Downloadable Resources - Training

INTERGROWTH-21st Very Preterm Size at Birth References and Z Scores (Standard Deviations)

The INTERGROWTH-21st global references and z scores for head circumference, length and weight at birth of very preterm newborns are available to download below.

INTERGROWTH-21st Very Preterm Size at Birth Reference Charts

New INTERGROWTH-21st very preterm size at birth reference charts have been published in The Lancet.

Sri Lanka becomes the first country to adopt the INTERGROWTH-21st Preterm Standards

We are delighted to announce that Sri Lanka has become the first country to adopt the INTERGROWTH-21st Preterm Standards.

INTERGROWTH-21st in Sri Lanka

Drs Leila Cheikh Ismail and Jane Hirst are currently introducing the Preterm Growth Standards through a series of workshops in Sri Lanka.

INTERGROWTH-21st Postnatal Growth Standards and z-scores for Preterm Infants

INTERGROWTH-21st in China

New INTERGROWTH-21st International Postnatal Growth Standards for Preterm Infants - Charts available

New INTERGROWTH-21st Postnatal Growth Standards charts for individual measurements of length, weight, head circumference, as well as a combined standards chart for length, weight and head circumference are now available for download here.

Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21st Project

The first international stnadards for monitroing the growth of preterm babies have now been published in the Lancet Global Health (October 2015). 

International Fetal Growth Standards - latest charts available

New INTERGROWTH-21st Fetal Growth Standards charts for measurements of head circumference (HC), bi-parietal diameter (BPD), occipito-frontal diameter (OFD), femur length (FL) and abdominal circumference (AC) are now available for download.

INTERGROWTH-21st Newborn Charts in use in Nairobi

INTERGROWTH-21st Fetal Growth Standards

Fetal Growth Standards for ultrasound measurements of head circumference (HC), bi-parietal diameter (BPD), occipito-frontal diameter (OFD), femur length (FL) and abdominal circumference (AC) are now available for download. For information about how to perform these measurements, or for other information on standards in ultrasound imaging, please see the ultrasound training toolkit.

INTERGROWTH-21st Newborn Size at Birth Chart

Practical chart for health practitioners to use to assess newborn size (weight, length, head circumference) at birth against global standards. This version of the chart is being piloted within the University of Oxford hospital network, and plans to pilot in the INTERGROWTH-21st study sites and in Boston area hospitals are developing quickly. Practitioners can download and use this version of the chart freely. To connect with the INTERGROWTH-21st team regarding your experience with piloting this chart, or to request modifications to the chart (e.g. language; different institutional logo), please contact intergrowth21st@tghn.org.  

INTERGROWTH-21st Newborn Birth Length Standards and Z Scores

Global standards and z scores for length at birth, with information related to their use. Online calculators will be available shortly.

INTERGROWTH-21st Newborn Head Circumference Standards and Z Scores

Global standards and z scores for head circumference at birth, with information related to their use. Online calculators will be available shortly. 

INTERGROWTH-21st Newborn Birth Weight Standards and Z Scores

Global standards and z scores for birth weight at birth, with information related to their use. Online calculators will be available shortly.  

International standards for newborn weight, length, and head circumference by gestational age and sex: the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project

These international anthropometric standards were developed to assess newborn size in routine clinical practice that are intended to complement the WHO Child Growth Standards and allow comparisons across multiethnic populations.

International standards for fetal growth based on serial ultrasound measurements: the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project

Using the same methods and conceptual approach as the WHO child growth standards, the Fetal Growth Longitudinal Study of the INTERGROWTH-21st Project developed international growth and size standards for fetuses for clinical interpretation of routinely taken ultrasound measurements and for comparisons across populations.

Translating research into practice: the introduction of the INTERGROWTH-21st package of clinical standards, tools and guidelines into policies, programmes and services

This paper describes the approach to translating the findings, tools and resources generated by the INTERGROWTH-21^st Project into practice. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12416/abstract

Implementation of the INTERGROWTH-21st Project in the United States

This paper describes the implementation of the INTERGROWTH-21^st Project in Seattle, USA. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12126/abstract

Implementation of the INTERGROWTH-21st Project in the UK

This paper describes the implementation of the INTERGROWTH-21^st Project in Oxford, UK. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12033/abstract

Implementation of the INTERGROWTH-21st Project in Oman

This paper describes the implementation of the INTERGROWTH-21^st Project in Muscat, Oman. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12043/abstract

Implementation of the INTERGROWTH-21st Project in Kenya

This paper describes the implementation of the INTERGROWTH-21^st Project in Nairobi, Kenya. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12045/abstract

