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ELECTRONIC ARTICLE:
Pam Thomas, Joyce Peabody, Virginia Turnier, and Reese H. Clark
A New Look at Intrauterine Growth and the Impact of Race, Altitude, and Gender
Pediatrics 2000; 106: e21 [Abstract] [Full text] [PDF]
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eLetters published:

[Read eLetters] Variation in best obstetrical estimate vs neonatal estimate of gestational age
Salil K Gupta   (12 August 2000)
[Read eLetters] Response -- Variation in OB vs neonatal EGA
Reese H Clark   (14 August 2000)

Variation in best obstetrical estimate vs neonatal estimate of gestational age 12 August 2000
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Salil K Gupta,
Physician
community based NICU neonatologist

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Re: Variation in best obstetrical estimate vs neonatal estimate of gestational age

salilg56{at}hotmail.com Salil K Gupta

This is a well needed reference data and I hope we can get the "new" intrauterine growth curves for clinical use. The gestational age used in these curves need some clarification as to how variable this gestational age was from the best obstetrical estimation BEFORE delivery. Unless a nationally accepted normal is used to accurately classify the gestational age of newborns, the present and all of the past databases wouldn't be accurately useful for clinical practise.

Response -- Variation in OB vs neonatal EGA 14 August 2000
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Reese H Clark,
Neonatologist
Pediatrix Medical Group

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Re: Response -- Variation in OB vs neonatal EGA

reese_clark{at}Pediatrix.com Reese H Clark

We appreciate the comments of Dr. Gupta. Dr. Gupta is correct and makes an important point that applies to all currently used growth curves and our data. Estimating gestational age is not a precise or nationally standardized science. In our study, we used the Vermont Oxford approach. Both obstetrical measures and neonatal physical examination were used to derive the "best" estimate of gestational age (EGA).

In addition to "best" EGA, we have collected data on obstetrical estimated date of confinement (EDC). In a recent review of our database, we found that the absolute difference between EGA calculated using EDC and "best" EGA was less than 2weeks in 89% of our patients.

We suspect that the error in estimating gestational age was larger in the 60s and 70s when the growth curves commonly used in neonatal units today were developed. Our primary message in this paper is that the old curves are inaccurate. We appreciate and agree with Dr Gupta’s comments, however, we do believe the curves we have presented are a more accurate estimate of intrauterine growth than those previously published.

Submitted with respect Reese Clark, MD