New Intrauterine Growth Curves Based on
United States Data
WHAT’S KNOWN ON THIS SUBJECT: Intrauterine growth curves
for preterm infants are limited by small, older, homogeneous
samples; non-US data; combined genders; a lack of length and
head circumference curves and/or are based on different
samples for weight, length, and head circumference curves.
WHAT THIS STUDY ADDS: The new intrauterine growth curves
created and validated in this study using a contemporary, large,
racially diverse US sample provide clinicians and researchers
with an updated tool for growth assessment in US NICUs.
abstract
OBJECTIVE: The objective of this study was to create and validate new
intrauterine weight, length, and head circumference growth curves
using a contemporary, large, racially diverse US sample and compare
with the Lubchenco curves.
METHODS: Data on 391 681 infants (Pediatrix Medical Group) aged 22
to 42 weeks at birth from 248 hospitals within 33 US states (1998 –
2006) for birth weight, length, head circumference, estimated gesta-
tional age, gender, and race were used. Separate subsamples were
used to create and validate curves. Smoothed percentile curves (3rd to
97th) were created by the Lambda Mu Sigma (LMS) method. The vali-
dation sample was used to confirm representativeness of the curves.
The new curves were compared with the Lubchenco curves.
RESULTS: Final sample included 257 855 singleton infants (57.2%
male) who survived to discharge. Gender-specific weight-, length-, and
head circumference-for-age curves were created (n ⫽ 130 111) and
successfully validated (n ⫽ 127 744). Small-for-gestational age
and large-for-gestational age classifications using the Lubchenco
curves differed significantly from the new curves for each gestational
age (all P ⬍ .0001). The Lubchenco curves underestimated the percent-
age of infants who were small-for-gestational-age except for younger
girls (ⱕ36 weeks), for whom it was more likely to be overestimated;
underestimated percentage of infants (ⱕ36 weeks) who were large-
for-gestational-age; and overestimated percentage of infants (ⱖ36
weeks) who were large-for-gestational-age.
CONCLUSIONS: The Lubchenco curves may not represent the current
US population. The new intrauterine growth curves created and vali-
dated in this study, based on a contemporary, large, racially diverse US
sample, provide clinicians with an updated tool for growth assessment
in US NICUs. Research into the ability of the new definitions of small-
for-gestational-age and large-for-gestational-age to identify high-risk
infants in terms of short-term and long-term health outcomes is
needed. Pediatrics 2010;125:e214–e224
e214 OLSEN et al
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
AUTHORS: Irene E. Olsen, PhD, RD, LDN,a,b Sue A.
Groveman, MS,a M. Louise Lawson, PhD,c Reese H. Clark,
MD,d and Babette S. Zemel, PhDe
aDepartment of Bioscience and Biotechnology, College of Arts
and Sciences, Drexel University, Philadelphia, Pennsylvania;
bSchool of Nursing, University of Pennsylvania, Philadelphia,
Pennsylvania; cDepartment of Mathematics and Statistics,
College of Science and Mathematics, Kennesaw State University,
Kennesaw, Georgia; dPediatrix Medical Group, Inc, Sunrise,
Florida; and eDivision of Gastroenterology, Hepatology and
Nutrition, Children’s Hospital of Philadelphia, Department of
Pediatrics, University of Pennsylvania School of Medicine,
Philadelphia, Pennsylvania
KEY WORDS
growth curves, intrauterine growth curves, growth, weight-for-
age, length-for-age, head circumference-for-age, small for
gestational age, large for gestational age, nutrition
ABBREVIATIONS
GA— gestational age
HC— head circumference
SGA—small-for-gestational-age
AGA—appropriate-for-gestational-age
LGA—large-for-gestational-age
CI— confidence interval
www.pediatrics.org/cgi/doi/10.1542/peds.2009-0913
doi:10.1542/peds.2009-0913
Accepted for publication Aug 3, 2009
Address correspondence to Irene E. Olsen, PhD, RD, LDN, c/o
Louise Lawson, PhD, Kennesaw State, Department of Math and
Stats, Box 1204, building 12, 1000 Chastain Rd, Kennesaw, GA
30144-5591. E-mail: ieolsen@yahoo.com
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2010 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have
no financial relationships relevant to this article to disclose.

Intrauterine growth curves are the
standard for assessing the growth of
preterm infants1 and are widely used
in the NICU setting. Intrauterine
curves, which are based on cross-
sectional birth data, differ from longi-
tudinal postnatal curves2–6 in that
these illustrate “ideal” or fetal growth
versus actual growth of preterm in-
fants over time, respectively. Newer in-
trauterine growth curves7–14 have been
published to improve on earlier
curves,3,15–18 by using more current,
larger, and more diverse samples of
infants; however, these more recent
curves still have limitations, such as the
lack of length- and head circumference-
for-age curves to accompany the weight-
for-age curves,7,8,10,12,14 different sam-
ples for growth measurements (eg,
different sample of infants for weight-
for-age than length-for-age),9 and/or
the curves are based on samples of
infants from outside the United
States.9,11 The goals for this study were
to develop a new set of growth curves
for the assessment of weight, length,
and head circumference of preterm in-
fants in the NICU setting using a con-
temporary, large, racially diverse US
sample; validate these curves; and
compare them with 1 of the older but
still commonly used growth curves in
NICUs, the Lubchenco curves.15,16
METHODS
This study used a deidentified, cross-
sectional sample of birth data from Pe-
diatrix Medical Group, Inc (data collec-
tion details previously summarized19).
The sample included 391 681 insured
and uninsured infants aged 22 to 42
weeks at birth born in 1 of 248 hospi-
tals within 33 US states (1998 –2006).
Available data included birth weight
(measured on electronic scale to near-
est gram), length and head circumfer-
ence (using measuring tape to nearest
millimeter), estimated gestational age
(GA; by neonatologist best estimate us-
ing obstetric history, obstetric exami-
PEDIATRICS Volume 125, Number 2, February 2010
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
nations, prenatal ultrasound, and
postnatal physical examinations; in
completed weeks) gender, and race
(using maternal race).
Infants were excluded for missing
weight, length, or head circumference
(HC); unknown gender; and factors
with a known or suspected negative
impact on intrauterine growth (eg,
multiple births, congenital anomalies,
mortality before discharge). These
data were divided into male and fe-
male because of differences in birth
size found in the current sample20 as
well as in a previous study of Pedia-
trix data19 and other data sets.11,12,16
Infants with physiologically improba-
ble growth measurements (“extreme
outliers”) were excluded from the
gender-specific samples. As in previ-
ous growth studies,21,22 extreme outli-
ers were defined as values ⬎2 times
the interquartile range (25th to 75th
percentiles) below the first quartile
and above the third quartile for each
GA.23 For each gender, these data were
randomly divided into 2 subsamples:
the “curve samples” were used to cre-
ate the curves, and the “validation
samples” were used to validate the
resultant curves. SAS SURVEYSELECT
procedure was used to create strati-
fied random samples; gender-specific
stratification was by GA, race, and
state in which the birth hospital was
located.
Curve Creation
Gender-specific weight-, length-, and
HC-for-age intrauterine curves were
created in this study. LmsChartMaker
Pro 2.324 was used to create smoothed
percentile curves for the 3rd, 10th,
25th, 50th, 75th, 90th, and 97th percen-
tiles from these raw data. Cole’s
Lambda Mu Sigma (LMS) method esti-
mates 3 age-specific parameters: a
Box-Cox power transformation of
skewness (L), median (M), and coeffi-
cient of variation (S) that correspond
ARTICLES
to the relationships in the following
formulas: z ⫽ [(X/M)L ⫺ 1]/LS, where X
is the measured value of weight (in
kg), length, or HC; and Centile ⫽ M(1 ⫹
LSZ)1/L, where Z is the z score that cor-
responds to a given percentile. The
curves were developed so that the re-
sulting z scores follow a normal distri-
bution and then were smoothed and
converted to percentiles for clinical
use.
Several techniques were used to as-
sess goodness of fit for each curve.
Worm plots25 were used for visual in-
spection of the fit of the smoothed
curves, and the “best” version was
confirmed by visual inspection of the
empirical percentiles (on the basis of
these raw data) superimposed on the
smoothed curves. Z scores were calcu-
lated for each infant in the curve sam-
ples by using the aforementioned cal-
culations and grouped by GA. Because
standard percentile curves such as
ours are based on a normal distribu-
tion of z scores, the overall mean and
SD for the calculated z scores for the
sample should be 0.0 ⫾ 1.0. Inspection
of the calculated z score distributions
by GA was used to determine whether
the curves fit these data well at all GAs.
Curve Validation
The new growth curves were validated
by using gender-specific validation
samples. For each growth measure, z
scores, SDs, and confidence intervals
(CIs) for all validation infants were cal-
culated using the LMS parameters
from the new growth curves for each
GA. Means and CIs were compared
with 0, and SDs were compared with 1
(using an adjusted ␣ of .003 for 19
comparisons within each gender).
The new curves were further evaluated
by examining the percentage of infants
whose growth measurements fell
within the size-for-age categories rou-
tinely used in NICUs. By definition,
⬃10% of a population should be
e215
 A B
4500 97th
97th 55
Weight, gm 90th
75th
90th
Length
4000 50th
75th
50 25th

