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Question 1: UK-WHO versus customised growth charts for the identification of at-risk small for gestational age infants: which one should we use?
  1. Umberto Piaggio
  1. Paediatrics, Sheffield Children’s Hospital, Sheffield S10 2TH, UK
  1. Correspondence to Dr Umberto Piaggio, Sheffield Children’s Hospital, Sheffield S10 2TH, UK; umberto.piaggio{at}nhs.net

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Scenario

You admit a 2-day-old term child from the postnatal ward, who over the last 24 hours was found hypothermic and hypoglycaemic. He has required a heated cot and is following a feeding plan which has stabilised the blood sugar, but not increased it above 2.7 mmol. You admit him as you want to control environmental temperature factors as well as providing glucose, increased monitoring and management. Looking at the maternal notes, you see no risk factors for sepsis (although you are already covering for this) or gestational diabetes. Inflammatory markers and clinical examination are unremarkable. You notice that the mum weights 85 kg, but her body mass index is 24.6 and she is otherwise healthy. Plotting the infant’s birth weight (3560 g), it plots above the 25th centile on the UK-WHO growth chart.

On speaking with the mum, she mentions that the obstetric team were concerned throughout the pregnancy, because the baby was ‘too small for her’, and was below the 10th centile on the customised growth chart. They even warned her that the baby might need some ‘extra support’ once it was born.

You wonder whether this child should have been monitored from birth as a small-for-gestational-age (SGA) infant would have been, as it was identified as such by the customised growth chart. Could this have avoided an admission by recognising and treating the problem sooner?

Structured clinical question

In newborn infants (P), should paediatricians use customised growth charts (I) instead of population-based ones (C) to identify infants (at birth), who are at risk of developing complications (both morbidity and mortality) associated with being SGA (O)?

Search

Secondary sources (Cochrane and DARE databases): One relevant Systematic Review article1 was found, …

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