10th August 2018 • comment

World Prematurity Day 17th November 2017 We would like to highlight WHO World Prematurity Day. Premature birth is a very serious health problem. Worldwide, 15 million babies are born preterm and more than a million die as a result. Babies who survive often have lifelong health problems such as cerebral palsy, vision and hearing loss, and intellectual disabilities.

16th November 2017 • comment

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.

19th February 2016 • comment

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

19th February 2016 • comment

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

11th December 2015 • comment

INTERGROWTH-21st in Sri Lanka

by iNTERGROWTH-21st

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

10th December 2015 • comment
1st December 2015 • comment

INTERGROWTH-21st in China

by INTERGROWTH-21st
30th November 2015 • comment

Chinese translations of the INTERGROWTH-21st Fetal and Newborn Lancet articles are now available for download.二十一世纪国际胎儿、新生儿生长发育项目(INTERGROWTH-21st) 柳叶刀文章的中文翻译本现在可供下载。

24th November 2015 • comment

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

14th October 2015 • comment

The EMPOWER Program (EMpowering Progress in Obstetric and Women's hEalth Research)  is now accepting research proposals related to preeclampsia and other hypertensive disorders of pregnancy from young investigators in low resource settings. Letters of Intent are due November 15, 2015. Thereafter, projects deemed feasible will be invited to submit full applications by April 15, 2016. The grant recipient will be announced in October 2016 at the World Congress of the International Society for the Study of Hypertension in Pregnancy (ISSHP).

30th September 2015 • comment

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.

18th August 2015 • comment

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.

11th June 2015 • comment

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.  

30th March 2015 • comment

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

23rd March 2015 • comment

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

23rd March 2015 • comment

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

23rd March 2015 • comment

This WHO policy brief is part of a series on six global nutrition targets for 2025. This brief covers the third target: a 30% reduction in low birth weight. The purpose of the brief is to increase attention to, investment in, and action for a set of cost effective interventions and policies that can help WHO Member States and their partners in reducing rates of low birth weight. INTERGROWTH-21st Chief Investigators Stephen Kennedy and Jose Villar provided expert review of these strategies, contributing the unique perspective that data from the Project, and the resulting growth standards and tools as part of overall strategies for reducing rates of low birth weight in settings across the globe. The  full policy brief series can be found here: http://www.who.int/nutrition/publications/globaltargets2025_policybrief_overview/en/

23rd January 2015 • comment

The INTERGROWTH-21st Neurodevelopment Package is a multi-dimensional instrument measuring early childhood development (ECD). Its developmental approach may be useful to those involved in large-scale ECD research and surveillance efforts. This paper describes neurodevelopment tools for preschoolers and the systematic approach leading to the development of the Package. The Package measures vision; cortical auditory processing; and cognition, language skills, behavior, motor skills, and attention in 35-45 minutes. Sleep-wake patterns are also assessed. Tablet-based applications with integrated quality checks and automated, wireless electroencephalography make the Package easy to administer in the field by non-specialist staff. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0113360

1st December 2014 • comment

The INTERGROWTH-21st Project has produced the first, international standards for relating fetal crown-rump length to gestational age. 

25th September 2014 • comment

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.

5th September 2014 • comment

INTERGROWTH-21st Study Forms

by INTERGROWTH-21st

All of the forms that the INTERGROWTH-21st Project used to implement their studies can be downloaded here.

23rd June 2014 • comment

Several biomarkers for predicting intrauterine growth restriction (IUGR) have been proposed in recent years. However, the predictive performance of these biomarkers has not been systematically evaluated. This objective of this paper is to determine the predictive accuracy of novel biomarkers for IUGR in women with singleton gestations. http://www.ncbi.nlm.nih.gov/pubmed/23398929

15th May 2014 • comment

This paper assess the intra- and interobserver variability of fetal biometry measurements throughout pregnancy. Authors concluded that although intra- and interobserver variability increases with advancing gestation when expressed in milimeters, both are constant as a percentage of the fetal dimensions or when reported as a Z-score. Thus, measurement variability should be considered when interpreting fetal growth rates.  http://www.ncbi.nlm.nih.gov/pubmed/22535628