10th
50th
3500 3rd

25th 45

Centimeters
3000 10th

3rd 40
2500
97th
90th
75th
35 50th
2000
25th
10th
3rd

1500 30

Head Circumference
1000
25

500
23 25 27 29 31 33 35 37 39 41 20
Gestational Age, weeks
23 25 27 29 31 33 35 37 39 41
Gestational Age, weeks

C D 97th
Weight, gm 97th 90th
4500 55
75th
90th Length
50th
75th 25th
4000 50
10th
50th 3rd
3500
25th 45
Centimeters

10th
3000
3rd
40
2500 97th
90th
75th
35 50th
2000 25th
10th
3rd

1500 30

Head Circumference
1000
25

500
23 25 27 29 31 33 35 37 39 41 20
Gestational Age, weeks
23 25 27 29 31 33 35 37 39 41
Gestational Age, weeks

FIGURE 1
New gender-specific intrauterine growth curves for girls’ weight for age (A), girls’ length and HC for age (B), boys’ weight for age (C), and boys’ length and
HC for age (D). Of note, 3rd and 97th percentiles on all curves for 23 weeks should be interpreted cautiously given the small sample size; for boys’ HC curve
at 24 weeks, all percentiles should be interpreted cautiously because the distribution of data is skewed left. Adapted from Groveman.20

