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Abstract：
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.
摘要：
已经提出了宫外生长限制（EUGR）的多个标准和生长参考。我们假设这些可能会影响EUGR的诊断。目的是根据Fenton的不同定义和一致性评估EUGR的患病率，奥尔森,和INTERGROWTH-21在极低出生体重（VLBW）婴儿中。这是一个观察,回顾性,和多中心研究，包括2011年至2020年西班牙SEN1500网络的VLBW婴儿。患有严重先天性异常的患者，胚胎病,并排除胎龄小于24周。EUGR患病率在出院时采用横断面计算，纵向,“真实”横截面，和“真实”纵向定义。用Fleiss\'kappa系数评估一致性。包括来自77个NICU的23582名VLBW婴儿。总的来说,50.4％的男性孕龄中位数为29（4）周。EUGR的患病率(横截面，纵向,和“true”)是可变的重量，长度,和头围。总的来说,Fenton组的患病率较高,Olsen组(横截面和"真"横截面)和INTERGROWTH-21(纵向和"真"纵向)的患病率较低.按重量划分的图表之间的一致性仅适用于横截面EUGR，而适用于纵向，“真实”横截面，和“真实”纵向。通过长度和头围，EUGR的一致性良好或非常好。结论：采用最常用定义的EUGR的患病率在队列中是可变的。对于EUGR的所有定义，除横截面外，按重量计算的增长图表之间的一致性均中等，长度和头围良好或非常好。参考图的选择会影响EUGR诊断的建立。已知内容：•EUGR已在文献和日常实践中定义，考虑到体重，具有多个标准的长度和头围(横截面，纵向,和“真实”定义）•EUGR诊断使用了不同的生长图。新功能：•EUGR的患病率是可变的，具体取决于我们的VLBW婴儿队列中使用的定义和生长图•对于最常用的EUGR标准，传统上考虑重量，芬顿之间的和谐，Olsen和INTERGROWTH-21增长图对于EUGR的所有定义（除横截面定义外）都是中等的。通过头围和长度，对于EUGR的不同标准，图表之间的一致性很好或非常好。
