403 Parity adjusted term neonatal growth chart modifies neonatal morbidities and mortality risk stratification

Abstract

To investigate the impact of parity-customized (CUST) and population-based (POP) birth weight charts on the identification of neonatal risk for adverse outcome in small (SGA) - or large (LGA) birth weight as compared to the appropriate for gestational age (AGA). Data for this observational, retrospective, cohort study was obtained from electronic medical charts for births at a single center in 2006–2017. Singleton, live, term neonates born to mothers with no background disease were included. Neonates were categorized as SGA, LGA or AGA, with the 10th and 90th percentiles as boundaries in a standard population-based model adjusted for gender only and a customized model adjusted for gender and parity. A multivariable logistic regression model was applied to investigate the risk of a neonatal composite adverse outcome for subgroups defined as LGA or SGA according to one model but not the other. A 132,815 neonates met inclusion criteria. The customized model defined 53% more neonates as SGA compared to the population-based model. Neonates defined as SGA by the customized model but not by the population-based model (SGA CUST) had significantly higher rates of morbidity and mortality compared to those with normal birth weight (OR=1.33 95%CI [1.16–1.53]; p<0.0001). The customized and population-base models defined comparable groups of neonates as LGA. Those defined as LGA by the customized model and AGA by the population-based model (LGA-CUST) had significantly higher risk for morbidity compared to AGA neonates. (OR=1.36 95%CI [1.09–1.71]; p=0.007). Neonatal mortality occurred solely in the SGA groups. Both groups of LGA had a significantly higher risk for shoulder dystocia The application of a parity-customized birth weight chart in a high-parity population of singleton, term neonates may become a simple platform to better identify neonates with a significant high risk for morbidity and mortality.View Large Image Figure ViewerDownload Hi-res image Download (PPT)