e216 OLSEN et al
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
 ARTICLES

⬍10th percentile (small for GA [SGA]), TABLE 1 Female Birth Weight, Length, and HC Percentiles by GA
⬃80% between the 10th and 90th per- GA, wk n Birth Size Percentile
centiles (appropriate-for-GA [AGA]), Mean SD 3rd 10th 25th 50th 75th 90th 97th
and ⬃10% ⬎90th percentile (large- Weight, g
for-GA [LGA]). 23 133 587 80 NAa 477 528 584 639 687 NAa
24 438 649 89 464 524 585 651 715 772 828
25 603 738 121 511 584 657 737 816 885 953
Comparison of Lubchenco Curves
26 773 822 143 558 645 732 827 921 1004 1085
With New Curves and Validation 27 966 934 168 615 719 822 936 1047 1147 1244
Data Set 28 1187 1058 203 686 807 928 1061 1193 1310 1425
29 1254 1199 226 778 915 1052 1204 1354 1489 1621
The new curves were also compared 30 1606 1376 246 902 1052 1204 1373 1542 1693 1842
with the Lubchenco curves15,16 because 31 2044 1548 271 1033 1196 1361 1546 1731 1897 2062
32 3007 1730 300 1177 1352 1530 1731 1933 2116 2297
these are commonly used in NICUs and 33 4186 1960 328 1356 1545 1738 1956 2178 2379 2580
met the following a priori criteria: in- 34 5936 2194 357 1523 1730 1944 2187 2434 2661 2888
cluded curves for weight-, length-, and 35 5082 2420 440 1626 1869 2123 2413 2711 2985 3261
36 4690 2675 514 1745 2028 2324 2664 3015 3339 3667
HC-for-age, which were created from
37 4372 2946 551 1958 2260 2575 2937 3308 3651 3997
the same sample; and the curves were 38 5755 3184 512 2235 2526 2829 3173 3525 3847 4172
based on US data. The validation infants 39 5978 3342 489 2445 2724 3012 3338 3670 3973 4276
40 5529 3461 465 2581 2855 3136 3454 3776 4070 4363
(as a whole and stratified by GA and GA
41 1906 3546 477 2660 2933 3214 3530 3851 4142 4433
groups 23–26 weeks, 27–31 weeks, Length, cm
32–36 weeks, and 37– 41 weeks) were 23 133 29.9 1.8 NAa 27.7 28.7 29.9 31.0 31.9 NAa
24 438 31.0 1.7 27.5 28.7 29.8 31.1 32.3 33.3 34.3
classified as SGA or LGA by using the Lub-
25 603 32.3 2.0 28.3 29.7 31.0 32.3 33.6 34.8 35.9
chenco curves. The amount of misclassi- 26 773 33.4 2.2 29.2 30.7 32.1 33.6 35.1 36.3 37.4
fication was summarized, and a likeli- 27 966 35.0 2.3 30.2 31.9 33.4 35.0 36.6 37.9 39.1
hood ratio ␹2 was calculated to assess 28 1187 36.4 2.5 31.4 33.1 34.8 36.5 38.1 39.5 40.8
29 1254 37.8 2.7 32.8 34.6 36.3 38.0 39.7 41.2 42.5
statistical significance of differences 30 1606 39.6 2.6 34.3 36.0 37.7 39.5 41.3 42.7 44.1
with a Bonferroni adjusted ␣. 31 2044 40.9 2.6 35.7 37.5 39.2 41.0 42.7 44.1 45.5
32 3007 42.1 2.6 37.1 38.9 40.6 42.3 44.0 45.5 46.9
Statistical Analysis 33 4186 43.7 2.6 38.6 40.3 41.9 43.7 45.4 46.9 48.3
34 5936 45.0 2.6 39.8 41.5 43.2 45.0 46.7 48.2 49.7
The worm plots were generated by us- 35 5082 46.0 2.7 40.9 42.6 44.3 46.2 48.0 49.5 51.0
ing S-PLUS 8.0, and SAS 9.1 was used 36 4690 47.2 2.8 42.0 43.7 45.5 47.4 49.2 50.8 52.3
37 4372 48.4 2.8 43.2 44.9 46.6 48.5 50.3 51.9 53.4
for all other statistics. 38 5755 49.5 2.6 44.4 46.1 47.7 49.5 51.2 52.7 54.2
39 5978 50.1 2.5 45.3 46.9 48.5 50.2 51.9 53.3 54.7
RESULTS 40 5529 50.7 2.4 46.1 47.6 49.1 50.8 52.4 53.8 55.1
41 1906 51.3 2.4 46.7 48.2 49.7 51.3 52.8 54.2 55.5
From the 391 681 infants, exclusions HC, cm
were made for missing growth data 23 133 20.8 1.2 NAa 19.5 20.1 20.9 21.6 22.2 NAa
(n ⫽ 31 319; 8% of total sample), un- 24 438 21.7 1.1 19.6 20.3 21.0 21.8 22.5 23.2 23.8
known gender (n ⫽ 215; 0.05%), factors 25 603 22.7 1.2 20.4 21.1 21.9 22.7 23.4 24.1 24.8
26 773 23.5 1.2 21.2 22.0 22.7 23.6 24.4 25.1 25.9
that negatively affect growth (n ⫽ 27 966 24.5 1.3 21.9 22.8 23.6 24.5 25.4 26.2 27.0
95 962; 24.5%), and physiologically im- 28 1187 25.5 1.5 22.7 23.7 24.6 25.5 26.5 27.3 28.1
probable growth measurements (1.6% 29 1254 26.5 1.5 23.6 24.6 25.5 26.5 27.5 28.4 29.2
30 1606 27.5 1.5 24.6 25.6 26.5 27.5 28.5 29.4 30.2
of total sample: n ⫽ 3578 or 0.9% boys; 31 2044 28.4 1.5 25.5 26.5 27.4 28.4 29.4 30.3 31.1
n ⫽ 2752 or 0.7% girls). The final sample 32 3007 29.3 1.5 26.5 27.4 28.3 29.3 30.3 31.2 32.0
included 257 855 infants (57.2% male) 33 4186 30.2 1.5 27.3 28.3 29.2 30.2 31.2 32.1 33.0
34 5936 31.1 1.6 28.1 29.1 30.1 31.1 32.2 33.1 34.0
with a race distribution of 50.6% white, 35 5082 31.9 1.6 28.8 29.8 30.8 31.9 33.0 34.0 34.9
15.7% black, 24.4% Hispanic, and 9.3% 36 4690 32.6 1.7 29.4 30.5 31.5 32.7 33.8 34.8 35.8
other, similar to US birth data available 37 4372 33.3 1.7 30.1 31.1 32.2 33.3 34.4 35.4 36.3
38 5755 33.8 1.6 30.7 31.7 32.7 33.7 34.8 35.7 36.7
from National Vital Statistics System
39 5978 34.0 1.5 31.1 32.0 33.0 34.0 35.1 36.0 36.9
2005 (55.1% white, 14.1% black, 23.8% 40 5529 34.2 1.5 31.4 32.3 33.3 34.3 35.3 36.1 37.0
Hispanic, and 7.0% other). The “curve 41 1906 34.5 1.5 31.7 32.6 33.5 34.5 35.5 36.3 37.1
samples” included 74 390 boys and Adapted from Groveman.20
a Not available because of small sample size.
55 721 girls, and the “validation sam-

