Predictors of Neonatal Outcome in Early- Onset Placental Dysfunction

Baschat, Ahmet A. MD; Cosmi, Erich MD; Bilardo, Catarina M. MD; Wolf, Hans MD; Berg, Christoph MD; Rigano, Serena MD; Germer, Ute MD; Moyano, Dolores MD; Turan, Sifa MD; Hartung, John MD; Bhide, Amarnath MD; Müller, Thomas MD; Bower, Sarah MD; Nicolaides, Kypros H. MD; Thilaganathan, Baskaran MD; Gembruch, Ulrich MD; Ferrazzi, Enrico MD; Hecher, Kurt MD; Galan, Henry L. MD; Harman, Chris R. MD

Obstetrics & Gynecology:
doi: 10.1097/01.AOG.0000253215.79121.75
Original Research
Abstract

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 prenataly 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 266/7 weeks (r2=0.27), and intact survival until 292/7 weeks (r2=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, r2=0.38), and ductus venosus Doppler alone predicted intact survival (P<.001, r2=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

In Brief

Expectations for neonatal outcomes need to be tailored in early onset fetal growth restriction requiring consideration of gestational age, birth weight, and ductus venosus Doppler parameters.

Author Information

From the Departments of 1Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, Baltimore; 2Obstetrics & Prenatal Medicine, University Hamburg-Eppendorf, Germany; 3Gynecological Sciences and Human Reproduction, University of Padua, Italy; 4Obstetrics and Gynecology, Academic Medical Center, Amsterdam, the Netherlands; 5Obstetrics and Prenatal Medicine, Friedrich-Wilhelm University, Bonn, Germany; 6Obstetrics and Gynecology, University of Milan, Milan, Italy; 7Gynecology and Obstetrics, University Schleswig-Holstein, Campus Lübeck, Germany; 8Harris Birthright Research Centre for Fetal Medicine, Kings College Hospital, London; 9Prenatal Diagnosis and Therapy, Universitäts Frauenklinik Charite, Berlin, Germany; 10Fetal Medicine Unit, St George’s Hospital Medical School, London, United Kingdom; 11Obstetrics & Gynecology, Hanau City Hospital, Germany; 12Obstetrics and Gynecology, University of Colorado Health Sciences Center, Denver, Colorado.

See related editorial on page 250.

The authors thank Hegang Chen, PhD, from the Division of Biostatistics and Bioinformatics, Department for Epidemiology and Preventive Medicine of the University of Maryland School of Medicine, for his advice and assistance in the statistical analysis of the data.

Corresponding author: Ahmet Alexander Baschat, MD, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, 405 West Redwood Street, 4th Floor, Baltimore, MD 21201-1703; e-mail: abaschat@umm.edu.

© 2007 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.