Detection of Small for Gestational Age (SGA) newborn: a comparison of
‘gold’ standards
Abstract
Objective: Comparison of birthweight references for diagnosing SGA. To
provide denominator data for suspicion and diagnosis of SGA. Design: A
retrospective cohort study of 10,616 babies. Setting: A regional
obstetric centre. Population: 10,616 consecutive newborns, born in
Derriford Hospital, University Hospitals Plymouth NHS Trust (UPHT),
whilst using the GROW package,1 compared with using Intergrowth 21st
(IG21),2 and British 1990 (UK90) references.3 Methods: Statistical
analysis of centile data from GROW, IG21 and UK90 references. Main
outcomes: Induction rates, detection of suspected and/or diagnosed SGA.
Assessment of goodness of fit to the Plymouth population. Results: GROW
and IG21 showed bias. GROW had a systematic bias towards smaller
centiles (skewness 0.169). IG21 had a systematic bias towards larger
centiles (skewness -0.452). UK90 was best fit to the Plymouth dataset
with insignificant bias across centiles (skewness -0.047). Conclusions:
GROW and IG21 are not appropriate gold standards for our population for
allocation of birthweight centile. The size of the population suggests
the conclusions may be extrapolatable to other centres. UK90 does not
have everyday accessible tools compared with GROW and IG21. A continual
local audit of birthweight would be ideal, enabling accurate local
centile allocation. If a national SGA screening programme monitoring
units’ ability to detect SGA was introduced, it could not start without
validated, unit specific birthweight data. Funding: The statistician’s
funding was obtained from UHPT Research and Development generic funding.