non-SGA Neonates Research Articles

Thyroid Hormone Function in Small for Gestational Age Term Newborns

To test the hypothesis that term-born small for gestational age (SGA) neonates have elevated thyroid-stimulating hormone (TSH) concentrations and an increased incidence of congenital hypothyroidism compared with non-SGA term neonates. This retrospective cohort study included all term neonates screened in Wisconsin in 2015 and 2016. The cohort was divided based on SGA status, defined as birth weight <10th percentile as calculated from the World Health Organization's sex-specific growth charts for age 0-2years. TSH concentration on first newborn screening performed between birth and 96hours of life and incidence of congenital hypothyroidism were compared between the SGA and non-SGA groups. A total of 115 466 term neonates, including 11 498 (9.96%) SGA neonates, were included in the study. TSH concentration and incidence of congenital hypothyroidism was significantly higher in the SGA group, but only TSH concentration remained significant when adjusted for potential confounding variables. Our data do not support a higher incidence of congenital hypothyroidism in term SGA neonates after adjusting for potential confounders. However, TSH concentrations were higher in term SGA neonates compared with term non-SGA neonates. The effects of mild thyroid hormone dysfunction on neurodevelopmental outcomes and development of chronic medical conditions merit long-term study.

The effect of antenatal corticosteroids on small-for-gestational age preterm neonates

Objective Treatment of preterm small-for-gestational age (SGA) neonates with antenatal corticosteroids (ACS) is not entirely straightforward. We sought to examine the effect of a full course of ACS on outcomes of SGA and non-SGA preterm singletons. Patients and methods We compared maternal characteristics and outcomes of preterm births at <28 and 28 + 0–33 + 0 weeks’ gestation that received a complete course of ACS within a week before birth. We further divided our cohort into those with or without a SGA neonate. Results We included 290 infants: 73 (25.2%) and 217 (74.8%) born at <28 and 28 + 0–33 + 0 weeks’ gestation, respectively. Analysis of maternal characteristics showed a strong association of maternal body mass index (p = .01), along with smoking during pregnancy (OR 0.4, 95% CI 0.2, 0.9), with being SGA. Spontaneous onset of delivery more commonly occurred in non-SGA preterm neonates, whereas iatrogenic induction of labor prevailed with SGA neonates (p < .01). There was no significant difference between SGA and non-SGA infants in all the tested neonatal variables except for necrotizing enterocolitis, which prevailed in the SGA group. Conclusion A full course of ACS appears to have the same effect in SGA and non-SGA preterm singletons in our studied cohort on all neonatal outcomes but for necrotizing enterocolitis, where its role in SGA preterm neonates seems to be detrimental rather than beneficial to the fetus.

293: Does prostaglandin use affect mode of delivery in SGA vs non-SGA neonates?

293: Does prostaglandin use affect mode of delivery in SGA vs non-SGA neonates?

Red cell distribution width as a potential prognostic biomarker in fetal growth restriction

Objective Red cell distribution width (RDW) is a prognostic marker for adverse outcomes in cardiovascular disease. This association has been attributed to the impaired erythropoiesis and abnormal red blood cell survival originating from chronic hypoxic status or poor nutrition. Considering the pathophysiologic association between fetal growth restriction (FGR) and chronic intrauterine hypoxia, which in turn can result in impaired erythropoiesis, RDW could be a biomarker in FGR. To address this issue, we evaluated the RDW in FGR. Study design The study population consisted of singleton preterm neonates (24–34 weeks of gestation) and RDW in cord blood was measured at delivery, and was compared between small-for-gestational age (SGA) neonates (birthweight <10 percentile) and non-SGA neonates (birthweight >10 percentile). Among them, RDW was also examined according to the adverse neonatal outcomes. Results Five hundred eighty-four neonates were included, of these, 117 SGA neonates and 467 non-SGA neonates. RDW in the SGA neonates was significantly higher than that in the non-SGA neonates (18.4 versus 16.4, p < .001). This association between SGA and RDW remained significant after adjustment for gestational age at delivery, histologic chorioamnionitis, and hematologic parameters. Among the SGA neonates, RDW was higher in neonates with adverse neonatal outcomes than those without them. The RDW >90 percentile was an independent parameter for the prediction of neonatal outcomes, even after adjustment. Conclusion The RDW was higher in the SGA neonates and was associated with adverse outcomes. RDW can be a prognostic marker in predicting outcomes among preterm neonates.

