Arch Dis Child: first published as 10.1136/adc.63.10_Spec_No.1170 on 1 October 1988. Downloaded from http://adc.bmj.com/ on 28 July 2019 by guest.

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1170 Archives of Disease ini Childhood, 1988, 63
haemorrhage due to any cause is extremely rare. It References
may occur after maternal trauma, although it is rare Machin SJ, Winter MR, Davies SC, Mackie IJ. Factor X
in the absence of skull fractures or other severe fetal deficiency in the neonatal period. Arch Dis Child 1980;55:
or maternal injuries.' 406-8.
This patient's clotting disorder rendered her more 2 Whitelaw A, Haines ME, Bolsover W, Harris E. Factor V
liable to haemorrhage after minor trauma. Her deficiency and antenatal intraiventricular haemorrhage. Arch
Dis Child 1984;59:997-9.
mother's fall down stairs at 33 weeks' gestation was 3 Eastman JR, Triplett DA, Nowakowski AR. Inherited factor X
a likely cause of her subdural haemorrhage. Because deficiency: prescntation of a case with etiologic and treatment
the haemorrhage had been detected antenatally it considerations. Oral Slurg 1983;56:461-6.
4 Bachman F, Duckert F, Fliickiger P, Hitzig W, Koller F. Uber
was possible to deliver the infant by caesarean cinen neuartigen kongenitalen Gerinnungsdefekt (Mangel an
section, thus minimising the risk of further trauma. Stuart-Faktor). Thrombosis et Diathesis Haernorrhagica
This also permitted a diagnosis to be arrived at and (Stuttgart) 1957;:1:87-92.
treatment to be instituted within hours of birth. This Knight RD, Barr CF. Alving BM. Replacement therapy for
case emphasises the importance of recognising congenital factor X deficiency. Transfusion 1985;25:78-80.
" Gunn TR, Bccroft DM. Unexplained intracranial haemorrhage
intracranial haemorrhage on obstetric ultrasound, in utero: the hattered fetus'? Aust NZ J Obstet Gvtsaecol
and the need to identify potentially treatable coagu- 1984;24: 17-22.
lation disorders in such patients. In some disorders,
such as this one, it should be possible to arrive at a
diagnosis even before delivery, thus optimising Correspondence to Dr C de Sousa, Queen Mary's Hospital for
Children, Carshalton, Surrcy SM5 4NR.
management in the postnatal period.
We thank Professor MG Elder and Dr M Silverman for permission
to report thesc patients who wcrc under their carc. Accepted 13 April 1988

Weight, length, and head circumference curves for boys and girls of

copyright.
between 20 and 42 weeks' gestation
D V KEEN AND R G PEARSE
Jessop Hospital for Women, Sheffield

