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ANNALES
UNIVERSITATIS MARIAE CURIE-SKŁODOWSKA
LUBLIN - POLONIA

VOL.LX, SUPPL. XVI, 142 SECTIO D 2005

Katedra Anatomii Prawidłowej1

Department of Normal Anatomy AM Wrocław

Zakład Anatomii Stomatologicznej2

Department of Stomatological Anatomy AM Wrocław

BOHDAN GWORYS1, WIESŁAW KURLEJ2

Contribution to constructing centile charts for prenatal

and neonatal period of a human

Przyczynek do konstruowania siatek centylowych dla okresu

prenatalnego i neonatalnego człowieka

Monitoring fetus development and early detection of developmental disorders is a very important task of developmental age medicine. According to Cieślik [2], centile charts are the best graphic presentation of one-trait developmental standards. The centile charts enable to determine the progression level of development of an individual and their position in the population. The analysis of the position of a particular point in the centile chart of a given trait enables to interpret precisely which of the examined traits has the biggest effect on their ontogenesis. At the same time the analysis allows to place an individual in appropriate “developmental channel”. The childhood period is relatively well drawn up [3].

The purpose of the work is to present the centile charts for fetal and neonatal period of a human. The charts, prepared for routinely examined traits of fetuses in ultrasonography examinations and in direct measurements of infants, handed to the obstetricians and neonatologists enable proper diagnosis and monitoring of the child’s development.

MATERIALS AND METHODS


The material used in the research is fetuses from miscarriage obtained from 1964 to 2003, collected in the Department of Anatomy, Wroclaw Medical University - 2472 fetuses (1278 male and 1194 female) and 2800 infants were analysed (1500 male and 1300 female).

The age of the fetuses oscillated from 84th day to 256th day, and infants from 245th day to 336th day. There were taken measurements for each individual: 1. total Body Length (BL); 2. Body Mass (BM); 3. Head Circumference (HC); 4. Thorax Circumference (ThC) and 5. Rohrer Index - Body Mass / (B-v)3 x 100 (Body Mass in grams, Height in centimeters). The material was divided into 14-day age classes. In all age classes the numbers are representative. All the average values of the traits and their standard deviations were calculated to the value of the middle of age class [1]. In order to construct the centile charts by means of programmes Statistica and Statgraphics, there were marked values for each analysed feature in two week intervals 3, 10, 25, 50, 75, 90 and 95 centile.



RESULTS

Making the observation of for the joined material of male and female individuals is justified in the light of earlier works on fetuses [1] because of small dimorphic differences of the analysed traits (tab. 1-5). There are also works [4] which justify taking into account dimorphic differences in prenatal and neonatal researches. Dimorphic differences of the analysed features in case of our research were statistically unimportant and were of vague and indeterminate nature. In the context of the executed aim of the research the dimorphic differences did not influence the obtained results of the research.

Joining fetal material from miscarriage with the material of infants born alive is also justified [2] because of the adopted procedure of both fetal and neonatal material selection.

All the analysed traits are characterized by a huge range of variability in particular age intervals. In case of younger individuals the range of the changeability is bigger.



Representative character of the analyzed material is supported by the fact that the metric traits which we analyzed increase not only in particular age intervals in accordance with the centile value gradient but they also increase with age in particular centiles. In case of Roher index one can observe decrease of its value in the first half of the examined development. Due to the indeterminate and very vague nature of its changeability, Roher index may be the least useful form the analyzed traits while evaluating the advancement of fetus and infant development.

CONCLUSIONS


  1. During the fetal and neonatal period, body mass and body length, (Rohrer index) head circumference and thorax circumference are characterised by a very big changeability.

  2. There were not stated any statistically important dimorphic differences in the range of analyzed features. No developmental differences between miscarried fetuses and infants born alive were stated.

  3. The obtained outcome from the examination of metric features allows to use the obtained results while evaluating the advance level of fetus development and infants in the form of constructing centile charts.

