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Oxford University Hospitals NHS Trust will this week become the first in the world to assess newborn babies using international standards which were developed by the University of Oxford with the aim of ensuring that every newborn baby across the world is evaluated in the same way.

Oxford University Hospitals NHS Trust will assess the size of all babies at birth using the INTERGROWTH-21st standards. © Shutterstock
Oxford University Hospitals NHS Trust will assess the size of all babies at birth using the INTERGROWTH-21st standards.

At present, there are more than 100 different charts in use around the world to assess a baby’s size at birth, i.e. to determine whether a baby is too large or small at birth, both of which are associated with health issues in later life.  As so many charts are in use, doctors and midwives often reach different conclusions about a baby’s size at birth depending on where the baby was born and which chart was used.

In addition, in some countries, the baby’s ethnicity is taken into account in assessing its size at birth on the grounds that some people believe that certain ethnic groups have smaller babies because of their ethnicity.

 However, research led by the University of Oxford has shown that babies grow in a similar way in the womb and achieve a similar size at birth, irrespective of the mother’s ethnic background, provided that she is healthy, educated, well-nourished and receiving good healthcare. 

 These findings, published in the Lancet at the end of last year, were based on the INTERGROWTH-21st Project, which involved nearly 60,000 mothers and babies in eight urban areas in Brazil, China, India, Italy, Kenya, Oman, the UK and USA.

 From 25th March, Trust staff will assess the size of all babies at birth using the INTERGROWTH-21st standards.  These perfectly complement existing  World Health Organisation international standards that are used to monitor the growth of all babies from birth to the age of 5 - the same charts that appear in the ‘Redbook’ in the UK.

 These international standards show the optimal pattern of healthy growth for all babies everywhere, regardless of their ethnicity or country of birth.

 Thus, for the first time, it is possible to assess all 120 million babies born each year across the world using a common set of standards, reflecting how babies should grow when mothers have adequate health, nutrition, medical care and socioeconomic status.  This means underweight and overweight babies can be detected early in life no matter where in the world they are born.

 Poor growth in the womb resulting in small size at birth is associated with illness and death in infancy and childhood. It also impacts on adult health with increased risks of diabetes, high blood pressure and cardiovascular disease. Smaller babies result in substantial costs for health services and they are a significant economic burden on society as a whole.

 Being born overweight is also a worsening problem, particularly in developed and emerging countries, as a result of rising maternal obesity rates due to overnutrition. Overweight babies are at increased risk of diabetes and high blood pressure later in life.

 In the UK alone, the international standards will identify around 8% more babies as being overweight (approximately 60,000 newborns a year). These babies are presently considered ‘normal’ using the local UK charts. They will benefit from early interventions such as exclusive breastfeeding.

 ‘Being able to identify millions of additional undernourished babies at birth provides an opportunity for them to receive nutritional support and targeted treatment, without which close to 5% are likely to die in their first year or develop severe, long-term health problems,’ said Professor José Villar (University of Oxford) who leads the INTERGROWTH-21st Project. ‘The huge improvement in health care we can achieve is unprecedented.’

The Trust is very proud to be the first in the world to introduce the INTERGROWTH-21st standards into practice in partnership with the University of Oxford.  It shows our commitment to ensuring that our patients benefit rapidly from advances in medical care made as a result of high quality research.
 Professor Stephen Kennedy







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