Document Detail


Predictors of neonatal outcome in early-onset placental dysfunction.
MedLine Citation:
PMID:  17267821     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To identify specific estimates and predictors of neonatal morbidity and mortality in early onset fetal growth restriction due to placental dysfunction. METHODS: 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. RESULTS: 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). CONCLUSION: 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. LEVEL OF EVIDENCE: II.
Authors:
Ahmet A Baschat; Erich Cosmi; Catarina M Bilardo; Hans Wolf; Christoph Berg; Serena Rigano; Ute Germer; Dolores Moyano; Sifa Turan; John Hartung; Amarnath Bhide; Thomas Müller; Sarah Bower; Kypros H Nicolaides; Baskaran Thilaganathan; Ulrich Gembruch; Enrico Ferrazzi; Kurt Hecher; Henry L Galan; Chris R Harman
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Obstetrics and gynecology     Volume:  109     ISSN:  0029-7844     ISO Abbreviation:  Obstet Gynecol     Publication Date:  2007 Feb 
Date Detail:
Created Date:  2007-02-01     Completed Date:  2007-02-27     Revised Date:  2009-10-26    
Medline Journal Info:
Nlm Unique ID:  0401101     Medline TA:  Obstet Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  253-61     Citation Subset:  AIM; IM    
Affiliation:
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, 405 West Redwood Street, Baltimore, MD 21201, USA. abaschat@umm.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Birth Weight
Cohort Studies
Female
Fetal Growth Retardation / mortality*,  ultrasonography
Gestational Age
Humans
Infant, Newborn
Infant, Premature
Infant, Premature, Diseases / etiology*,  mortality*,  ultrasonography
Placental Circulation / physiology
Placental Insufficiency / mortality*,  ultrasonography
Predictive Value of Tests
Pregnancy
Ultrasonography, Prenatal
Umbilical Cord / physiopathology,  ultrasonography
Comments/Corrections
Comment In:
Obstet Gynecol. 2007 Feb;109(2 Pt 1):250-2   [PMID:  17267820 ]

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