PEDIATRICS Volume 125, Number 2, February 2010 e217

Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
ples” included 73 175 boys and 54 569 TABLE 2 Male Birth Weight, Length, and HC Percentiles by GA
girls.20 The curve and validation sam- GA, wk n Birth Size Percentile
ples had similar racial, GA, and state Mean SD 3rd 10th 25th 50th 75th 90th 97th
distributions. Weight, g
23 153 622 74 NAa 509 563 621 677 727 NAa
24 451 689 96 497 561 623 690 756 813 869
Curve Creation and Presentation
25 722 777 116 550 626 700 780 857 926 992
Final weight-, length-, and HC-for-age 26 881 888 145 613 704 794 890 983 1065 1145
27 1030 1001 170 680 789 895 1009 1120 1218 1312
curves for girls and boys are pre- 28 1281 1138 203 758 884 1007 1141 1271 1385 1496
sented in Fig 1.20 These curves met the 29 1505 1277 218 845 988 1128 1280 1429 1560 1688
selection criteria described already, 30 1992 1435 261 955 1114 1272 1443 1612 1761 1906
31 2460 1633 275 1093 1267 1441 1631 1818 1984 2147
and the resulting z score distribu- 32 3677 1823 306 1246 1433 1622 1829 2034 2218 2398
tions for each GA were 0.0 ⫾ 1.0 33 5014 2058 341 1422 1625 1830 2057 2284 2488 2688
(mean ⫾ SD). 34 7291 2288 364 1589 1810 2035 2285 2536 2763 2987
35 6952 2529 433 1728 1980 2238 2527 2819 3084 3348
Data from all GAs were used in the de- 36 7011 2798 498 1886 2170 2462 2792 3127 3432 3737
velopment of the curves; however, 37 6692 3058 518 2103 2401 2708 3056 3411 3736 4060
38 8786 3319 527 2356 2652 2959 3306 3661 3986 4312
there were a small number of infants
39 8324 3476 498 2545 2833 3131 3469 3813 4129 4446
in the 22-week group (n ⬍ 20), and the 40 7235 3582 493 2666 2950 3245 3579 3919 4232 4545
42-week group did not seem to repre- 41 2538 3691 518 2755 3039 3333 3666 4007 4319 4633
Length, cm
sent healthy 42-week infants given the
23 153 30.5 1.6 NAa 28.0 29.1 30.3 31.4 32.4 NAa
drop in their average size compared 24 451 31.5 1.8 27.9 29.1 30.3 31.5 32.8 33.9 34.9
with those at 41 weeks. Although these 25 722 32.7 2.1 28.8 30.2 31.5 32.9 34.2 35.4 36.5
data from the 22- and 42-week infants 26 881 34.2 2.2 29.9 31.3 32.8 34.3 35.7 37.0 38.2
27 1030 35.6 2.4 31.0 32.6 34.1 35.7 37.3 38.6 39.8
provided information about the shape 28 1281 37.2 2.5 32.2 33.9 35.5 37.2 38.8 40.2 41.5
of the overall curve, inspection of the 29 1505 38.6 2.5 33.5 35.2 36.9 38.7 40.3 41.7 43.1
curves compared with the empirical 30 1992 39.9 2.8 34.8 36.6 38.3 40.1 41.8 43.2 44.6
31 2460 41.5 2.5 36.2 38.0 39.8 41.6 43.3 44.7 46.1
distributions did not show a good fit; 32 3677 42.8 2.7 37.7 39.5 41.2 43.0 44.7 46.1 47.5
therefore, the final curves were trun- 33 5014 44.3 2.6 39.1 40.9 42.6 44.4 46.1 47.5 48.9
cated to describe infants 23 to 41 34 7291 45.6 2.6 40.4 42.2 43.9 45.7 47.4 48.9 50.3
35 6952 46.8 2.7 41.5 43.3 45.0 46.9 48.6 50.2 51.6
weeks’ GA. 36 7011 48.0 2.8 42.7 44.5 46.2 48.1 49.9 51.5 53.0
Descriptive statistics (mean, SD, and 37 6692 49.2 2.7 44.0 45.7 47.4 49.3 51.1 52.6 54.1
38 8786 50.2 2.7 45.2 46.8 48.5 50.2 52.0 53.5 55.0
3rd to 97th percentiles) for the new 39 8324 51.0 2.4 46.1 47.7 49.3 51.0 52.7 54.2 55.6
curves are presented in Tables 1 and 2. 40 7235 51.6 2.4 46.9 48.4 49.9 51.6 53.2 54.7 56.1
New definitions for SGA (⬍10th per- 41 2538 52.1 2.4 47.5 49.0 50.5 52.1 53.7 55.1 56.5
HC, cm
centile for age) and LGA (⬎90th per- 23 153 21.3 1.0 NAa 20.0 20.6 21.3 22.0 22.7 NAa
centile for age) are included in these 24b 451 22.2 1.1 20.1 20.8 21.5 22.2 23.0 23.6 24.3
tables and illustrated by the curves. 25 722 23.1 1.1 20.9 21.7 22.4 23.2 23.9 24.6 25.3
26 881 24.1 1.3 21.8 22.5 23.3 24.2 25.0 25.7 26.4
The LMS parameters for the curves are 27 1030 25.2 1.3 22.6 23.5 24.3 25.2 26.0 26.8 27.6
presented in Table 3. 28 1281 26.1 1.4 23.5 24.3 25.2 26.1 27.1 27.9 28.6
29 1505 27.0 1.4 24.3 25.2 26.1 27.1 28.0 28.8 29.6
30 1992 27.9 1.5 25.1 26.1 27.0 28.0 29.0 29.8 30.6
Curve Validation 31 2460 28.9 1.5 26.0 27.0 27.9 28.9 29.9 30.8 31.6
The newly created growth curves were 32 3677 29.8 1.5 26.9 27.8 28.8 29.9 30.9 31.8 32.6
33 5014 30.7 1.6 27.7 28.7 29.7 30.8 31.8 32.7 33.6
validated on separate samples. 34 7291 31.6 1.6 28.5 29.5 30.5 31.6 32.7 33.6 34.6
Gender-specific group (all ages com- 35 6952 32.4 1.6 29.2 30.3 31.3 32.4 33.6 34.5 35.5
bined) z score means and CIs were cal- 36 7011 33.2 1.7 29.9 31.0 32.1 33.2 34.3 35.3 36.3
37 6692 33.8 1.7 30.6 31.7 32.7 33.9 35.0 36.0 36.9
culated for all 3 measures (weight, 38 8786 34.4 1.7 31.2 32.2 33.2 34.4 35.5 36.4 37.3
length, and HC) and at each GA. As ex- 39 8324 34.6 1.6 31.5 32.5 33.5 34.6 35.7 36.6 37.6
pected for a normal curve, the com- 40 7235 34.8 1.5 31.8 32.8 33.8 34.8 35.9 36.8 37.7
41 2538 35.1 1.5 32.0 33.0 34.0 35.0 36.1 37.0 37.8
bined group means and medians were
Adapted from Groveman.20
essentially 0 (ⱕ0.01), all SDs were a Not available because of small sample size.

within 0.01 of 1.00, skewness was es- b Distribution skewed left.