Implementation of the INTERGROWTH-21st Project in Italy

This paper describes the implementation of the INTERGROWTH-21^st Project in Turin, Italy. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12124/abstract

Implementation of the INTERGROWTH-21st Project in India

This paper describes the implementation of the INTERGROWTH-21^st Project in Nagpur, India. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12058/abstract

Implementation of the INTERGROWTH-21st Project in China

This paper describes the implementation of the INTERGROWTH-21^st Project in Beijing, China. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12044/abstract

Implementation of the INTERGROWTH-21st Project in Brazil

This paper describes the implementation of the INTERGROWTH-21^st Project in Pelotas, Brazil. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12046/abstract

Ethical issues arising from the INTERGROWTH-21st Fetal Growth Longitudinal Study

The INTERGROWTH-21^st Project presented a complex set of ethical challenges given the involvement of health institutions in geographically and culturally diverse areas of the world, with differing attitudes to pregnancy. This paper addresses how the research team dealt with some of those issues. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12030/abstract

Statistical considerations for the development of prescriptive fetal and newborn growth standards in the INTERGROWTH-21st Project

This paper considers the statistical aspects of the three components of the INTERGROWTH-21^st Project - the Fetal Growth Longitudinal Study, the Preterm Postnatal Follow-up Study, and the Newborn Corss-Sectional Study - as they relate to the construction of the INTERGROWTH-21^st standards, in particular, the sample size. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12031/abstract

Standardisation of neonatal clinical practice

Given the multicentre nature of the INTERGROWTH-21^st Project and the expected number of preterm births, it is vital that all centres follow the same standardised clinical care protocols to assess and manage preterm infants, so as to ensure maximum validity of the resulting standards as indicators of growth and nutrition with minimal confounding. Moreover, it is well known that evidence-based clinical practice guidelines can reduce the delivery of inappropriate care and support the introduction of new knowledge into clinical practice. The INTERGROWTH-21^st Neonatal Group produced an operations manual, which reflects the consensus reached by members of the group regarding standardised definitions of neonatal morbidities and the minimum standards of care to be provided by all centres taking part in the project. This paper describes the process of developing the Basic Neonatal Care Manual, as well as the morbidity definitions and standardised neonatal care protocols applied across all the INTERGROWTH-21^st participating centres. Thoughts about implementation strategies are presented. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12312/abstract

Anthropometric standardisation and quality control protocols for the construction of new, international, fetal and newborn growth standards: the INTERGROWTH-21st Project

The INTERGROWTH-21^st Project involved taking anthropometric measurements, including head circumference, recumbent length and weight of infants, and the stature and weight of parents. In a large, international, multicentre project, it is critical that all study sites follow standardised protocols to ensure maximal validity of the growth and nutrition indicators used. This paper describes, in detal, the anthropometric training, standardisation and quality control procedures used to collect data for these new standards. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12127/abstract

Standardisation and quality control of ultrasound measurements taken in the INTERGROWTH-21st Project

Meticulous standardisation and ongoing monitoring of adherence to measurement protocols during data collection are essential to ensure consistency and to minimise systematic error in multicentre studies. Strict ultrasound fetal biometric measurement protocols are used in the INTERGROWTH-21^st Project so that data of the highest quality from different centres can be compared and potentially pooled. A central Ultrasound Quality Unit (USQU) has been set up to oversee this standardisation, training and quality control process. This paper describes the procedures used, which can form a model for research settings involving ultrasound measurements.

Ultrasound methodology used to construct the fetal growth standards in the INTERGROWTH-21st Project

A unified protocol is essential to ensure that fetal ultrasound measurements taken in multicentre research studies are accurate and reproducible. This paper describes the methodology used to take two-dimensional, ultrasound measurements in the longitudinal, fetal growth component of the INTERGROWTH-21^st Project. These standardised methods should minimise the systematic errors associated with pooling data from different sites. They represent a model for carrying out similar research studies in the future. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12313/abstract

The objectives, design and implementation of the INTERGROWTH-21st Project

This paper outlines the objectives, design and implementation of the INTERGROWTH-21^st Project, a multicentre, multiethnic, population-based project conducted in eight geographical areas (Brazil, China, India, Italy, Kenya, Oman, UK and USA), with technical support from four global specialised units, to study growth, health and nutrition from pregnancy to early infancy. It aims to produce prescriptive growth standards, which conceptually extend the World Health Organization (WHO) Multicentre Growth Reference Study (MGRS) to cover fetal and newborn life. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12047/abstract