15th May 2014 • comment

A comprehensive classification system for preterm birth requires expanded gestational boundaries that recognize the early origins of preterm parturition and emphasize fetal maturity over fetal age. This paper explores the issues to consider in creating a classification system for preterm birth syndrome. http://www.ncbi.nlm.nih.gov/pubmed/22177186

15th May 2014 • comment

The University of Oxford's Emerging Markets Symposium convened a gathering of health and nutrition experts, leading economists, and policymakers to discuss actionable priorities for improving maternal and child health and nutrition in emerging market countries. Universal adoption of the INTERGROWTH-21st Project's new global indicators at birth to capture differences in population-level nutritional and environmental exposures during pregnancy was one of their recommendations. http://ems.gtc.ox.ac.uk/sites/ems.gtc.ox.ac.uk/files/findings_and_recommendations_ems2014.pdf

15th May 2014 • comment

Source: The Nuffield Department of Obstetrics and Gynaecology at the University of Oxford and the Geneva Foundation for Medical Education and Research Language: English, Spanish, Russian Overview: This course provides key information on postpartum hemorrhage for health care professionals. It covers basic clinical issues, as well as background information, such as the global burden of postpartum hemorrhage.The course is accompanied by key articles and documents for further reading. Certification is available to those who qualify.

15th May 2014 • comment

Source: The Nuffield Department of Obstetrics and Gynaecology at the University of Oxford and the Geneva Foundation for Medical Education and Research Language: English, Spanish Overview: Course content includes both a basic module covering critical recommendations on prevention and treatment of pre-eclampsia/eclampsia (PE/E) for those unfamiliar with PE/E, and an advanced version for users interested in learning the evidence behind the recommendations, and is accompanied by key articles and documents for further reading. Certification is available to those who qualify.

15th May 2014 • comment

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

15th May 2014 • comment

Impaired fetal growth and preterm birth are the leading causes of neonatal and infant mortality worldwide and there is a growing scientific literature suggesting that environmental exposures during pregnancy may play a causal role in these outcomes. This paper describes the creation of a global tool for screening pregnant women for environmental exposures in the Fetal Growth Longitudinal Study, a component of the INTERGROWTH-21st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12430/abstract

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

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

15th May 2014 • comment

The INTERGROWTH-21st 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

15th May 2014 • comment

This paper considers the statistical aspects of the three components of the INTERGROWTH-21st 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-21st standards, in particular, the sample size. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12031/abstract

15th May 2014 • comment

The INTERGROWTH-21st Project data management was structured incorporating both a centralise and decentralised system for the eight study centres, which all used the same database and standardised data collection instruments, manual and processes. This paper describes the data collection, entry and management processes that ensure that the data collected in the INTERGROWTH-21st Project were of exceptionally high quality. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12080/abstract

15th May 2014 • comment

Given the multicentre nature of the INTERGROWTH-21st 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-21st 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-21st participating centres. Thoughts about implementation strategies are presented. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12312/abstract

15th May 2014 • comment

The INTERGROWTH-21st 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

15th May 2014 • comment

The INTERGROWTH-21st 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 selection of anthropometric personnel, equipment, measurement and calibration protocols used to construct the new INTERGROWTH-21st standards. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12125/abstract

15th May 2014 • comment

Correct estimation of gestational age is essential for any study of ultrasound biometry and for everyday clinical practice. However, inconsistency in pregnancy dating may occur through differences in measurement methods or errors during measurement. This paper describes the standardised crown-rump length (CRL) measurement methodology and interpretation used across study sites in the INTERGROWTH-21st Project. These methods should minimise potential systematic errors in dating associated with pooling data drom different health institutions, and represent a model for standardising CRL measurement in future studies. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12056/abstract

15th May 2014 • comment

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-21st 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.

