In 2014, the INTERGROWTH-21st Consortium published international standards for newborn baby size, based on neonates with no major complications or ultrasound evidence of fetal growth restriction (FGR), who were born to healthy mothers without FGR risk factors. 1 Despite our large sample size, very few neonates born at 33 weeks’ gestation or earlier met these prescriptive inclusion criteria. While implementing these standards, we have received many requests for very preterm, size at birth charts for clinical practice and research. Unsurprisingly, at these low gestational ages, most pregnancies have some risk factors, and prescriptive standards are difficult to construct. Therefore, we opted to generate very preterm reference charts to avoid previous methodological shortcomings. 2 We supplemented the original sample by including neonates from the same INTERGROWTH-21st population who, despite being born to mothers with some FGR risk factors (except smoking and severe obesity), did not have congenital malformations or ultrasound evidence of FGR before birth. We used the same statistical methods as for the Newborn Size Standards. 1 All other methods and ethics approvals have been described previously. 3, 4 408 neonates (214 boys, 194 girls) were included in the reference study population, after excluding 216 newborn babies because of maternal smoking, severe maternal obesity or morbidity, congenital