Preface to INTERGROWTH-21st Methodology

Professor Sir Sabaratnam Arulkumaran, President of FIGO, introduces the methods of the INTERGROWTH-21^st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12314/abstract

Systematic review of methodology used in ultrasound studies aimed at creating charts of fetal size

Reliable ultrasound charts are necessary for the prenatal assessment of fetal size, yet there is a wide variation of methodologies for the creation of such charts. This paper evaluates the methodological quality of studies of fetal biometry using a set of predefined quality criteria of study design, statistical analysis and reporting methods. Eighty-three studies met the inclusion criteria, and although multiple regression analysis shows that quality of studies has improved over time, there is considerable heterogeneity in study methodology still observed today. Standardisation of methodologies is necessary in order to make correct interpretations and comparisons between different charts. A checklist of recommended methodologies in proposed. http://www.ncbi.nlm.nih.gov/pubmed/22882780

INTERGROWTH-21st Study Protocol

This study protocol descibes the the objectives, design and implementation of the Fetal Growth Longitudinal Study (FGLS), the Preterm Postnatal Followup Study (PPFS), and the Newborn Cross Sectional Study (NCSS). Data from these studies inform new, international fetal and newborn growth standards and a package of accompanying resources, including a new international equation for estimating gestational age through ultrasound. http://www.medscinet.net/Intergrowth/patientinfodocs/Intergrowth%20Protocol%20Sept%202009.pdf

Fetal Growth Longitudinal Study Operation Manual

This operation manual was used to implement the Fetal Growth Longitudinal Study (FGLS), which involved screening healthy women between 9 and 14 weeks gestation at the time of their early antenatal visit, and followed-up with standard clinical and 2D ultrasound examinations every 5 weeks, i.e. up to six times during a term pregnancy. The results of the FGLS inform new, international fetal and newborn growth standards and a package of supportive tools, guidelines and resources, including a new international equation for estimating gestational age through ultrasound. http://www.medscinet.net/Intergrowth/patientinfodocs/FGLS%20Manual%2015-09.pdf

Pregnancy and Delivery Form Instructions

This resource was used to train health professionals on how to record key data on pregnancies and deliveries for women participating in the Fetal Growth Longitudinal Study (FGLS) and Newborn Cross Sectional Study (NCSS). http://www.medscinet.net/Intergrowth/patientinfodocs/Pregnancy%20and%20Delivery%20Form%20Instructions.pdf

Basic Neonatal Care Manual

The INTERGROWTH-21^st Project used this manual to standardize definitions, treatment and management recommendations of neonatal morbidities.  http://www.medscinet.net/Intergrowth/patientinfodocs/Neonatal%20Manual%20Final.pdf

Anthropometry Handbook

This handbook describes the methods used to perform accurate, precise and standardized anthropometric measurements for all components of the INTERGROWTH-21^st study, including:

• height and weight of pregnant mothers
• birth weight, length and head circumference of newborns
• weight, length and head circumference of preterm babies

Measurement of Symphysis Fundus Height Protocol

This protocol outlines the technique for measuring symphysis fundus height. http://www.medscinet.net/Intergrowth/patientinfodocs/Measurement%20of%20Symphysis%20Fundus%20Height.pdf

Blood Pressure Measurement Protocol

This protocol outlines the technique for taking a pregnant woman's blood pressure. http://www.medscinet.net/Intergrowth/patientinfodocs/BP%20protocol.pdf

Ultrasound Operations Manual

The aims of this manual are to ensure all trained ultrasonographers are familiar with the standardized way measurements should be taken for the purposes of using the INTERGROWTH-21^st growth standards, including standardization of the way the equipment should be used, ultrasound findings are recorded, data is entered and transfered, and how to train, asesses and certify these standardized techniques.  http://www.medscinet.net/Intergrowth/patientinfodocs/US%20Manual%20FINAL.pdf

Correct Measurement of Fetal Crown Rump Length and Standardization of Ultrasonographers

The aim of this manual is to ensure all trained ultrasonographers are familiar with the standardized way crown-rump length measurements should be taken for the purposes of using the INTERGROWTH-21^st fetal growth standards. http://www.medscinet.net/Intergrowth/patientinfodocs/CRLstandardisation_Website.pdf

Sleep-Wake Cycle Assessment Manual

This manual details the technique for assessing sleep-wake cycles in children. http://www.medscinet.net/Intergrowth/patientinfodocs/Sleep-wake%20cycle%20assessment%20manual%20July%202014.pdf