e218 OLSEN et al
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
 ARTICLES

TABLE 3 Gender-Specific Weight-, Length-, and HC-for-Age Growth Curves L, M, and S Parameters tion for each measure within each gen-
GA, wk Weight-for-Age Curve Length-for-Age Curve HC-for-Age Curve der, and percentiles within expected
L Curve M Curve S Curve L Curve M Curve S Curve L Curve M Curve S Curve ranges. These indicate that the curves
Value Value Value Value Value Value Value Value Value are a good fit to the validation samples
Female growth and would be expected to show a sim-
curves
23 1.195 0.584 0.140 1.613 29.861 0.055 1.338 20.863 0.052
ilar good fit to the population from
24 1.180 0.651 0.149 1.799 31.074 0.058 1.412 21.759 0.051 which the samples were drawn.
25 1.161 0.737 0.159 2.005 32.323 0.062 1.500 22.667 0.052
26 1.140 0.827 0.169 2.234 33.638 0.065 1.599 23.584 0.053
The percentage of the validation sam-
27 1.116 0.936 0.178 2.395 35.047 0.067 1.685 24.541 0.054 ple classified as SGA or LGA for the
28 1.087 1.061 0.185 2.396 36.522 0.068 1.740 25.529 0.056 group overall (⬃10% SGA and ⬃10%
29 1.054 1.204 0.186 2.231 38.041 0.068 1.771 26.525 0.055
LGA), for individual GAs (⬃10% for
30 1.015 1.373 0.182 2.125 39.545 0.066 1.778 27.507 0.054
31 0.975 1.546 0.177 2.217 40.961 0.063 1.774 28.433 0.052 each), and for GA groups was deter-
32 0.930 1.731 0.172 2.172 42.334 0.061 1.754 29.333 0.050 mined. For GA groups, boys and girls
33 0.878 1.956 0.167 1.938 43.701 0.059 1.720 30.241 0.050 were combined when calculating CIs
34 0.827 2.187 0.166 1.784 44.978 0.058 1.677 31.126 0.050
35 0.786 2.413 0.181 1.746 46.167 0.058 1.647 31.944 0.051 for the percentage of SGA/LGA as a re-
36 0.764 2.664 0.192 1.750 47.356 0.058 1.629 32.675 0.052 sult of small sample size at the
37 0.771 2.937 0.185 1.809 48.501 0.056 1.613 33.289 0.050 younger GAs. In all cases, the CIs and
38 0.796 3.173 0.163 1.840 49.476 0.052 1.601 33.742 0.047
39 0.821 3.338 0.146 1.883 50.214 0.050 1.597 34.040 0.045 percentages were consistent with
40 0.841 3.454 0.137 1.922 50.788 0.047 1.595 34.273 0.043 ⬃10%, as would be expected if the
41 0.855 3.530 0.134 1.958 51.271 0.046 1.595 34.497 0.042 curves were correctly classifying in-
Male growth
curves
fants. Figure 4 shows an example of 1
23 1.317 0.621 0.136 1.608 30.282 0.057 1.450 21.349 0.049 of these analyses for GA groups.
24 1.305 0.690 0.142 1.748 31.543 0.059 1.510 22.246 0.049
25 1.289 0.780 0.150 1.889 32.862 0.062 1.570 23.174 0.050
Comparison of Lubchenco Curves
26 1.270 0.890 0.158 2.029 34.265 0.064 1.630 24.164 0.051
27 1.248 1.009 0.165 2.159 35.732 0.065 1.685 25.178 0.052 With New Curves and Validation
28 1.224 1.141 0.171 2.264 37.221 0.066 1.727 26.145 0.052 Data Set
29 1.196 1.280 0.174 2.335 38.669 0.065 1.750 27.062 0.052
30 1.162 1.443 0.174 2.367 40.110 0.064 1.756 27.987 0.052 The new gender-specific curves were
31 1.122 1.631 0.171 2.357 41.555 0.062 1.747 28.935 0.052 plotted with the unisex Lubchenco
32 1.075 1.829 0.167 2.314 42.974 0.060 1.734 29.855 0.051 curves (gender-specific US curves
33 1.021 2.057 0.164 2.244 44.368 0.058 1.727 30.758 0.051
34 0.968 2.285 0.163 2.163 45.658 0.057 1.729 31.630 0.051 not available) for comparison. Figure
35 0.917 2.527 0.171 2.074 46.876 0.057 1.736 32.448 0.051 5 presents the weight-for-age curves
36 0.873 2.792 0.177 1.973 48.102 0.057 1.744 33.212 0.051 as an example of these comparisons.
37 0.839 3.056 0.171 1.866 49.270 0.055 1.748 33.869 0.050
38 0.814 3.306 0.158 1.769 50.249 0.052 1.750 34.358 0.048 Generally, the new curves had lower
39 0.796 3.469 0.146 1.689 51.007 0.049 1.751 34.638 0.046 average weights, lengths, and HC at
40 0.785 3.579 0.140 1.626 51.612 0.047 1.752 34.832 0.045 younger GAs than the Lubchenco
41 0.776 3.666 0.136 1.572 52.122 0.046 1.752 35.033 0.044
curves until 30 to 36 weeks; the new
Adapted from Groveman.20 The LMS method estimates 3 age-specific parameters: a Box-Cox power transformation of
skewness (L), median (M), and coefficient of variation (S). curves had higher average growth
measurements at older GAs. When
sentially 0, and the z scores exhibited a length and HC z scores were approxi- the validation samples were catego-
Gaussian distribution. mately normally distributed. The only rized as SGA/AGA/LGA by using the
Similar results were observed when exception was that HC z scores for in- Lubchenco curves, we found a statis-
these data were stratified by GA for fants ⬍26 weeks approached a nor- tically significant difference for each
which all but 1 of the means were ⬍0.1 mal distribution except for 24-week GA, GA group, and the group as a
away from 0. Figure 2 shows an exam- boys, which showed a slight skew with whole (all P ⬍ .0001). Table 4 presents
ple of this, illustrating that all CIs in- a mean of 0.02, a median of 0.22, and the overall comparisons (boys and girls
clude 0. In addition, the age-specific z skewness of 0.24. combined). Overall, the percentage of
scores had means and medians within Figure 3 shows the gender-specific SGA infants was underestimated by the
ⱕ0.02 of each other, and each had a percentile distributions in the valida- Lubchenco curves except for younger
skewness of ⱕ0.009. Weight z scores tion samples by using the curve LMS girls (approximately ⱕ36 weeks), for
were always normally distributed, and values, illustrating a normal distribu- whom it was more likely to be overesti-

PEDIATRICS Volume 125, Number 2, February 2010 e219

Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
 0.3 DISCUSSION
0.2 We developed a new set of weight-,
length-, and HC-for-age intrauterine
Mean z-score

0.1

0 growth curves for the assessment of

-0.1 preterm infants in NICUs. The advan-
-0.2
tages of these curves are the inclusion
Mean indicated by bar, expected value 0 of the 3 routine NICU growth measure-
-0.3
ments (weight, length, and HC) on the
-0.4
same infants at birth; a contemporary,
23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41
Gestational age, weeks
large, racially diverse US sample that
is racially similar to national birth
FIGURE 2
Birth weight mean z scores and 99.7% CIs (using an adjusted ␣ of .003 for 19 comparisons) by GA in statistics; and validation on separate
female validation sample (n ⫽ 54 352). gender-specific subsamples to con-
firm that these new curves are accu-
rate. The misclassification of SGA and
LGA infants in the validation samples
by using the Lubchenco curve defini-
tions supports the need for updated
and gender-specific growth curves.
These new intrauterine growth curves
offer an updated set of curves that
should be generalizable to infants in
US NICUs.
Of the available intrauterine growth
curves that include weight-, length-,
and HC for age 9,15–17,26, the Lubchenco
curves offer advantages of a reason-
able sample size (⬎5000 infants), the
same sample of infants for all 3 curves;
small grid increments (ie, weekly for
GA; every 200 g of weight; every 1 cm of
length/HC); percentiles (versus SDs
from mean) for ease of interpretation;
and a measure of body proportionali-
ty.27 These advantages help to explain
why the Lubchenco curves are still
used in NICUs today and why we chose
them to compare with our new curves.
These curves are used at birth for the
assessment of intrauterine growth to
FIGURE 3
Comparison of expected to actual birth size percentiles on the basis of new curves for female valida-
identify infants who are large or small
tion sample (n ⫽ 54 352; A) and male validation sample (n ⫽ 72 845; B). For a standard normal curve, for their age and allow for the compar-
expected values (f) are 3%, 7%, 15%, 25%, 25%, 15%, 7%, and 3%, respectively. ison of postnatal growth with that of
the gold standard, fetal growth.1
Our exclusions resulted in a sample of
mated. The percentage of LGA infants none of the infants in the validation or healthy, singleton infants to create
was consistently underestimated at curve samples (n ⫽ 7399) were catego- standard-type growth curves that
younger ages (ⱕ36 weeks) and overes- rized as LGA for weight, indicating sub- represent an estimate of optimal
timated at older ages (⬎36 weeks). In stantial lack of fit with the Lubchenco growth.28 Concerns have been pub-
fact, for the younger GAs (24 –26 weeks), curves. lished29–32 regarding intrauterine-type

