Tejón-Fernández Marta, Armenteros-López Ana Isabel, Fernández-Rosales Nazareth, Díez-Delgado Javier, Salagre Diego, Galera-Martínez Rafael, Martin-González Manuel, Bonillo-Perales Antonio
Department of Biomedical Investigation, Foundation for Biosanitary Research in Eastern Andalusia-FIBAO, Almeria, Spain.
Department of Neonatology, Infanta Leonor Women's and Children's Hospital, Almeria, Spain.
PLoS One. 2025 May 8;20(5):e0323470. doi: 10.1371/journal.pone.0323470. eCollection 2025.
It is not precisely known whether the use of national (Carrascosa 2008) and international growth standards (INTERGROWTH-21) shows good concordance in classifying very low birth weight infants as small-for-gestational-age or whether with the same degree of morbidity and mortality. The aims of this study were a) to evaluate the concordance between small-for-gestational-age neonates weighing <1500 g classified using the national and international standards, and b) to compare the morbidity and mortality of small-for-gestational-age neonates classified by both standards.
A retrospective cohort study was conducted with very low birth weight infants. The concordance between the INTERGROWTH-21 and Carrascosa 2008 standards was analyzed, along with differences in gestational age, weight, medical requirements, morbidity, and mortality, among small-for-gestational-age neonates classified by both standards. Small-for-gestational-age was defined as a birth weight z score ≤ -1.28.
A total of 250 neonates weighing <1500 g, who were born between 26 and 36 weeks of gestation, were included. There was a high level of concordance in the classification of small-for-gestational-age between the two standards (Cohen's kappa = 0.80, p < 0.001). A lower incidence was observed when the INTERGROWTH-21 standard was used (31.6%) compared to the Carrascosa 2008 standard (40.8%), p = 0.03. No significant differences were found in mortality or morbidity among neonates classified as small-for-gestational-age by both standards.
The Carrascosa 2008 and INTERGROWTH-21 standards classify small-for-gestational-age infants with comparable morbidity and mortality. We recommend the use of the INTERGROWTH-21 standard for its inclusion of multiple pregnancies, diverse ethnicities, and international comparability.
目前尚不清楚使用国内（卡拉斯科萨，2008年）和国际生长标准（INTERGROWTH - 21）在将极低出生体重儿分类为小于胎龄儿方面是否具有良好的一致性，或者在发病率和死亡率方面是否相同。本研究的目的是：a）评估使用国内和国际标准对体重<1500g的小于胎龄新生儿进行分类的一致性；b）比较两种标准分类的小于胎龄新生儿的发病率和死亡率。
对极低出生体重儿进行回顾性队列研究。分析了INTERGROWTH - 21和卡拉斯科萨2008标准之间的一致性，以及两种标准分类的小于胎龄新生儿在胎龄、体重、医疗需求、发病率和死亡率方面的差异。小于胎龄定义为出生体重z评分≤ -1.28。
共纳入250例出生体重<1500g、孕周在26至36周之间的新生儿。两种标准在小于胎龄分类方面具有高度一致性（科恩kappa系数 = 0.80，p < 0.001）。与卡拉斯科萨2008标准（40.8%）相比，使用INTERGROWTH - 21标准时观察到的发病率较低（31.6%），p = 0.03。两种标准分类为小于胎龄的新生儿在死亡率或发病率方面未发现显著差异。
卡拉斯科萨2008标准和INTERGROWTH - 21标准对小于胎龄儿的发病率和死亡率分类相当。我们建议使用INTERGROWTH - 21标准，因为它涵盖了多胎妊娠、不同种族且具有国际可比性。
