1. At which specific date (day, month and year) did the Trust switch to Intergrowth charts? January 2023
2. When adopting Intergrowth, did the Trust consider alterations of thresholds (i.e.- trigger centiles usually at 3%
and 10%) for monitoring or delivery recommendations based on consideration of local population variation and local perinatal mortality and morbidity?
Standardised, nationally agreed thresholds were used for definitions of SGA/FGR (<10th for SGA, <3rd for FGR). This is in line with the current regional guidance for diagnosis and management of fetal growth restriction.
3. Why did the Trust adopt Intergrowth fetal growth charts? Please share the decision-making and ratification
process for the Trust changing to Intergrowth charts including all documentation related to this change, i.e- ratification and guideline group meeting notes, papers considering the evidence, internal emails, etc.
The Trust previously used GAP/GROW from the Perinatal Institute. The system/servers used by the Perinatal Institute integrated poorly with the Trust Badgernet system. This meant that often scans and SFH measurements could not be plotted until after a patient's appointment and presented a significant clinical risk. Intergrowth is incorporated into
the Badgernet system which eliminated this risk. An options paper was collated by a fetal medicine consultant and presented at local Specialty Board where it was agreed to adopt Intergrowth (rather than WHO or GAP/GROW).
4. Please share the following data for the last four years, broken down into quarters:
a. Percentage of babies born <3rd birthweight centile at any gestation.
b. Percentage of babies born <10th birthweight centile at any gestation.
c. Percentage of babies born <3rd birthweight centile >37+6 weeks’ gestation.
d. Percentage of babies born >39+6 and <10th birthweight centile.
Please see attachment
e. Percentage of pregnancies where an SGA fetus (<10th centile) is antenatally detected.
Unfortunately the BadgerNet system does not provide a robust mechanism to determine the percentage of patients were found to have an SGA baby antenatally (it relies on human input of data outside routine clinical care, and is therefore not reliable). This would require a manual review of all cases and is not possible to undertake this in a reasonable timeframe.
f. Percentage of perinatal mortality cases annually where the identification and management of FGR was a relevant issue (using the PMRT).
0% - a deep dive was performed in December 2023 examining if the change to Intergrowth had any impact
on the care (actual or theoretical) in any mother who suffered stillbirth or neonatal death. The change to Intergrowth was not implicated in any perinatal loss. The review of impact of Intergrowth on detection of SGA was presented as a poster at an international conference.
5.Please share which birthweight charts were used to identify the centiles of newborns for the data requested in questions 4a-d. Please share the journal references for these charts, and indicate for which time periods (date, month, year started and ended as applicable) each chart was used within the data period requested.
Intergrowth charts were used from January 2023, prior to this Perinatal Institute charts were used.