e220 OLSEN et al
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
 ARTICLES

16% Similar to previous studies, we found

14% that birth size differs by gender. Lub-
12%
chenco et al16 noted small but signifi-
10%
cant differences in weight between
8%
6%
boys and girls 38 to 41 weeks. Thomas
4% et al19 found that girls on average were
2% 95 g lighter, were 0.6 cm shorter, and
0% had 0.6 cm smaller HC. The average dif-
SGA LGA SGA LGA SGA LGA SGA LGA
ferences in our study were compara-
23 to 26 weeks 27 to 31 weeks 32 to 36 weeks 37 to 41 weeks
n=3531 n=14718 n=52216 n=56523
ble to those of the study by Thomas et
al19 (96 g, 0.7 cm, and 0.6 cm, respec-
Gestational age group and percentile
tively); all were statistically different
FIGURE 4 by age group, and most were consid-
Percentages and 98.75% CIs (using an adjusted ␣ of .0125 for 4 GA groups) for the amount of SGA
(⬍10th percentile weight-for-age) and LGA (⬎90th percentile weight-for-age) infants in the validation ered clinically different enough (ⱖ48 g
samples (boys and girls combined, n ⫽ 127 197). weight, ⱖ0.5 cm length/HC) to justify
separate curves.
curves that are based on cross- of the size/age relationships repre- SGA and LGA are commonly used to de-
sectional birth data, in particular of sented in growth curves31,35,36; however, fine high-risk groups of infants who re-
preterm infants. Cross-sectional birth the use of ultrasound data for estimating ceive extra attention in the NICU. SGA in-
data do not represent growth over time; size and GA dates has been associated fants are at risk for adverse outcomes
however, these do represent intrauter- with error,9,37,38 it is not a direct mea- such as growth40,41 and neurodevelop-
ine growth of fetuses up to the time of surement of fetal size,9,32 and it is not mental delays,42 and LGA infants are at
birth, which is the American Academy of feasible in a large study of infants. De- risk for early hypoglycemia43 and later
Pediatrics’s recommended goal for pre- spite the limitations, cross-sectional metabolic syndrome.44 The misclassifi-
term infants.1 Preterm infants at birth birth data from infants of varying ages cation that we found by using the old
are smaller in size than fetuses of the remain the generally accepted best Lubchenco unisex curves may lead to
same GA,16,33,34 and error in GA dating is a sources for creating growth curves for many SGA infants not receiving the
widely known concern because of the the assessment of infant size at birth care that they need because they are
questions that it brings to the accuracy and postnatally.30,35,39 misclassified as AGA, younger LGA in-

A B
Weight, grams Weight, grams
4500 4500
90th
90th 4000
4000

3500 3500 50th

50th

3000 3000
10th
th
10
2500 2500

2000 2000

1500 1500

1000 1000

500 500
24 26 28 30 32 34 36 38 40 24 26 28 30 32 34 36 38 40
Gestational Age, Weeks Gestational Age, Weeks

FIGURE 5
New weight-for-age gender-specific curves (solid line) for girls (A) and boys (B) compared with Lubchenco unisex curves (dashed line; start at 24 weeks16).
Adapted from Groveman.20

PEDIATRICS Volume 125, Number 2, February 2010 e221

Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
TABLE 4 Weight-for-Age Classification of the Validation Sample (Boys and Girls Combined) as more accurate representation of in-
Defined by the Lubchenco Curve and the New Curve for GA Groups
fant size than the Lubchenco curves.
GA, wk Lubchenco New Curve
Curve, n (%) One limitation of these curves was that
SGA AGA LGA
the sample included NICU admissions
24–26a SGA 302 (85) 42 (1) 0 (0)
AGA 55 (15) 2800 (99) 332 (100)
only. As a result, our sample may not
LGA 0 (0) 0 (0) 0 (0) represent all infants, especially those
Total 357 2842 332 at older GAs; however, our sample was
27–31 SGA 1267 (82) 152 (1) 0 (0)
AGA 282 (18) 11 688 (99) 898 (68)
made up of all NICU admissions to a
LGA 0 (0) 0 (0) 431 (32) large number of NICUs from around
Total 1549 11 840 1329 the United States and was racially sim-
32–36 SGA 3051 (58) 39 (⬃0) 0 (0) ilar to recent US birth data, and the
AGA 2203 (42) 41 852 (⬃100) 2067 (41)
LGA 0 (0) 73 (0) 2931 (59) size of our term infants were similar
Total 5254 41 964 4998 to those in the 2000 Centers for Dis-
37–41 SGA 2705 (50) 0 (0) 0 (0) ease Control and Prevention’s growth
AGA 2653 (50) 38 144 (84) 0 (0)
LGA 0 (0) 7424 (16) 5597 (100)
charts.47
Total 5358 45 568 5597
Grand totalb 12 518 102 214 12 256 CONCLUSIONS
P ⬍ .0001 for overall association and for association within each age category. The new gender-specific intrauterine
a Lubchenco weight-for-age curve starts at 24 weeks; therefore, the first GA group is defined as 24 to 26 weeks instead of 23