Comparison of fetal middle cerebral artery versus umbilical artery color Doppler ultrasound for predicting neonatal outcome in complicated pregnancies with fetal growth restriction

Background: Although using Doppler ultrasonography of umbilical structures is a common method for predicting prenatal adverse outcome, recent studies have proposed the importance of middle cerebral artery (MCA) Doppler assessment for antenatal monitoring. The aim of the present study was to compare alterations in the fetalMCAversus umbilical artery (UA) pulsatility indices (PI) in complicated pregnancies by fetal growth restriction (FGR).&#x0D; Methods: A cohort study was carried out in Yas Hospital (Tehran, Iran) in 2016. One hundred fifty pregnant women in third trimester with estimation of FGR participated in the study. Transabdominal ultrasound was performed to determine fetal weight. After birth, all neonates were divided into 2 groups: small for gestational age (SGA) and non-SGA.We compared the values of UA and MCA Doppler in predicting SGA. Data were analyzed with t-test and Chi-square test.&#x0D; Results: After delivery, 126 mothers had SGA while 24 subjects had non-SGA neonates. Unlike UA PI, MCA artery PI of the SGA and non-SGA groups were significantly different (p=0.062 for UA PI comparison; p=0.0001 for MCA PI comparison). Of the 126 cases, there was decreased MCA PI in 40.5% of fetuses and increased UA PI in 22.2% of fetuses. There were significant differences in both sensitivity and specificity for MCA PI versus UA PI (p=0.014 for sensitivity; p=0.009 for specificity).&#x0D; Conclusion: Results showed that of all the SGA cases, a decrease in MCA PI was more notable than changes in UA PI. Sensitivity, specificity and prediction of SGA for MCA PI were higher than those for UA PI.

Population-based study on antenatal corticosteroid treatment in preterm small for gestational age and non-small for gestational age twin infants

Objectives: To assess the associations between antenatal corticosteroid use (ACU), mortality and severe morbidities in preterm, twin neonates and compare these between small for gestational age (SGA) and non-SGA twins.Materials and methods: Population-based study using data collected by the Israel National Very Low Birth Weight infant database from 1995 to 2012, comprising twin infants of 24–31 weeks' gestation, without major malformations. Univariate and multivariable logistic regression analyses were performed.Results: Among the 6195 study twin infants, 784 were SGA. Among SGA neonates, ACU were associated with decreased mortality (23.9% vs. 39.2%, p < 0.0001) and composite adverse outcome including mortality or severe neonatal morbidity (43.8% vs. 56.8%, p = 0.0015), similar to the effect in non-SGA neonates (mortality 13.0% vs. 24.5%, p < 0.0001; composite outcome 34.2% vs. 44.8%, p < 0.0001). In the multivariable logistic regression analyses, ACU were associated with an almost 50% reduced mortality risk among SGA twin neonates (OR = 0.52, 95% CI 0.31–0.88) similar to the effect in non-SGA twin neonates (OR = 0.56, 95% CI 0.45–0.70), Pinteraction = 0.69. Composite adverse outcome risk was also reduced in SGA (OR = 0.78, 95% CI 0.50–1.23) and non-SGA groups (OR = 0.78, 95% CI 0.65–0.95), Pinteraction = 0.95.Conclusions: ACU should be considered in all mothers with twin gestation, at risk for preterm delivery at 24–31 weeks, in order to improve perinatal outcome.

Prediction of Small for Gestational Age: Accuracy of Different Sonographic Fetal Weight Estimation Formulas

Objective: To compare the accuracy of various sonographic estimated fetal weight (sEFW) formulas for the prediction of small for gestational age (SGA) neonates. Methods: A retrospective analysis of 6,126 fetal biometrical measurements performed within 3 days of delivery. SGA prediction was evaluated for various sEFW formulas by calculating the sensitivity, specificity, positive/negative predictive value (PPV/NPV), likelihood ratio (+LR/-LR), overall accuracy and area under the receiver operating characteristic curve (AUC). Systematic error, random error, proportion of estimates >10% of birth weights, actual and absolute weight differences were compared between SGA and non-SGA neonates. Results: Overall, 638 (10.4%) neonates were SGA. There was considerable variation among formulas in sensitivity (mean ± SD, 62 ± 14.4%; range, 32.4-91.2), PPV (72.5 ± 10.7%; 45.8-95.6) and +LR (24.2 ± 10.9; 7.2-57.3), mild variation in specificity (96.6 ± 2.7%; 87.4-99.4), NPV (94.6 ± 5.3%; 72.2-98.9) and -LR (0.4 ± 0.1; 0.1-0.7) and minimal variation in AUC (mean, 0.93; range, 0.91-0.93). The majority of formulas had a lower accuracy for the SGA neonates, with systematic error and random error ranging from -4.2 to 14.3% and from 8.4 to 12.9% for SGA, and from -8.7 to 16.1% and from 7.2 to 10.5% for non-SGA, respectively. Conclusion: sEFW formulas differ in their accuracy for SGA prediction. In our population, the most accurate formula for SGA prediction was Hadlock's formula utilizing femur length, abdominal and head circumference.

