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Comparison of regional versus global growth charts for the classification of small-for-gestational age neonates
  1. Pratima Anand,
  2. Deena Thomas,
  3. Ramesh Agarwal,
  4. Anu Thukral,
  5. Ashok K Deorari,
  6. Vinod Kumar Paul,
  7. M Jeeva Sankar
  1. Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India
  1. Correspondence to Dr M Jeeva Sankar, Pediatrics, All India Institute of Medical Sciences, New Delhi, Delhi, India; jeevasankar{at}


Objective To compare the performance of regional versus global charts for identifying small-for-gestational age (SGA) neonates with short-term adverse outcomes.

Design Prospective cohort study.

Setting Level-3 neonatal unit in India.

Patients Neonates were categorised into SGA and appropriate-for-gestational age (AGA; 10th−90th centile) using four charts, namely, the AIIMS, Lubchenco, Fenton and Intergrowth 21st charts. They were followed up for adverse outcomes until 28 days.

Outcomes We evaluated the (1) burden of SGA, (2) sensitivity and diagnostic OR (DOR), (3) relative risk (RR) and number needed to screen (NNS) to detect adverse outcomes in SGA versus ‘optimal’ AGA (50th−90th centile) and (4) RR of morbidities in ‘additional SGA’ (ie, classified as SGA by others but not by AIIMS chart).

Results Among 1367 neonates, 19.6%, 4.5% and 12.5% were classified as SGA by Intergrowth 21st, AIIMS and Lubchenco charts, respectively. Intergrowth 21st had the highest sensitivity (39.1%) but the least DOR (2.6) to detect adverse outcomes; AIIMS chart had low sensitivity (19.3%) but higher DOR (4.3). RR and NNS were 3.7 and 14; 4.4 and 7; 4.0 and 8; 3.6 and 10 with Intergrowth 21st, AIIMS, Lubchenco and Fenton charts, respectively. ‘Additional SGA’ identified by Intergrowth 21st had lower risk of adverse outcomes than SGA identified by both the charts (RR 0.39; 95% CI 0.19 to 0.82).

Conclusions Compared with AIIMS and Lubchenco charts, Intergrowth 21st runs the risk of overdiagnosing SGA neonates who may not be at a higher risk of short-term morbidities.

  • Neonatology
  • Growth

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors PA designed the study, collected the data, did the initial analyses, and drafted the initial manuscript. DT contributed to the data analysis and critically reviewed and revised the initial and final manuscripts. RA, AT, AKD and VKP helped in designing the study, supervised the data collection, and reviewed and approved the final manuscript. MJS conceptualised and designed the study, supervised the conduct of the study, did the initial and final analysis, and reviewed and finalised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work. PA and MJS act as the guarantors of the study.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.