Turktan Ilkyaz, Erdeve Omer, Kostekci Ezgi, Okulu Emel, Atasay Begum, Arsan Saadet
Department of Pediatric Endocrinology, Ankara University School of Medicine, Ankara, Turkey.
Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine, Ankara, Turkey.
Ital J Pediatr. 2025 Jun 7;51(1):176. doi: 10.1186/s13052-025-01939-3.
The growth of premature infants is expected to be equivalent to healthy fetal growth, but this is rarely achieved in practice. It is predicted that many premature infants, especially severe premature infants, will be discharged with growth restriction. Extrauterine growth retardation (EUGR) is defined as growth below the 10th percentile of the growth curve at discharge at corrected 36th/40th week of gestation, or a difference between birth and discharge z-score > 1 SD. The aim of our study is to determine the differences between the INTERGROWTH-21ST and the Fenton chart in the assessment of extrauterine growth.
Infants < 1500 g born or transferred in the first 24 h at Ankara University NICU between January 1, 2015 and December 31, 2019 were included. Infants with major congenital anomalies, unknown gestational age, chromosomal anomalies, hydrops fetalis, TORCH infection, infants born to substance abusing mothers, and infants who died during hospitalization were excluded.
According to the Fenton, the rate of EUGR at discharge was 66.3%. There was no significant difference between the groups EUGR and non-EUGR in gender, gestational diabetes, maternal smoking during pregnancy, placental abruption, magnesium sulphate prophylaxis, development of respiratory distress, and need for intubation in the first 3 days after birth. When patients were grouped according to birth weight, the highest rate of EUGR according to the Fenton was found in the group with a birth weight ≤ 1000 g (78.8%) (p = 0.036). The proportion of patients defined as SGA by INTERGROWTH-21ST was significantly higher than by Fenton (p < 0.001). Comparing the mean z scores for body weight, height and head circumference at birth and discharge calculated from the Fenton and INTERGROWTH-21 charts, the z scores for body weight and height at birth and discharge were significantly lower in the INTERGROWTH-21 (p < 0.001). Head circumference z-scores at birth and discharge were found to be higher in the Fenton chart than in the INTERGROWTH-21ST (p < 0.001). When EUGR rates were evaluated by body weight in Fenton and INTERGROWTH-21ST, the EUGR rate was found to be higher in Fenton (p < 0.001).
The results show that when INTERGROWTH-21ST and Fenton are compared, INTERGROWTH-21ST is more sensitive in defining the SGA rate. The Fenton is more sensitive in defining EUGR at discharge. These differences between the charts make it difficult to monitor the growth of premature infants and to follow comorbidities. Therefore, the establishment of ideal growth curves is of great importance both during hospitalization and after discharge of premature infants.
早产儿的生长预期应等同于健康胎儿的生长，但在实际中这很少能实现。据预测，许多早产儿，尤其是重度早产儿，将在出院时存在生长受限。宫外生长迟缓（EUGR）的定义为在矫正胎龄36/40周出院时生长低于生长曲线的第10百分位数，或出生与出院时的z评分差值＞1个标准差。我们研究的目的是确定INTERGROWTH-21ST图表和芬顿图表在评估宫外生长方面的差异。
纳入2015年1月1日至2019年12月31日在安卡拉大学新生儿重症监护病房出生或在出生后24小时内转入的体重＜1500g的婴儿。排除患有严重先天性畸形、胎龄不明、染色体异常、胎儿水肿、TORCH感染、母亲有药物滥用史的婴儿以及住院期间死亡的婴儿。
根据芬顿图表，出院时EUGR的发生率为66.3%。EUGR组和非EUGR组在性别、妊娠期糖尿病、孕期母亲吸烟、胎盘早剥、硫酸镁预防、呼吸窘迫的发生以及出生后前3天的插管需求方面无显著差异。当根据出生体重对患者进行分组时，芬顿图表显示出生体重≤1000g组的EUGR发生率最高（78.8%）（p = 0.036）。INTERGROWTH-21ST定义为小于胎龄儿（SGA）的患者比例显著高于芬顿图表（p＜0.001）。比较根据芬顿图表和INTERGROWTH-21图表计算的出生和出院时体重、身高和头围的平均z评分，INTERGROWTH-21图表中出生和出院时体重及身高的z评分显著更低（p＜0.001）。芬顿图表中出生和出院时头围的z评分高于INTERGROWTH-21ST图表（p＜0.001）。当按体重评估芬顿图表和INTERGROWTH-21ST图表中的EUGR发生率时，发现芬顿图表中的EUGR发生率更高（p＜0.001）。
结果表明，比较INTERGROWTH-21ST图表和芬顿图表时，INTERGROWTH-21ST图表在定义SGA发生率方面更敏感。芬顿图表在定义出院时的EUGR方面更敏感。这些图表之间的差异使得监测早产儿的生长和追踪合并症变得困难。因此，建立理想的生长曲线对于早产儿住院期间和出院后都非常重要。
