Objective To systematically evaluate the diagnostic consistency of different definitions of extrauterine growth retardation (EUGR) in preterm infants, and to quantify the interaction effects of growth charts, assessment dimensions, and gestational age, so as to provide evidence for prioritizing and standardizing the diagnosis criteria of EUGR. Methods In this retrospective cohort study, 1 471 preterm infants admitted to the neonatal ward of the First Affiliated Hospital of Naval Medical University and two participating centers between January 2015 and December 2024 were included. Infants were categorized into three groups according to gestational age: extremely preterm infants (<32 weeks), moderately preterm infants (32 to <34 weeks), and late preterm infants (34 to <37 weeks). Twelve EUGR definitions were constructed based on three growth charts (Fenton, INTERGROWTH-21st, and Olsen) and four assessment dimensions (cross-sectional, longitudinal, true cross-sectional, and true longitudinal). Cohen's Kappa coefficient was used to assess agreement among definitions, and generalized linear mixed models were used to analyze the effects of each factor. Results The EUGR detection rate significantly decreased with increasing gestational age (χ2=11.633 - 404.237,P<0.001). Consistency analysis showed the highest agreement among different charts within the same assessment dimension (κ=0.55), moderate agreement among different dimensions within the same chart (κ=0.50). The agreement was the weakest across different chart-dimension combinations (κ=0.29). The choice of growth chart had a greater impact on the detection rate than the choice of assessment dimension (Wald χ2=604.43/ χ2=107.44). There was a significant interaction between gestational age and assessment dimensions, with the longitudinal dimension showing a sharp decline in detection rate in the late preterm group, approaching nearly zero (95%CI: 0.0% - 0.0%). Conclusion Based on the study findings, a stratified diagnostic approach may be proposed: for extremely preterm infants, the true longitudinal definitions based on the Fenton or Olsen growth charts may be prioritized; for moderately preterm infants, a combined assessment may be considered; and for late preterm infants, the Olsen cross-sectional definition may be an option.
Key words
extrauterine growth retardation /
growth curve /
gestational age effect /
assessment dimensions /
preterm infants
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