Tab. 1. The value of centile charts of total body length (BL) for fetuses and infants


centyl/days

92

106

120

134

148

162

176

190

204

3%

74

111

140

165

213

220

250

284

302

10%

86

120

155

190

225

242

284

310

321

25%

91

129

168,5

205

235

260

290

319

331

50%

103

142

184

220

252

272

300

334,5

347

75%

116

152

200,5

232

265

286

310

348

362

90%

130

163

217

245

275

303

319

361

374

97%

150

178

247

270

282

315

331

370

387

centyl/days

218

232

246

260

274

288

302

316

330

3%

319

348

389

481

492

497

501

502

503

10%

326

361

416,5

491,5

501

510

511

512

513

25%

351

374

446

500

517

527

529

534

535

50%

381

390

476

516,5

532

537

544

547

548

75%

405

420

498

536

554

564

572

561

551

90%

425

471

524,5

554,5

568

583

585

586

586

97%

492

512

551

572

586

601

609

612

615

Tab. 2. The value of centile charts of body mass (BM) for fetuses and infants


centyl/days

92

106

120

134

148

162

176

190

204

3%

19

40

55

80

200

250

340

470

590

10%

22

44

80

139

240

320

461

585

672

25%

27

50

111

190

285

386

520

681

732

50%

36

64

144

245

350

450

573,5

786

835

75%

47

80

184

278

406

513

640

899

898

90%

70

105

230

330

462

590

701

1003

1097

97%

99

120

365

435

508

670

768

1091

1108

centyl/days

218

232

246

260

274

288

302

316

330

3%

750

1045

1427

2113

2600

2700

2820

2170

3120

10%

869

1134

1639

2411,5

2850

2995

3100

3005

3120

25%

945

1321

1999,5

2650

3100

3250

3350

3240

3150

50%

1078

1532

2267

2990

3350

3550

3650

3550

3250

75%

1211

1900

2432

3320

3640

3840

4000

3800

3350

90%

1327

2165

3090

3625

3850

4105

4350

3890

4590

97%

2530

2850

3520

3980

4200

4400

4650

4300

4590

Tab. 3. The value of centile charts of head circumference (HC) for fetuses and infants


centyl/days

92

106

120

134

148

162

176

190

204

3%

43

78

108

128

148

164

179

216

224

10%

47

89

115

137

156

175

197

221

234

25%

62

100

124

148

165

185

209

228

243

50%

75

109

134

155

177

195

214

239

248

75%

89

119

143

165

187

212

227

248

258

90%

100

126

154

174

198

224

243

256

269

97%

109

134

169

182

209

237

261

278

279

centyl/days

218

232

246

260

274

288

302

316

330

3%

254

267

291

300

300

301

302

310

321

10%

258

269

301

306

310

314

318

318

321

25%

267

279

310,5

317

320

321

325

327

330

50%

271

296

327,5

330

330

332

337

335

342

75%

279

313

341

342

343

344

347

346

354

90%

289

323

345

351

355

356

362

370

377

97%

318

338

351

361

364

367

376

392

397

Tab. 4. The value of centile charts of thorax circumference (ThC) for fetuses and infants


