Predictors of neonatal outcome in early-onset placental dysfunction.
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).


CONCLUSIONS
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.


METHODS
II.
Baschat
Ahmet A
AA
Department of Obstetrics, Gynecology and Reproductive Sciences, University of Maryland, 405 West Redwood Street, Baltimore, MD 21201, USA. abaschat@umm.edu
Cosmi
Erich
E
Bilardo
Catarina M
CM
Wolf
Hans
H
Berg
Christoph
C
Rigano
Serena
S
Germer
Ute
U
Moyano
Dolores
D
Turan
Sifa
S
Hartung
John
J
Bhide
Amarnath
A
Müller
Thomas
T
Bower
Sarah
S
Nicolaides
Kypros H
KH
Thilaganathan
Baskaran
B
Gembruch
Ulrich
U
Ferrazzi
Enrico
E
Hecher
Kurt
K
Galan
Henry L
HL
Harman
Chris R
CR
D000293:Adolescent; D000328:Adult; D001724:Birth Weight; D015331:Cohort Studies; D005260:Female; D005317:Fetal Growth Retardation / Q000000981:diagnostic imaging / Q000401:mortality*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality*; D021041:Placental Circulation / Q000502:physiology; D010927:Placental Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality*; D011237:Predictive Value of Tests; D011247:Pregnancy; D016216:Ultrasonography, Prenatal; D014470:Umbilical Cord / Q000000981:diagnostic imaging / Q000503:physiopathology