824 Prediction of perinatal demise and severe adverse neonatal outcomes in pregnancies with fetal growth restriction

Abstract

To evaluate our ability to use clinical factors available at the time of diagnosis of fetal growth restriction (FGR) to predict perinatal demise and severe adverse neonatal outcomes. Retrospective analysis of 907 singleton non-anomalous pregnancies at a single tertiary-care institution (2010-2020) that met Delphi procedure-based consensus (Gordijn 2016) criteria for fetal growth restriction. This secondary analysis of 423 pregnancies was limited to those that ended in either perinatal demise or neonatal intensive care unit (NICU) admission. Regression analysis incorporated factors available at time of FGR diagnosis to predict composite severe adverse outcomes: grade III-IV intraventricular hemorrhage or periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and perinatal demise or death prior to NICU discharge. Severe adverse outcome occurred in 168 (39.7%) cases; 54 (32.1%) ended in demise. Mean NICU admission duration was 69.4 compared to 26.5 days in those with and without the composite outcome, respectively (P < .0001). Factors at diagnosis of growth restriction positively correlated with adverse outcomes include: gestational age < 30 weeks (adjusted OR 7.75, 95% CI 4.63-13.45), absent/reversed umbilical artery end diastolic flow (aOR 3.56, 95% CI 2.15-5.97), and chronic hypertension (aOR 4.10, 95% CI 1.80-9.83). Umbilical artery pulsatility index >95th centile was associated with decreased odds of adverse outcome on univariate analysis (P < .001), but was not significant after adjustment. Superimposed preeclampsia was associated with a decreased odds of adverse outcome (aOR 0.30, 95% CI 0.11-0.75). Bias-corrected bootstrapped (1000 replicates) area under the curve for the 5-item predictive model was 0.81 (95% CI 0.76-0.84). A model comprised of five factors widely available in daily clinical practice at time of diagnosis of fetal growth restriction is predictive of perinatal demise and severe adverse neonatal outcomes. If validated, this model may aid in counseling patients and guide management.View Large Image Figure ViewerDownload Hi-res image Download (PPT)