Modified neonatal growth assessment score: A multivariate approach to the detection of intrauterine growth retardation in the neonate

The objective of this investigation was the development of a modified Neonatal Growth Assessment Score (mNGAS) for use in the evaluation of neonatal growth status. The growth of 74 fetuses at risk for intrauterine growth retardation (IUGR) was followed longitudinally, beginning in the first or early second trimester. Rossavik growth models derived from data obtained in the second trimester were used to predict the weight (WT), crown-heel length (CHL) and head (HC), abdominal (AC) and thigh circumferences (ThC) at birth, which were then actually measured within 24 h after delivery. These measurements were compared to age-specific size curves and used to calculate sets of five growth potential index (GPRI(i)) values, which in turn were used to calculate; five-variable Neonatal Growth Assessment Scores (NGAS(5)). Neonates were initially classified as normal or IUGR on the basis of NGAS(5), GPRI(i), and anatomic measurements. A final classification based on principal component analysis and linear discriminant analysis was carried out. The score obtained using the first principal component function was defined to be mNGAS(51). The effectiveness of mNGAS(ij) values, determined from 1-4 GPRI(i) values, in separating normal and IUGR neonates was also evaluated. Neonates initially considered to be normal had very few abnormal GPRI values or anatomic measurements, whereas the frequency of these abnormalities in IUGR neonates was significantly increased However, no single anatomic variable was 100% normal in the normal neonates and 100% abnormal in IUGR neonates. Only 40% of IUGR neonates were small for gestational age. Classification of these neonates using principal component analysis and linear discriminant analysis was essentially the same (98.6%) as that made initially after reclassification of two IUGR neonates as normal. The characteristics of the initial and final normal and IUGR groups were very similar and the mNCAS(51) was strongly correlated with the NGAS(5) in the IUGR group. The effectiveness of mNGAS(ij) in separating normal and IUGR neonates increased with the number of GPRI(i) values included and the types used. GPRI(ThC) and GPRI(WT) were the most important, followed by GPRI(AC). GPRI(CHL) and CPRI(HC) were much less important and in some cases detrimental. These findings support the concepts of a decrease in soft tissue mass as the initial step in the development of IUGR and the protection of head growth (brain-sparing). The characteristics of mNGAS(51), particularly its comprehensiveness, its independence of differences in growth potential its weighting of GPRI(i) values according to their importance in the detection of IUGR and its ability to detect different manifestations of IUGR in different individuals, indicate that this should be a most effective parameter for separating normal and IUGR neonates.