Beruflich Dokumente
Kultur Dokumente
PEDIATRICS
AUGUST 1967 V o l u m e 71 Number 2
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W E E K S OF G E S T A T I O N
CLASSIFICATION OF NEWBORNS
Fig. 2
24 25 26 27 2B 29 3 0 31 32 33 34 3 5 3 6 37 3 8 39 4 0 41 42 43 44 45 46
WEEKS OF GESTATION
that have reported neonatal and perinatal ideal for such purposes, it is the best available
mortality rates, there has been good agree- at this time. Ideally, one would like more nu-
ment among the studies for mortality rates merous Neonatal Mortality Rate zones with
in a given birth weight and gestationaI age each zone encompassing a narrower mortality
group5 ~'4 All of these studies have confirmed rate group. In addition, such mortality rates
the clinical impression that infants born with should be based upon local data and revised
birth weights small for their gestational ages frequently (Figs. 1 and 2 contain the same
have lower neonatal mortality rates than do birth weight-gestational age classification; one
infants of the same weight born earlier in with and one without the superimposed
gestation but greater mortality rates than in- mortality zones). Thus, the basic classifica-
fants of the same gestational age who have tion of nine newborn groups can be used
appropriate birth weights. as is, or with Erhardt's data, or with local
The tenth and ninetieth percentile group- Neonatal Mortality Rates substituted when
ings based upon both male and female in- indicated.
fants from the study of Lubchenco and as-
NURSERY PROCEDURE
sociates ~ have been used for the subdivisions
by weight. At the time of admission to the nursery,
All infants above the ninetieth percentile the head nurse plots the infant's birth weight
are referred to as Large for their Gestational and gestationai age on the chart shown in Fig.
Age, those below the tenth percentile as 2, using the estimated age calculated by the
Small for their Gestational Age, and those house staff from the last day of menstrual
between the tenth and ninetieth percentile period on the obstetrical chart. The color
as Appropriate for their Gestational Age. As of the tape denotes the appropriate Neo-
pointed out by Battaglia and asso.ciates, 3 the natal Mortality Rate zone and the letter-
choice of which population distribution is ing, which of the nine gestational age-
used in the subdivisions by weight would birth weight groups the infant falls into
make little difference in the position of the ( Table 1).
tenth percentile, but does make a big dif- All infants falling in a blue or red mortal-
ference in the position of the ninetieth per- ity zone, i.e., 25 per cent or greater risk of
centile. dying, should be admitted to a high-risk
The Colorado study was chosen for two nursery. In addition, all infants who have
reasons: first, it was one of the earliest stud- any significant clinical problem, regardless of
ies giving a frequency distribution by birth classification, are admitted to a high-risk
weight and gestational age and thus is the one nursery.
most familiar to pediatricians. Secondly, this The method described above provides a
study has the tightest distribution of appro- convenient means of defining Pre-Term,
priate for their gestational age infants at Term, and Post-Term infants, and the mor-
early gestational ages. It seemed worthwhile to tality risk makes possible a decision as to type
incorporate "this tight distribution" in a clas- of nursery care needed for an individual in-
sification proposed for detection of high- fant. The advantages of setting up such a
risk infants, since previous studies have routine on a nursery service are considerable.
shown that the neonatal mortality rate of First, it ensures that all infants in a high
large infants born early is higher by weight Neonatal Mortality Rate group will be ob-
alone than is expected. served closely. Secondly, it makes it a great
deal more convenient on house staff or at-
NEONATAL MORTALITY RATES
tending staff rounds to identify small for their
The Neonatal Mortality Rate data of gestational age and large for their gestational
Erhardt, ~ have been adapted to the birth age infants, particularly in separating small
weight-gestational age chart. This is the for their gestationaI age Term infants from
largest study of mortality rates at given birth appropriate for their gestational age Pre-
weights and gestational ages. Though it is not Term infants.
Volume 71 Birth-weight and gestationaI-age classification 1 6 3
Number 2
REFERENCES
1. Lubchenco, L. O., Hansman, C., Dressler, M., 4. Ehrhardt, C. L., Joshi, G. B., Nelson, F. G.,
and Boyd, E.: Intrauterine growth as estimated Kroll, B. H., and Weiner, L.: Influence of
from liveborn birth-weight data at 24 to 42 weight and gestation on perinatal and neonatal
weeks of gestation, Pediatrics 32: 793, 1963. mortality by ethnic group, Am. J. Pub. Health
2. Butler, N. R., and Bonham, D. G., editors: 54: 1841, 1964.
Perinatal mortality: The first report of the 5. Gruenwald, P.: Growth of the human fetus:
British perinatal mortality survey, London, I. Normal growth and its variation, Am. J.
1963, E. & S. Livingstone, Ltd. Obst. & Gynec. 94" 1112, 1966.
3. Battaglla, F. C., Frazier, T. M., and I-Iellegers, 6. van den Berg, B. J., and Yerushalmy, J.: The
A. E.: Birth weight, gestational age, and preg- relationship of the rate of intrauterine growth
nancy outcome, with special reference to high- of infants of low birth weight to mortality,
birth-weight-low-gestational-age infant, Pedi- morbidity, and congenital anomalies, J. PEDIAT.
atrics 37: 717, 1966. 69: 531, 1966.