Premium
Prediction of Large‐for‐Gestational‐Age Neonates by Different Growth Standards
Author(s) -
Duncan Jose R.,
Odibo Linda,
Hoover Elizabeth A.,
Odibo Anthony O.
Publication year - 2021
Publication title -
journal of ultrasound in medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.574
H-Index - 91
eISSN - 1550-9613
pISSN - 0278-4297
DOI - 10.1002/jum.15470
Subject(s) - medicine , gestational age , percentile , birth weight , neonatal intensive care unit , apgar score , obstetrics , gestation , receiver operating characteristic , pediatrics , pregnancy , statistics , genetics , mathematics , biology
Objective Compare the accuracy of the Hadlock, the NICHD, and the Fetal Medicine Foundation (FMF) charts to detect large‐for‐gestational‐age (LGA) and adverse neonatal outcomes (as a secondary outcome). Methods This is a secondary analysis from a prospective study that included singleton non‐anomalous gestations with growth ultrasound at 26–36 weeks. LGA was suspected with estimated fetal weight > 90 th percentile by the NICHD, FMF, and Hadlock charts. LGA was diagnosed with birth weight > 90 th percentile. We tested the performance of these charts to detect LGA and adverse neonatal outcomes (neonatal intensive care unit admission, Ph < 7.1, Apgar <7 at 5 minutes, seizures, and neonatal death) by calculating the area under the curve, sensitivity, specificity, positive predictive value, and negative predictive value. Results Of 1054 pregnancies, 123 neonates (12%) developed LGA. LGA was suspected in 58 (5.5%) by Hadlock, 229 (21.7%) by NICHD standard, and 231 (22%) by FMF chart. The NICHD standard (AUC: .79; 95% CI: .75–.83 vs. AUC .64; 95%CI: .6–.68; p = < .001) and FMF chart (AUC: .81 95% CI: .77–.85 vs. AUC .64; 95%CI: .6–.68; p = < .001) were more accurate than Hadlock. The FMF and NICHD had higher sensitivity (77.2 vs. 72.4 vs. 30.1%) but Hadlock had higher specificity for LGA (97.5 vs. 88.5 vs. 85.4%). All standards were poor predictors for adverse neonatal outcomes. Conclusions The NICHD and the FMF standards may increase the detection rate of LGA in comparison to the Hadlock chart. However, this may increase obstetrical interventions.