centyl/days

92

106

120

134

148

162

176

190

204

3%

43

76

100

125

141

162

178

213

224

10%

46

87

113

135

150

168

192

217

231

25%

60

98

119,5

143

162

177

204

224

237

50%

73

106

128,5

152

172

189

212

235

245,5

75%

85

116

139

162

184

206

224

245

254,5

90%

97

123

154

168

193

220

238

253

268

97%

104

131

164

176

206

234

256

278

279

centyl/days

218

232

246

260

274

288

302

316s

330

3%

247

261

289

289

298

300

304

307

324

10%

256

267

300

302

310

312

314

316

324

25%

261

278

316,5

318

319

321

324

324

324

50%

268

288

324,5

328

328

330

332

340

345

75%

276

312

333

334

340

341

345

346

346

90%

283

326

342

343,5

347

349,5

356

358

359

97%

314

334

345

352

356

362

378

384

387

Tab. 5. The value of centile charts of Rohrer index (RI) for fetuses and infants


centyl/days

92

106

120

134

148

162

176

190

204

3%

1,87

1,44

1,51

1,53

1,65

1,47

1,55

1,59

1,45

10%

2,07

1,76

1,70

1,73

1,82

1,78

1,78

1,80

1,63

25%

2,53

2,03

1,96

1,99

1,99

1,97

1,94

1,97

1,81

50%

3,19

2,36

2,27

2,23

2,16

2,22

2,11

2,13

1,98

75%

4,26

2,70

2,52

2,50

2,40

2,46

2,34

2,26

2,19

90%

5,43

3,25

2,97

2,70

2,62

2,70

2,56

2,39

2,32

97%

7,32

3,62

3,58

3,36

2,86

3,54

2,83

2,52

2,73

centyl/days

218

232

246

260

274

288

302

316

330

3%

1,31

1,69

1,55

1,66

1,71

1,71

1,75

1,68

1,94

10%

145

1,98

1,75

1,84

1,87

1,89

1,86

1,75

1,99

25%

1,69

2,26

1,93

1,96

2,02

2,00

1,98

1,98

2,29

50%

1,84

2,72

2,41

2,12

2,21

2,17

2,12

2,18

2,31

75%

1,98

3,33

2,45

2,28

2,38

2,36

2,31

2,45

2,41

90%

2,13

3,76

2,66

2,41

2,53

2,53

2,51

2,50

2,48

97%

2,33

4,18

3,05

2,67

2,76

2,74

2,72

2,66

2,48

REFERENCES


  1. Bożilow W., Sawicki K.: metody badań zmienności cech anatomicznych człowieka podczas rozwoju prenatalnego i okołoporodowego. Wydawnictwo AM we Wrocławiu. Wrocław 1980.

  2. Cieślik K: Próba konstrukcji standardów rozwoju morfologicznego płodów i noworodków. Przegl. Antrop. 1983, 49(1-2), 41-55.

  3. Rożnowski J., “i wsp.”: Siatki centylowe dzieci wiejskich z Pomorza w wieku 7 – 15 lat. Porównanie z odpowiednimi siatkami dla dzieci wiejskich z Kujaw i Pomorza oraz IMiDZ. w: „Auksologia a promocja zdrowia” [red.] A. Jopkiewicz. Kielce 2003, 3, 227-234.

  4. Waszak M., Cieślik K.: Sex dimorphism in development dynamics and in development progression of morphological features in human foetuses. Fol. Morph. 2002, 62(1), 33-39.

SUMMARY


Centile charts are the best graphic presentation of evaluating the level of development of an individual and they are determinants of an individual’s position in the population. The aim of this study is an attempt to evaluate developmental changes in fetuses and infants in 14-day age intervals in the context of constructing centile charts. The research was conducted on the archival material of 2472 fetuses and on 2800 infants at the age of - from 84 to 336 days. For each individual the following measurements were taken: total body length and mass, head and thorax circumference and Rohrer index. The study showed that during the prenatal and neonatal period the analysed measure features are characterised by a very big changeability. There were not stated any statistically important dimorphic differences in the range of analysed features. There were not stated any developmental differences between miscarried fetuses and infants born alive. Therefore, it was possible to join the material of fetuses and infants regardless of their sex. The obtained outcome from the examination of metric features allows to using the obtained results while evaluating the advance level of fetus development and infants in the form of constructing centile charts.

STRESZCZENIE


Siatki centylowe są najlepszym graficznym obrazem określenia stopnia zaawansowania w rozwoju osobnika oraz wyznacznikiem jego miejsca w populacji. Celem pracy jest próba oceny zmian rozwojowych płodów i noworodków w 14 dniowych interwałach wiekowych w kontekście skonstruowania siatek centylowych. Badania przeprowadzono na materiale archiwalnym 2472 płodów oraz na 2800 noworodków wrocławskich w wieku od 84 do 336 dnia. Dla każdego osobnika wykonane zostały następujące pomiary: całkowita długość i masa ciała, obwód głowy i klatki piersiowej oraz wskaźnik Rohrera. Stwierdzono, że w okresie płodowym i noworodkowym analizowane cechy pomiarowe odznaczają się bardzo dużą zmiennością. Nie zaobserwowano istotnych statystycznie różnic dymorficznych w zakresie analizowanych cech. Nie stwierdzono różnic rozwojowych między poronionymi płodami, a żywo urodzonymi noworodkami. Uzyskane rezultaty badań cech metrycznych upoważniają do wykorzystania uzyskanych wyników przy ocenie zaawansowania rozwoju płodów i noworodków w formie skonstruowania siatek centylowych.






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