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Original research
Fitness of INTERGROWTH-21st birth weight standards for Chinese-ethnicity babies
  1. Xuelian Wang1,2,
  2. Lai Ling Hui3,
  3. Tim J Cole4,
  4. E Anthony S Nelson2,5,
  5. Hugh Simon Lam2,6
  1. 1 Neonatology, Guangzhou Women and Children's Medical Center, Guangzhou, Guangdong, People's Republic of China
  2. 2 Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
  3. 3 Department of Food Science and Nutrition, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region, People's Republic of China
  4. 4 UCL Great Ormond Street Institute of Child Health, London, UK
  5. 5 School of Medicine, The Chinese University of Hong Kong-Shenzhen, Shenzhen, Guangdong, People's Republic of China
  6. 6 Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
  1. Correspondence to Dr Hugh Simon Lam, Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; hshslam{at}cuhk.edu.hk

Abstract

Objective To determine the fitness of the INTERGROWTH-21st birth weight standards (INTERGROWTH21) for ethnic Chinese babies compared with a local reference (FOK2003).

Design Population-based analysis of territory-wide birth data.

Setting All public hospitals in Hong Kong.

Participants Live births between 24 and 42 complete weeks’ gestation during 2006–2017.

Main outcome measures Babies’ birth weight Z-scores were calculated using published methods. The two references were compared in three aspects: (1) the proportions of large-for-gestational-age (LGA) or small-for-gestational-age (SGA) infants, (2) the gestation-specific and sex-specific mean birth weight Z-scores and (3) the predictive power for SGA-related complications.

Results 488 896 infants were included. Using INTERGROWTH21, among neonates born <33 weeks’ gestation, the mean birth weight Z-scores per week were closer to zero (−0.2 to 0.05), while most of them were further from zero (0.06 to 0.34) after excluding infants with a high risk of abnormal intrauterine growth. Compared with FOK2003, INTERGROWTH21 classified smaller proportions of infants as SGA (8.3% vs 9.6%) and LGA (6.6% vs 7.9%), especially SGA among preterm infants (13.1% vs 17.0%). The area under the receiver operating characteristic curve for predicting SGA-related complications was greater with FOK2003 (0.674, 95% CI 0.670 to 0.677) than INTERGROWTH21 (0.658, 95% CI 0.655 to 0.661) (p<0.001).

Conclusions INTERGROWTH21 performed less well than FOK2003, a local reference for ethnic Chinese babies, especially in infants born <33 weeks’ gestation. Although the differences are clinically small, both these references performed poorly for extremely preterm infants, and thus a more robust chart based on a larger sample of appropriately selected infants is needed.

  • neonatology
  • growth

Data availability statement

The data that support the findings of this study are available from the Hong Kong Hospital Authority Data Collaboration Laboratory, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Hong Kong Hospital Authority Data Collaboration Laboratory.

https://doi.org/10.1136/archdischild-2022-325066

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    Data availability statement

    The data that support the findings of this study are available from the Hong Kong Hospital Authority Data Collaboration Laboratory, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are, however, available from the authors upon reasonable request and with permission of the Hong Kong Hospital Authority Data Collaboration Laboratory.

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    Footnotes

    • Contributors HSL: conceptualisation, methodology, project administration, resources, writing—review and editing, supervision, and responsibility as guarantor. XW: conceptualisation, methodology, software, formal analysis, investigation, writing—original draft, visualisation. LLH: methodology, resources, writing—review and editing. TJC: methodology, writing—review and editing. EASN: methodology, writing—review and editing.

    • 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; internally 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.