Implementation of the INTERGROWTH-21st standards
Maternal Training Toolkit
The training tools currently available to maternal health professionals to apply the Gestational Weight Gain in Pregnancy Standards and Symphysis-Fundal Height Standards are:
Fetal Ultrasound
The training tools currently available to ultrasonographers to apply the INTERGROWTH-21st Pregnancy Dating Standards and Fetal Growth Standards are:
- Ultrasound Operations Manual: The aim of this manual is to ensure trained ultrasonographers are familiar with the standardized way measurements should be taken for the purposes of using the INTERGROWTH-21st fetal growth standards, including standardization of the way the equipment should be used, ultrasound findings are recorded, data is entered and transferred, and how to train, assess and certify these standardized techniques.
- Correct Measurement of Fetal Crown Rump Length and Standardization of Ultrasonographers: The aim of this manual is to ensure all trained ultrasonographers are familiar with the standardized way crown-rump length measurements should be taken for the purposes of using the INTERGROWTH-21st fetal growth standards.
Newborn Care
The training tools currently available to newborn health professionals to apply the INTERGROWTH-21st Newborn Size at Birth Standards are:
- The Basic Neonatal Care manual: This manual can be used to train healthcare professionals on standardized definitions, treatment and management recommendations of neonatal morbidities.
- The Anthropompetry Handbook: This handbook describes the methods used to perform accurate, precise and standardized anthropometric measurements for all components of the INTERGROWTH-21st study, including:
1. Height and weight of pregnant mothers
2. Birth weight, length and head circumference of newborns
3. Weight, length and head circumference of preterm babies
Neurodevelopment Assessment
The training tools currently available to health professionals to apply the INTERGROWTH-21st Neurodevelopment Assessment Package are:
- Visual assessment: This manual details the technique for administering the Cardiff Acuity Tests and Cardiff Contrast tests for vision assessment in children.
- Neuropsychological assessment (the INTER-NDA): assessment of cognition, language skills, motor skills, behavior, attention and social-emotional reactivity at age 2 years old.
- Measurement of cortical auditory evoked response potential
- Measurement of sleep-wake cycle and daytime physical activity: This manual details the technique for assessing sleep-wake cycles in children.
gigs Package
Produced as part of the Guidance for International Growth Standards project at the London School of Hygiene & Tropical Medicine, gigs provides a single, simple interface for working with the WHO Child Growth standards and outputs from the INTERGROWTH-21st project. You will find functions for converting from anthropometric measures (e.g. weight or length) to z-scores and centiles, and the inverse. Also included are functions for classifying newborn and infant growth according to literature-based cut-offs.
gigs is of use to anyone interested in fetal and child growth, including child health researchers, policymakers, and clinicians. This package is best suited to growth data where the gestational age (GA) of each child is known, as the use of the growth standards included in gigs is GA-dependent. We recommend you check out the available standards section to see if your anthropometric measurements can be converted to z-scores/centiles by gigs. We recommend using gigs to generate continuous or categorical measures of fetal/newborn/child growth, which can then be used in downstream analyses.
The map below highlights the countries and hospitals that are using the INTERGROWTH-21st tools as part of their routine clinical care.
If you are using the tools but not listed here, please email us at intergrowth@wrh.ox.ac.uk