Antenatal corticosteroid treatment in singleton, small-for-gestational-age infants born at 24-31weeks' gestation: a population-based study.

To assess the impact of antenatal corticosteroid therapy on mortality and severe morbidities in preterm, small-for-gestational-age (SGA) neonates compared with preterm non-SGA neonates. Population-based study. Israel National Very Low Birth Weight infant database from 1995-2012. Singleton infants of 24-31weeks' gestation, without major malformations. Antenatal corticosteroids were considered either any treatment or no treatment. Univariate and multivariable logistic regression analyses were performed to assess the effect of antenatal corticosteroids on neonatal mortality and a composite adverse outcome of mortality or severe neonatal morbidity. Among the 10887 study infants, 1771 were SGA. Of these, 70.4% of SGA and 66.7% of non-SGA neonates were exposed to antenatal corticosteroids. Among SGA neonates, antenatal corticosteroids were associated with decreased mortality (32.2 versus 19.3%, P<0.0001) and composite adverse outcome (54.1 versus 43.4%, P<0.0001), similar to the effect in non-SGA neonates (mortality 26.7 versus 12.2%, P<0.0001; composite outcome 50.5 versus 34.6%, P<0.0001). Multivariable logistic regression analyses demonstrated a 50% reduction in mortality risk among SGA and 57% reduction in non-SGA neonates exposed to corticosteroids [OR=0.50, 95% confidence interval (95% CI) 0.39-0.64 and OR=0.43, 95% CI 0.38-0.47, respectively], P-value for interaction=0.08. Composite adverse outcome risk was significantly reduced in SGA (OR=0.67, 95% CI 0.54-0.83) and non-SGA infants (OR=0.57, 95% CI 0.52-0.63), P-value for interaction =0.04. Antenatal corticosteroids significantly reduced mortality and severe morbidities among preterm SGA neonates, with slightly a less pronounced effect compared with non-SGA preterm infants. Antenatal corticosteroids should be given to fetuses suspected of intrauterine growth retardation, at risk for preterm delivery, in order to improve perinatal outcome. Antenatal steroids reduced mortality and severe morbidities among singleton, preterm SGA neonates.

Impact on obstetric outcome of third-trimester screening for small-for-gestational-age fetuses.

To evaluate the performance of screening for small-for-gestational-age (SGA) fetuses by ultrasound biometry at 30-35 weeks' gestation, and to determine the impact of screening on obstetric and neonatal outcomes. For this prospective cohort study, pregnant women were recruited from two French university maternity centers between 2003 and 2006. Performance measures of third-trimester biometry for the prediction of SGA, defined as estimated fetal weight < 10(th) centile, were analyzed. Obstetric outcomes and neonatal health status were compared, first, between SGA neonates diagnosed correctly at ultrasound examination (true positive (TP); n = 45) and SGA neonates that went undiagnosed (false negative (FN); n = 110) and, second, between non-SGA neonates identified as normal at ultrasound examination (true negative (TN); n = 1641) and non-SGA neonates diagnosed incorrectly as SGA (false positive (FP); n = 101). In the prediction of SGA, third-trimester ultrasound had a sensitivity of 29.0% (95% CI, 22.5-36.6%) and specificity of 94.2% (95% CI, 93.0-95.2%). Positive and negative predictive values were 30.8% (95% CI, 23.9-38.7%) and 93.7% (95% CI, 92.5-94.8%), respectively. One hundred and ten SGA neonates went undiagnosed at ultrasound. Compared to the TN neonates considered as of normal weight at ultrasound, planned preterm delivery (before 37 weeks) and elective Cesarean section for a fetal growth indication were 2.4 (P = 0.01) and 2.85 (P = 0.003) times more likely to occur, respectively, in the FP group of non-SGA neonates, diagnosed incorrectly as SGA during the antenatal period. There was no statistically significant difference in 5-min Apgar score < 7, cord blood pH at birth < 7.15 and need for neonatal resuscitation between the two subgroups (TN vs FP and TP vs FN). The performance of third-trimester ultrasound screening for SGA seems poor, as it misses the diagnosis of a large number of SGA neonates. The consequences of routine screening for SGA in a low-risk population may lead to unnecessary planned preterm deliveries and elective Cesarean sections in FP pregnancies, without improved neonatal outcome in the FN pregnancies.

Fetal growth, cognitive function, and brain volumes in childhood and adolescence.

