infancia y Adolescencia, Hospital Universitario Central de Asturias, Oviedo, Spain.
Instituto Investigación Sanitaria Principado de Asturias, ISPA, Oviedo, Spain.
Eur J Pediatr. 2024 Sep;183(9):4073-4083. doi: 10.1007/s00431-024-05673-6. Epub 2024 Jul 3.
Multiple criteria and growth references have been proposed for extrauterine growth restriction (EUGR). We hypothesized that these may impact the diagnosis of EUGR. The objective was to evaluate the prevalence of EUGR with its different definitions and the concordance according to Fenton, Olsen, and INTERGROWTH-21st in very-low-birthweight (VLBW) infants. This is an observational, retrospective, and multicenter study including VLBW infants from the Spanish SEN1500 Network from 2011 to 2020. Patients with major congenital anomalies, embryopathies, and gestational age less than 24 weeks were excluded. EUGR prevalence was calculated at discharge with cross-sectional, longitudinal, "true" cross-sectional, and "true" longitudinal definitions. Concordance was assessed with Fleiss' kappa coefficient. 23582 VLBW infants from 77 NICUs were included. In total, 50.4% were men with a median of gestational age of 29 (4) weeks. The prevalence of EUGR (cross-sectional, longitudinal, and "true") was variable for weight, length, and head circumference. Overall, the prevalence was higher with Fenton and lower with Olsen (cross-sectional and "true" cross-sectional) and INTERGROWTH-21st (longitudinal and "true" longitudinal). Agreement among the charts by weight was good only for cross-sectional EUGR and moderate for longitudinal, "true" cross-sectional, and "true" longitudinal. Concordance was good or very good for EUGR by length and head circumference.Conclusions: The prevalence of EUGR with the most commonly used definitions was variable in the cohort. Agreement among growth charts was moderate for all the definitions of EUGR by weight except cross-sectional and good or very good for length and head circumference. The choice of reference chart can impact the establishment of the diagnosis of EUGR. What is known: • EUGR has been defined in the literature and daily practice considering weight, length and head circumference with multiple criteria (cross-sectional, longitudinal, and "true" definition) • Different growth charts have been used for EUGR diagnosis What is new: • Prevalence of EUGR is variable depending on the definition and growth chart used in our cohort of VLBW infants • For the most frequently EUGR criteria used, traditionally considering weight, concordance among Fenton, Olsen and INTERGROWTH-21st growth charts is only moderate for all the definitions of EUGR by weight except cross-sectional definition. Concordance among the charts is good or very good for the different criteria of EUGR by head circumference and length.
宫外生长受限（EUGR）有多种标准和生长参考，我们假设这些标准可能会影响 EUGR 的诊断。本研究的目的是评估不同定义的 EUGR 患病率以及根据 Fenton、Olsen 和 INTERGROWTH-21st 标准在极低出生体重儿（VLBW）中的一致性。这是一项观察性、回顾性和多中心研究，纳入了 2011 年至 2020 年期间来自西班牙 SEN1500 网络的 VLBW 婴儿。排除了有重大先天畸形、胚胎病和胎龄<24 周的患者。使用横断面、纵向、“真实”横断面和“真实”纵向定义在出院时计算 EUGR 患病率。采用 Fleiss' kappa 系数评估一致性。共纳入 77 家 NICU 的 23582 名 VLBW 婴儿。其中，男性占 50.4%，中位胎龄为 29（4）周。体重、身长和头围的 EUGR（横断面、纵向和“真实”）患病率各不相同。总体而言，Fenton 定义的 EUGR 患病率较高，而 Olsen（横断面和“真实”横断面）和 INTERGROWTH-21st（纵向和“真实”纵向）定义的 EUGR 患病率较低。体重图表之间的一致性仅在横断面 EUGR 良好，而在纵向、“真实”横断面和“真实”纵向中为中度。长度和头围的 EUGR 图表之间的一致性为良好或极好。结论：在该队列中，最常用定义的 EUGR 患病率各不相同。除横断面外，所有体重 EUGR 定义的生长图表之间的一致性为中度，而长度和头围的一致性为良好或极好。参考图表的选择可能会影响 EUGR 诊断的建立。已知：• 文献和日常实践中已经定义了 EUGR，考虑到体重、身长和头围，使用了多种标准（横断面、纵向和“真实”定义）。• 已经使用了不同的生长图表来诊断 EUGR。新发现：• 在我们的极低出生体重儿队列中，EUGR 的患病率取决于使用的定义和生长图表，不同定义的 EUGR 患病率各不相同。• 在最常使用的 EUGR 标准中，传统上仅考虑体重，Fenton、Olsen 和 INTERGROWTH-21st 生长图表之间的一致性在所有体重 EUGR 定义中除了横断面定义外为中度，而头围和长度的不同 EUGR 标准之间的一致性为良好或极好。
