Risk Factors for Neonatal Intensive Care Unit Admission Among Growth Restricted Fetuses [25P

Abstract

INTRODUCTION: Growth restricted fetuses are at risk for admission to the neonatal intensive care unit (NICU). NICU admission is a proxy for long-term health consequences and societal costs. We aimed to assess risk factors for NICU admission among pregnancies complicated by fetal growth restriction. METHODS: This is a retrospective cohort study of non-anomalous, singleton, growth restricted fetuses - defined as estimated fetal weight (EFW) less than the 10th percentile - delivered in a single tertiary referral center from 01/2011 to 12/2016. Institutional Review Board approval was obtained. Factors significantly associated with NICU admission were identified using univariate analyses (P<.1). Multivariable logistic regression analysis was used to determine the final risk factors and to estimate adjusted odds ratios. RESULTS: 594 pregnancies with fetal growth restriction met inclusion criteria. 204 (34.3%) resulted in NICU admission. Significant risk factors for NICU admission were smoking, EFW < 5th percentile, method of labor induction, non-reassuring fetal heart tracing, and gestational age at delivery. Labor induction with oxytocin or prostaglandins and higher gestational age at delivery appeared to be protective from NICU admission. If these risk factors were used to develop a prediction model, the area under the receiver-operator curve would be 0.83 (95% CI 0.79-0.86). The model would have a sensitivity of 50.0%, specificity of 92.3%. CONCLUSION: We identified several significant risk factors for NICU admission among growth restricted fetuses, which could be helpful in anticipating need for additional neonatal support at the time of delivery and for counseling women with growth restricted fetuses about risk of NICU admission.