data to include length and head circumference and

SUMMARY The value of available growth curves for produced a comprehensive chart suitable for use in
preterm infants is limited because they exclude neonatal units.
infants of less than 28 weeks' gestation. We describe
growth curves for weight, length, and head cir- Sample and methods
cumference for boys and girls of between 20 and 42
weeks' gestation. The sample was derived from three subgroups from
the Sheffield area: live born infants, fetuses from
therapeutic abortions, and fetuses from spontaneous
We have previously reported an analysis of fetal and abortions; only morphologically normal singletons
infant birth weights derived from data from Shef- were included. The following were excluded: hydro-
field from 1976 to 1984, and compiled a weight chart pic infants, infants of diabetic mothers, and macer-
for those between 20 and 42 weeks' gestation.' At ated fetuses. The previously published data were
certain gestational ages there were significant differ- expanded to include fetuses and infants born in 1984
ences between our data and the weight curves in and 1985 at between 20 and 28 weeks' gestation in
current use, and subsequently the Gairdner-Pearson four local maternity units. This increased the total
chart was revised using this and other data.2 number of fetuses and infants below 28 weeks'
Despite the considerable developments in neona- gestation from 192 to 281 and enabled us to provide
tology resulting in the treatment of increasing separate curves for boys and girls.
numbers of infants born at less than 28 weeks' The data were taken retrospectively from the
gestation, the practical value of most of the available babies' records. All babies were weighed and
growth charts is limited by the exclusion of this measured while still on the labour ward or directly
group of infants. We have therefore expanded our after admission to the special care baby unit. Dead
 Arch Dis Child: first published as 10.1136/adc.63.10_Spec_No.1170 on 1 October 1988. Downloaded from http://adc.bmj.com/ on 28 July 2019 by guest. Protected by
Weight, length, and head circumference curves for boys and girls of between 20 and 42 weeks' gestation 1171
fetuses were measured at necropsy, which usually Discussion
took place within 48 hours of delivery. The curves
for dead fetuses did not deviate from those of live We recognise that the use of cross sectional data in
born infants, so the figures for the two groups were the derivation of postnatal growth norms for pre-
amalgamated for analysis. Gestational age was term infants has inherent weaknesses. This is
calculated by comparing estimations of time from particularly apparent for head circumference, and
last menstrual period, by study of early antenatal caution should be exercised when any such chart is
ultrasound scans, and by the Dubowitz score, or used to assess growth longitudinally.4 Almost all the
pathological examination. Where there was any data from which published charts are compiled have
ambiguity, the anthropometric data were excluded. excluded some infants. We excluded hydropic in-
Means and standard deviations were calculated fants, infants of diabetic mothers, and macerated
for weight, length, and head circumference at each fetuses. We thought it appropriate, however, to
completed week of gestation. Calculations were include morphologically normal babies who were
made for the whole group, and for boys and girls thought to have retardation of growth before
separately. delivery; their exclusion would have biased the
results. Previous studies, for example Gruenwald,s
Results have excluded babies whose measurements were at
the extremes of the range, usually because of the
The means for the whole group are in close accord lack of certainty about gestational age. We were
with those reported by Kitchen et al for between 24 more certain of the gestational ages of the babies in
and 42 weeks' gestation.3 Although size differences our studies and so have not excluded extreme
between boys and girls were apparent by the third measurements; nor have we excluded babies from
trimester they could not be distinguished graphically ethnic minorities. These made up less than 5% of
until about 32 weeks' gestation. the total sample and so their data are unlikely to
The raw data are shown in the table and the cause bias. We believe that these charts may be of
smoothed curves constructed from those data in figs practical use in neonatal units, especially those

copyright.
1 and 2. dealing with extremely premature infants.

Table Means (SD) weight, length, and head circumference by week of gestation
Gestation No Weight (g) Lenigth (cm) Head circumference
(weeks) (cm)
20 49 340(54) 26-4(2-2) 18-6(0-5)
21 28 455(90) 27-0(0-8) 21*0(0-8)
22 20 508(97) 29-6(0-6) 27-0(1-1)
23 21 575(63) 31*3(2-4) 21*3(1*3)
24 24 676(115) 31-3(2-1) 22-0(1-5)
25 37 752(117) 33-3(2- 1) 23-4(1-1)
26 51 909(155) 33-8(2-7) 24-2(1-4)
27 51 1083(130) 37-6(2-3) 25.8(1 1)
28 85 1126(227) 37-2(3-2) 26-3(1.4)
29 52 1285(203) 38-4(2-6) 26-7(1*2)
30 89 1433(404) 41-4(3-3) 28-4(3-1)
31 60) 1547(241) 40-2(4-4) 28-8(1*0)
*
Boys Girls Boys Girls Boys Girls
32 101 1894(423) 1523(320) 44-6(4.5) 41*3(4.3) 30-5(2-3) 29-6(4-3)
33 114 2020(376) 1696(365) 44.7(3-0) 42.4(4-0) 30-7(1-3) 29-6(2-4)
34 156 2177(431) 1960(329) 46-8(4-3) 45-8(2.9) 32-1(1-8) 31-1(1.2)
35 60 2588(347) 2592(452) 47.1(4-4) 49-3(1.6) 33-4(1*2) 32-8(1*3)
36 60 2640(298) 2693(467) 48-2(2-2) 47.5(3-8) 33-2(1-2) 33-1(1-4)
37 61) 3047(431) 2945(365) 50-4(2-4) 50.2(3-0) 34-3(0-9) 33-9(1*2)
38 120 3350(422) 3130(394) 52.2(2-3) 51 1(3-1) 35-0(1*2) 34-0(1*5)
39 120 3527(502) 3379(497) 51.9(3-2) 51*8(2-9) 35-2(1*4) 34-4(1*2)
40 120 3726(341) 3438(334) 53.7(2.3) 52-7(1*8) 35-6(0-9) 34-7(1*2)
41 60 3584(409) 3467(537) 53.2(2-8) 53-0(2-7) 35-9(1-2) 34-8(1.4)
42 60 3788(429) 3599(483) 54.5(3-6) 53.2(2-5) 35-5(1*2) 35.2(1*2)
*We could not distinguish accurately between boys and girls until 32 weeks' gestation.
 Arch Dis Child: first published as 10.1136/adc.63.10_Spec_No.1170 on 1 October 1988. Downloaded from http://adc.bmj.com/ on 28 July 2019 by guest. Protected by
1172 Archives of Disease in Childhood, 1988, 63
BOYS~