15th May 2014 • comment

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-21st 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

15th May 2014 • comment

This paper outlines the objectives, design and implementation of the INTERGROWTH-21st 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

15th May 2014 • comment

Healthy growth in utero and after birth is fundamental for lifelong health and wellbeing. Current fetal growth charts in use are not true standards, since they are based on cross-sectional measurements of attained size under conditions that do not accurately reflect normal growth. The development of prescriptive intrauterine and newborn growth standards derived from the INTERGROWTH-21st Project provides the data that will allow us for the first time to establish what 'normal' fetal growth is. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12057/abstract

15th May 2014 • comment

Zulfiqar Bhutta, Chair of the INTERGROWTH-21st Steering Committee, introduces the rationale for the INTERGROWTH-21st Project. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12032/abstract

15th May 2014 • comment

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

15th May 2014 • comment

Preterm birth is a syndrome with many causes and phenotypes. We propose a classification system that is based on clinical phenotypes that are defined by >1 characteristics of the mother, the fetus, the placenta, the signs of parturition, and the pathway to delivery. Risk factors and mode of delivery are not included. There are 5 components in a preterm birth phenotype:

  1. Maternal conditions that are present before presentation for delivery,
  2. Fetal conditions that are present before presentation for delivery,
  3. Placental pathologic conditions,
  4. Signs of the initiation of parturition, and,
  5. The pathway to delivery
This system does not force any preterm birth into a predefined phenotype and allows all relevant conditions to become part of the phenotype. Needed data can be collected from the medical records to classify every preterm birth. The classification system will improve understanding of the cause and improve surveillance across populations. http://www.ncbi.nlm.nih.gov/pubmed/22177191

15th May 2014 • comment

In 2009, the Global Alliance to Prevent Prematurity and Stillbirth Conference charged the authors to propose a new comprehensive, consistent, and uniform classification system for preterm birth. This first article reviews issues related to measurement of gestational age, clinical vs etiologic phenotypes, inclusion vs exclusion of multifetal and stillborn infants, and separation vs combination of pathways to preterm birth. http://www.ncbi.nlm.nih.gov/pubmed/22118964

15th May 2014 • comment

Being able to predict preterm birth is important, as it may allow a high-risk population to be selected for future interventional studies and help in understanding the pathways that lead to preterm birth. This paper investigates the accuracy of novel biomarkers to predict spontaneous preterm birth in women with singleton pregnancies and no symptoms of preterm labour. http://www.ncbi.nlm.nih.gov/pubmed/21401853  

15th May 2014 • comment

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

15th May 2014 • comment

The objective of this paper was to assess whether a standardization exercise prior to commencing a fetal growth study involving multiple sonographers can reduce interobserver variation. http://www.ncbi.nlm.nih.gov/pubmed/22411446

14th May 2014 • comment

INTERGROWTH-21st Study Protocol

by INTERGROWTH-21st

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

25th April 2014 • comment

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

25th April 2014 • comment

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

25th April 2014 • comment

Basic Neonatal Care Manual

by INTERGROWTH-21st

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

25th April 2014 • comment

Anthropometry Handbook

by INTERGROWTH-21st

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

  • height and weight of pregnant mothers
  • birth weight, length and head circumference of newborns
  • weight, length and head circumference of preterm babies
http://www.medscinet.net/Intergrowth/patientinfodocs/Anthropometry%20Handbook%20April%202012.pdf

25th April 2014 • comment

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

25th April 2014 • comment

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

25th April 2014 • comment

Ultrasound Operations Manual

by INTERGROWTH-21st

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-21st 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

25th April 2014 • comment

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-21st fetal growth standards. http://www.medscinet.net/Intergrowth/patientinfodocs/CRLstandardisation_Website.pdf

25th April 2014 • comment

Vision Assessment Manual

by INTERGROWTH-21st

This manual details the technique for administering the Cardiff Acuity Tests and Cardiff Contrast tests for vision assessment in children. http://www.medscinet.net/Intergrowth/patientinfodocs/Vision%20manual%20-%20July%202014.pdf

25th April 2014 • comment

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

25th April 2014 • comment