Predictors of neonatal outcome in early-onset placental dysfunction

To identify specific estimates and predictors of neonatal morbidity and mortality in early onset fetal growth restriction due to placental dysfunction. Prospective multicenter study of prenatally diagnosed growth-restricted liveborn neonates of less than 33 weeks of gestational age. Relationships be...

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Published in:	Obstetrics and gynecology (New York. 1953) Vol. 109; no. 2; pp. 253 - 261
Main Authors:	BASCHAT, Ahment A, COSMI, Erich, BHIDE, Amarnath, MÜLLER, Thomas, BOWER, Sarah, NICOLAIDES, Kypros H, THILAGANATHAN, Baskaran, GEMBRUCH, Ulrich, FERRAZZI, Enrico, HECHER, Kurt, GALAN, Henry L, HARMAN, Chris R, BILARDO, Catarina M, WOLF, Hans, BERG, Christoph, RIGANO, Serena, GERMER, Ute, MOYANO, Dolores, TURAN, Sifa, HARTUNG, John
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Science 01-02-2007
Subjects:	Adolescent Adult Biological and medical sciences Birth Weight Cohort Studies Female Fetal Growth Retardation - diagnostic imaging Fetal Growth Retardation - mortality Gestational Age Gynecology. Andrology. Obstetrics Humans Infant, Newborn Infant, Premature Infant, Premature, Diseases - diagnostic imaging Infant, Premature, Diseases - etiology Infant, Premature, Diseases - mortality Medical sciences Placental Circulation - physiology Placental Insufficiency - diagnostic imaging Placental Insufficiency - mortality Predictive Value of Tests Pregnancy Ultrasonography, Prenatal Umbilical Cord - diagnostic imaging Umbilical Cord - physiopathology Human Intrauterine growth retardation Neonatal Prognosis Pregnancy disorders Fetal membrane Gynecology Obstetrics Gestational age Fetal diseases Newborn Placenta Dysfunction Predictive factor
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Summary:	To identify specific estimates and predictors of neonatal morbidity and mortality in early onset fetal growth restriction due to placental dysfunction. Prospective multicenter study of prenatally diagnosed growth-restricted liveborn neonates of less than 33 weeks of gestational age. Relationships between perinatal variables (arterial and venous Dopplers, gestational age, birth weight, acid-base status, and Apgar scores) and major neonatal complications, neonatal death, and intact survival were analyzed by logistic regression. Predictive cutoffs were determined by receiver operating characteristic curves. Major morbidity occurred in 35.9% of 604 neonates: bronchopulmonary dysplasia in 23.2% (n=140), intraventricular hemorrhage in 15.2% (n=92), and necrotizing enterocolitis in 12.4% (n=75). Total mortality was 21.5 % (n=130), and 58.3% survived without complication (n=352). From 24 to 32 weeks, major morbidity declined (56.6% to 10.5%), coinciding with survival that exceeded 50% after 26 weeks. Gestational age was the most significant determinant (P<.005) of total survival until 26(6/7) weeks (r(2)=0.27), and intact survival until 29(2/7) weeks (r(2)=0.42). Beyond these gestational-age cutoffs, and above birth weight of 600 g, ductus venosus Doppler and cord artery pH predicted neonatal mortality (P<.001, r(2)=0.38), and ductus venosus Doppler alone predicted intact survival (P<.001, r(2)=0.34). This study provides neonatal outcomes specific for early-onset placenta-based fetal growth restriction quantifying the impact of gestational age, birth weight, and fetal cardiovascular parameters. Early gestational age and birth weight are the primary quantifying parameters. Beyond these thresholds, ductus venosus Doppler parameters emerge as the primary cardiovascular factor in predicting neonatal outcome. II.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0029-7844 1873-233X
DOI:	10.1097/01.aog.0000253215.79121.75