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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

Managing data for the international, multicentre INTERGROWTH-21st Project

The INTERGROWTH-21^st 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-21^st Project were of exceptionally high quality. http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.12080/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

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

Conceptual basis for prescriptive growth standards from conception to early childhood: present and future

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-21^st 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

Introduction to INTERGROWTH-21st Methodology

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

The preterm birth syndrome: a prototype phenotypic classification

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

Challenges in defining and classifying the preterm birth syndrome

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

Novel biomarkers for the prediction of the spontaneous preterm birth phenotype: a systematic review and meta-analysis

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  

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

Standardization of fetal ultrasound biometry measurements: improving the quality and consistency of measurements

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

A Practical Guide to Planning an Academic or Research Career

Helpful, interactive eBook that aids those deciding how to further their career in research, or considernig whether to study as a post graduate.

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