背景:我们的目的是确定哪些胎儿或新生儿生长曲线可以区分低出生体重新生儿的胎龄(胎龄小,SGA)和性别(体重<10百分位数),并建立可能对监测10岁以下年龄的生长最有用的曲线。
方法:分析包括在我们医院(2013-2022)管理的每名新生儿(15.122)和在SEN1500数据库(2019-2022)中登记的32周前出生的所有早产儿(6913)。我们认为,在每个孕龄亚组中,有或没有SGA病史的死亡似然比(LR)最高的曲线最有用。理论上,监测生长的最佳曲线是第50百分位数的分位数回归公式中R2较高的曲线。
结果:在32周前早产的婴儿中,SGA与住院死亡率之间表现出最强关联的生长曲线是共生胎儿曲线和Fenton新生儿曲线。然而,早产儿和新生儿的最佳曲线总体上是Olsen和Intergrowth的曲线。在10岁之前,仅监测人体测量值最有用的曲线是纵向生长曲线,该曲线遵循WHO标准。但是如果从出生到10岁需要一个单一的参考,最好的选择是遵循WHO标准的Fenton曲线.
结论:共生参考提供了最有区别的胎儿生长曲线。在新生儿临床实践中,最佳参考是Fenton,其次是WHO图表。
BACKGROUND: Our aim was to determine which foetal or neonatal growth curves discriminate the probability of dying of newborns with low birth weight for their gestational age (small for gestational age, SGA) and sex (weight < 10th percentile) and to establish the curves that are presumably most useful for monitoring growth through age 10 years.
METHODS: The analysis included every neonate (15 122) managed in our hospital (2013-2022) and all neonates born preterm before 32 weeks (6913) registered in the SEN1500 database (2019-2022). We considered most useful those curves with the highest likelihood ratio (LR) for dying with or without a history of SGA in each subgroup of gestational ages. Theoretically, the optimal curves for monitoring growth would be those with a higher R2 in the quantile regression formulas for the 50th percentile.
RESULTS: The growth curves exhibiting the strongest association between SGA and hospital mortality are the Intergrowth fetal curves and the Fenton neonatal curves in infants born preterm before 32 weeks. However, the optimal curves for premature babies and neonates overall were those of Olsen and Intergrowth. The most useful curves to monitor anthropometric values alone until age 10 years of age are the longitudinal Intergrowth curves followed by the WHO standards, but if a single reference is desired from birth through age 10 years, the best option is the Fenton curves followed by the WHO standards.
CONCLUSIONS: The Intergrowth reference provides the most discriminating foetal growth curves. In neonatal clinical practice, the optimal references are the Fenton followed by the WHO charts.