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Fitness of INTERGROWTH-21st birth weight standards for Chinese-ethnicity babies


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.

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