to 26 weeks. growth curves created and validated

b Grand total n ⫽ 126 988 because Lubchenco weight-for-age curve does not include 23-week infants.
fants may be overlooked because they
are misclassified as AGA, and older in-
fants may be mistargeted for extra
NICU attention because they are misclas-
sified as LGA. This could lead to misdirec-
tion of NICU resources and suboptimal
outcomes in NICU infants. Research is
needed to validate our new definitions of
SGA and LGA with short-term and long-
term health outcomes.
The differences found between our
new curves and the Lubchenco curves
may be explained in part by differ-
ences in the infants who were from
1998 to 2006 versus from 1948 to 1963,
respectively. Given advancements in
prenatal care that extend high-risk
pregnancies, some of the infants who
were born at very preterm ages in the
new curves may be more likely to have
experienced extended periods of
growth restriction than the young in-
fants in the older curves; this could
help to explain in part why the new
curves are shifted down at this end of
the age spectrum. Higher maternal
body weight and pregnancy weight
gain in recent years45,46 may help to ex-
plain why the new curves are shifted
up in the older GAs.
Our data also illustrate that the Lub-
chenco weight curve may not accu-
rately reflect the current US popula-
tion at GAs ⬍27 weeks. More than
16 000 infants who were ⬍27 weeks
were in the Pediatrix sample (before
our exclusions), and only 87 of these
were classified as LGA by Lubchenco
(all of whom were removed as extreme
outliers, consistent with previous
curves21,22). It was extremely unlikely to
have so few infants considered LGA in
our sample if the Lubchenco curve
were correct at these ages. The Lub-
chenco weight curve was based on an
extremely small number of 24- to 26-
week infants (n ⫽ 24, 27, and 68, re-
spectively). Lubchenco’s 90th percen-
tile was defined by only two 24-week
infants, three 25-week infants, and
seven 26-week infants. Removing any 1
of these infants would have changed
the curves dramatically. Thus, we pro-
pose that our curves may provide a
in this study using a contemporary,
large, racially diverse US sample pro-
vide clinicians with an updated tool for
the assessment of growth status of
preterm infants in US NICUs. Research
into the ability of our new definitions of
SGA and LGA to identify high-risk infants
in terms of short-term and long-term
health outcomes is needed.
ACKNOWLEDGMENTS
This project was funded, in part, under
a grant from the Pennsylvania Depart-
ment of Health. Dr Olsen is a member
of the Biobehavioral Research Center
in the School of Nursing at the Univer-
sity of Pennsylvania.
Part of the results presented were in-
cluded in a master’s thesis (New Pre-
term Infant Growth Curves Influence of
Gender and Race on Birth Size) by Ms
Groveman in partial fulfillment of the
Masters of Science in Human Nutrition
degree requirements at Drexel Univer-
sity (July 2008).
We thank Amy Sapsford, RD, and Deir-
dre Ellard, MS, RD, for sharing clinical
expertise on the curves’ design and
Lauren Ackerman and Paul Hamby for
statistical assistance.

