ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: J Pediatr 2018. 196:71-76

Fetal growth restriction describes a fetus who fails to achieve their biological growth potential, remaining smaller than its genetic potential, and occurs in ~10% of pregnancies [22]. FGR and SGA are terms that are often and wrongly used in an interchangeable way. SGA does not inevitably entail a pathological condition, but rather is based on a statistical deviation of size from population-based references. By contrast, FGR indicates that the fetus has not reached its optimal growth, due to some underlying problem. Recently, using a Delphi procedure, a consensus definition of FGR was achieved [23]. That definition was based on antenatal ultrasound parameters, and provided clear criteria to distinguish between SGA and FGR, allowing tailored monitoring and management.

Here, Beune et al. describe a consensus-based definition of growth restriction in newborns, including, for the first time, not only auxological measures but also prenatal factors. Birth weight <3^rd percentile is only parameter that allows the diagnosis of growth restriction on its own. Otherwise at least 3 of 5 defined criteria have to be fulfilled. This study underlines that the commonly used single cut-off of birth weight (or birth length) <10^th percentile can be misleading, as this includes many non-growth restricted subjects, whereas other growth restricted newborns can exceed this threshold. The Delphi procedure, used to reach these consensus-definitions, involved a panel of experts, who received feedback on the results of the previous round, while in subsequent rounds, questions became more precise to reach consensus [24]. One of the strengths of this procedure is the anonymity of individual responses, ruling out the influence of dominant individuals and peer pressure.

This consensus fills the void of a universally accepted definition of growth restriction in newborns, which has led to communication problems between healthcare professionals and has prevented comparison of cohorts and studies. However, a consensus-based agreement does not last perpetually. Over time, changes may be required as new evidence arises. Future studies should prospectively test the utility of this consensus definition.

22. Gordijn SJ, Beune IM, Ganzevoort W. Building consensus and standards in fetal growth restriction studies. Best Pract Res Clin Obstet Gynaecol. 2018;49:117-26.

23. Gordijn SJ, Beune IM, Thilaganathan B, Papageorghiou A, Baschat AA, Baker PN, et al. Consensus definition of fetal growth restriction: a Delphi procedure. Ultrasound Obstet Gynecol. 2016;48:333-9.

24. McKenna HP. The Delphi technique: a worthwhile research approach for nursing? J Adv Nurs. 1994;19:1221-5.