title: Classifying neonatal growth outcomes: use of birth weight, placental evaluation and individualized growth assessment.
abstract: OBJECTIVE
  To compare neonatal growth outcomes determined by birth weight (BW), placental assessment (Plac Assess) and individualized growth assessment (IGA).
  
  
  METHODS
  This retrospective analysis was carried out in 45 selected pregnancies at risk for fetal growth restriction. Serial fetal biometry was carried out in the 2nd and 3rd trimester. First and second trimester placental biomarkers, 2nd trimester uterine artery (Ut A) velocimetry and postnatal placental pathology were evaluated as indicators of placental insufficiency. At delivery, weight (WT), head circumference (HC) and crown-heel length (CHL) were measured. BWs were categorized as large-for-gestational-age (LGA), appropriate-for-gestational-age (AGA) and small-for-gestational age (SGA) (<10th, 10th-90th and >90th percentiles). In these categories, neonatal growth outcomes were classified as growth restricted (GR), normal (NORMAL) or macrosomic (MACRO) based on BW plus Plac Assess (Ut A velocimetry, biomarkers, pathology) or IGA [growth potential realization index profile (WT, HC and CHL)].
  
  
  RESULTS
  There were 6 LGA, 14 AGA and 25 SGA neonates in this sample. All 14 AGA neonates were considered NORMAL by both IGA and BW + Plac Assess. All six LGA neonates were classified as MACRO by BW + Plac Assess but only four by IGA (the remaining two were NORMAL and high NORMAL). The 25 SGA cases could be divided into five subgroups based on IGA and BW + Plac Assess. The largest subgroup (56%) was GR and the next largest (24%) was NORMAL by both classification methods. In the remaining 20%, there was some evidence of GR but IGA and BW + Plac Assess were not in complete agreement.
  
  
  CONCLUSIONS
  Agreement was good for all three methods in the LGA and AGA groups. The SGA group was heterogeneous but agreement between IGA and BW + Plac Assess was 89%. These results, using more sophisticated growth assessment methods, confirm placental insufficiency as a primary cause of growth restriction. Most normal and GR SGA neonates can be identified with conventional anatomical measurements if IGA is used.
authors.affiliation: a Department of Obstetrics and Gynecology , Texas Children's Hospital, Baylor College of Medicine , Houston , TX , USA and.
authors.forename: Russell L
authors.initials: RL
authors.lastname: Deter
authors.affiliation: b Division of Maternal-Fetal Medicine , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada.
authors.forename: Khrystyna
authors.initials: K
authors.lastname: Levytska
authors.affiliation: b Division of Maternal-Fetal Medicine , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada.
authors.forename: Nir
authors.initials: N
authors.lastname: Melamed
authors.affiliation: a Department of Obstetrics and Gynecology , Texas Children's Hospital, Baylor College of Medicine , Houston , TX , USA and.
authors.forename: Wesley
authors.initials: W
authors.lastname: Lee
authors.affiliation: b Division of Maternal-Fetal Medicine , Mount Sinai Hospital, University of Toronto , Toronto , ON , Canada.
authors.forename: John C P
authors.initials: JC
authors.lastname: Kingdom
mesh_terms: D001724:Birth Weight; D005260:Female; D047109:Fetal Development; D005317:Fetal Growth Retardation / Q000209:etiology* / Q000503:physiopathology; D006801:Humans; D007231:Infant, Newborn; D010920:Placenta / Q000473:pathology*; D010927:Placental Insufficiency / Q000175:diagnosis*; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000379:methods*; D012189:Retrospective Studies; D055988:Uterine Artery
keywords: Fetal growth restriction; SGA; macrosomia; placenta