Predicting adverse neonatal outcome in severe fetal compromise: A pivotal role for estimated fetal weight Z scores

Abstract

To identify significant predictors for adverse neonatal outcome in severe by compromised fetuses. Consecutive premature fetuses at between 25 and 32 weeks' with severe placental insufficiency were examined prospectively. Inclusion criteria were: singletons; normal anatomy; abnormal umbilical artery Doppler pulsatility index; abnormal cerebroplacental ratio; middle cerebral artery pulsatility index (PI) <or=2 standard deviations. We considered as independent potential predicting variables: absent or reversed end diastolic flow in umbilical artery, abnormal ductus venosus S/A ratio, absent or reversed flow during atrial contraction in the ductus venosus, and estimated fetal weight (EFW) Z score. Outcome parameters were: neonatal mortality and severe neonatal morbidity (Periventricular-Intraventricular Hemorrhage grade 03 or 04, Retinopathy of Prematurity stage 3 or 4, Periventricular Leukomalacia or Broncopulmonary Dysplasia). Univariate analysis for all potential predicting variables was performed. EFW Z score index showed the strongest association with mortality and there was no fetal death or Retinopathy of Prematurity in the group with EFW Z-score index below lower limit. There was no case of Cystic Periventricular Leukomalatia in these analyses. The area under receiver-operator characteristic curve was significant for EFW Z-score index. Our study suggests that EFW Z score is the strongest predictor of adverse neonatal outcome in severely compromised fetuses.