cm cm
50-
50

45 --
Ler_gt -Length
35 - 3 0-_ w . 35-

30 o _ - kgL.-
30- 4.5

25- 4.0 25- 4.0 -:-

20- 3.5 20 3.5

15 3.0
Head
2. circumference_7 _-6 - 2.5 circumferene 7
2.0 Or-
11 1

*.a 1.0
Weight
0.5_

20e 21 22 23 24R25262 292003 3334i36

32 36t3736n 40 41 42 20 21 22 23 24252627 282633132 33 34 35 3637 3 39640 41 4
and Wed
_DrRP Pece for5 comuc __ _ng __
proccss
Fig 1 Growth parameters: boys (means±J and 2 SDs). Fig 2 Growth parameters: girls (means±+ and2 SDs).

We thank Mrs P Kenyon for her assistance in collecting the data, uterine growth curvcs for an Australian hospital population.

copyright.
and Dr RP Petchey for computer processing. Aust Paediatr J 1983;19:157-61.
4 Baum JD, Scarls D. Hcad shapc and size of pretcrm low-
birthweight infants. Dev Med Child Neurol 1971;13:576-81.
5 Gruenwald P. Growth of the human fetus. Am J Obstet Gynecol
References 1966;94:1 112-9.
'Keen DV, Pearse RG. Birthweight hetween 20 and 42 weeks'
gestation. Arch Dis Child 1985;60:44(-6. Correspondence to Dr D V Keen, Department of Paediatrics,
2
Gairdner D, Pearson J. Revised Gairdner-Pcarson growth Northern General Hospital, Sheffield S5 7AU.
charts. Arch Dis Child 1985;60:1202.
3 Kitchen WH, Robinson HP, Dickenson AJ. Revised intra- Accepted 3 February 1988

Pansystolic murmur in the newborn: tricuspid regurgitation versus

ventricular septal defect
J R KELLEY AND W G GUNTHEROTH
Division of Pediatric Cardiology, Department of Pediatrics, University of Washington School of Medicine,
Seattle, USA

When we began peforming Doppler echocardio-

SUMMARY Neonates with a pansystolic murmur graphy in neonates with murmurs that suggested a
who had Doppler echocardiography were reviewed. ventricular septal defect, we found that many of
Ten infants had tricuspid regurgitation (detected at them had neither an image of a ventricular septal
a mean age of 25 hours), 12 had a ventricular septal defect nor flow disturbance; instead, we found
defect (detected at 65 hours), and seven had both. turbulent systolic flow of tricuspid regurgitation.
Tricuspid regurgitation is the more likely cause of a Further, we had the impression that the infants with
pansystolic murmur at the lower left sternal border tricuspid regurgitation had the onset of murmurs
in the first day of life. during the first day of life. We decided to investigate
this in all newborn infants in our hospital who were