e222 OLSEN et al
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015

REFERENCES
1. American Academy of Pediatrics, Commit-
tee on Nutrition. Nutritional needs of low-
birth-weight infants. Pediatrics. 1977;60(4):
519 –530
2. Casey PH, Kraemer HC, Bernbaum J, Yog-
man MW, Sells JC. Growth status and
growth rates of a varied sample of low birth
weight, preterm infants: a longitudinal
cohort from birth to three years of age.
J Pediatr. 1991;119(4):599 – 605
3. Dancis J, O’Connell JR, Holt LE Jr. A grid for
recording the weight of premature infants.
J Pediatr. 1948;33(11):570 –572
4. Ehrenkranz RA, Younes N, Lemons JA, et al.
Longitudinal growth of hospitalized very
low birth weight infants. Pediatrics. 1999;
104(2 pt 1):280 –289
5. Guo SS, Roche AF, Chumlea WC, Casey PH,
Moore WM. Growth in weight, recumbent
length, and head circumference for pre-
term low-birthweight infants during the
first three years of life using gestation-
adjusted ages. Early Hum Dev. 1997;47(3):
305–325
6. Wright K, Dawson JP, Fallis D, Vogt E, Lorch
V. New postnatal growth grids for very low
birth weight infants. Pediatrics. 1993;91(5):
922–926
7. Alexander GR, Himes JH, Kaufman RB, Mor J,
Kogan M. A United States national reference
for fetal growth. Obstet Gynecol. 1996;87(2):
163–168
8. Bonellie S, Chalmers J, Gray R, Greer I,
Jarvis S, Williams C. Centile charts for birth-
weight for gestational age for Scottish sin-
gleton births. BMC Pregnancy Childbirth.
2008;8:5–14
9. Fenton TR. A new growth chart for preterm
babies: Babson and Benda’s chart updated
with recent data and a new format. BMC
Pediatr. 2003;3:13–22
10. Kramer MS, Platt RW, Wen SW, et al. A new
and improved population-based Canadian
reference for birth weight for gestational
age. Pediatrics. 2001;108(2). Available at:
www.pediatrics.org/cgi/content/full/108/
2/e35
11. Niklasson A, Albertsson-Wikland K. Continu-
ous growth reference from 24th week of
gestation to 24 months by gender. BMC Pe-
diatr. 2008;8:8 –32
12. Oken E, Kleinman KP, Rich-Edwards J, Gill-
man MW. A nearly continuous measure of
birth weight for gestational age using a
United States national reference. BMC Pedi-
atr. 2003;3:6 –15
13. Riddle WR, Donlevy SC, Lafleur BJ, Rosen-
bloom ST, Shenai JP. Equations describing
PEDIATRICS Volume 125, Number 2, February 2010
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
percentiles for birth weight, head circum-
ference, and length of preterm infants. J
Perinatol. 2006;26(9):556 –561
14. Williams RL, Creasy RK, Cunningham GC,
Hawes WE, Norris FD, Tashiro M. Fetal
growth and perinatal viability in California.
Obstet Gynecol. 1982;59(5):624 – 632
15. Lubchenco LO, Hansman C, Boyd E. Intra-
uterine growth in length and head circum-
ference as estimated from live births at
gestational ages from 26 to 42 weeks. Pedi-
atrics. 1966;37(3):403– 408
16. Lubchenco LO, Hansman C, Dressler M, Boyd
E. Intrauterine growth as estimated from
liveborn birth-weight data at 24 to 42 weeks
of gestation. Pediatrics. 1963;32:793– 800
17. Babson SG, Benda GI. Growth graphs for the
clinical assessment of infants of varying
gestational age. J Pediatr. 1976;89(5):
814 – 820
18. McLean F, Usher R. Measurements of live-
born fetal malnutrition infants compared
with similar gestation and with similar
birth weight normal controls. Biol Neonate.
1970;16(4):215–221
19. Thomas P, Peabody J, Turnier V, Clark RH.
A new look at intrauterine growth and the
impact of race, altitude, and gender. Pe-
diatrics. 2000;106(2). Available at:
www.pediatrics.org/cgi/content/full/106/
2/e21
20. Groveman SA. New Preterm Infant Growth
Curves Influence of Gender and Race on
Birth Size [master’s thesis]. Philadelphia,
PA: Biotechnology and Bioscience, Drexel
University; 2008
21. Arbuckle TE, Wilkins R, Sherman GJ. Birth
weight percentiles by gestational age in
Canada. Obstet Gynecol. 1993;81(1):39 – 48
22. Beeby PJ, Bhutap T, Taylor LK. New South
Wales population-based birthweight per-
centile charts. J Paediatr Child Health. 1996;
32(6):512–518
23. Tukey JW. Exploratory Data Analysis. Don
Mills, Ontario, Canada: Addison-Wesley;
1977
24. Cole TJ, Green PJ. Smoothing reference cen-
tile curves: the LMS method and penalized
likelihood. Stat Med. 1992;11(10):1305–1319
25. van Buuren S, Fredriks M. Worm plot: a sim-
ple diagnostic device for modeling growth
reference curves. Stat Med. 2001;20(8):
1259 –1277
26. Usher R, McLean F. Intrauterine growth of
live-born Caucasian infants at sea level:
standards obtained from measurements in
7 dimensions of infants born between 25
ARTICLES
and 44 weeks of gestation. J Pediatr. 1969;
74(6):901–910
27. Olsen IE, Lawson ML, Meinzen-Derr J, et al.
Use of a body proportionality index for
growth assessment of preterm infants.
J Pediatr. 2009;154(4):486 – 491
28. Cameron N. The use and abuse of growth
charts. In: Johnston FE, Zemel B, Eveleth PB,
eds. Human Growth in Context. London,
England: Smith-Gordon; 1999:65–74
29. Cooke RW. Conventional birth weight stan-
dards obscure fetal growth restriction in
preterm infants. Arch Dis Child Fetal Neona-
tal Ed. 2007;92(3):F189 –F192
30. Rao SC, Tompkins J. Growth curves for pre-
term infants. Early Hum Dev. 2007;83(10):
643– 651
31. Sauer PJ. Can extrauterine growth approx-
imate intrauterine growth? Should it? Am J
Clin Nutr. 2007;85(2):608S– 613S
32. Marsál K, Persson PH, Larsen T, Lilja H, Sel-
bing A, Sultan B. Intrauterine growth curves
based on ultrasonically estimated foetal
weights. Acta Paediatr. 1996;85(7):843– 848
33. Bukowski R, Gahn D, Denning J, Saade G.
Impairment of growth in fetuses destined to
deliver preterm. Am J Obstet Gynecol. 2001;
185(2):463– 467
34. Doubilet PM, Benson CB, Wilkins-Haug L,
Ringer S. Fetuses subsequently born pre-
mature are smaller than gestational age-
matched fetuses not born premature. J
Ultrasound Med. 2003;22(4):359 –363
35. Ehrenkranz RA. Estimated fetal weights ver-
sus birth weights: should the reference in-
trauterine growth curves based on birth
weights be retired? Arch Dis Child Fetal Neo-
natal Ed. 2007;92(3):F161–F162
36. Karna P, Brooks K, Muttineni J, Karmaus W.
Anthropometric measurements for neo-
nates, 23 to 29 weeks gestation, in the
1990s. Paediatr Perinat Epidemiol. 2005;
19(3):215–226
37. Chauhan SP, Hendrix NW, Magann EF, Morri-
son JC, Kenney SP, Devoe LD. Limitations of
clinical and sonographic estimates of birth
weight: experience with 1034 parturients.
Obstet Gynecol. 1998;91(1):72–77
38. Platt RW. The effect of gestational age er-
rors and their correction in interpreting
population trends in fetal growth and ges-
tational age-specific mortality. Semin Peri-
natol. 2002;26(4):306 –311
39. Moyer-Mileur LJ. Anthropometric and labo-
ratory assessment of very low birth weight
infants: the most helpful measurements
and why. Semin Perinatol. 2007;31(2):
96 –103
e223
40. Hack M, Schluchter M, Cartar L, Rahman M,
Cuttler L, Borawski E. Growth of very low
birth weight infants to age 20 years. Pediat-
rics. 2003;112(1). Available at: www.
pediatrics.org/cgi/content/full/112/1/e30
41. Hediger ML, Overpeck MD, Maurer KR, Kucz-
marski RJ, McGlynn A, Davis WW. Growth of
infants and young children born small or
large for gestational age: findings from the
Third National Health and Nutrition Exami-
nation Survey. Arch Pediatr Adolesc Med.
1998;152(12):1225–1231
42. Monset-Couchard M, de Bethmann O, Relier
e224 OLSEN et al
Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
JP. Long term outcome of small versus ap-
propriate size for gestational age co-twins/
triplets. Arch Dis Child Fetal Neonatal Ed.
2004;89(4):F310 –314
43. Hooy SK, Amorde-Spalding K. Infants of dia-
betic mothers. In: Groh-Wargo S, Thompson
M, Cox JH, Hartline JV, eds. Nutritional Care
for High-Risk Newborns. 3rd ed. Chicago, IL:
Precept Press, Inc; 2000:535–546
44. Boney CM, Verma A, Tucker R, Vohr BR. Met-
abolic syndrome in childhood: association
with birth weight, maternal obesity, and
gestational diabetes mellitus. Pediatrics.
2005;115(3). Available at: www.pediatrics.
org/cgi/content/full/115/3/e290
45. Ramachenderan J, Bradford J, McLean M. Ma-
ternal obesity and pregnancy complications: a
review. Aust N Z J Obstet Gynaecol. 2008;48(3):
228 –235
46. Yeh J, Shelton JA. Increasing prepregnancy
body mass index: analysis of trends and
contributing variables. Am J Obstet Gynecol.
2005;193(6):1994 –1998
47. Kuczmarski RJ, Ogden CL, Grummer-Strawn
LM, et al. CDC growth charts: United States.
Adv Data. 2000;(314):1–27
 New Intrauterine Growth Curves Based on United States Data
Irene E. Olsen, Sue A. Groveman, M. Louise Lawson, Reese H. Clark and Babette S.
Zemel
Pediatrics; originally published online January 25, 2010;
DOI: 10.1542/peds.2009-0913
Updated Information & including high resolution figures, can be found at:
Services http://pediatrics.aappublications.org/content/early/2010/01/25
/peds.2009-0913
Citations This article has been cited by 32 HighWire-hosted articles:
http://pediatrics.aappublications.org/content/early/2010/01/25
/peds.2009-0913#related-urls
Permissions & Licensing Information about reproducing this article in parts (figures,
tables) or in its entirety can be found online at:
http://pediatrics.aappublications.org/site/misc/Permissions.xht
ml
Reprints Information about ordering reprints can be found online:
http://pediatrics.aappublications.org/site/misc/reprints.xhtml

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned, published,
and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk
Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy of Pediatrics. All
rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015
 New Intrauterine Growth Curves Based on United States Data
Irene E. Olsen, Sue A. Groveman, M. Louise Lawson, Reese H. Clark and Babette S.
Zemel
Pediatrics; originally published online January 25, 2010;
DOI: 10.1542/peds.2009-0913

The online version of this article, along with updated information and services, is
located on the World Wide Web at:
http://pediatrics.aappublications.org/content/early/2010/01/25/peds.2009-0913

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly

publication, it has been published continuously since 1948. PEDIATRICS is owned,
published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point
Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2010 by the American Academy
of Pediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from pediatrics.aappublications.org at Virginia Hosp Ctr Arlington on August 16, 2015