The clinical performance and population health impact of birthweight-for-gestational age indices at term gestation.
Paediatr Perinat Epidemiol
; 38(1): 1-11, 2024 Jan.
Article
em En
| MEDLINE
| ID: mdl-37337693
ABSTRACT
BACKGROUND:
The assessment of birthweight for gestational age and the identification of small- and large-for-gestational age (SGA and LGA) infants remain contentious, despite the recent creation of the Intergrowth 21st Project and World Health Organisation (WHO) birthweight-for-gestational age standards.OBJECTIVE:
We carried out a study to identify birthweight-for-gestational age cut-offs, and corresponding population-based, Intergrowth 21st and WHO centiles associated with higher risks of adverse neonatal outcomes, and to evaluate their ability to predict serious neonatal morbidity and neonatal mortality (SNMM) at term gestation.METHODS:
The study population was based on non-anomalous, singleton live births between 37 and 41 weeks' gestation in the United States from 2003 to 2017. SNMM included 5-min Apgar score <4, neonatal seizures, need for assisted ventilation, and neonatal death. Birthweight-specific SNMM was modelled by gestational week using penalised B-splines. The birthweights at which SNMM odds were minimised (and higher by 10%, 50% and 100%) were estimated, and the corresponding population, Intergrowth 21st, and WHO centiles were identified. The clinical performance and population impact of these cut-offs for predicting SNMM were evaluated.RESULTS:
The study included 40,179,663 live births and 991,486 SNMM cases. Among female singletons at 39 weeks' gestation, SNMM odds was lowest at 3203 g birthweight, and 10% higher at 2835 g and 3685 g (population centiles 11th and 82nd, Intergrowth centiles 17th and 88th and WHO centiles 15th and 85th). Birthweight cut-offs were poor predictors of SNMM, for example, the cut-offs associated with 10% and 50% higher odds of SNMM among female singletons at 39 weeks' gestation resulted in a sensitivity, specificity, and population attributable fraction of 12.5%, 89.4%, and 2.1%, and 2.9%, 98.4% and 1.3%, respectively.CONCLUSIONS:
Reference- and standard-based birthweight-for-gestational age indices and centiles perform poorly for predicting adverse neonatal outcomes in individual infants, and their associated population impact is also small.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Recém-Nascido Pequeno para a Idade Gestacional
/
Mortalidade Infantil
Tipo de estudo:
Guideline
/
Prognostic_studies
Limite:
Female
/
Humans
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Infant
/
Newborn
/
Pregnancy
Idioma:
En
Revista:
Paediatr Perinat Epidemiol
Assunto da revista:
EPIDEMIOLOGIA
/
PEDIATRIA
/
PERINATOLOGIA
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Canadá