To evaluate the association between fetal growth pattern and cognitive function at 5 and 9 years and regional brain volumes at 15 years. Eighty-three term-born small-for-gestational-age (SGA) neonates and 105 non-SGA neonates in a control group were available for follow-up. Based on serial fetal ultrasound measurements from gestational weeks 25-37, SGA neonates were classified with fetal growth restriction (n=13) or non-fetal growth restriction (n=36). Cognitive function was assessed at 5 and 9 years, and brain volumes were estimated with cerebral magnetic resonance imaging at 15 years. Small-for-gestational-age children had lower performance intelligence quotient at 5 years compared with those in a control group (107.3 compared with 112.5, P<.05). Although there were no differences between the SGA non-fetal growth restriction and control groups, the SGA fetal growth restriction group had significantly lower performance intelligence quotient at 5 years (103.5 compared with 112.5, P<.05) and 9 years (96.2 compared with 107.5, P<.05) compared with those in the control group. There were some brain volume differences at 15 years between SGA children and those in the control group, but after adjustment for total intracranial volume, age at examination, and sex, there were only significant differences between the SGA fetal growth restriction and control groups for thalamic (17.4 compared with 18.6 cm, P<.01) and cerebellar white matter volumes (21.5 compared with 24.3 cm, P<.01). Small-for-gestational-age children had lower intelligence quotient scores at 5 and 9 years and smaller brain volumes at 15 years compared with those in the control group, but these findings were only found in those with fetal growth restriction, indicating a possible relationship to decelerated fetal growth. II.

Maternal Vitamin D Status and Small-for-Gestational-Age Offspring in Women at High Risk for Preeclampsia

To examine the association between second-trimester maternal serum 25-hydroxyvitamin D concentrations and risk of small for gestational age (SGA) in singleton live births. We assayed serum samples at 12-26 weeks of gestation for 25-hydroxyvitamin D in a sample of participants in a multicenter clinical trial of low-dose aspirin for the prevention of preeclampsia in high-risk women (n=792). Multivariable log-binomial regression models were used to assess the association between 25-hydroxyvitamin D and risk of SGA (birth weight less than the 10 percentile for gestational age) after adjustment for confounders including maternal prepregnancy obesity, race, treatment allocation, and risk group. Thirteen percent of neonates were SGA at birth. Mean (standard deviation) 25-hydroxyvitamin D concentrations were lower in women who delivered SGA (57.9 [29.9] nmol/L) compared with non-SGA neonates (64.8 [29.3] nmol/L, P=.028). In adjusted models, 25-hydroxyvitamin D concentrations of 50-74 nmol/L and 75 nmol/L or greater compared with less than 30 nmol/L were associated with 43% (95% confidence interval [CI] 0.33-0.99) and 54% (95% CI 0.24-0.87) reductions in risk of SGA, respectively. Race and maternal obesity each modified this association. White women with 25-hydroxyvitamin D 50 nmol/L or greater compared with less than 50 nmol/L had a 68% reduction in SGA risk (adjusted risk ratio 0.32, 95% CI 0.17-0.63) and nonobese women with 25-hydroxyvitamin D 50 nmol/L or greater compared with less than 50 nmol/L had a 50% reduction in SGA risk (adjusted risk ratio 0.50, 95% CI 0.31-0.82). There was no association between 25-hydroxyvitamin D and risk of SGA in black or obese mothers. Maternal vitamin D status in the second trimester is associated with risk of SGA among all women and in the subgroups of white and nonobese women. II.

Maternal Thyroid Function at Eleven to Thirteen Weeks of Gestation and Subsequent Delivery of Small for Gestational Age Neonates

Studies have shown that altered thyroid function in early pregnancy may affect normal placental development and hence fetal growth. Our hypothesis is that maternal thyroid function in the first trimester is altered in pregnancies that subsequently deliver small for gestational age (SGA) neonates. Maternal serum thyroid-stimulating hormone (TSH), free thyroxine (FT4), and free triiodothyronine (FT3) were measured at 11(+0) to 13(+6) weeks' gestation in 212 singleton pregnancies with no history of thyroid disease that subsequently delivered SGA neonates and the values were compared with the results of 3598 normal pregnancies delivering neonates with birth weight above the 5th percentile for gestation. There were no significant differences between the normal and SGA groups in median multiple of the median (MoM) TSH (1.07 vs. 1.061 MoM), FT4 (0.992 vs. 1.010 MoM), and FT3 (0.991 vs. 0.990 MoM). In women with no history of thyroid disease delivering SGA neonates, thyroid function during the first trimester of pregnancy is not significantly different from women delivering non-SGA neonates.

Customised birthweight standards accurately predict perinatal morbidity

Objective: Fetal growth restriction is associated with adverse perinatal outcome but is often not recognised antenatally, and low birthweight centiles based on population norms are used as a proxy instead....